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If tricuspid regurgitation (primary and secondary) is left untreated, it will be associated with significant complications and death, even if left ventricular dysfunctions are corrected, TR does not decrease in many cases. Since many studies have not been conducted in this area, we decided to evaluate the results of tricuspid repair. In this retrospective study conducted since 2006 to 2011, 448 patients undergoing tricuspid surgery with different methods with or without surgery were studied. Statistical analysis was performed by Friedman, Fisher exact and Pearson chi-square methods. In the Mod and Severe RV dysfunction section, the mean age of the patients was 52 years, 289 were female (64%), 343 (76%) had rheumatic pathology, 79 (17%) had myxomatous pathology, 12 (2%) had endocarditis pathology, and 14 had an unknown pathology. Before surgery, Mod and Severe dysfunction was seen in 226 patients (40%) and after surgery (follow up), it was seen in 85 patients (19%). Before surgery, Mod and Severe TR was seen in 356 patients (79%) and after surgery, it was seen in 91 patients (20%). The mean of PAP before surgery was 54 mmHg and after surgery, it was 37 mmHg, which was significant in all cases (P

Introduction Hypertrophic obstructive cardiomyopathy (HOCM) is a hereditary heart muscle disorder characterized by significant myocardial hypertrophy. we assessed perioperative and long-term follow-up data of Iranian HOCM patients who underwent SM in 2 pioneering centers. Methods Clinical data of patients with HOCM septal myectomy are collected. Thirty-day outcome and long-term follow-up data for recurrence of gradient and mortality are reported. Results Ninety-six patients in two different centers enrolled in the study. Most patients of 52 patients in center 1 were male (34/52 [65.3%]).and the mean age was of 36.7 ± 19 years. Syncope before admission was reported in 5.7%, the mean left ventricular ejection fraction on admission was 53 ± 8%, the mean left ventricular outflow tract gradient was 66.3 ± 20.4 mm Hg, and the mean preoperativeseptal thickness was 25.4 ± 6.7 mm. A redo SM was performed in 3 patients (5.8%), mitral valve repair in 5 patients (9.6%), and atrioventricular repair in 5 patients (9.6%). A residual systolic anterior motion was detected in 4 patients (7.7%), the mean postoperative septal thickness was 19 ± 6 mm (25.1% septal thickness reduction), and in-hospital mortality was 5.8% (n = 3). A longer-term follow-up showed death in 3 patients (5.8%) and late recurrent left ventricular outflow tract obstruction in 1 patient. Conclusions Transaortic myectomy is an effective surgery with acceptable early and late mortality rates. Improvements in functional status are seen in almost all patients. Appropriate SM is crucial to a good clinical outcome. Long-term survival is excellent and cardiac sudden death is extremely rare after a good surgical treatment.

Background: There are many surgical methods used to treat sinus of Valsalva aneurysms, and these methods vary depending on the surgical team's expertise and the patient's health, which has an impact on the surgical outcomes. Objectives: In our study, we evaluated the midterm outcomes of a single center's highly skilled surgical team. Methods: In this retrospective cohort study the clinical data of 42 consecutive patients from November 1, 2005 to 21 august 2018 were reviewed and early and mid-term results were assessed. Twenty-two patients (53%) were presented with ruptured aneurysms; 8 of these patients (28.5%) had their aneurysms repaired with a double patch and an AV repair; nonetheless, 20 patients (46.6%) required valve replacement. Results: It was found that there was no bicuspid valve in our patients, no correlation between the presence of VSD and the severity of aortic insufficiency in our series (P = 0.89), and the severity of aortic insufficiency increased when the Valsalva aneurysm ruptured into the heart chambers. There was a strong association between female gender and ruptured sinus of Valsalva aneurysms (P = 0.02, AI severity, P = 0.05, aortic valve surgery, P = 0.03, and total AV replacement, P = 0.001). RSOV and the likelihood of a heart block did not correlate in our series (P = 0. 29). Conclusions: Results from one surgical team, particularly when the same specialist is making decisions, are more trustworthy. Excellent long-term outcomes are obtained, and rupture of the SOV is linked to an increase in AI and, ultimately, to aortic valve surgery, primarily AV replacement. Using patch technique for closing fistulas does not increase the post op arrhythmia.

Primary cardiac lymphoma (PCL) is a rare primary cardiac neoplasm with a relatively poor prognosis despite confinement to the heart and/or pericardium. We report a 54-year-old man who had presented with complete heart block for which he had undergone permanent pacemaker implantation, and six months later he was referred to us for evaluation of progressive exertional dyspnea. Multislice spiral computed tomography angiography of the heart and major vasculature showed infiltrative tumoral lesion that has involved interatrial septum, right atrium, left atrium, and left ventricle with invasion into the pulmonary artery. Tissue samples were taken using uniportal video-assisted thoracoscopic surgery, and the histologic examination revealed diffuse large B-cell lymphoma. Chemoimmunotherapy was effective in inducing tumor regression and the patient was still in remission during the next six months after treatment.

Graphical abstract, Highlights • Cardiac echinococcosis is a rare but potentially fatal manifestation of hydatid disease. • Antiparasitic agents with surgical cyst excision is the treatment of choice. • Heart team decision-based management is warranted in cases of other organ involvement.

Although coronary artery bypass graft (CABG) surgery is one of the most worldwide commonly performed cardiac surgeries to enhance myocardial perfusion in high-grade myocardial occlusion, it remains a high-risk procedure. Photobiomodulation (PBM) is one of the methods which have been shown to have positive effects on the healing process after CABG and postoperative complications. The aim of this study was to evaluate the efficacy of PBM in patients who underwent a coronary artery bypass graft (CABG). Ths study was conducted with 192 volunteers who electively submitted to CABG. The volunteers were randomly allocated into two groups: laser-treated (transdermal: 980 nm, 200 mW, continuous, average energy fluency of 6 J/cm2 and intravenous: 405 nm, 1.5 mW, continuous for 30 min) and standard treatment and control group (standard treatment only). Intravenous laser was illuminated the day before the surgery, immediately after transferring the patient to CCU post-operation and IV laser in addition to transdermal laser was applied every day after surgery for 6 days. A total of 170 out of 192 participants completed the study, 82 (48.2%) in the PBM group and 88 (51.8%) in the control group. Level of LDH and CPK was significantly lower in the PBM group (P < 0.05) in the 4th day postoperatively. The PBM group also showed significantly lower post-surgery complications, including pericardial effusion, ejection fraction, pathologic ST changes, pathologic Q, rehospitalization, heart failure, and mediastinitis (P < 0.05). Likewise, the VAS pain score after surgery was significantly lower in patients in the laser group (P < 0.05). PBM seems a promising, safe, cost-benefit therapeutic modality to reduce postoperative complications of CABG. Trial registration number: IRCT2016052926069N4 .

Given the nature of heart disease and the importance of continuing heart surgery during the pandemic and its aftermath and in order to provide adequate safety for the surgical team and achieve the desired result for patients, as well as the optimal use of ICU beds, the medical team, blood, blood products, and personal protective equipment, it is essential to change the usual approach during the pandemic. There are still a lot of evidences and experiences needed to produce the perfect protocol. Some centers may have a special program for their centers during this period of epidemics that can be respected and performed. Generally, in pandemic conditions, the use of non-surgical approaches is preferred if similar outcomes can be obtained.

Background:The standard transthoracic echocardiography has some limitations in emergent and community-based situations. The emergence of pocket-sized ultrasound has led to influential advancements.Methods:In this prospective study, in the hospital-based phase, children with suspected structural heart diseases were enrolled. In the school-based phase, healthy children were randomly selected from six schools. All individuals were examined by experienced operators using both the standard and the pocket-sized echocardiography.Results:A total of 73 individuals with a mean age of 9.9 ± 3.2 years in the hospital-based cohort and 143 individuals with a mean age of 12.8 ± 2.9 years in the school-based cohort were examined. The agreements between the standard and the pocket-sized echocardiography were good or excellent for major CHDs in both cohorts (κ statistics > 0.61). Among valvular pathologies, agreements for tricuspid and pulmonary valves’ regurgitation were moderate among school-based cohorts (0.56 [95% confidence interval 0.12–1] and 0.6 [95% confidence interval 0.28–0.91], respectively). The agreements for tricuspid and pulmonary valves’ regurgitation were excellent (>0.9) among hospital-based population. Other values for valvular findings were good or excellent. The overall sensitivity and specificity were 87.5% (95% confidence interval 47.3–99.7) and 93.8% (95% confidence interval 85–98.3) among the hospital-based individuals, respectively, and those were 88% (95% confidence interval 77.8–94.7) and 68.4% (95% confidence interval 56.7–78.6) among the school-based individuals, respectively. The cost of examination was reduced by approximately 70% for an individual using the pocket-sized device.Conclusions:When interpreted by experienced operators, the pocket-sized echocardiography can be used as screening tool among school-aged population.

Purpose:Non-ischemic Functional Mitral Regurgitation (FMR) is accompanied by dire long-term consequences. The treatment revolves around correcting the underlying LV dysfunction. This study reports long-term follow-up outcomes and prognosis predictors of non-ischemic FMR.Methods:We enrolled 200 patients with at-least-moderate non-ischemic FMR, undergoing medical treatment and/or cardiac resynchronization therapy (CRT) between 2003 and 2019. MR severity and LV dysfunction parameters were obtained. The endpoint outcomes were all-cause mortality, stroke, all-cause rehospitalization, and the need for heart transplantation.Results:Two hundred participants, 104 (52%) men and 96 (48%) women with the median age of 61 years (IQR 50-70) at diagnosis and the median follow-up of 2 years (IQR 1-4), were enrolled. The all-cause mortality, all-cause rehospitalization, and need for heart transplantation were significantly associated with lower LVEF and TAPSE at diagnosis (P-valueConclusion: We detected a significant decline in MR severity and NYHA classification during follow-up. Overall, the FMR-associated mortality risk will be significantly reduced by closely sticking to the treatment guidelines in a tertiary heart center.

Background: Several surgical procedures such as excision or exclusion are recommended for the closure of the left atrial appendage (LAA). This study was conducted with the aim to evaluate the success rate of different surgical techniques for LAA closure, their respective complications, and the rate of post-surgical cerebrovascular accident (CVA). Methods: This retrospective study included 150 consecutive patients who underwent LAA closure most commonly after mitral valve surgery within 3 to 6 months after surgery. An expert echocardiographic fellow collected the data on patients’ surgical LAA closure methods and history of CVA, types of prosthetic valves, mortality, and bleeding. Results: The failure rate for complete LAA closure was 36.7% (55 patients) in our study. The greatest success rate of complete LAA closure was seen in purse-string method (75.5%), followed by resection method (71.4%), while the lowest success rate (≈ 33.3%) was observed in ligation method. A significant relationship was observed between clots on the surface of metallic valve and postoperative CVA (P = 0.001; likelihood ratio: 32). significant relationship between partial LAA closure and the incidence of post-surgical CVA (P > 0.050). Conclusion: We observed the highest success rate of complete LAA closure in purse-string method followed by resection method. Interestingly, our results showed that despite the higher rate of residual LAA clot in cases of partial LAA closure, the occurrence of post-surgical CVA was mostly related to the presence of clots on the surface of metallic mitral prostheses rather than the presence of partial LAA closure.

Multidisciplinary approach towards cardiovascular diseases plays a major role in achieving the optimum clinical outcome. It is essential for cardiologists to have sufficient information regarding the basic principles of cardiopulmonary bypass, pre and postoperative care, different surgical techniques and prosthesis and also postoperative common complications. It would provide them with sufficient knowledge to choose appropriate medical treatment, early diagnosis of postoperative complication and proper long-term management of patients undergoing cardiac surgeries. This chapter aims to provide cardiologists with brief and essential information about common cardiovascular operation.

Primary tumors of the heart are rare with a reported incidence of about 0.002% to 0.3% at autopsy. A cardiac hemangioma is a form of benign primary cardiac tumor that often presents with atypical clinical symptoms. Hemangiomas are generally isolated lesions. Here, we report a patient with previous hepatic hemangioma who later was found to have a large coexistent cardiac hemangioma presenting with cardiac compressive symptoms.

Introduction: According to the several evidences, using thromboelastometry as a point of care test canbe effective in reduction in blood loss and transfusion requirements in cardiac surgeries. However,there are limited data regarding to the comparison of thromboelastometry and the standard coagulationtests. In this study, we compared thromboelastometry and standard coagulation tests (PT, PTT andfibrinogen level) in patients under combined coronary-valve surgery. Methods: Forty adult patients who were under on-pump combined coronary-valve surgery wereincluded in this study. Thromboelastometry tests Fibtem, Intem, Extem and Heptem), along withstandard coagulation tests (PT, PTT and fibrinogen assay) were simultaneously performed in two timepoints, before and after the pump (pre-CPB and post-CPB, respectively). Results: A total of 80 blood samples were analyzed. There were no significant correlation between PTtest and the CT-Extem parameter as well as PTT and CT-Intem parameter either in pre-CPB and post-CPB (P > 0.05). On the contrary, fibrinogen level had high correlation with A10-Fibtem and A10-Extemin pre-PCB (P < 0.05). 82% of PT and 84% of PTT measurements were outside the reference range,while abnormal CT in Extem and Intem was observed in 17.9%. Conclusion: For management of bleeding, adequate perioperative haemostatic monitoring isindispensable during cardiac surgery. Standard coagulation tests are time consuming and cannot beinterchangeably used with thromboelastomety and relying on their results to decide whether bloodtransfusion is necessary, leads to the inappropriate transfusion.

Introduction: Human amnion-derived mesenchymal stem cells (hAMSCs) have been used in the treatment of acute myocardial infarction. In the current study, we investigated the efficacy of hAMSCs for the treatment of chronic model of myocardial ischemia and heart failure (HF) in rats. Methods: Male Wistar rats weighing between 250 to 350 g were randomized into three groups: sham, HF control and HF+hAMSCs. For HF induction, animals were anesthetized and underwent left anterior descending artery ligation. In HF+hAMSCs group, 2×106 cells were injected into the left ventricular muscle four weeks post ischemia in the border zone of the ischemic area. Cardiac function was studied using echocardiography. Masson’s trichrome staining was used for studying tissue fibrosis. Cells were transduced with green fluorescent protein (GFP) coding lentiviral vector. Immunohistochemistry was used for detecting GFP, vascular-endothelial growth factor (VEGF) and troponin T markers in the tissue sections. Results: Assessment of the cardiac function revealed no improvement in the myocardial function compared to the control HF group. Moreover, tissue fibrosis was similar in two groups. Immunohistochemical study revealed the homing of the injected hAMSCs to the myocardium. Cells were stained positive for VEGF and troponin T markers. Conclusion: injection of hAMSCs 4 weeks after ischemia does not improve cardiac function and cardiac muscle fibrosis, although the cells show markers of differentiation into vascular endothelial cells and cardiomyocytes. In sum, it appears that hAMSCs are effective in the early phases of myocardial ischemia and does not offer a significant advantage in patients with chronic HF.

Background: Standards play an important role in representing the minimum favorable and acceptable performance and are used in determining the exact current status of a hospital and evaluating and monitoring its performances. Standards also play an important role in providing quality services by perfusionists to patients undergoing open heart surgery with heart–lung machine. Objectives: This study aimed to analyze the compliance with standards related to perfusionists in Iran by comparison with the American Society of Extracorporeal Technology Standards. Methods: In this descriptive cross-sectional study, a questionnaire developed by the American Society of Extracorporeal Technology Standards was used to collect data from 48 Iranian hospitals and educational medical centers. The level of compliance with perfusion standards related to perfusionists was analyzed and compared with the American Society of Extracorporeal Technology Standards. Results: The results showed that 45.52% of the centers were in compliance with factors related to standards of competence, qualification, and backup staffing for critical situation. Only 23% of the centers comply with standards of perfusionists' interaction with the medical team which indicates an unsatisfactory interaction between perfusionists and the medical team, and regarding the working hours, only 18.5% of the centers comply with the standards in this area. Conclusion: The comparison made between the compliance of Iranian perfusionists and the American Society of Extracorporeal Technology Standards reveals an unsatisfactory level. This suggests the need for the development of accreditation programs and standards of care on the one hand and conduction of a continuous evaluation of these standards on the other hand.

Background: Cognitive impairment is among the most prevalent complications in patients undergoing CABG. Selection of the proper temperature is one of the main moderating factors in cognitive impairment following CABG. Today, heart surgery is done using the two methods of hypothermia and normothermia. However, there is no consensus over the method with the least side effects. Objectives: This study aims to compare the effects of hypothermia and normothermia on cognitive functions after undergoing CABG during the hospitalization period. Methods: A total of 130 patients in this cohort observational study were divided into two groups of normothermic (n = 65) and hypothermic (n = 65). In the hypothermic group, the temperature was down to 32°C, and in the normothermic group, the temperature decreased to 35°C. After the surgery and transferring the patients to the ICU, demographic information and MMSE questionnaires were completed from the second to the sixth day at the same time. Results: The results showed no significant differences between the two groups in educational and social demographic characteristics (P > 0.05). Besides, there was no significant differences between the two groups in the history of the disease (P = 1.000). In addition, there was no significant relationship between cognitive performance scores of the two groups before the surgery (P = 1.000). However, there was a significant relationship between the two groups from the second (P = 0.003), third (P = 0.000) and the fourth day (P = 0.023) after the surgery. In the normothermic group, on the second, as well as third and fourth days 14 and 9 patients suffered from cognitive impairment, respectively. Besides, in the hypothermic group, on the second, third, and fourth days after surgery, 28, 30, and 23 patients suffered from cognitive impairment, respectively. However, there was no significant relationship between the two groups on the fifth and sixth days after the surgery (P = 0.079). Conclusions: The present study showed that during hospitalization after undergoing CABG, cognitive impairment in patients with the normothermic method was less severe than that in patients with the hypothermic method. Besides, clinical outcomes were more satisfactory in the former group.

Background: Structural heart disease (SHD) has great impacts on healthcare systems, creating further public health concerns. Proper data are scant regarding the magnitude of the affected population by SHD. We aimed to determine the prevalence of SHD among children and adolescents. Methods: In this population-based study, multistage cluster-random sampling was used to choose schools from the Tehran urban area. All students were examined using a handheld Vscan device by echocardiographer, and the results were concurrently supervised and interpreted by cardiologists. All the major findings were reevaluated in hospital clinics. Findings: Of 15130 students (6-18 years, 52.2% boys) who were examined, the prevalence of individuals with congenital heart disease (CHD) and cardiomyopathy was 152 (10.04 per 1000 persons) and 9 (0.6 per 1000 persons), respectively. The prevalence of definite and borderline rheumatic heart disease (RHD) was 30 (2 per 1000 persons) and 113 (7.5 per 1000 persons), correspondingly. Non-rheumatic valvular heart disease (VHD) was also detected in 465 (30.7 per 1000 persons) students. Of all the pathologies, only 39 (25.6%) cases with CHD and 1 (0.007%) cases with RHD had already been diagnosed. Parental consanguinity was the strongest predictor of CHD and SHD (odds ratio [OR]: 1.907, 95% CI: 1.358 to 2.680; P < 0.001 and OR: 1.855, 95% CI: 1.334 to 2.579; P

The aim of this study was to evaluate the impact of using a thromboelastometry-based protocol on transfusion requirements in patients undergoing combined coronary artery bypass grafting (CABG) and valve surgery. 80 adult patients scheduled for elective combined CABG and valve surgery were included in this clinical trial study. Patients were randomly allocated to the thromboelastometry (ROTEM) (n = 40) or control groups (n = 40). In the ROTEM group, transfusion was directed according to a thromboelastometry—based protocol. In the control group, transfusion was conducted according to the routine practices including conventional coagulation testing and clinical judgments. Finally, transfusion requirements were compared between groups. Use of thromboelastometry- based protocol resulted in 67% reduction in blood products units’ consumption as well as 23% in the percentage of patients transfused. This reduction was especially evident in relation to fresh frozen plasma (FFP) and platelet consumption. No significant differences were found both in the percentage of patients receiving RBC and number of transfused RBC units. Using thromboelastometry tests incorporated a protocol results in reduction of transfusion requirements in patients undergoing elective combined CABG and valve surgery.

Although coronary artery bypass graft (CABG) surgery is one of the most worldwide commonly performed cardiac surgeries to enhance myocardial perfusion in high-grade myocardial occlusion, it remains a high-risk procedure. Photobiomodulation (PBM) is one of the methods which have been shown to have positive effects on the healing process after CABG and postoperative complications. The aim of this study was to evaluate the efficacy of PBM in patients who underwent a coronary artery bypass graft (CABG). Ths study was conducted with 192 volunteers who electively submitted to CABG. The volunteers were randomly allocated into two groups: laser-treated (transdermal: 980 nm, 200 mW, continuous, average energy fluency of 6 J/cm

Introduction: Over a period of time, kidney blood vessels will be damaged in those patients suffering from hypertension. Objectives: This study aimed to investigate the effect of mean arterial pressure during cardiopulmonary bypass (CBP). Patients and Methods: The present observational prospective study was conducted on 90 high risk patients, having records of hypertension and being candidates for open heart surgery. Patients divided into three groups based on their mean arterial pressure (MAP), lower than 60 mmHg (first group), between 60 to 70 mm Hg (second group) and higher than 70 mm Hg (third group) respectively during cardiopulmonary bypass. Clinical outcomes being studied included cardiac surgery-associated acute kidney injury (CSA-AKI) (RIFLE class), serum creatinine levels, glomerular filtration rate (GFR) and urinary output up to 24 hours after the surgery. Results: Data related to 90 case-patients have been analyzed. There was no difference between the groups in terms of demographic information. Prevalence of AKI in preliminary course after cardiac surgery was different among the groups. AKI occurred in six patients (15%) of the first group, five patients (12.5%) of the second group and two patients (5%) of the third group (P = 0.03). There have been no differences in terms of serum creatinine levels, GFR and urinary output during 24 hours after cardiac surgery, among the groups. However, delta creatinine level and delta GFR were significant in those groups with MAP of lower than 60 mm Hg and also between 60-70 mm Hg. Conclusion: This study showed that MAP level during CBP directly affects occurrence of AKI in patients after open heart surgery. High risk patients such as those suffering from hypertension have to be constantly monitored during CBP regarding their MAP. We concluded that MAP drops to lower than 70 mm Hg has to be prevented in hypertensive patients.

The Bi-monthly Meeting of the Iranian Society of Cardiac Surgeon (ISCS) has been held regularly since 2005. The first ISCS bi-monthly virtual meeting was held in May 2020 during the COVID-19 outbreak. We have briefly reported the content of this virtual meeting in this article.

Aortic surgery is a complex procedure posing high risks in comparison to other adult cardiac surgeries. Novel surgical approaches including minimally invasive procedures, sutureless aortic valve replacement, and transcatheter aortic valve implantation have been found to be acceptable alternatives to conventional surgeries. In addition, novel endovascular repair techniques and hybrid procedures have been introduced for the management of patients with thoracoabdominal aortic pathologies. However, these modalities are not readily available in every center, and such novel procedures impose a learning curve for surgeons and high costs for affected patients. In this review, we discuss the challenges of setting up an aortic service, having regard to the Iranian experience.

The effects of recent Covid-19 pandemic on this planet must be viewed with a wise eye and we should learn that human beings are interconnected chains, and that ignoring the laws of existence will undoubtedly continue with reflections similar to the way we are today. Although the community of heart surgeons is not at the forefront of the treatment of this epidemic, they are ready to rush to the aid of other colleagues if necessary. The aim of preparing this protocol is to prioritize cardiac surgery procedures, maintain blood and blood product reserves and provide the appropriate care for patients while taking precautions for the safety of medical staff. The general recommendation in this first version of protocol is to postpone all elective cardiac surgeries and perform emergent and urgent cases according to suggested personal protection strategies for Covid-19.

Background: Minimizing ischemic-reperfusion injury following valvular heart surgeries is very important with the goal of providing appropriate cardiac systolic function, preventing arrhythmic events as well as inhibiting ischemic related processes. Due to the protective effects of adenosine, this chemical has been used as an additive to a cardioplegic solution for achieving this purpose. Objectives: The present study aimed to assess the effects of cold blood cardioplegia with adenosine on hemodynamic status of patients undergoing mitral valve surgery. Methods: This randomized single-blinded clinical trial was performed on 40 consecutive patients who were candidates for mitral valve surgery. The patients were randomly assigned to receive cold blood cardioplegia in combination with or without adenosine or hyperkalemic cardioplegia as the control. Primary endpoints were returning sinus rhythm, requiring inotropes after cardiopulmonary bypass and secondary endpoints were the change in hemodynamic parameters and postoperative complications. Results: Except for mean time required for induction of cardiac arrest that was significantly shorter in intervention group, no differences were found between the two groups regarding cardiopulmonary bypass time, cross clamp duration, and rhythm return time. In assessment of postoperative consequences, there were no differences in post-procedural events with respect to returning sinus rhythm, requiring inotropes, requiring DC shock, mean intubation time, length of ICU stay and also left ventricular systolic function. Conclusions: Except for reducing the time for inducing cardiac arrest within mitral valve surgery, adding adenosine to cold blood cardioplegia may not be beneficial regarding the improvement of postoperative outcome.

A 57–year-old man presented with atypical chest pain. Transthoracic echocardiography was performed and revealed a very large and well defined intra-myocardial multicystic mass in the posterolateral and basal inferoseptal segments of left ventricle suggestive of hydatid cyst. Although the echocardiographic diagnosis was straightforward, serologic test (hydatid cyst antibody) with enzyme-linked immunosorbent assay (ELISA) was performed which was positive for echinococcal infection. Other works up showed no involvement of other organ system. Albendazol was started for him and he referred to cardiac surgeon for resection of cystic mass.

Anomalous origin of the left coronary artery from the pulmonary artery (ALCAPA) syndrome is a rare congenital anomaly occurring in 1 of 300,000 births. As it has high mortality rate during the 1st year of life, adult type is very rare. Arrhythmias, heart failure, myocardial infarction, and sudden cardiac death are common presentations of ALCAPA syndrome in adults. Here, we report a 28-year-old male with malignant ventricular arrhythmia and sudden cardiac death. ALCAPA syndrome was diagnosed by coronary angiography and echocardiography; finally, cardiac surgery was performed with a good result.

Background: Patients undergoing cardiac surgery are at increased risk of bleeding due to multifactorial coagulopathies. In the present study, we aimed at investigating the changes in platelet count and function during and after surgery as well as determining the association of the platelet dysfunction with bleeding and transfusion requirements in these patients. Methods: A total of 40 adult patients scheduled for elective valve coronary cardiac surgery were included in this prospective observational study. Changes in platelet count and function with ADP, acid arachidonic, and collagen (light transmission aggregometry) were analyzed at three time points: before CPB, after CPB, and 24 hours after end of surgery. Postoperative bleeding and intraoperative transfusion requirements were recorded. Results: There were a significant reverse correlation between CPB time and ADP-induced aggregation, particularly after CPB and postoperative AA-induced aggregation. There was not any significant correlation between platelet count and function at all-time points. Both platelet count and platelet aggregation significantly reduced during CPB. While platelet aggregation increased on postoperative Day 1, platelet count reduced by about 40% after CPB, and remained at this level postoperatively. Patients with abnormal ADP-induced aggregation had significant increased postoperative bleeding and transfusion requirements. Conclusion: The results of this study demonstrate that platelet count and platelet aggregation are reduced during CPB. Our results emphasized the effect of platelet dysfunction on increased postoperative bleeding and transfusion requirements. Perioperative monitoring of platelet function can be considered as a bleeding management strategy for implantation of PBM programs.

Background Zero-balance ultrafiltration (Z-BUF) is considered a significant method during cardiopulmonary bypass (CPB), and has always received support regarding its key role in monitoring electrolyte abnormalities including potassium and sodium derangements and managing them which occur commonly during CPB. With Z-BUF procedure's impact on controlling electrolyte abnormalities, we conducted a study in order to find out the most efficient solution regarding managing potassium and sodium levels to be selected as replacement fluid in Z-BUF out of the three commonly used normal saline, ringer's and ringer's lactate. Method a randomized clinical trial study was conducted and 90 patients were divided into three groups. Each group was given a certain solution out of the three normal saline (Z-BUF-NS), ringer's (Z-BUF-R), and ringer's lactate (Z-BUF-RL) with allocation concealment strategy then potassium and sodium levels were measured at 5 points of the whole procedure: prior to CPB and after anesthesia induction, cardioplegic solution's delivery, pre-Z-BUF, post-Z-BUFF, and at the end of CPB. Results Comparing pre-Z-BUF and post-CPB patients' serum potassium demonstrated a change from 4.7 0.9 mEq/L to 5.2 0.7 mEq/L in Z-BUF-RL, 4.4 0.6 mEq/L to 4.7 0.5mEq/L in Z-BUF-R, and 5.1 0.5 mEq/L to 5.1 0.5 mEq/L in Z-BUF-NS. No significant difference was observed between groups regarding managing K+ abnormalities. Changes in Na+ from pre-Z-BUF to post-CPB were as following: from 134 mEq/L to 133 mEq/L in Z-BUF-RL, 137 mEq/L to 137 mEq/L in Z-BUF-R, and 135.2 4 mEq/L to 136.5 4 mEq/L in Z-BUF-NS. Ringer's lactate managed sodium abnormalities more efficiently. Conclusion Ringer's lactate is more efficient than Ringer's and normal saline regarding managing sodium and potassium abnormalities.

Background: This randomized clinical trial was carried out so as to discover the efficacy of both ɛ-aminocaproic acid (Caproamin Fides®) and tranexamic acid (Transamin®) among high risk patients in primary coronary artery bypass grafting surgery. Methods: From December 2010 to January 2013, 100 consecutive high-risk adult patients undergoing CABG at Rajaie Cardiovascular Medical & Research Center, Tehran, Iran were included in this randomized double-blinded study. Patients who had a past history of, coagulation disorders and allergy reactions to both Caproamin Fides® and Transamin® were excluded. One group of patients received 150 mg/kg Caproamin Fides at the beginning of surgical incision and an additional 1 gr/h during operation (group 1). The second group were administered transamin with a primary dose of 10 mg/kg infusion being coincident with surgical incision (group 2). Then, patients were followed by their blood transfusion volumes, mediastinal bleeding and postoperative complications. Results: One hundred patients as 79 males and 21 females with ages at the mean of 66.4 ± 7 years were enrolled in the study. The mean volumes of chest drainage in group one (416 ± 322 in 24 hours and 681 ± 374 in 48 hours) and group 2 (420 ± 303 in 24 hours and 532 ± 399 in 48 hours). The 56% of patients in Caproamin Fides group and 58% of patients in transamin group received a mean of 1.46 ± 1.06 and 1.65 ± 1.04 units of packed cell respectively. During ICU stay 66% of patients in Caproamin Fides group and 25% of patients in transamin group required additional red blood cell transfusion at the rate of 2.4 ± 1.8 and 1.5 ± 0.6 units. Only 1 patient in transamin group received a pack cell transfusion. There were no significant differences in postoperative major adverse cardiovascular and cerebrovascular events (MACCE) between two groups. Conclusions: Caproamin Fides and transamin are both safe and effective in postoperative bleeding reduction. They also reduce the need for blood transfusion in high risk patients undergoing CABGs and could be used as an acceptable alternative for aprotinin. Tranexamic acid seems to be more effective regarding the need for blood product transfusion in these patients.

Introduction: Kawasaki disease (KD) is a systemic vasculitis syndrome usually presented with acute fever which occurs primarily in children younger than 5 years of age. KD has become the most common cause of acquired heart disease in pediatric population in developed countries. Kawasaki disease can damage cardiovascular system including myocarditis, pericarditis, coronary artery aneurysms complicated by thrombotic or stenotic lesions that are at risk of myocardial infarction (MI), congestive heart failure and also sudden cardiac death. The incidence of such complications can be dramatically reduced by early diagnosis and intravenous immunoglobulin (IVIg) therapy and high dose aspirin. Case Presentation: A 25-year-old man with a history of Kawasaki disease 17 years ago presented with anterior ST-segment elevation myocardial infarction (STEMI), left anterior descending artery (LAD) and right coronary artery (RCA) aneurysmal dilation and thrombosis with left ventricle ejection fraction (LVEF) of 25% that underwent coronary artery bypass graft (CABG) surgery and surgical closure of coronary artery aneurysms. Conclusions: The surgical management of cardiac disease in Kawasaki patients could be safe and effective.

Aims Infective endocarditis (IE) remained a potentially fatal disease with high rate of mortality and morbidity. The epidemiology and global burden of IE are largely different between the countries. We aimed to address the epidemiological aspects of IE in a tertiary hospital in Tehran, Iran. Methods and Results Between 2006–2018, all adults patients with diagnosis of IE were enrolled in the Iranian Registry of Infective Endocarditis (IRIE). The data were analyzed using the χ2, Kolmogorov–Smirnov, and Mann–Whitney U tests. Overall, 602 patients, 407 (67.6%) men, mean age 46 ± 16 years were recruited. Positive blood culture found in 49%.The most common underlying heart diseases were: Congenital heart diseases (CHD) particularly bicuspid aortic valves (BAV) and ventricular septal defects (VSD) in 37%, followed by degenerative heart diseases :flail and mitral valve prolapse (16.3%), intravenous drug user in 12.6%, prosthetic valves in 11.1%, previous IE (8.9%), rheumatic heart diseases (RHD) in 8.4%. The most causative microorganisms were Staphylococcus aureus, Enterococci, coagulase-negative staphylococci and Streptococcus viridans. Cardiac or extra cardiac complications occurred in 56.6% of the patients. Conclusions Based on IRIE, IE occurs in the younger population in Iran with high rates of blood culture-negative IE. RHD are not the main cause of IE in Iran, CHD including BAV and VSDs, followed by prolaptic or flail mitral valve were the most common. These 2 groups can be considered a high-risk group for IE. More than half of the patients with IE had cardiac or extra cardiac complications.