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Introduction: For those with ST-segment myocardial infarction (STEMI), therapeutic delays are the leading cause of mortality. Contacting a health-care provider takes longer than the emergent prehospital system, the patient referral process, the emergency room, and within the hospital. In our nation’s various cities, we aimed to compare these variables. Methods: In the Iranian cities of Sanandaj and Tehran, the Rajaie Cardiovascular Medical and Research Center (RHC) and Tohid Hospital, respectively, undertook this multicenter, multiprefectural, cross-sectional study between 2016 and 2020. Baseline characteristics were gathered from medical records, including age, sex, and employment. In two centers, the first medical contact-to-door (FTD) and door-to-balloon (DTB) times as well as electrocardiographic abnormalities, adjunctive therapy, causal lesions, and FTD and DTB times were evaluated. Results: The study population consisted of 600 STEMI patients, 300 from each institutions. Most of the participants were male, approximately a third of the patients arrived at the hospital using emergency medical service, the most frequent culprit artery in both hospitals was the left anterior descending artery, the average FTD was 333 min in Tehran and 151 min in Sanandaj, with the statistical significance difference (P < 0.001), DTB was significantly lower at RHC than at Tohid Hospital (54.8 min vs. 88.3 min; P < 0.001), the maximum FTD was observed among patients older than 70-year-old (284.72 min). Conclusion: Preparing sufficient facilities for primary percutaneous coronary intervention units, increasing the number of specialists and ensuring their permanent presence in hospitals, and providing health-care personnel with improved training may play significant roles in minimizing DTB.

Abstract Background Percutaneous pulmonary valve implantation (PPVI) is a recognized alternative treatment to surgery for patients with dysfunctional right ventricular outflow tracts. Patient selection is essential to avoid serious complications from attempted treatment, such as rupture or dissection, especially of the calcified outflow tracts. We describe a case with an unexpected rupture of a calcified homograft valve and main pulmonary artery, which was treated successfully by emergency implantation of a self-expanding Venus P-Valve (Venus MedTech, Hangzhou, China) without the need for pre-stenting with a covered stent. Case details A 13-year-old boy had two previous operations of tetralogy of Fallot, one a total repair and the other a homograft valved conduit for pulmonary regurgitation. He presented with dyspnea and severe right ventricular outflow tract obstruction (RVOTO) and had a calcified outflow tract and main pulmonary artery. In the catheter laboratory, a non-compliant balloon dilation resulted in a contained rupture of the conduit. The patient remained hemodynamically stable, and the rupture was treated with a self-expandable Venus P-Valve without the need for a covered stent combined with a balloon-expandable valve or a further surgical procedure. Discussion Preprocedural evaluation with an inflating balloon is necessary to examine tissue compliance and determine suitability for PPVI. However, this condition is accompanied by a risk of conduit rupture. Risk factors of this complication are calcification and homograft use. These ruptures are mostly controlled with a prophylactic or therapeutic covered stent, with a low rate of requiring surgery. However, there are severe ruptures which lead to hemothorax and death. In the available literature, there was no similar reported case of conduit rupture, which a self-expandable Pulmonary valve stent has managed. It seems that fibrosis and collagen tissue around the heart, formed after open surgeries, can contribute to the control of bleeding in these cases. Conclusion (clinical Learning Point) The suitability of patients for the PPVI procedure should be examined more carefully, specifically patients with homograft and calcification in their conduit. Furthermore, conduit rupture might be manageable with self-expandable artificial pulmonary valves, specifically in previously operated patients, and the applicability of this hypothesis is worth examining in future research.

Background: The radial approach is now recommended as the default strategy in diagnostic coronary angiography and percutaneous coronary intervention. Radial artery occlusion (RAO) is the most common complication that limits subsequent angiographic procedures through this access. Recently, distal radial access (DRA) has been recommended as an alternative access site. Despite lower RAO rates in DRA in some recent clinical trials, concerns remain regarding possible complications and limitations due to the small size of the distal radial artery. Objective: The present study aimed to compare traditional radial access (TRA) and DRA concerning RAO in percutaneous coronary procedures. Methods: In the present prospective cohort study, percutaneous coronary procedures were performed via DRA or TRA in 2 study groups. All consecutive participants underwent DRA from September 2021 to March 2022 and TRA from April 2022 to June 2022. Ultrasonography was performed preprocedurally in the DRA group, and patients with small distal artery diameters (

Most cases of congenital coronary artery fistula (CAF) resolve spontaneously, symptomatic patients with severe shunting require surgical intervention. Our aim is to evaluate success rate and outcome of CAFs treatment using transcatheter interventional methods.This retrospective study conducted on 28 CAF patients who were referred to Rajaie Cardiovascular Medical and Research Center in Tehran between 2015 and 2020. Baseline characteristics were collected by assessing hospital records, and patients were followed up annually for long-term evaluation. All of 28 patients gone throughtranscatheter closure of CAF. In 23 patient’s it was proximal type (82.1%) and in 5 patients was distal type (17.9%). In 11 patients, the fistula originated from the RCA (39.3%) and in 11 patients, it originated from the LAD and Diagonal. Most common drainage site was the pulmonary artery (82.1%). Coil used in 23 patients(82.1%). PDA occluder (7.1%) for 2 patients. VSD occluder for one patient (3.6%) and VSD+PDA occluder combination was used for one patient (3.6%). Procedure failure was in only one patient. Non-significant remaining shunt in the injection immediately after the procedure was seen in 4 patients (14.3%), which was reduced during the follow-up. None of the patients had significant shunt or clinical symptoms during long-term follow-up. As for complications, fistula dissection occurred in only one patient.The transcatheter interventional approach for the treatment of CAFs leads to favorable long-term results.

Abstract Background Percutaneous balloon mitral valvuloplasty (PBMV) is the ACC/AHA class I recommendation for treating symptomatic rheumatic mitral stenosis with suitable valve morphology, less than moderate MR and absence of left atrium clot. The mitral valve restenosis and significant mitral regurgitation (MR) are known adverse outcomes of PBMV. This study aimed to evaluate the outcomes of PBMV in patients with severe mitral stenosis and the effect of Commissural Calcification (CC) on the outcomes. Methods In this single-center retrospective cohort study, 876 patients who underwent PBMV were categorized into three groups based on their Wilkins score (Group I: score ≤ 8, Group II: score 9–10, and Group III: score 11–12). Patients were evaluated before, early after PBMV and at 6- and 24-month follow-ups. Main clinical outcomes were defined as significant restenosis and or symptomatic significant MR (moderate to severe and severe MR) or candidate for mitral valve replacement (MVR). The outcomes were compared between patients with and without CC. Results A total of 876 patients with mean age 46.4 ± 12.3 years (81.0% females) were categorized based on Wilkins score. 333 (38.0%) were in Group I, 501 (57.2%) were in Group II, and 42 (4.8%) were in Group III. CC was present in 175 (20.0%) of the patients, among whom 95 (54.3%) had calcification of the anterolateral commissure, 64 (36.6%) had calcification of the posteromedial commissure, and in 16 (9.1%) patients both commissures were calcified. There was a significant difference in Wilkins score between patients with and without CC (P

Abstract Background Cardiovascular events and poor quality of life are frequently observed in patients with coronary slow flow phenomenon (CSFP). This trial evaluated the effect of nano-curcumin supplement containing curcuminoids, as multifunctional nutraceuticals, on angina status, and some traditional and novel cardiovascular risk factors in overweight or obese patients with CSFP. Methods In this double-blind, randomized, placebo-controlled clinical trial, 42 overweight or obese patients with CSFP received either 80 mg/day of nano-curcumin or placebo for 12 weeks. Seattle angina questionnaire (SAQ) as a clinical measure of angina status, circulating endocan, adropin, homocysteine, lipid profile, and the novel scores of visceral adiposity index (VAI) and waist-triglyceride index (WTI) were assessed before and after the intervention. The independent samples t-test, Mann-Whitney test, analysis of covariance, Chi-square, and Fisher’s exact tests were used where appropriate. Results All domains of SAQ including physical limitation, angina stability, angina frequency-severity, treatment satisfaction, and disease perception and quality of life improved significantly in the nano-curcumin compared with the placebo group. No significant changes were observed in serum endocan, adropin, and homocysteine following the intervention. Triglycerides, triglyceride/high-density lipoprotein cholesterol ratio, WTI and VAI values improved significantly only within the nano-curcumin group. Conclusions Supplementation with 80 mg/day nano-curcumin (containing curcuminoids) for 12 weeks significantly improved clinically important disease-specific aspects of health in patients with CSFP. Some traditional and novel cardiovascular risk factors improved significantly only compared with the baseline values, which need further investigation. Trial registration This study was approved by the Ethics Committee of Tehran University of Medical Sciences (IR.TUMS.VCR.REC.1398.794). The study protocol was registered at Iranian Registry of Clinical Trials by IRCT20131125015536N8 registration ID at 19.06.2019.

Objective: While most of the evidence in CTO interventions emerge from Western and Japanese studies, few data have been published up today from the Middle East. Objective of this study was to evaluate technical success rates and clinical outcomes of an Iranian population undergoing CTO PCI in a tertiary referral hospital. Moreover, we sought to evaluate the efficacy of our CTO teaching program. Methods: This is a retrospective single-center cohort study including 790 patients who underwent CTO PCI performed by operators with different volumes of CTOs PCI performed per year. According to PCI result, all patients have been divided into successful (n = 555, 70.3 %) and unsuccessful (n = 235, 29.7 %) groups. Study endpoints were Major Adverse Cardiovascular Events and Health Status Improvement evaluated using the Seattle Angina Questionnaire at one year. Results: A global success rate of 70 % for antegrade and 80 % for retrograde approach was shown despite the lack of some CTO-dedicated devices. During the enrollment period, the success rate increased significantly among operators with a lower number of CTO procedures per year. One-year MACE rate was similar in both successful and unsuccessful groups (13.5 % in successful and 10.6 % in unsuccessful group, p = 0.173). One year patients’ health status improved significantly only in successful group. Conclusions: No significant differences of in-hospital and one-year MACE were found between the successful and unsuccessful groups. Angina symptoms and quality of life significantly improved after successful CTO PCI. The RAIAN registry confirmed the importance of operator expertise for CTO PCI success.

Key Clinical Message Transcatheter mitral valve implantation (TMVI) is considered a less‐invasive approach than open‐heart surgery, favored in high‐risk patients elected for valve replacement. Although seemingly suitable, this procedure is highly operator‐dependent. Abstract Transcatheter mitral valve implantation (TMVI) is an alternative in high‐risk patients. We reported a 72‐year‐old patient with mitral bioprosthesis degeneration successfully receiving TMVI. The procedure has lower morbidity and mortality rate than the surgical approach but can be accompanied by several complications, especially when conducted by an inexperienced operator.

Abstract This cross-sectional study was designed to assess alterations of choroidal and retinal microvasculature in patients with Heart Failure with Reduced Ejection Fraction (HFrEF) and compare them with a normal age and sex-matched population. Fifty-two eyes of 26 patients with HFrEF (left ventricular ejection fraction [LVEF]

Aim and Objectives: Recent randomized controlled trials have demonstrated the benefit of patent foramen ovale (PFO) device closure over medical therapy alone for secondary prevention of cryptogenic stroke in carefully selected patients. In the current study, we sought to investigate the outcomes and complications of PFO device closure in our referral tertiary cardiovascular center. Materials and Methods: In this retrospective study, 155 adult patients who underwent PFO device closure between 2006 and 2021 were included. Patient characteristics, recurrent neurologic events, and procedure-related complications were evaluated. Results: The follow-up period was 2.3 ± 1.2 years. The average age of the participants was 41.3 ± 10 years, and 59.4% were male. Six patients (3.9%) suffered recurrent cerebrovascular events in the follow-up. No procedure-related complications were reported in our study population. Two patients (1.3%) with recurrent stroke had developed newly diagnosed atrial fibrillation (AF). Conclusion: PFO device closure is a safe and effective method for the prevention of recurrent ischemic stroke in patients with no other detectable etiology. Patients, particularly those with cardiovascular risk factors, should be meticulously investigated for the asymptomatic episodes of AF as the contributing factor with prolonged Holter monitoring or use of loop recorders.

Penetrating cardiac injuries are heart crises requiring immediate surgical intervention, and nail-gun injuries have also been documented. This case report covers a 19-year-old male who self-inflicted a single chest wound using a nail gun. Examination of the heart revealed a nail that touched the myocardium around the right ventricular outflow tract.

BACKGROUND: Enterococci are responsible for 5% to 18% of infective endocarditis (IE) cases. We aimed to determine demographic data, predisposing factors, clinical presentations, complications and echocardiographic findings concerning enterococcal endocarditis.METHODS: Since 2006, all adult patients with a possible or definite diagnosis of IE based on the modified Duke criteria have been enrolled in the Iranian Registry of Infective Endocarditis. In this study, patients with IE of enterococcal origin were detected and their demographic characteristics, predisposing factors, complications, laboratory data and echocardiographic findings were assessed.RESULTS: Out of 731 patients diagnosed with endocarditis. Enterococci were found in 60 patients: 32 men (53.3%) and 28 women (46.7%) at a mean age of 55.21 ± 17.9 years. Definite IE was diagnosed in 57 (95%) patients, and possible IE was suspected in 3 patients (5%). The most frequent predisposing factor was the prosthetic valve (n=28, 46.7%), followed by a history of previous endocarditis (n=12, 20%). An acute course (

Abstract Background Ascending aortic pseudoaneurysms (AAPs) constitute a rare, albeit potentially dangerous, condition that occurs in up to 13% of patients after cardiac or aortic surgeries. For patients with a history of cardiac surgery, repeat thoracotomy poses additive risks. The high morbidity and mortality rates associated with the surgical management of AAPs have led to the development of transcatheter approaches. Case report We report a case of AAP percutaneous closure at the site of aortic cannulation with an ASO device in a post-CABG 65-year-old man, who refused surgery. Conclusion The use of the Amplatzer Atrial Septal Defect Occluder (ASO) device represents an acceptable alternative to surgery in treatment of Ascending aortic pseudoaneurysms.

Background: Transcatheter pulmonary valves (TPVs) are feasible and much less invasive options for surgical right ventricular outflow tract (RVOT) repair or valve replacement in patients with degeneration of the pulmonary valve bioprosthesis or RVOT conduit failure. In 2005, the first Sapien valve was implanted in the pulmonic position, and proceeding In March 2016, the Food and Drug Administration approved the SAPIEN valve (Edwards Lifesciences) for use in malfunctioning RVOT conduits. Material and method: We describe the first ten cases of TPV-in-valve procedure conducted in our center, along with the patients' prior surgical history, procedural details, and their clinical and echocardiographic data. Result and conclusion: Our data provided safety and efficacy of transcatheter valve-in-valve procedure in degenerated pulmonary bioprotheses and our follow-up proved durability of this procedure.

Abstract Background Peripheral pulmonary artery stenosis (PPAS) is a rare and underdiagnosed phenomenon that is reported infrequently in adult patients. Most patients with PPAS have concomitant congenital heart diseases, a history of palliative surgical therapies during childhood, or syndromic characteristics. Acquired cases are rare, and they are underestimated in adulthood and managed inappropriately. Case presentation This case series describes 3 adult patients with PPAS of diverse etiologies and discusses their underlying causes, diagnostic modalities, and treatment strategies. Conclusions In patients with PPAS, sufficient heed should be paid to endovascular interventions such as balloon dilation and primary or bailout stenting, not least vis-à-vis the type and size of balloons or stents as well as complications and preventive strategies.

In tanscatheter aortic valve replacement (TAVR) era, knowing complications related to the procedure guides interventional cardiologist in predicting the obstacles and helps them in manage these infirmities. We describe a case of TAVR which deploying the valve resulted in left ventricle outlet tract (LVOT) obstruction which was perfectly managed pacing and medical therapy.

Background There are limited data about the clinical outcomes of patients with coronavirus disease 2019 (COVID-19) who present with ST-Segment-Elevation Myocardial Infarction (STEMI). Objectives The aim of this multicenter study is to compare baseline clinical and procedural data between the case group (STEMI patients with COVID-19) and the control group (STEMI patients before the COVID-19 pandemic) and to determine in-hospital infarct-related artery thrombus grades; major adverse cardio-cerebrovascular events (MACCE), defined as a composite of deaths from any cause (cardiovascular and non-cardiovascular), nonfatal strokes, and stent thrombosis. Results There were no significant differences between two groups regarding baseline characteristics. Primary PCI was performed in 81% of the case group and 97% of the control group (P=0.043), and primary CABG was performed in 7% of the case group and 1.4% of the control group (P=0.04). The number of successful PCI procedures (final TIMI flow grade III) was significantly lower in the case group (66.5% vs 93%; P=0.0). The baseline thrombus grade before wire crossing was not statistically significantly different between the 2 groups. The summation of thrombus grades IV and V was 75% in the case group and 82% in the control group (P=0.43). The rate of MACCE was 17% and 2.1% in the case and control groups, correspondingly (P=0.002). Conclusions In our study, the thrombus grade had no significant differences between the case group and the control group; however, the in-hospital rates of the no-reflow phenomenon, periprocedural MI, mechanical complications, and MACCE were statistically significantly higher in the case group.

Abstract Background Secundum-type atrial septal defects (ASD) constitute 8% to 10% of congenital heart defect. Secundum ASDs can be closed either percutaneously or surgically. However, ASD device closure has proven to be technically safe and feasible; it is not free of complications. These complications include device embolization/malposition which have been reported in 3.5% of cases, arrhythmia, and pericardial effusion in 2.6% and 0.5–1.5% respectively, device thrombus, residual shunting, and impingement of the device on the adjacent structures. Case presentation We introduce three patients with secundum ASD who had preexisting pericardial effusion, device closure was performed for them, and after the procedure, the effusion size progressed significantly. We used multimodality imaging to diagnose the cause of pericardial effusion (PE). Cardiac erosion was diagnosed in one of the patients that managed surgically. We did not found any specific procedure-related cause for worsening the pericardial effusion in the other two patients. Conclusion Several reasons include procedure-related complication and other systemic causes should be considered in patients who develop pericardial effusion after trans catheter closure of ASDs.

Superior cavopulmonary anastomosis is a type of palliative cardiac surgeries that usually done in children with cyanotic and complex congenital heart disease who have single ventricle profile. BDG shunt is staged palliation procedure for single ventricle patients who are candidates for total cavopulmonary connection (TCPC). Sometimes the surgeon misses ligating or intentionally leaves the azygos vein as a fenestration or emergency exit. This allows an abnormal flow from the superior vena cava (SVC into azygos vein). These patients can present progressive desaturation, chest tightness, progressive dyspnea, edema and shortness of breath. Therapeutic options include observation, surgical ligation and trans catheter closure. Because of high risks and extra traumas of surgery and greater chance for difficulties and the feasibility of trans catheter therapy, it is done in some centers as a method of choice.

Background: Patients' hesitation to seek medical care has seriously compromised the management of acute coronary syndrome during coronavirus disease 2019 (COVID-19) outbreak. In the present study, we have reported the rate of discharged against medical advice (DAMA) among patients referred to chest pain unit (CPU) of a tertiary cardiovascular center and compared their clinical outcomes with whom admitted or managed conservatively. Methods: Patients with modified HEART risk score ≥4 referred to the CPU were included in the present study. Population requiring CPU admission due to positive serial troponin were divided into admitted and DAMA groups. Patients with negative serial troponin were managed as outpatient (conservative treatment group). 30-day major adverse cardiac events (MACE) and all-cause mortality were compared between the study groups. Results: A modified HEART risk score (≥4) was calculated for 440 of 5490 patients visited our CPU. One hundred and one (22.9%), 80 (18.1%), and 249 (56.5%) patients were categorized as DAMA, admitted, and conservative treatment groups, respectively. Myocardial infarction was significantly higher in the DAMA versus admitted group (2 vs. 0; P ≤ 0.001). MACE and all-cause mortality were significantly higher in the DAMA group than that in the conservative treatment group (5 vs. 2; P = 0.02 and 4 vs. 2; P = 0.055, respectively). Conclusion: In the present study, we have demonstrated a considerable rate of DAMA in patients with high modified HEART risk score referring to CPU during the COVID-19 outbreak. Importantly, the DAMA group experienced a higher incidence rate of 30-day MACE and all-cause mortality compared to patients who were admitted or managed conservatively.

Purpose: The goal of the study was to identify earlier pathology of the Left Ventricle (LV) using Speckle Tracking Echocardiography (STE) without angiography results for detecting Coronary Artery Disease (CAD) patients who have need invasive coronary reperfusion. Materials and Methods: A total of seventy-five referral patients to angiography (mean age 57±9 years) with chest pain, underwent Two-Dimensional Echocardiography (2D-ECG). Conventional echocardiographic parameters were calculated for the assessment of LV function. End systole and early diastole longitudinal strain, strain rate, and velocity with 2D-STE were estimated to evaluate myocardial function. Discriminated analysis was performed to detect CAD patients from the healthy group. Results: According to the angiography results, patients were divided into CAD group (n=55) and healthy group (n=20). There was a significant decrease in longitudinal strain, strain rate, and velocity in patients with CAD compared to the healthy group (systolic longitudinal strain for CAD group -15.9±2.2% vs. -19.6±2.2% for healthy group and early diastolic longitudinal strain for CAD patients -9.5±1.2% vs. -12.0±1.3% for the healthy group) (P-value

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.

Introduction: Cardiovascular diseases, including coronary artery disease (CAD), are among the most common causes of death in the elderly population. Recent studies have found that coronary artery calcium score (CACS) is a strong independent predictor of CAD. Here we aimed to investigate the association between CACS and demographic, clinical, laboratory, and CT angiographic findings inpatients with suspected CAD. Methods: From June 2008 to August 2018, we retrospectively reviewed 219 consecutive patients suspected with CAD who were referred for CT angiography in Rajaie Cardiovascular, Medical, and Research Center. Medical records were reviewed, and relevant demographic, clinical, laboratory and imaging were collected. Results: A total of 219 patients with an average age of 62.64±12.39 were included. Twelve patients(5.5%) had normal coronary angiography, and 50.2% had mild CAD. An obstructive CAD was found in97 patients (44.3%). The median CACS was 76.4 (IQR, 13.0-289.1). The frequency of obstructive CAD was 28.1% in the CACS 100 group (P < 0.001). On multiple logistic regression analysis, age (OR=1.04 [1.01-1.07], P = 0.006), CACS (OR= 4.31 [2.33-7.98], P < 0.001), and neutrophil to lymphocyte ratio (NLR) (OR = 0.82 [0.68-0.98], P = 0.027) were independent predictors of obstructive CAD. Conclusion: We found a direct association between higher CACS and obstructive patterns in coronary CT angiography. Our findings indicate that the possibility of the presence of obstructive CAD was higher among symptomatic patients with older age, lower NLR, and CACS >100.

Objective: The aim of the present study was to examine the association between 2 polymorphisms of the endothelial nitric oxide (eNOS) gene (-786T>C and +894G>T) and the no-reflow/slow-flow phenomenon in post-primary percutaneous coronary intervention (PPCI) patients. Methods: A total of 103 post-PPCI patients were enrolled. Coronary no-reflow phenomenon was defined as a Thrombolysis in Myocardial Infarction (TIMI) flow grade 0–1 and coronary slow-flow phenomenon (CSFP) was defined as a TIMI flow grade ≤2. Results: Due to the small number of post-PPCI patients with the no-reflow phenomenon (n=4), the primary comparison was made between CSFP (n=20) and normal flow (n=83) groups. There was a greater frequency of CSFP among carriers of the –786C allele of the eNOS –786T>C polymorphism (odds ratio [OR]: 3.90; 95% confidence interval [CI]: 0.87–17.45; p=0.07). However, no such association was detected between the +894T allele of the eNOS +894G>T and CSFP (OR: 0.92; 95% CI: 0.21–3.98; p=0.91). In the adjusted analysis, the -786T>C polymorphism did not reach statistical significance. Conclusion: There was no significant association between CSFP and 2 of the most common polymorphisms of the eNOS gene in post-PPCI patients.

Introduction: The risk of contrast-induced nephropathy (CIN) as a common and important complication of coronary procedures may be influenced by the vascular access site. We compared the risks of CIN in diagnostic or interventional coronary management between patients treated via the transradial access (TRA) and those treated via the transfemoral access (TFA). Methods: Patients undergoing invasive coronary catheterization or percutaneous coronary intervention (PCI) were enrolled. We excluded patients with congenital or structural heart disease and those with end-stage renal disease on dialysis. Based on the vascular access site used for invasive coronary catheterization, the patients were divided into 2 study groups: the TFA and the TRA. CIN was defined as an absolute (≥0.5 mg/dL) or relative (>25%) increase in the baseline serum creatinine level within 48 hours following cardiac catheterization or PCI. Results: Overall, 410 patients (mean age = 61.3 ± 10.8 years) underwent diagnostic or interventional coronary management: 258 were treated via the TFA approach and 152 via the TRA approach. The patients treated via the TFA had a significantly higher incidence of postprocedural CIN (15.1% vs 6.6%; P = 0.01). The multivariate analysis showed that the TFA was the independent predictor of CIN (OR: 2.37, 95% CI: 1.11 to 5.10, and P = 0.027). Moreover, the BARC (Bleeding Academic Research Consortium) and Mehran scores were the other independent predictors of CIN in our study. Conclusion: The risk of CIN was lower with the TRA, and the TFA was the independent predictor of CIN after the diagnostic or interventional coronary management.

Shone syndrome or complex is defined by sequential left-sided heart stenosis, including supravalvular mitral membrane, valvular mitral stenosis (MS) by a parachute mitral valve, subaortic stenosis, and aortic coarctation. It is a rare entity which occurs most frequently in its incomplete form, a 31-year-old man who referred to our adult congenital clinic with a chief complaint of recent chest discomfort. He had a history of hypertension since last year. Echocardiography revealed congenital severe MS (parachute-like mitral valve), two papillary muscles with decreased space between them and underdeveloped lateral papillary muscle. Other findings of echocardiography were bicuspid aortic valve (fusion of the right coronary cusp [RCC] and left coronary cusp) with moderate-to-severe aortic stenosis (AS) and moderate eccentric aortic insufficiency. Deformed aortic arch (gothic arch) and aortic coarctation were also reported in transthoracic echocardiography. We also found an abnormal vessel like density in 5-chamber view that suggested bleb sign and retroaortic course of the left circumflex (LCX). The patient was scheduled for coronary angiography and intervention for coarctation of the aorta, which revealed an abnormally originated LCX from RCC, significant coarctation of the aorta, and significant AS. Aortic coarctoplasty with CP STENT 8 × 39 mounted on balloon Altosa-XL-Gemini 26 × 40 was done in this session. Shone complex is a rare anomaly that may need multiple procedures for correction. Echocardiography is a specially important modality in these patients for diagnosis and evaluation of severity. By this modality, even we can diagnose some coronary artery origin abnormality.

Introduction: Most fatal presentation of coronary artery disease (CAD) has been related to acute coronary syndrome (ACS), and we as a referral center in the country decide to launch a registry of patients with ACS to monitor the way they are managed and the way they are treated. Materials and Methods: Rajaie Cardiovascular, Medical and Research Center ACS registry (RHC-ACS registry) launched on December 2015 with enrolling all ACS patients referred or presented to the center. All patients' demographic variables, presenting symptoms, known risk factors, past medical history, past CAD records, serial ischemic electrocardiogram (ECG) changes, presenting echocardiographic data (such as left ventricular ejection fraction [LVEF], valvular abnormality, and mechanical complication of myocardial infarction [MI]), laboratory assessment (biochemistry, complete blood count, cardiac markers, and inflammatory indicators), and their angiographic and angioplasty data were recorded. Results: Recordings showed in the RHC-ACS registry, most patients were men (73.2%), with mean age of 59.16 ± 11.64 years, hypertension were the most known cardiac risk factor. Most patients were non-ST elevation MI patients (43.2%), 32.8% were in premature CAD group, and typical retrosternal chest pain were complained in 83.5% of our registry population. Most patients had no new ECG changes (51.7%) and from whom with new ECG changes, anterior territory ECG changes were the most common pattern (28.2%). LVEF was reported 30% or less in 171 (16.6%) of patients. Angiographic findings revealed femoral access was most common access (63.9%), most involved vessel was left anterior descending with 49.3% of the patients, percutaneous coronary intervention was performed in 48% of patients with drug-eluting stent implantation in 99.3% of these patients, dissection was the most angiographic-related complication in our registry (1%), and in-hospital death was reported in six patients (0.5%). Conclusion: RHC-ACS registry as a real-world middle-east running ACS registry would help cardiologists justify their revascularization strategy in ACS patients and would have a promising impact in future multi-center studies.

Introduction: Clinical registries are a targeted way of data collection aimed at finding a solution to a specific clinical inquiry. The present report introduces the Rajaie Cardiovascular, Medical and Research Center percutaneous coronary intervention (RHC-PCI) Registry. The primary objectives of the RHC-PCI Registry consist of monitoring different complex PCI procedures and their mutual impact on interventional cardiology programs. Methods: RHC is a large and well-known cardiovascular tertiary center in Iran. The RHC-PCI Registry was first launched in 2015, since which time it has collected >5000 parameters regarding the baseline, clinical, and procedural characteristics of various PCI procedures. Noncomplex coronary interventions, bifurcation stenting, left main interventions, chronic total occlusion (CTO) PCI, and bypass graft interventions comprise the major categories gathered by the RHC-PCI Registry. The main registry outcomes are comprised in-hospital mortality, major adverse cardiovascular events, vascular access site complications, and 6-month all-cause mortality. Results: In this primary report, we elaborate on the principal infrastructure of the RHC-PCI Registry and present a synopsis of the registry scope. During the first 40 months of the registry, 11,005 patients underwent PCI. The acute coronary syndrome was reported in 5043 (45.8%) patients. Bifurcation stenting, left main interventions, CTO PCI, and bypass graft interventions were performed in 1679 (15.2%), 236 (2.1%), 946 (8.5%), and 764 (6.9%) patients, respectively. The preferred access site was the femoral artery (n = 6614, 60%), and drug-eluting stents were deployed in 9230 (83.8%) patients. In-hospital mortality in the total registry data was reported in 104 (0.9%) patients. Conclusions: This report introduces the RHC-PCI Registry, its primary objectives, infrastructure, and preliminary results (the 3-year outcome).

The retrograde approach has significantly increased the overall success rate of chronic total occlusion (CTO) percutaneous coronary intervention (PCI), up to 90% in the hands of experienced CTO operators. The “tip-in” technique involves inserting an antegrade microcatheter over the retrograde guidewire, allowing for antegrade intervention on the CTO segment. Through the presentation of the following case, we want to illustrate how to undertake a retrograde approach to bridge the occluded segment via the “reverse tip-in” or “introspect” technique, using a single guiding catheter with one microcatheter inside.

Background: The shape of the left ventricle (LV) is an important index to explore cardiac pathophysiology. A comparison was provided to estimate circumferential, longitudinal, and radial wall stress in LV based on the thick-walled ellipsoidal models of Mirsky and Ghista-Sandler for discriminating significant coronary artery disease (CAD) patients from no CAD patients. Materials and Methods: According to the angiography findings, 82 patients with CAD were divided into two groups: 25 patients without significant CAD and 57 patients with significant CAD of single vessel and multivessel. An ellipsoidal LV geometry was used to calculate end-systolic passive stress as the mechanical behavior of LV. Echocardiographic views-based measurements of LV diameters used to estimate the end-systolic wall stress. Results: Circumferential wall stress between the control group and significant CAD groups was significantly elevated for the Ghista model (P = 0.008); also, radial and longitudinal stress of the multi-vessel CAD group was significantly higher than the control group (P = 0.01 and P = 0.005, respectively). All stress parameters of the multi-vessel CAD group were statistically significant compared to the control group for the Mirsky model. Receiver operating characteristics curve analysis was shown the circumferential stress of multi-vessel CAD with an area under the curve (AUC) of 0.736 for the Ghista model and an AUC of 0.742 for the Mirsky model. Conclusion: These results indicated that Ghista and Mirsky model estimates of circumferential passive stress were the potential biomechanical markers to predict patients with multi-vessel CAD. It could be a noninvasive and helpful tool to quantify the contractility of LV.

Background: Iran is one of the countries hit hard and early by the corona virus disease 2019 (COVID-19) outbreak. Interventions for congenital and structural heart disease came to a halt in the initial part the year 2020, however as the pandemic seemed no closer to an end there was a mandate for elective catheterization procedures to be slowly and cautiously resumed. Aims and Objectives: In the present report we discuss the challenges we faced and the experiences earned as a cardiovascular tertiary center in the field of adult congenital and structural interventions in the COVID era. Material and Methods: Adult congenital and structural interventions were resumed in May 2020 with implementing strict screening protocols regulated by our institutional COVID committee. Patients were closely monitored for developing COVID-19 symptoms in hospital and two weeks following discharge. Results: In the regular review performed by the COVID committee there was no increase in new cases of the disease related to the interventional procedures and related admission. Conclusion: As the fate of pandemic remains unforeseeable, structural and congenital interventions need to be resumed in a sustainable fashion and with an instituted system of patient protection. The workflow might slow down during disease peaks with a catch-up in more stable disease periods.

Arterial tortuosity syndrome (ATS) is a very rare autosomal recessive disease which results from mutations of the SLC2A10 gene. In this article, we describe the results of vascular imaging of an adult patient with ATS who was presented with pulmonary hypertension and after a complete evaluation, he was a candidate for interventional balloon angioplasty. Our patient is one of the very limited numbers of list patients in the studies for whom percutaneous balloon angioplasty performed successfully.

Introduction: There is some controversy over the efficacy of statins for the prevention of contrastinduced nephropathy (CIN). There have also been reports on varying efficacies of different statins. Hence, in this study the efficacy of atorvastatin and rosuvastatin for the prevention of CIN was assessed. Methods: This single-blind randomized clinical trial was performed on 495 random patients with myocardial infarction with ST-segment elevation undergoing primary percutaneous coronary intervention (PCI) in a training referral hospital in 2015. Patients were randomly assigned to receive either atorvastatin 80 mg at admission and daily or rosuvastatin 40 mg at admission and daily. CIN was defined based on serum creatinine elevation after 48 hours from the PCI. Results: The incidence of CIN was observed in 63 patients (21.4%) After 48 hours from primary PCI. Of those, 17% (n = 50) were grade 1 CIN, while 4.4% (n = 13) were grade 2 CIN. There was no significant difference between rosuvastatin group compared with atorvastatin group, regarding the CIN grading (P = 0.14). Conclusion: Our results indicate that atorvastatin and rosuvastatin have similar efficacy for the prevention of CIN.

Objective: To evaluate the effect of bone marrow-derived mononuclear cells (BM-MNCs) on clinical outcome and cardiac function in chronic heart failure (HF). Methods: An uncontrolled, open-label trial was performed on symptomatic patients (New York Heart Association [NYHA] Functional Classification II–IV) receiving maximal medical therapy for at least 2 months, with a left ventricular (LV) ejection fraction

Background: Radial artery occlusion (RAO) is one of the few postprocedural complications of transradial approach (TRA) which may be symptomatic in some cases. The aim of this study was to investigate the safety and efficacy of enoxaparin compared with unfractionated heparin (UFH) for preventing RAO among patients who underwent elective diagnostic coronary artery angiography (CAG) via TRA. Patients and Methods: This randomized clinical trial study was conducted on patients who underwent TRA for elective diagnostic CAG. Then, the patients included were randomly divided into 2 groups. A group received 0.75 mg enoxaparin intravenously and the second group received 70–100 IU/Kg UFH single-bolus dose intravenously. During 24 h after the procedure and 3 months later, all the participants were monitored for the occurrence of RAO, access hematoma, periprocedural myocardial infarction, stroke, and death. Results: From 189 patients with mean age of 52.52 ± 6.23 years old, 95 patients received UFH (70–100 IU/kg), and the other group (n = 94) received enoxaparin after radial sheath insertion. After 24 h, decrease in radial pulse was observed in 17.6% patient (14.9% in UFH group and 20.2% in enoxaparin group) and only one patient had absent radial pulse in UFH group. There were no significant differences between UFH group compared with enoxaparin group in the reduction of the radial pulse that examined with reverse Allen test (P = 0.359). Furthermore, other complications did not differ significantly between the two groups. Conclusion: This study demonstrates that intravenous enoxaparin administration compared with intravenous UFH during diagnostic CAG via TRA is a safe and effective strategy for preventing RAO at 24 h after the procedure.

Background: Preinfarction angina has been recognized as a surrogate for preconditioning episodes. This study was designed to evaluate the cardiovascular effects of preinfarction anginal episodes among acute myocardial infarction (AMI) patients undergoing primary percutaneous coronary intervention (PCI). Materials and Methods: Of 520 patients who had undergone primary PCI, 393 patients were finally included in a prospective cohort study. Standard primary PCI procedure according to the latest guidelines was performed. The patients were divided into three groups based on previous symptoms as follows: asymptomatic (Group A), chronic stable angina (Group B) and unstable angina (Group C). Results: A total of 393 patients were evaluated. 185 (47.1%) patients were described as asymptomatic, 48 (12.2%) had stable angina and 160 (40.7%) were categorized as unstable angina. There was no significant difference among the study groups regarding pre- and post-PCI thrombolysis in myocardial infarction flow grade (P = 0.81). Median of peak post-PCI creatine-kinase-muscle/brain level of Group A (asymptomatic) was 250.5 (115.5–389), and it was significantly higher than Group C (176 [60.00–313.50]) (P = 0.03). Q wave formation was observed in 142 (88.75%), 31 (64.5%), and 96 (52.0%) patients of Group A, B, and C patients, respectively, which was significantly higher in asymptomatic patients (P = 0.002). There was no significant difference among the three groups regarding in-hospital and 6-month mortality (P = 0.36, 0.06, respectively). The composite endpoint of 6-month mortality, acute coronary events, cerebrovascular accidents, and target vessel revascularization was not significantly different between the three groups (P = 0.11). Conclusion: Preinfarction angina among AMI patients undergoing primary PCI seems to have a limited beneficial effect on infarct size, and this benefit was not translated to any clinical benefit.

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.

Introduction: We evaluated chest pain alongside other midterm subjective and objective complications of the transcatheter closure of atrial septal defects (ASDs) and patent foramen ovales (PFOs) with various closure devices. Methods: This cross-sectional study, performed from March 2010 to October 2015 in Rajaie Cardiovascular, Medical, and Research Center, evaluated 313 patients (mean age = 29.12 ± 10 years, 32.9% male) for probable complications associated with the transcatheter occlusion of secundum ASDs (n = 289, mean age = 30.5 ± 11.4 years, 28% male) or PFOs (n = 24, mean age = 42.8 ± 10.2 years). ASD closure was performed under sedation and transesophageal echocardiography (TEE) guidance. Duration of follow-up was 12 ± 3 months (mean follow-up = 11.52 months). Results: Among the subjective complications, chest pain was the most frequent complaint during the follow-up period and although it was common (7.3%), a clear cardiac etiology was rare. Thirteen (4.2%) patients reported palpitation during the follow-up period, and 4 had documented arrhythmias—including atrial flutter, atrial fibrillation, and 2:1 atrioventricular block. Migraine with or without aura occurred in 1.6% of the patients. Objective complications comprising tamponade, device embolization, and thrombus formation occurred in 6 (1.9%) patients. There was no procedure-related mortality in our patients. Conclusion: Transcatheter closure of PFOs and secundum-type ASDs in our adult patients using ASD septal occluders was associated with a high degree of success, minimal procedural subjective and objective complication rates, and excellent short- and midterm results. Although chest pain was common after the first month following ASD closure, there was no cardiac death or aortic erosion in 11.52 months follow up.

In surface electrocardiography (ECG), Q wave is often considered as a sign of irreversibly scarred myocardium. Cardiac magnetic resonance (CMR) imaging is an accurate mean for the detection of myocardial viability. Herein, we study the predictive value of Q wave in nonviable (scarred) myocardium by CMR study. Retrospective analysis of the ECG and CMR data of 35 coronary artery disease patients was performed. The delayed enhancement CMR protocol was used for the detection of viability. The presence of a pathologic Q wave in surface ECG was negatively related to myocardial viability with a kappa measurement of agreement of −0.544 and P< 0.0001. Pathologic Q wave in surface ECG can be used as a simple tool for myocardial viability prediction.

Background: Mitral stenosis tends to worsen during pregnancy because of the increase in the cardiac output and the heart rate. In nonresponders to medical therapy, percutaneous transluminal mitral commissurotomy (PTMC) may be performed when there is a suitable valvular anatomy. In this study, we aimed to investigate the clinical and fetal outcomes of pregnant women with mitral stenosis who underwent PTMC. Methods: Thirty-one patients undergoing PTMC during pregnancy were enrolled in this study. The mitral valve area (MVA), the transmitral valve mean gradient (MVMG), and the severity of mitral regurgitation were assessed pre- and postprocedurally by transthoracic and transesophageal echocardiography. The radiation time was measured during the procedure. The patients were followed up during pregnancy, and the neonates were monitored for weight, height, the head circumference, the birth Apgar score, and the adverse effects of radiation for at least 12 months. Results: PTMC was successfully performed on 29 (93.5%) patients. No maternal death or pulmonary edema was reported. The mean MVA significantly increased (from 0.73±0.17 cm2 to 1.28±0.24 cm2; P

BACKGROUND: Elderly patients constitute a rapidly growing proportion of the population, and hence the increasing rises in the number of patients with ST-segment-elevation myocardial infarction (STEMI). Primary percutaneous coronary intervention (PCI), which is now established as the preferred reperfusion strategy in STEMI patients, has been inadequately investigated in this high-risk group. The aim of the present study was to investigate the in-hospital and 6-month outcomes of primary PCI in elderly patients (≥ 75 years) with STEMI. METHODS: A total of 100 elderly patients with STEMI including those with cardiogenic shock were included. Primary PCI procedures were performed in a tertiary referral center between 2009 and 2014. In-hospital, 6-month outcomes of patients were recorded and analyzed. RESULTS: The average age of the patients was 79.6 ± 3.8 years (range = 75-90 years) and 27.0% were women. Cardiovascular risk factors and prior events were common. Nearly, half of the patients had three-vessel disease and the left anterior descending artery (LAD) was the most common infarct-related artery. The presence of cardiogenic shock but not the other variables was associated with less anatomic and procedural success (P < 0.001). It was also the major independent predictors of 6-month mortality in the patients aged ≥ 75 years, [hazard ratio (HR) = 8.02; 95% confidence interval (CI): 1.75-25.97, P < 0.001]. In-hospital mortality was 2.4% in the patients without and 83.0% in those with cardiogenic shock. CONCLUSION: Primary PCI in aged patients could be associated with low complication rates and improved survival if performed in high-volume centers with experienced operators. Considering the very high rate of mortality in patients with cardiogenic shock, there should be measures to treat these patients before the onset of hemodynamic instability.

Background: TIMI Frame Count (TFC) is one of the methods to estimate the coronary blood flow velocity. This is a simple, inexpensive, quantitative, reproducible, and continuous variable method. Many studies have been conducted on TFC assessment in ST elevation myocardial infarction (STEMI) patients. Objectives: The present study is aimed to measure the TFC in the coronary arteries of UA/NSTEMI patients to find abnormalities in diseased or patent vessels and compare with the normal values. Patients and Methods: The participants were 105 consecutive UA/NSTEMI patients who underwent coronary angiography in Shahid Rajaie Cardiovascular Medical and Research Center, Tehran, Iran in 2009. Exclusion criteria were history of CABG, PCI, or STEMI or presence of occluded arteries in angiography. We measured the coronary TFC in these patients. We examined also 55 stable patients without coronary lesions and with TIMI 3 flow to have an estimation of normal TFCs. Results: From a total of 105 patients, 25 (23.8%) had no significant coronary lesion (> 60%); 35 (33.3%) were diagnosed with single vessel disease; 22 (21%) were 2VD; and 23 (21.9%) were 3 VD.). In overall, mean TFC in UA/NSTEMI group was 28.7 (± 14) frames compared to 23.8 (± 7.8) frames in the normal group (P < 0.05). In the vessels with significant lesions, TFC was significantly higher than normal (30.84 vs. 23.8; P < 0.001) and also significantly higher than patent vessels of the same patients (30.84 vs. 26.10; P = 0.029). In these patients, patent vessels had higher TFC values compared to normal coronaries (26.10 vs. 23.8), but the difference was not significant (P = 0.12). In the patients with significant lesions, mean TFC was higher than the same value in acute coronary patients without significant lesions (29.3 vs. 27.2), but the difference was not significant (P = 0.114). In the patients who underwent PCI and stenting, TFC changed significantly after PCI toward the normal value (P = 0.001). In the patients with elevated cardiac enzymes, TFC was higher but the difference was not significant (P = 0.35). Conclusions: Patent coronaries of UA/NSTEMI patients have a trend to higher TFCs compared to normal values. Presence of significant coronary lesions in these patients significantly increases TFC.

Background: Recently, the value of various structural body components have been proposed for predicting cardio-metabolic risk. The present study aimed to assess the wrist circumference (WrC) as an alternative measure for differentiating patients with CAD and METs from those without CAD and METs. Methods: We studied 228 consecutive subjects who underwent coronary angiography. Those with and without evidence of coronary artery involvement at angiography were considered as the coronary artery disease (CAD) group (n = 139) and the non-CAD group (n = 89), respectively. WrC was measured; and metabolic syndrome (METs) was defined according to the modified National Cholesterol Education Program Adult Treatment Panel III criteria. Results: WrC was significantly higher in CAD compared to non-CAD patients (17.85 ± 1.29 mm vs 17.43 ± 1.29 mm, P = 0.017). The overall prevalence of METs was significantly different between the CAD and non-CAD subjects (74.3% vs 58.8%, P = 0.016). Although there was a tendency for association, no statistically significant association between the mean of the WrC and the severity of CAD was found (P = 0.065). WrC had a weak positive correlation with triglyceride (r = 0.172, P = 0.011) and cholesterol (r = 0.141, P = 0.038) level and a weak negative association with high-density lipoprotein level (r = −0.279, P

Background: Significant elevation of cardiac biomarkers after percutaneous coronary intervention (PCI) is associated with increased mortality. However, clinical importance of lesser degrees of cardiac enzyme elevation has not been well understood. Multiple factors might have an etiologic role, and the incidence of myonecrosis has not changed dramatically despite pharmacological and technological advances in PCI. The aim of this study was to evaluate the role of intracoronary (IC) Adenosine in preventing the elevation of cardiac enzymes as a marker of myonecrosis after PCI in patients with chronic stable angina. Methods: Two hundred sixty patients with chronic stable angina who were candidates for PCI were randomly assigned to double-blinded pretreatment with IC Adenosine or placebo before crossing of the guide wire. The patients were observed during the hospital course, and blood samples were obtained in standard intervals after the intervention for cardiac biomarkers. The primary end point of this study was post-PCI myonecrosis, and secondary end point was safety of IC Adenosine administration in the setting of PCI in patients with chronic stable angina. Results: Of the 260 patients, who were initially randomized, finally 83 patients were analyzed in the placebo and 96 in the Adenosine arms. The study patients were comparable in clinical and angiographic characteristics. The mean of the patients’ age was 57.3 years (range = 35 to 79 years), and 71.5% were male. There were no differences in the mean serum cardiac biomarkers between the study groups (mean creatine kinase-MB [CK.MB] level of 29.5 ± 14.5 IU/L in the placebo group and 31.5 ± 18.5 IU/L in the control group; p value = 0.41; mean cardiac troponin I (cTnI) level of 0.097 ± 0.178 µg/L in the placebo group and 0.167 ± 0.5 µg/L in the control group; p value = 0.24). Conclusion: Despite promising results in primary PCI, our study showed that a strategy of IC Adenosine pretreatment is not beneficial in reducing post-PCI myonecrosis in patients with chronic stable angina and should not be routinely used.

Thrombotic thrombocytopenic purpura (TTP) is a rare syndrome affecting multiple organs. There is no sufficient evidence regarding the clinical cardiac manifestations of TTP. Nonetheless, pathologic cardiac involvement is quite frequent in acute TTP, which is predominantly manifested as myocardial necrosis due to coronary arteriolar microthrombosis. The present case report describes a 43-year-old man with long-standing remitted TTP, who suffered from a sequence of refractory thrombotic epicardial coronary events. Aggressive medical and interventional therapies, including long-term dual antiplatelets and coronary angioplasty, were finally successful in remitting the thrombotic events. During his two-year follow up, he has been asymptomatic.

Background: Atrial fibrillation (AF) is one of the most common complications occurring after cardiac surgeries. The incidence of post-operative AF is increasing continuously over the past decades and it is associated with lengthened hospital stay and risk of stroke. Objectives: This study was designed to examine the relationship between coronary artery involvement and the occurrence of AF after coronary artery bypass graft (CABG). Methods: This prospective observational study was to assess the relationship between the coronary artery involvement and the occurrence of post CABG surgery AF. Patients with chronic and paroxysmal AF before surgery were excluded. All patients had a complete evaluation by echocardiography, electrocardiography, and laboratory testing. The patients were monitored for 3 days after surgery and any tachycardia monitored as AF was noted. Patients were also divided into two groups of having post-operative AF and not having AF. Coronary artery involvement was defined using the Rentrop system. The coronary arteries were divided into 14 segments for better understanding of the lesions. Results: In this study 232 patients were selected, from which 106 patients had AF and 126 patients had sinus rhythm. The results of the present study confirmed that the older patients had a more frequent occurrence of AF after CABG (P < 0.001). There was no significant relationship between the right coronary artery (RCA) lesion and the development of AF after CABG. Proximal left anterior descending (LAD) artery lesion was associated with a higher occurrence of AF after CABG (P = 0.022). Patients with single vessel or two-vessel coronary artery disease had a more frequent occurrence of AF after CABG versus those with three vessel disease (P = 0.021). Conclusions: Although age has been the most important predictor for occurrence of AF after CABG in the past and present studies, there are many other variables affecting its occurrence. Out of the variables evaluated in this study, higher PAP, proximal LAD lesion, higher levels of BNP, and D dimer as well as single vessel and two vessel coronary artery diseases were noted to significantly predict a higher occurrence of AF after CABG.

Background: There is a paucity of data regarding the role of side branch (SB) predilation during the provisional stenting of bifurcation lesions. Objectives: The present study aimed to assess the effects of SB predilation on the outcomes of true bifurcation interventions. Patients and Methods: Sixty patients with true bifurcation lesions according to the Medina classification were included in the study and randomly assigned to receive SB predilation before stenting the main branch (n = 30) or no predilation as the control group (n = 30). Results: There was a trend toward the higher occurrence of dissection in the predilated ostial lesions of the SB compared to the non- predilated group (16.7% vs. 0, P = 0.07). Performance of the SB predilation was not associated with improved flow of the SB or fewer degrees of ostial stenosis after stenting the main branch, the need to rewire, rewiring time, or the rate of use of the final kissing balloon dilation and double stents procedures. Conclusions: Routine predilation of the SB in provisional stenting of true bifurcation lesions seems to be ineffective and might be associated with some undesirable consequences. Still, there are some complex ostial lesions of the SB which could benefit from predilation.