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Lutembacher syndrome refers to the rare combination of a congenital atrial septal defect and acquired mitral stenosis. Traditionally, Lutembacher syndrome has been corrected by surgical treatment. We describe two patients treated percutaneouly with a combined Inoue balloon valvuloplasty and septal defect closure using the Amplatzer septal occlusion device.

Lutembacher syndrome refers to the rare combination of a congenital atrial septal defect and acquired mitral stenosis. Traditionally, Lutembacher syndrome has been corrected by surgical treatment. We describe two patients treated percutaneouly with a combined Inoue balloon valvuloplasty and septal defect closure using the Amplatzer septal occlusion device.

Lutembacher syndrome refers to the rare combination of a congenital atrial septal defect and acquired mitral stenosis. Traditionally, Lutembacher syndrome has been corrected by surgical treatment. We describe two patients treated percutaneouly with a combined Inoue balloon valvuloplasty and septal defect closure using the Amplatzer septal occlusion device.

Objective: Interventional treatment for childhood combined congenital heart disease (CHD) has developed very quickly and more new types of occluders have emerged in recent years. The aim of this study is to investigate the efficiency and safety of interventional treatment for combined CHD in children., Methods: Eight children with combined CHD (4 boys and 4 girls), aged 6.1+/-2.9 years, underwent simultaneous transcatheter therapy. Of the 8 children with CHD, 1 case had atrial septal defect (ASD), ventricular septal defect (VSD) and patent ductus arteriosus (PDA), 1 case had ASD, PDA and pulmonary stenosis (PS), 1 case had ASD and PDA, 1 case had patent foramen ovale (PFO) and PS, and 4 cases had ASD and PS. The methods of transcatheter intervention for these patients were as follows: in patients with ASD,VSD and PDA, the occlusion of VSD was performed first, followed by PDA and ASD occlusions; in patients with ASD, PDA and PS, the occlusion of percutaneous balloon pulmonary valvuloplasty (PBPV) was performed first, followed by PDA and ASD occlusions; in patients with PFO and PS, the occlusion of PBPV was performed first, and PFO occlusion followed; in patients with ASD and PS, the occlusion of PBPV was performed first, and ASD occlusion followed., Results: The intervention operation was successfully performed in all of the 8 patients. No serious adverse events occurred during the operation. No residual shunt was found and all the occlusion devices were in the suitable sites shown by transthoracic echocardiography (TTE) and X-ray right after the operation. In the 6 patients with PS, the systolic pressure across the pulmonary valve decreased from 75.3+/-15.6 mmHg (before operation) to 14.0+/-5.6 mmHg after operation (P<0.05).A 3.4+/-1.2 years follow-up demonstrated that no residual shunt occurred and gradients across valve or coarctation sites were within the limit of satisfactory results. No complications were observed during the follow-up., Conclusions: Transcatheter interventional therapy for childhood combined CHD can obtain satisfactory results by proper procedures.

Background: Severe functional tricuspid regurgitation (TR) is associated with poor outcomes. We sought to examine the predictors of early mortality and if severe TR with heart failure (HF) is a stage too late for intervention. Methods: Our study retrospectively identified 635 consecutive patients who had severe functional TR diagnosed on trans-thoracic echocardiography in an academic medical centre from 2000- 2016. We assessed their underlying comorbidities and analyzed their impact on survival. Results: Mean follow-up was 1084 days. There were 371 (58.4%) females, and the mean age at diagnosis was 68.6 years. The mean Body Mass Index, left ventricular ejection fraction (LVEF) and pulmonary artery systolic pressure (PASP) were 23.8 kg/m2, 48.6% and 53.8 mmHg, respectively. Pre-existing or incident atrial fibrillation (AF) and ischemic heart disease were 420 (66.1%) and 312 (49.1%) respectively. A total of 307 (48.4%) patients had HF prior and 123 (19.4%) had incident HF. The mechanisms for severe TR were left heart disease ± pulmonary hypertension (72 %), AF with annular modeling (20.4 %), and isolated right ventricular dilatation (7.6 %). There were 286 (45.0%) deaths during follow up, with 154 (24.3%) dying within a year. The median survival was about 690 days. Multivariate analysis revealed that age at diagnosis (HR 1.03, p: 0.001), prior HF admission (HR: 1.31, p: 0.048), PASP of more than 50 mmHg (HR: 1.48, p: 0.004) and LVEF less than 50% (HR: 1.35, p: 0.041) were significantly associated with time to death. Conclusion: In patients with severe functional TR, advanced age, prior HF admission, LVEF <50%, PASP >50 mm Hg are malignant features, representing an advanced stage of the disease and associated with early mortality. Ability to interpret effectiveness of trans-catheter therapies in this group of patients may be limited, which future clinical intervention trials should take into account. [ABSTRACT FROM AUTHOR]

In this review management of the most common cyanotic congenital heart defects (CHDs) was discussed; the management of acyanotic CHD was reviewed in Part I of this series. While the need for intervention in acyanotic CHD is by and large determined by the severity of the lesion, most cyanotic CHDs require intervention, mostly by surgery. Different types of tetralogy of Fallot require different types of total surgical corrective procedures, and some may require initial palliation, mainly by modified Blalock–Taussig shunts. Babies with transposition of the great arteries with an intact ventricular septum as well as those with ventricular septal defects (VSD) need an arterial switch (Jatene) procedure while those with both VSD and pulmonary stenosis should be addressed by Rastelli procedure. These procedures may need to be preceded by prostaglandin infusion and/or balloon atrial septostomy in some babies. Infants with tricuspid atresia require initial palliation either with a modified Blalock–Taussig shunt or banding of the pulmonary artery and subsequent staged Fontan (bidirectional Glenn and fenestrated Fontan with extra-cardiac conduit). Neonates with total anomalous pulmonary venous connection are managed by anastomosis of the common pulmonary vein with the left atrium either electively in non-obstructed types or as an emergency procedure in the obstructed types. Babies with truncus arteriosus are treated by surgical closure of VSD along with right ventricle to pulmonary artery conduit. The other defects, namely, hypoplastic left heart syndrome, pulmonary atresia with intact ventricular septum, double-outlet right ventricle, double-inlet left ventricle and univentricular hearts largely require multistage surgical correction. The currently existing medical, trans-catheter and surgical techniques to manage cyanotic CHD are safe and effective and can be performed at a relatively low risk.

Background: Congenital heart disease is a defect in the heart or great vessel discovered during infancy or later in life. Congenital heart disease is divided into acyanotic and cyanotic. Surgery is the primary therapeutic option for any congenital heart disease. The cardiopulmonary bypass has advancements in on-pump cardiac surgery. It provides circulatory and respiratory support. An aortic cross-clamp is necessary in most on-pump cardiac surgeries to isolate the heart from Circulation. Patients undergoing cardiac surgery on cardiopulmonary bypass often have disturbances in arterial blood gases, including partial pressure of oxygen, partial pressure of carbon dioxide, PH value, and bicarbonate. Materials and Methods: This study was a cross-sectional study performed at Al-Najaf Center For Open Heart Surgery and Trans Catheter Therapy in Al-Najaf City, Iraq, along a period that extends from November 2023 to March 2024. The study involved (50) pediatric patients: (27) male and (23) female who suffered from congenital heart disease and submitted to surgical repair. The 20 cases are cyanotic, and 30 cases are acyanotic. The blood samples were taken from each patient via an arterial line to assay blood PH, bicarbonate level, partial pressure of oxygen, and partial pressure of carbon dioxide. Result: The study showed significant differences in arterial blood gases between preoperative and postoperative (P value ≤ 0.05). Also, there was a correlation between changes in arterial blood gases and aortic cross-clamp time. Conclusion: This study finds the partial pressure of carbon dioxide is more predictive of lung injury after on-pump cardiac surgery than the P/F ratio in cyanotic cases. In acyanotic cases, the P/F ratio and partial pressure of carbon dioxide are essential in determining lung injury. Also, this study finds that the prolonged cross-clamp time increases lung injury after on-pump cardiac surgery. [ABSTRACT FROM AUTHOR]

Open-heart surgery is considered a major surgery with potential risks and complications, but it is a lifesaving operation that can treat a variety of diseases such as heart valve disease, heart birth defects, and coronary artery disease. A Quasi-experimental design has been used in the existing study to evaluate the effect of clinical guideline concerning cardiopulmonary bypass on nurses' knowledge in open heart surgery center in AL-Najaf AL-Ashraf city at Al-Najaf center for cardiac surgery and trans-catheter therapy through the period October 1th, 2020 to, April 19th, 2021. The results of the study show there is a high significant effect of the educational program, it also, show that high Significant mean difference among study group concerning pre-test and post-test scores at p-value (0.0001). Also, in this study there is a significant association between posttest knowledge and year of experience as a perfusionists and number of training courses at p-value (0.02) and (0.01). The study concluded that educational program can improve in nurses' knowledge and to produce perfusionists who are able to successfully apply their knowledge and skills to improve patients' outcome. The study recommended a written program for all new nurses working in heart-lung machine department, and improving the expertise of nurses and medical staff through use the finding of the present study to give care for the patient. [ABSTRACT FROM AUTHOR]

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. [ABSTRACT FROM AUTHOR]

During routine dissection of abdomen an accessory left gastric artery was found arising from the splenic artery in one out of 30 adult formalin fixed cadavers in the Department of Anatomy, Kasturba Medical College Manipal. The origin of left gastric artery was normal. The accessory artery was running upwards behind usual left gastric artery and run along lesser curvature of the stomach and also gave oesophageal branch supplying the lower part of esophagus. Before attempting any surgical procedure on stomach or lower end of oesophagus, preoperative evaluation of the arterial pattern and variations is desirable for correct surgical approach and to reduce postoperative complications. However, accessory left gastric origin from splenic artery becomes important to be noted when the patient undergoes angiography for diagnostic bleeding or during trans catheter therapy. Knowledge about these variations is also important to be noted prior to surgery in order to prevent postoperative complications which would be fatal. [ABSTRACT FROM AUTHOR]

Fatigue is an important symptom caused by heart failure that can be as a complaint debilitating and effect negatively on patients' quality of life and often goes unnoticed by the health care team. Objectives: the current study is conducted to assess patients for fatigue after heart failure, assess patients' quality of life (physical and level of independence domains) after heart failure, and determine the correlation between fatigue and the quality of life. Methods: This quantitative correlational study was performed on 65 patients with heart failure who were selected purposively. The study was conducted in Al-Najaf Center for Cardiac Surgery and Trans Catheter Therapy. The study begins from13/8/2020 to 15/6/2021. Data collection tools were Fatigue Severity Scale (FSS) and Minnesota Living with Heart Failure Questionnaire (MLHFQ). Data were analyzed using SPSS software, descriptive and inferential statistics. Results: The study results indicate that 87.7 % of patients suffered from severe fatigue. And 72.3% of patients live with a low quality of life. Additionally, the study results indicate that the there is a negative correlation between the patients' fatigue levels and their quality of life. Conclusion: the study concludes that heart failure affects patients' quality of life negatively, and it is responsible for severe level fatigue. Recommendation: The study recommended activate nursing rehabilitation in different health organizations, nurses and other members of the rehabilitation team should encourage to implement the rehabilitation program to improve patients' quality of life. [ABSTRACT FROM AUTHOR]

Background: Long coronavirus disease 2019 (LC) is a chronic sequel of acute COVID-19. The exact pathophysiology of the affective, chronic fatigue and physiosomatic symptoms (labelled as "physio-affective phenome") of LC has remained elusive. Objective: The current study aims to delineate the effects of oxygen saturation (SpO2) and body temperature during the acute phase on the physio-affective phenome of LC. Method: We recruited 120 LC patients and 36 controls. For all participants, we assessed the lowest SpO2 and peak body temperature during acute COVID-19, and the Hamilton Depression and Anxiety Rating Scale (HAMD/HAMA) and Fibro Fatigue (FF) scales 3–4 months later. Results: Lowered SpO2 and increased body temperature during the acute phase and female sex predict 60.7% of the variance in the physio-affective phenome of LC. Using unsupervised learning techniques, we were able to delineate a new endophenotype class, which comprises around 26.7% of the LC patients and is characterised by very low SpO2 and very high body temperature, and depression, anxiety, chronic fatigue, and autonomic and gastro-intestinal symptoms scores. Single latent vectors could be extracted from both biomarkers, depression, anxiety and FF symptoms or from both biomarkers, insomnia, chronic fatigue, gastro-intestinal and autonomic symptoms. Conclusion: The newly constructed endophenotype class and pathway phenotypes indicate that the physio-affective phenome of LC is at least in part the consequence of the pathophysiology of acute COVID-19, namely the combined effects of lowered SpO2, increased body temperature and the associated immune-inflammatory processes and lung lesions. [ABSTRACT FROM AUTHOR]

Background This study aims to investigate the inflammatory response in Novolimus bioresorbable coronary scaffold implantation after a course treatment with trimetazidine (35 mg tablet/twice daily for 4 days). Methods This was a randomized single blind study. Forty diabetic patients with critical coronary stenosis were subjected to elective coronary scaffold implantation in Al-Najaf Center for Cardiac Surgery and Trans-Catheter Therapy, Najaf, Iraq, between January and July 2015. All patients were informed about the nature of the study and they signed the consent form before they included in the study. Patients were randomly allocated into the two study groups: Group 1 included 20 patients who did the elective coronary scaffold implementation without trimetazidine medication. Group 2 included 20 patients who did the elective coronary scaffold implementation with a course of the trimetazidine (35 mg tablet/twice daily for 4 days). Results There were significant reduction in the levels of the interleukin-6 and cardiac troponin-I in the trimetazidine-treated group (group 2) compared to the control group (group 1) ( P < 0.001), after 12 h and 24 h post-operative. This was associated with a significant rise in the levels of interleukin 10 in group 2 compared to group 1 ( P < 0.001). Pentraxin-3 was significantly reduced in group 2 but only 24 h post-operative ( P < 0.006). Conclusion Our study concluded that trimetazidine minimizes the acute inflammatory response occurred due to systemic release of inflammatory markers into blood in diabetic patients undergoing elective Novolimus bioresorbable coronary scaffold implementation. [ABSTRACT FROM AUTHOR]

Aims Tricuspid regurgitation (TR) is associated with significant morbidity and mortality. Its independent prognostic role has been repeatedly demonstrated. However, this valvular heart condition is largely undertreated because of the increased risk of surgical repair. Recently, transcatheter techniques for the treatment of TR have emerged, but their implications for the clinical endpoints are still unknown. Methods and results The Tri.fr trial will be a multicentre, controlled, randomized (1:1 ratio), superior, open-label, and parallel-group study conducted in 300 patients with severe secondary TR that is considered non-surgical by heart teams. Inclusion will be possible only after core laboratory review of transthoracic and transoesophageal echocardiography and after validation by the clinical eligibility committee. A description of the mechanisms of the TR will be conducted by the core laboratory. Atrial or ventricular impacts on the severity of the secondary TR will be taken into account for the randomization. The patients will be followed for 12-month, and the primary outcome will be the Packer composite clinical endpoint [combining New York Heart Association class, patient global assessment (PGA), and major cardiovascular events]. It will test the hypothesis that a tricuspid valve percutaneous repair strategy using a clip dedicated to the tricuspid valve is superior to best guideline-directed medical therapy in symptomatic patients with severe secondary TR. Conclusion Tri.fr will be the first randomized, academic, multicentre study testing the value of percutaneous correction in patients with severe secondary TR. [ABSTRACT FROM AUTHOR]

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.

Ascending Aortic pseudoaneurysms (AAP) are often formed as a result of prior thoracic surgery. In patients with large AAP, surgical correction is the established therapy. However, a group of patients are not suitable surgical candidates because of advanced age or multiple comorbidities. Instead, endovascular approach represents a viable option in this population. Here, we review the literature of the surgical and trans-catheter therapy for AAP. Additionally, we complement the review with a case presentation of a prohibitive surgical risk case that was treated with endovascular options including an unsuccessful septal occluder deployment, but final excellent angiographic AAP exclusion with coil embolization. [ABSTRACT FROM AUTHOR]

Lutembacher syndrome (LS) is a rare syndrome comprising a combination of atrial septal defect (ASD) and mitral stenosis. We present the case of a 28-year-old man, who presented with progressively worsening dyspnea of 2 months associated with orthopnea, paroxysmal nocturnal dyspnea, bilateral leg swelling and productive cough. Chest X-ray revealed plethoric lung fields with prominent pulmonary conus and cardiomegaly. Transthoracic echocardiography revealed a large ostium secundum ASD with left to right shunt, mild mitral stenosis, severe mitral and tricuspid regurgitations and pulmonary hypertension. A diagnosis of Lutembacher syndrome in heart failure with pulmonary hypertension was made. The patient was managed conservatively, but declined surgery primarily because of financial reasons. This rare case of LS presenting with heart failure and complicated by pulmonary hypertension is the first reported case in our centre and our region. The patient's inability to afford the cost of definitive care posed a significant problem in his management. [ABSTRACT FROM AUTHOR]

During routine dissection of abdomen an accessory left gastric artery was found arising from the splenic artery in one out of 30 adult formalin fixed cadavers in the Department of Anatomy, Kasturba Medical College Manipal. The origin of left gastric artery was normal. The accessory artery was running upwards behind usual left gastric artery and run along lesser curvature of the stomach and also gave oesophageal branch supplying the lower part of esophagus. Before attempting any surgical procedure on stomach or lower end of oesophagus, preoperative evaluation of the arterial pattern and variations is desirable for correct surgical approach and to reduce postoperative complications. However, accessory left gastric origin from splenic artery becomes important to be noted when the patient undergoes angiography for diagnostic bleeding or during trans catheter therapy. Knowledge about these variations is also important to be noted prior to surgery in order to prevent postoperative complications which would be fatal.

In this paper, the author enumerates cardiac defects with a functionally single ventricle, summarizes single ventricle physiology, presents a summary of management strategies to address the single ventricle defects, goes over the steps of staged total cavo-pulmonary connection, cites the prevalence of inter-stage mortality, names the causes of inter-stage mortality, discusses strategies to address the inter-stage mortality, reviews post-Fontan issues, and introduces alternative approaches to Fontan circulation. [ABSTRACT FROM AUTHOR]

Primary Epitheloid Angiosarcoma (EA) of liver is an aggressive malignant tumour with poor prognosis irrespective of aggressive surgical resection with or without adjuvant therapy. It constitutes for 0.1-2% of primary malignant tumours of liver and is seen commonly in sixth or seventh decade of life, with male preponderance. It can be asymptomatic or may present with nonspecific symptoms. Lack of pathognomonic features on serological, biochemical and radiological tests, makes it even difficult for an early diagnosis. Despite early surgical removal, EA has very high recurrence rate. Chemotherapy agents (paclitaxel, bevacizumab) and immunomodulators (mTOR inhibitors) have shown some survival benefit and reduction in recurrence rates in recent years as adjuvant therapy. To the best of our knowledge, a hanging morphological variant of EA of liver has not been reported yet in literature. We report a case of incidentally diagnosed aggressive, hanging variant of EA of liver. Despite early surgical resection and adjuvant, after chemotherapy patient had survival of less than eight months since first presentation. [ABSTRACT FROM AUTHOR]

Purpose: To investigate the effectiveness and safety of transarterial chemoembolization (TACE) combined with sorafenib and thermal ablation in patients with huge hepatocellular carcinoma (HCC). Materials and Methods: This retrospective study examined 50 patients with huge unresectable HCC treated from January 2009 to December 2015. Among them, 28 cases received TACE-sorafenib treatment (TACE-sorafenib group), and 22 cases received TACE-sorafenib plus thermal ablation treatment (TACE-sorafenib-thermal ablation group). The Overall survival (OS), progression-free survival (PFS), and adverse events (AEs) were compared. Results: The median follow-up was 13.5 months (ranges 4.2 to 96.7 months). The median OS was significantly longer in the TACE-sorafenib-thermal ablation group than that in the TACE-sorafenib group (20.8 vs. 10.4 months, P =0.003). The median PFS of the ablation and no ablation groups were 4.3 vs. 7.1 months (P =0.546). The treatment modality was an independent predictor of OS (P =0.004). There were no notable drug-related high grade adverse events or permanent adverse sequelae. Conclusion: TACE-sorafenib-thermal ablation provided extended OS to patients with huge unresectable HCC and could be a better choice than TACE-sorafenib. [ABSTRACT FROM AUTHOR]

Background: Coronary intervention is related to local vascular and systemic inflammation that leads to the stimulation of inflammatory reaction, caused by the rupture of the atherosclerotic plaque and the tunica media fallowing extension of the stent and insertion of a metallic foreign body. Arterial wall damage occurs in addition to the release of inflammatory and chemoattractant factors which stimulate an inflammatory response, leading to leukocyte and platelet activation. Bioresorbable vascular Scaffold (BVS) is considered the fourth revolution in interventional cardiology. It has introduced a novel technology in the treatment of coronary artery disease (CAD). Trimetazidine (TMZ) is an anti-ischemic agent which minimizes the myocardial damage induced by the percutaneous coronary intervention (PCI). Objective: To assess the effect of TMZ on the acute inflammatory response after BVS implantation in patients with CAD. Patients and Methods: A total of 40 diabetic patients with stable coronary artery disease were assigned into two groups: the control group and TMZ treated group. Both groups were admitted to AL-Najaf center for cardiac surgery and Tran’s catheter therapy. Thus, patients under went elective coronary scaffold implantation. Serum blood was collected from peripheral vein before implantation, 12 hrs and 24 hrs after implantation. Collected samples were used to measure IL-8, hs-CRP, cTn-I, MMP-9 and VCAM-1 levels by sand wichELISA method in addition to determine the WBC count. Results. Scaffold implantation produced significant changes in serum levelIL-8, hs-CRP, cTn-I, WBC and VCAM-1(p<0.05).However, no significant change in serum level MMP-9was found (p>0.05).On the other hand, TMZ treatment produced a significant decrease in cTn-I, hs-CRP levels and the WBC count (p<0.05).No significant changes in serum IL-8, MMP-9and VCAM-1were found (p>0.05). Conclusion: Trimetazidine reduced the systemic inflammatory response induced by implantation of Bioresorbable coronary scaffold. [ABSTRACT FROM AUTHOR]

Informing and educating patients are important for preparing them for the medical procedures both physically and psychologically. Consultation and education before cardiac catheterization are reported to decrease patients’ worries and fears, reduce the need for analgesics after the intervention by decreasing pain, prevent post-operative complications such as nausea and vomiting, and shorten hospital length of stay by enhancing recovery time after the procedure. Objectives: To assess patients’ anxiety levels before cardiac catheterization, to determine the effect of the sensory perceptual informational program on patients’ anxiety levels through comparing patients’ anxiety score before and after the program, and to find out the relationship between patients’ anxiety levels and their demographic and clinical data. Results: The study results indicate that the majority of the study sample are 54 years old and more (40.9 %), are male (68.2 %), within secondary school (51.5%), have barely sufficient monthly income (48.5 %), urban residents (69.7 %), married (90.9 %) and retired (42.4%). Also about (62.1%) of the patients are exhibit moderate level of anxiety before the application of the program. While (69.7%) of the patients are exhibit non or mild level of anxiety after the application of the program. [ABSTRACT FROM AUTHOR]

Coronary artery disease (CAD) is the single most common cause of morbidity and mortality in developed world. PCI with stent implantation is a widely used, safe and effective technique for the treatment of symptomatic ischemic heart disease. Stenting, however, causes significant injury to the vascular wall, resulting in a repair process that requires inflammatory process activation. This study was done to assess the effect of pre PCI atorvastatin reload on toll like receptor 2 expressions with its downstream signaling. A double blind randomized prospective trail in which 60 patients with stable angina pectoris, who are scheduled for an elective PCI at Al-Najaf Center for Cardiac Surgery and Trans Catheter were enrolled and were assigned randomly1:1 into two groups, after an ethical committee of the University of Kufa /Faculty of medicine approval, 30 patients who received low dose atorvastatin 40mg daily without reload (control group). Stent implantation was associated with an elevation in TLR 2 expression in peripheral monocyte in both study groups after stenting but significantly higher expression level was observed among control group than atorvastatin reload group (p<0.05) at 4hrand 12hr post PCI. Inflammatory cytokine (MMP9, MCP-1, and IL-6) were significantly increased after stenting in both study groups (P<0.005) but higher in control group than atorvastatin reload group (p<0.05) also myocardial injury markers (CKMB, troponin I) were significantly higher in control group than atorvastatin reload group (p<0.05). We conclude that atorvastatin reload before coronary artery interventions attenuate toll like receptor 2 expression on peripheral monocyte and significantly reduce serum level of MMP9,MCP-1 and IL-6and cardiac injury markers(CK·MB and cardiac troponin I) [ABSTRACT FROM AUTHOR]

The main objective of this study is to assess the possible protective role of Trimetazidine in the prevention of contrast induced nephropathy in patients with renal impairment undergoing coronary angiography or percutaneous coronary intervention. This was a randomized single-blind clinical trial study. A total of 100 consecutive diabetic patients with symptomatic ischemic heart disease and chronic kidney disease (CKD) were subjected to an elective percutaneous coronary intervention, at ALSADR teaching hospital /Al- Najaf Center for Cardiac surgery and Tran Catheter Therapy, Najaf, Iraq, in period between May and December 2018. The Patients were divided into two groups: Group I-Control Group (n=45) these patients with chronic kidney disease and critical coronary stenosis and they were needed to be subjected to coronary intervention. Group IITreatment Group (n=44) also these patients with chronic kidney disease and critical coronary stenosis and they were need to be subjected to coronary intervention and treated with 35 mg tablet /twice daily of Trimetazidine for the period of three days , starting 48 hours before surgical procedure and for 24 hours post the procedure. Trimetazidine significantly reduce the elevation in serum levels of nuclear factor kappa B , high-mobility group box 1, expression of Tolllike receptor 2 (p<0.05) while insignificantly reduce the elevation in serum levels of creatinine and urine level of Neutrophils gelatinaseassociated lipocalinis (p > 0.05). Our study concluded that Trimetazidine reduce the acute kidney injury response and systemic inflammatory response induced by contrast administration after coronary intervention. [ABSTRACT FROM AUTHOR]

This study aims to assess the possible protective role of Trimetazidine in the prevention of contrast induced nephropathy in patients with renal impairment undergoing coronary angiography or percutaneous coronary intervention. This was a randomized single-blind clinical trial study. A total of 100 consecutive diabetic patients with symptomatic ischemic heart disease and chronic kidney disease (CKD) were subjected to an elective percutaneous coronary intervention, at ALSADR teaching hospital /Al- Najaf Center for Cardiac surgery and Tran Catheter Therapy, Najaf, Iraq, in period between May and December 2018. The Patients were divided into two groups: Group I-Control Group (n=45) these patients with chronic kidney disease and critical coronary stenosis and they were needed to be subjected to coronary intervention. Group II- Treatment Group (n=44) also these patients with chronic kidney disease and critical coronary stenosis and they were need to be subjected to coronary intervention and treated with 35 mg tablet /twice daily of Trimetazidine for the period of three days. Trimetazidine significantly reduce the elevation in serum level of monocyte chemo tactic protein1, expression of Toll-like receptor 2 and the urine levels of kidney injury molecule-1,F2-isoprostanes (p<0.05) while insignificantly reduce the elevation in serum level of creatinine . (p > 0.05). Our study concluded that Trimetazidine reduce the acute kidney injury response and systemic inflammatory response induced by contrast administration after coronary intervention. [ABSTRACT FROM AUTHOR]

The aim of the study was to assess the activity of pre-PCI atorvastatin reload on the acute inflammatory responses and in Toll-Like Receptor 4 expressions with its downstream signaling. A double-blind randomized prospective study, 30 patients who received low dose atorvastatin 40 mg/day without reload. While, 30 patients who were already on the usual dose of atorvastatin with further 80 mg & 40 mg at 12 and 2 hrs before PCI respectively. TLR4 expression in peripheral monocyte investigate by flow cytometry, and cardiac troponin I, CK-MB, HsCRP and HMG-BOX protein by ELISA technique immediately before and at 4 hrs, 12 hrs. After PCI. Stent implantation was associated with an elevation in TLR 4 expression in peripheral monocyte of both study groups after stenting with higher expression level was found among control group (p<0.05) at 4 hr and 12 hr post-PCI. HsCRP, HMGbox1protein were lower in atorvastatin reload group (p<0.05), and the myocardial injury markers (CKMB, troponin I) were significantly higher among the control group than atorvastatin reload group (p<0.05). Atorvastatin attenuated toll-like receptor 4 expressions on peripheral monocyte subsequently its downstream effects HsCRP and HMGBOX1-protein. [ABSTRACT FROM AUTHOR]

Purpose of Review: The purpose of this review is to re-evaluate the role of intra-arterial therapies for hepatocellular carcinoma (HCC) recommended by contemporary staging systems.Recent Findings: Currently, intra-arterial therapies are recommended by the Barcelona Clinic Liver Cancer (BCLC) staging system only for patients with BCLC B HCC in the form of trans-arterial chemoembolization. Recently, randomized controlled trials in patients with BCLC C HCC without metastatic disease have suggested a potential role for trans-arterial radioembolization (TARE) with fewer adverse events and better quality of life compared to sorafenib. Randomized controlled trials have also demonstrated the benefit of using combination therapy of trans-arterial chemoembolization (TACE) with ablation for patients with BCLC A HCC [single tumors (3-7 cm)] compared to ablation alone. Finally, promising results from single-center studies indicate that TARE using a radiation segmentectomy technique may be a potentially curative therapy for tumors less than 3 cm, supporting its use in patients with BCLC A HCC that are not amenable to surgical or ablative therapies.Summary: Recent randomized clinical trials have demonstrated the benefit of intra-arterial therapies in subpopulations of BCLC stages A, B, and C. These studies highlight the need for careful patient assessment, staging, and multidisciplinary discussion to consider treatments that are not currently included in guidelines but can improve patient outcomes for HCC. [ABSTRACT FROM AUTHOR]

Sorafenib, a multi-kinase inhibitor, inhibits tumor angiogenesis and is the first-line systemic therapy for patients with advanced hepatocellular carcinoma (HCC). However, due to its limited effects and frequent occurrence of side effects, biomarkers are needed to predict the effects of sorafenib. We considered the possibility of using TIE-2-expressing monocytes (TEMs) to predict the response in sorafenib-treated patients with advanced HCC. TEMs serve as a diagnostic marker of HCC and are related to angiogenesis. We analyzed 25 advanced HCC patients and prospectively evaluated TEMs before (Pre TEMs) and at 1 month after initial therapy (T1m TEMs). The radiologic response was evaluated by modified Response Evaluation Criteria in Solid Tumors (mRECIST). Median survival time (MST) was significantly longer in the partial response/stable disease (PR/SD) group (21.8 months) than in the PD group (8.7 months). ΔTEMs (changes of T1m TEMs compared to Pre TEMs) were significantly lower in the PR/SD group than in the PD group. MST of the ΔTEMs low group (14.2 months) was significantly longer than that of the high group (8.7 months). Univariate and multivariate Cox regression analyses showed that ΔTEMs [hazard ratio (HR) = 8.53, 95% confidence interval (CI) = 1.51-48.16, p = 0.015] and Child-Pugh class (HR = 5.59, 95% CI = 1.06-29.63, p = 0.043) were independently associated with overall survival. Our results suggest that ΔTEMs could serve as a biomarker for predicting radiologic response and overall survival in sorafenib-treated patients with advanced HCC. [ABSTRACT FROM AUTHOR]

Tricuspid valve regurgitation is an insidious pathology that is associated with increased mortality if left untreated. Conversely, surgical correction of tricuspid regurgitation is burdened by poor outcomes, especially when right ventricular dysfunction, kidney disease, or liver disease occur. There is, therefore, increasing interest in transcatheter approaches as an alternative to surgery in patients at high or prohibitive surgical risk. The development of percutaneous devices to treat tricuspid regurgitation has several technical challenges, mainly because of the complexity of valve anatomy, thus requiring accurate patient selection. Here we review the currently available transcatheter approaches to treat severe tricuspid regurgitation., Competing Interests: The authors declare that they have no competing interests.No competing interests were disclosed.No competing interests were disclosed.No competing interests were disclosed., (Copyright: © 2020 Del Forno B et al.)

Purpose: Aim of our study was to compare the diagnostic performance of (18)F-FDG PET/CT and MR imaging (MRI) in the detection of liver metastases in patients with adenocarcinomas of the gastrointestinal tract.Methods: A total of 49 patients with adenocarcinomas of the gastrointestinal tract who had undergone (18)F-FDG PET/CT and MRI of the liver were included in this study. The MRI protocol included diffusion-weighted imaging and dynamic contrast-enhanced MR imaging after intravenous injection of Gd-DTPA. PET and MR images were analyzed by two experienced radiologists. Imaging results were correlated with histopathological findings or imaging follow-up as available. Sensitivities of both modalities were compared using McNemar Test. Receiver operating characteristic (ROC) curves were calculated to determine the diagnostic performance in correctly identifying liver metastases.Results: A total of 151 metastases were confirmed. For lesion detection, MRI was significantly superior to (18)F-FDG PET/CT. Sensitivity of MRI in detecting metastases was 86.8% for Reader 1 (R1) and 87.4% for Reader 2 (R2), of PET/CT 66.2% for R1 and 68.2% for R2. Regarding only metastases with diameters of 10 mm or less, sensitivities of MRI were 66.7% for R1 and 75.0% for R2, and were significantly higher than those of PET/CT (17.9% for R1 and 20.5% for R2). ROC analysis showed superiority for lesion classification of MRI as compared to (18)F-FDG PET/CT.Conclusion: MRI is significantly superior to (18)F-FDG PET/CT in the detection and classification of liver metastases in patients with adenocarcinomas of the gastrointestinal tract, especially in the detection of small metastases. [ABSTRACT FROM AUTHOR]