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<Journal>

<JournalID>16</JournalID>

<PubDate_Fa>Tabestan 1385</PubDate_Fa>

<PubDate_En>Summer 2006</PubDate_En>

<Volume>7</Volume>

<Number>2</Number>

<Abstract>

<AbstractID>124</AbstractID>

<Title>Adaptive Cardiac Binding: A New Method for

Treatment of Dilated Cardiomyopathy</Title>

<Author>Valeri Chekanov MD, PhD, FACC1, Arimantas Dumcius MD, PhD2, Pavel

Karakozov MD, PhD3, Mary Cayton RN, BSN, PA4, S. Hamid Mirkhani, MD,5

Mahmood Mirhoseini MD, DSc, FACS, FACC 4,5,6</Author>

<Background>We propose a new surgical procedure for advanced heart failure - adaptive

cardiac binding - which allows for a gradual increase in compression on the dilated heart

with separate loads on the left and right ventricles.</Background>

<Method>A canine model of biventricular heart failure (arteriovenous anastomosis   AVA,

and doxorubicin administration) was created. Twenty-four dogs were divided into four

groups: control, adynamic cardiomyoplasty (CMP), usual plastic cardiac binding (PCB),

and adaptive cardiac binding (ACB). Systolic and diastolic area and volume and LVEF

were measured before creation of heart failure, six weeks after, immediately after main

operation, and 4 weeks later. In the animal group with ACB, liquid was added

incrementally (35ml, 15ml, and finally 10ml) to each side of the pouch at weeks 1, 2,

and 3.</Method>

<Result>LVEF was 59±4 % before AVA and doxorubicin administration and dropped to

27±2% six weeks later. Immediately after the main operation, LVEF was 35±3%

(CMP), 34±4% (PCB), and 35±4 (ACB) (p&gt;0.05 between groups). Four weeks later,

LVEF had not changed in the CMP (37±3%) and PCB (32±2%) groups but had

significantly increased in the ACB group (48±5%, p&lt;0.05). LVEF was 23±4% in the

controls (p&lt;0.05 vs. all groups).</Result>

<Conclusion>Adaptive cardiac binding that gradually adapts to the heart s natural variations in

tension and contractile strength is a promising new surgical approach for patients who

have end-stage heart failure (Iranian Heart Journal 2006; 7 (2):5-14).</Conclusion>

<Keywords>cardiomyoplasty, myocardial remodeling, biventricular assist device, experimental surgery</Keywords>

</Abstract>

<Abstract>

<AbstractID>125</AbstractID>

<Title>Oral Ibuprofen for Closure of Hemodynamically

Significant Patent Dultus Arteriosus in Premature

Neonates: a Pilot Study</Title>

<Author>S. Rajaei MD, N. M. Noori MD*</Author>

<Background>A patent ductus arteriosus (PDA), resulting in hemodynamically-significant left to

right shunting of blood, increases complications and mortality in premature infants. PDA in

premature infants is conventionally treated by intravenous indomethacin. Intravenous

ibuprofen was recently shown to be as effective, but to have adverse reactions in premature

infants. If equally effective, then oral ibuprofen for PDA closure would have several

important advantages over the intravenous route. This study was designed to determine

whether oral ibuprofen treatment is efficacious and safe in the closure of a hemodynamicallysignificant

PDA in premature infants.</Background>

<Method>Ten premature infants with symptomatic PDA were studied prospectively. The average

gestational age and weight of them were 29.5 weeks and 1320 g, respectively. The neonates

were diagnosed to have symptomatic PDA based on the clinical criteria, chest radiography

and echocardiography. All the babies had CBC, PT, BUN, serum electrolytes and U/A done

before and after therapy. They received oral ibuprofen for three consecutive daily doses. All

the neonates underwent repeat echocardiography 24 h after three doses of ibuprofen.</Method>

<Result>Ductus closure was achieved in all the newborns except for one (90%). There were no

significant side effects like oliguria or bleeding tendencies. There was no reopening of the

ductus after the closure had been achieved.</Result>

<Conclusion>Ibuprofen, unlike indomethacin, dose not impair cerebral autoregulation and has much

fewer adverse effects on the renal and mesenteric circulation. Oral ibuprofen suspension may

be an effective and safe alternative for PDA closure in premature infants with PDA. However,

larger comparative studies are warranted (Iranian Heart Journal 2006; 7 (2):15-18).</Conclusion>

<Keywords>Premature neonatesª% Ibuprofenª% patent ductus arteriosus</Keywords>

</Abstract>

<Abstract>

<AbstractID>126</AbstractID>

<Title>Comparison of Early Results of Limited Thoracotomy Versus

Complete Sternotomy in Atrial Septal Defect Closure</Title>

<Author>R. Parvizi MD, M. Hashemzehi MD, S. Hassanzadeh PhD and N. Safaie MD</Author>

<Background>Atrial septal defect (ASD) closure by surgery is a standard method with low mortality

and complication rate. In recent years, there is increasing use of minimally invasive methods

including interventional and limited thoracotomy. The aim of this study is comparison of postsurgical

results in two groups who underwent ASD surgery by sternotomy and thoracotomy

methods.</Background>

<Method>This retrospective study was performed in Shahid Madani Heart Hospital from 1998-2003

in 73 patients who underwent ASD surgery. Collecting data has been performed through filling

a questionnaire. The statistical analysis is based on the SPSS software and has been done

through descriptive statistical method.</Method>

<Result>Group I (thoracotomy) included 38 patients with mean age of 23.84±3.2 years and group II

(complete sternotomy) included 35 patients with mean age of 21.82±2.3 years. The results were

nearly the same in both groups except for longer operation time (P=0.01) and shorter

hospitalization period (P=0.01) in group I.</Result>

<Conclusion>Regarding lower injury by surgery and better cosmetic results, ASD repair by

thoracotomy can be a suitable method. In this study, the obtained results with respect to

available equipment in hospital were acceptable (Iranian Heart Journal 2006; 7 (2):19-24).</Conclusion>

<Keywords>atrial septal defect, thoracotomy, sternotom</Keywords>

</Abstract>

<Abstract>

<AbstractID>127</AbstractID>

<Title>Quantification of Left-to-Right Shunt in Secundum Atrial

Septal Defect by PISA Method</Title>

<Author>Maryam Esmaeilzadeh MD, Majid Maleki, MD, and Fereidoon Noohi, MD</Author>

<Background>The purpose of this study was to quantitate the degree of left-to-right shunt in patients

with secundum atrial septal defect (2º ASD) with the PISA method and compare the results

with the usual continuity equation. Although the PISA method has been used extensively for

the quantitative measurement of regurgitant severity and valve area in patients with valvular

regurgitation and stenosis, its use in patients with left-to-right shunts including ASD is yet to

be evaluated extensively.</Background>

<Method>We studied 48 consecutive patients with 20 ASD (mean age: 32.5±4 years; range:18-54

years). Left-to-right shunting was quantified by continuity equation and PISA method. The

defect size was between 12 and 40 mm (mean: 26±6).</Method>

<Result>QP/QS by continuity equation was between 1.7-4.5/1 (mean: 2.91), and by PISA method

was between 1.6-4.8/1 (mean: 2.92), [r = 0.92, PV= 0.0001]. There was no significant

difference between the degree of shunt estimated by continuity equation and PISA method in

terms of the defect size and the degree of shunt (PV = 0.179).</Result>

<Conclusion>The PISA method could be used as an accurate alternative method to the continuity

equation for quantitation of the degree of shunt flow in patients with 20 ASD (Iranian Heart

Journal 2006; 7 (2):25-30).</Conclusion>

<Keywords>echocardiography, left-to-right shunt, secundum ASD.</Keywords>

</Abstract>

<Abstract>

<AbstractID>128</AbstractID>

<Title>The Effect of Normothermic Cardiopulmonary Bypass on

Postoperative Bleeding in CABG</Title>

<Author>Saeed Hoseini MD, Nasrin Elahi MSc RN, Sepideh Sobhani MSc RN,

Seyyed Mohammad Bagher Tabatabaee MD, Ali Sadeghpoor Tabaie MD,

Ali Yaghoubi MD, Masoud Shafiee MD, Mahsa Firoozi RN, Mohammad Hosein

Yousefzadeh RN, Maryam Moetamedkhah RN, Hamid Reza Davoudi RN and Zohre

Gholami, RN</Author>

<Background>CABG is the most common type of cardiac surgery which generally is done under

cardiopulmonary bypass (CPB). Hypothermic CPB was introduced in cardiac surgery in

order to protect organs against hypoperfusion. Hypothermia is associated with many adverse

effects on the vital organs, which result in impairment of organ and systemic function.

Normothermia on the other hand is more in agreement with the physiology of human organs.

The aim of this study is to evaluate the effect of body temperature during CPB on

postoperative bleeding.</Background>

<Method>One hundred patients were randomized into normothermic (35-37º C, N=50) and mild

hypothermic (28-32º C, N=50) CPB groups and compared with respect to blood loss,

transfusion requirements and platelet level in primary coronary artery bypass grafting. The

patients  hemoglobin levels, leukocyte counts and platelet counts were measured before

operation, immediately upon arrival in the intensive care unit, 4 hours afterwards and 6 days

after surgery. The volume of blood shed through mediastinal and pleural drainage tubes were

recorded at 6, 12 and 24 hours after operation.</Method>

<Result>There were no differences in preoperative characteristic including patient age, sex, number

of occluded vessels, weight, height, hemoglobin and hematocrit level, platelet and WBC

levels. Normothermic patients tended to bleed less at 24 hours (warm, 288±30ml vs. cold,

580±100ml). Platelet levels were preserved better in normothermic patients than in

hypothermic patients. The warm group had a reduced blood loss by 40 percent after 6, 34%

after 12 and 30% after 24 hours as compared with blood loss in hypothermically-perfused

patients.</Result>

<Conclusion>These data suggest that normothermic systemic perfusion reduced postoperative blood

loss and preserved platelets (Iranian Heart Journal 2006; 7 (2):31-36).</Conclusion>

<Keywords>normothermia ª% bleeding ª% coronary artery bypass grafting ª% hypothermia</Keywords>

</Abstract>

<Abstract>

<AbstractID>129</AbstractID>

<Title>Association between Body Iron Stores and Coronary

Artery Disease</Title>

<Author>Hossein Nough MD,* Hashem Sezavar MD,** Ahmad Mohebbi MD***

and Fereidoun Noohi MD***</Author>

<Background>Animal studies have indicated the effects of iron stores in the process of the

formation of free radicals and low density lipoprotein (LDL) oxidation. Oxidation of lipids,

especially LDLs, by oxidants such as iron plays a central role in atherogenesis. As a result, an

evaluation of the iron stores of the body in patients with coronary artery diseases is of utmost

importance.</Background>

<Method>In this prospective study, 112 patients with coronary artery disease (CAD) and 63

individuals without this disease were investigated. The coronary condition of the subjects was

determined with coronary angiography. The amount of iron, ferritin, total cholesterol,

triglycerides, LDL, and HDL was measured in both groups. The patients were also evaluated

for known CAD risk factors, including diabetes mellitus, hypertension, smoking, family

history of CAD, and hyperuricemia. Patients suffering from anemia, renal and hepatic

diseases, and those with a history of malabsorption, hemochromatosis, chronic infections, or

immunological and inflammatory disorders and patients with neoplastic diseases and cardiac

failure were excluded from the study. Moreover, all the subjects had a similar socio-economic

status.</Method>

<Result>Mean serum iron was 12.9±4 micromoles/liter and 10.8±5 micromoles/liter in the group

with CAD (case) and the group without CAD (control), respectively, which were significantly

different (P&lt;0.001). Mean serum ferritin was 126±75 microgram/liter in the case group, while

it was 101±75 microgram/liter in the control group, the difference also being significant

(P&lt;0.005).</Result>

<Conclusion>The findings indicated that the serum level of iron and ferritin - excluding other known

risk factors - in patients with CAD is higher compared to the subjects without CAD. It may,

therefore, be possible that iron stores in the body can play a role in the atherosclerotic process

(Iranian Heart Journal 2006; 7 (2):37-41).</Conclusion>

<Keywords>ferritin, coronary atherosclerosis, serum iron</Keywords>

</Abstract>

<Abstract>

<AbstractID>130</AbstractID>

<Title>What Is the Mechanism of Group Beating?</Title>

<Author>Maryam Shojaeifard MD, Arash Arya MD, Majid Haghjoo MD

and Mohammad Ali Sadr Ameli MD</Author>

<CaseReport>An eighty-year-old male was referred to our center because of dizziness and palpitation for

the previous two weeks. He had no history of syncope and the drug history was unremarkable.

Figure 1 shows the resting ECG, interpreted as complete heart block by the referring

physician. A transthoracic echocardiography was done and showed a left ventricular ejection

fraction of 35% and a severely calcified mitral valve with an estimated mitral valve orifice

area of 1.4 cm2.

Group beating was observed on the ECG, and a closer look at the ECG suggested the

diagnosis of sino-atrial node Wenckebach (SANW) exit block. Premature atrial beat

trigeminy could have also explained the group beating of the P-waves. However, the

similarity of the P-wave morphologies and the confirmation of the diagnosis of sick sinus

syndrome by electrophysiology study made this diagnosis unlikely and suggested the SANW

as the cause of P-wave group beating.

Apparently there seems to be a conduction defect at the atrio-ventricular nodal (AVN) level.

The PR interval of the first conducted P-wave is longer (first black arrow) than the subsequent

PR interval, which is then followed by a non-conducted P-wave. Nevertheless, a close look at

the ECG reveals the real underlying mechanism of apparent AV block. Due to SANW, the PP

intervals gradually shorten and the third P-wave is blocked as it encounters the physiologic

refractory period of the AVN. After the third P-wave, there is a pause due to SA exit block

(4th P-wave, blocked at the SAN level) followed by a conducted P-wave with a long PR

interval. This phenomenon could be best explained by phase-four (bradycardia-dependent)

conduction blocks.

Electrocardiographic changes in this patient could also be explained by the effect of cyclelength

duration on infra-Hissian conduction. Thus, PR interval prolongation can be due to

His-Purkinje refractoriness in the longer cycle length. The shorter PR interval in the next beat

may be due to a decrease in the HV interval in the shorter cycle length. In this scenario, the

last P-wave would be blocked in the AV node (Iranian Heart Journal 2006; 7 (2):42-43).</CaseReport>

</Abstract>

<Abstract>

<AbstractID>131</AbstractID>

<Title>A Mitral Valve Myxoma: Case Report</Title>

<Author>Abbas Ali Rafighdoust* MD, Mohammad Tayyebi MD, and Farzad Jalali</Author>

<CaseReport>Myxoma is the most common type of primary tumors of the heart. It is a rare tumor with an

estimated incidence of 0.5 per million population per year. Most cardiac myxomas originate in the

atrial septum in the area of the fossa ovalis and 75% occur in the left atrium. Valvular myxomas are

very rare: the tricuspid valve is the most frequently involved location, followed by the mitral,

pulmonic, and aortic valves.

Our case was a 24-year-old male with mitral valve myxoma and a history of progressive dyspnea.

After diagnosis was confirmed by 2-dimensional echocardiography, he underwent cardiac surgery,

the tumor was successfully excised from the posterior leaflet of the mitral valve, and the mitral

valve defect was repaired with direct suture (Iranian Heart Journal 2006; 7 (2):44-47).</CaseReport>

<Keywords>myxoma, mitral valve, 2D echocardiography</Keywords>

</Abstract>

</Journal>