16 Tabestan 1385 Summer 2006 7 2 124 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 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. 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. 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>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<0.05). LVEF was 23±4% in the controls (p<0.05 vs. all groups). 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). cardiomyoplasty■ myocardial remodeling■ biventricular assist device■ experimental surgery 125 S. Rajaei MD, N. M. Noori MD* 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. 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. 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. 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). Premature neonates▪ Ibuprofen▪ patent ductus arteriosus 126 R. Parvizi MD, M. Hashemzehi MD, S. Hassanzadeh PhD and N. Safaie MD 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. 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. 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. 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). atrial septal defect ■ thoracotomy ■ sternotom 127 Maryam Esmaeilzadeh MD, Majid Maleki, MD, and Fereidoon Noohi, MD 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. 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). 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). 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). echocardiography ■ left-to-right shunt ■ secundum ASD. 128 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 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. 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. 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. These data suggest that normothermic systemic perfusion reduced postoperative blood loss and preserved platelets (Iranian Heart Journal 2006; 7 (2):31-36). normothermia ▪ bleeding ▪ coronary artery bypass grafting ▪ hypothermia 129 Hossein Nough MD,* Hashem Sezavar MD,** Ahmad Mohebbi MD*** and Fereidoun Noohi MD*** 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. 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. 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<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<0.005). 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). ferritin ■ coronary atherosclerosis ■ serum iron 130 Maryam Shojaeifard MD, Arash Arya MD, Majid Haghjoo MD and Mohammad Ali Sadr Ameli MD 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). 131 Abbas Ali Rafighdoust* MD, Mohammad Tayyebi MD, and Farzad Jalali 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). myxoma ■ mitral valve ■ 2D echocardiography