9 Payiz 1385 Fall 2006 7 3 114 H. Bassiri, MD and S. Abdi, MD This study was performed to evaluate the early results of stent implantation for aortic coarctation or recoaratation. 19 patients with a mean age of 21±12 years with aortic coarctation, 14 native and 5 recoarctations, were treated by stenting in our center over a period of two years. The mean peak systolic pressure gradient across the coarcted segment was 54 mmHg ± 14 mmHg. The procedure was effective in all 19 cases. Immediately after stent implantation the mean peak systolic gradient fell to 6±4 mmHg (P< 0.001). Complications occurred in 2 patients (stent migration in 1, edge dissection in another patient). Stent implantation for aortic coarctation and native coarctation gives good immediate results. Non-invasive studies including spiral CT scan and echocardiographic study is recommended for follow-up after stent implantation in order to evaluate long-term results (Iranian Heart Journal 2006; 7 (3):5-8). coarctation of aorta ■ stent implantation ■ recurrent coarctation of aorta 115 F. Jalali MD* and K. O. Hajian-Tilaki PhD** Carnitine has a major role in utilization of fatty acids and glucose by the myocardium. Some patients with heart failure have carnitine deficiency. This study evaluates the effects of oral carnitine on heart failure. This prospective interventional study was conducted on 41 patients with heart failure on the basis of the Framingham classification. Before and after intervention with 500mg of carnitine in 2 divided doses for six months, the general condition and functional class were evaluated and end-diastolic, end-systolic diameters, ejection fraction, left atrial diameter and severity of mitral regurgitation were measured by color Doppler, M-mode, and 2-D echocardiography. These data in addition to sex, age and etiology of heart failure were analyzed using SPSS software with paired t- test and Wilcoxon-matched pair test. The mean age of the patients under study was 60.2 ± 15.3 years. Out of 41 patients, 27 subjects were males and 14 were female. The causes of heart failure were valvular heart disease, coronary artery disease and dilated cardiomyopathy in 10, 16 and 16 patients, respectively; and one patient had both valvular and coronary artery disease. Carnitine reduced end-diastolic, end-systolic and left atrial diameter, increased ejection fraction, improved function class and degree of mitral regurgitation. All the changes were statistically significant. The results show that 500mg oral daily carnitine for six months has favorable clinical effects on heart failure and improves cardiac echocardiographic parameters (Iranian Heart Journal 2006; 7 (3):9-15). carnitine ■ ejection fraction ■ heart failure■ echocardiography 116 Shahram Homayounfar MD* and Shayan Broomandi, MD** Since the relief of pain in patients with acute myocardial infarction (AMI) is very important; we sought to assess the effect of Entonox as an analgesic drug in our subjects. Our goal was to compare the analgesic effect of Entonox with opioid drugs such as morphine and meperidine. This study was a randomized clinical trial, which included 120 patients with wellestablished AMI admitted to the CCU ward. Exclusion criteria consisted of hemodynamic abnormality, heart block, cardiac arrhythmia, opioid addiction and a lack of participation of certain patients. The patients were divided in a randomized manner into two equal groups of 60 individuals each. The first group inhaled Entonox, while the second group received opioid drugs intravenously. The severity of pain in the patients of both groups was measured before and after the aforesaid procedure by employing the established criteria of visual analogue scale (VAS). Visual analog scale is a standard quantitative method for pain measurement, which is suggested by the patient. Pain severity reduction according to VAS criteria in the Entonox group was 4.55 and 4.4 in the opioid group, which did not show any statistical difference according to t-test (p=0.82). Conclusion- Entonox was as effective for pain relief as opioid drugs in patients with AMI. Given the known complications caused by opioid drugs, we should be able to substitute these drugs with Entonox (Iranian Heart Journal 2006; 7 (3):16-19). acute myocardial infarction ■ analgesic ■ opioid ■ Entonox acute myocardial infarction ■ analgesic ■ opioid ■ Entonox 117 Noor-Mohammad Noori, MD and Semira Mehralizadeh, MD* Cardiac involvement is one of the most common causes of morbidity and mortality in patients with thalassemia major. In this study the echocardiographic parameters which would predict cardiac involvement in the patients at an early stage were determined. A case control study was designed on 80 patients suffering from thalassemia major from September 2002 to December 2003 at a pediatric hospital. The following parameters were measured in the case group and age and sex-matched control group: isovolumic ventricular relaxation time (IVRT), deceleration time (DT), and pre-ejection period to ejection time (PEP/ET). Data were analyzed by T-student test and correlation coefficient. The mean age of the patients was 14.3±2.3 years, and age of the control group was 14±2.6 years. Mean ejection fraction in the case and control groups were 55.7±7.2 and 62.8±7.7 percent, respectively (p<0.001). Mean IVRT of the left ventricle was 126.21± 22.4 in the case group and 95.31±11.7 in the control group, (p<0.05). DT of the mitral valve in the case group was 144.67±23, in comparison to 141±30 (p>0.05) in the controls. Mean right ventricular IVRT in the case group was 128.18±21.62, and 98.32±15.16 (p<0.05) in the control group. Tricuspid valve DT in the case group was 134.87±25, and 144.93±20, (p<0.05) in the control group. PEP/ET in the left heart in the case group was 0.32±0.06, and 0.28±0.004 (p<0.05) in the control group. PEP/ET in the right side of the heart in the case group was 0.31±0.06 and in the control group, it was 0.26±0.04, (p<0.05). The data show that IVRT in both ventricles regressed to the same extent, also decreased DT and increased PEP/ET in the right heart shows earlier right-sided failure (Iranian Heart Journal 2006; 7 (3):20-24). thalassemia major ■cardiac involvement■ echocardiography 118 *Kobra Khazali PhD, and **Marzieh Shamse MS We sought to study stress, and in particular environmental, psychological and treatment-related stress factors, in coronary care unit (CCU) and intensive care unit (ICU) patients with particular emphasis upon their religious beliefs. Four hundred patients upon discharge from the CCU or ICU were asked to answer a standard questionnaire, composed of demographic data; 5 faith-based questions; 36 questions about treatment-related factors; 9 questions about environmental factors; and 3 questions about psychological factors. The data were analyzed with the SPSS software, as well as Chisquare, ANOVA and nonparametric correlations tests. Quantification of the severity of the said factors was done by allocating the number one for the non-provocation of the stress factors and the number 6 for the highest severity of the stress factors. Data having been collected and statistical analysis having been carried out, the severity of the stress factors was divided into the three categories of mild (mean: 1-2.99), medium (mean: 3-3.99) and severe (mean: 4-5.99). The results are as follows: a) Treatment-related stress factors when treatment was administered by the same-sex hospital staff (mean: 1.38) were mild; whereas the severity of the same factors, when treatment was provided by members of the opposite sex, increased (mean: 1.73), b) Environmental stress factors (mean: 2.08) were mild, and c) Psychological stress factors (mean: 3.2) were medium. In the management of stress factors, apart from concentration, relaxation, exercise, sleep, etc., patients’ beliefs and faith warrant great emphasis in as much as they make an enormous contribution to a speedier recovery (Iranian Heart Journal 2006; 7 (3):25-37). stress factors■ coronary artery disease■ religious beliefs 119 Ataollah Bagherzadeh MD, Maryam Moshkani Farahani MD, Zahra Emkanjoo MD, Majid Haghjoo MD, Arash Arya MD and Mohammad Ali Sadr-Ameli MD Implantation of transvenous permanent pacemakers (PPM) has become standard therapy for sinus node dysfunction and atrioventricular conduction abnormalities. It plays an important role in improving quality of life and preventing death in this group of patients. This study was conducted on 477 patients during their hospitalization and eight weeks after their discharge Complete heart block was the most frequent indication for pacemaker implantation (48.8%). The most frequent early complications of implantations were hematoma (2.1%) and hemothorax (0.5%). The most frequent malfunctions were lead displacement (1.9%), exit block (1.5%) and atrial undersensing (1%). There were no significant differences between single- and dual-chamber PPM in regard to complications and malfunctions (p=0.56). PPM implantations in our center are associated with a low incidence of early complications and malfunctions in comparison with other qualified centers. There is no significant difference between early complications of single- versus dual-chamber PPMs(Iranian Heart Journal 2006; 7 (3):38-42). pacemaker ■ complication ■ malfunction ■ single-chamber ■ dual-chamber 120 Mohammad Reza Dehghani MD,* Mohammad Reza Samiei Nasab MD,* Majid Haghjoo MD** and Mohammad Ali Sadr Ameli, MD** The short QT syndrome (SQTS) is a new member of the genetic arrhythmia family (including long QT syndrome, Brugada syndrome, catecholaminergic polymorphic ventricular tachycardia and familial atrial fibrillation) with a high incidence of syncope, sudden death and atrial fibrillation in all age groups. The cause of this syndrome is mutation in genes that encode for the potassium rectifier channels, leading to a gain of function in these channels and heterogeneous aberration of repolarization, such that patients with this syndrome become prone to ventricular tachyarrhythmias. To date, the implantable cardioverter-defibrillator (ICD) is the only therapeutic option for the prevention of sudden cardiac death. Although many potassium channel (IKr and IKs) blocking drugs have been tested for the treatment of this syndrome, only quinidine (and possibly flecainide) has the potential for effective therapy in patients with SQTS and serves as an adjunct to ICD or as a possible alternative treatment (Iranian Heart Journal 2006; 7 (3):43-51). short QT syndrome■ genetic arrhythmia■ sudden cardiac death. 121 M. Mirmohammad Sadeghi MD, A. A. Tavassoli MD, M. Hashemi MD, Z. Massaeli MD and M. R. Jaberi MD We describe three cases of hydatid cyst of the heart. The first patient was a 46-year-old man who was found to have a systolic murmur on routine physical examination and echocardiography showed an interventricular cyst. He was operated on and recovered uneventfully. The second patient was a 55-year-old woman with a hydatid cyst of the interventricular septum, which was diagnosed by echocardiography. The cyst was resected surgically. She developed complete heart block after surgery, which was managed by an epicardial pacemaker. The third patient was a 15-year-old girl who was diagnosed with a large hydatid cyst of the left ventricle by echocardiography, but during the operation in addition to the left ventricular cyst a mediastinal cyst was found in the left side of the inferior vena cava. Both cysts were resected surgically and the patient recovered without any complication (Iranian Heart Journal 2006; 7 (3):52-55). cardiac hydatid cyst ■ cardiac cyst ■cardiac echinococcosis 122 Gholamreza Omrani MD, Ramin Baqaii Tehrani MD and Bahador Baharestani MD Interrupted aortic arch is a complete luminal and anatomical discontinuity between two segments of the aortic arch. According to the site of interruption there are three types of this anomaly. As the nature of this anomaly is life threatening and that the complex corrective operation utilizing CPB and/or total circulatory arrest is associated with significant morbidity and mortality, we present a technique of off-pump repair of interrupted aortic arch via left thoracotomy approach (Iranian Heart Journal 2006; 7 (3):56-58). interrupted aortic arch ■ thoracotomy 123 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