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<Journal>

<JournalID>8</JournalID>

<PubDate_Fa>Zemestan 1385</PubDate_Fa>

<PubDate_En>Winter 2006</PubDate_En>

<Volume>7</Volume>

<Number>4</Number>

<Abstract>

<AbstractID>101</AbstractID>

<Title>Surgical Radiofrequency MAZE III Ablation for Treatment

of Atrial Fibrillation during Open Heart Surgery</Title>

<Author>F. Akbarzadeh MD and R. Parvizi MD</Author>

<Background>Atrial fibrillation is a common arrhythmia in patients with rheumatic mitral and other

valve diseases who are candidates for valve repair surgery. Conversion to sinus rhythm has

positive effects on quality of life and lowering medication use. The aim of this clinical study

was to evaluate the effectiveness of the radiofrequency ablation Maze III procedure in the

treatment of atrial fibrillation associated with rheumatic heart valve disease.</Background>

<Method>We applied the modified Cox III Maze procedure with the use of radiofrequency ablation

in the treatment of atrial fibrillation associated with rheumatic heart valve disease and

evaluated the outcome in 20 patients with atrial fibrillation. Demographic, echocardiographic,

electrocardiographic and Doppler study data were calculated before and six months and one

year after surgery.</Method>

<Result>No perioperative deaths occurred in the study group. Duration of additional time needed

for doing radiofrequency ablation was about 22 minutes. Freedom from atrial fibrillation was

85% and 75% at six months and one-year follow up, respectively.</Result>

<Conclusion>The addition of the radiofrequency ablation Maze procedure to heart valve surgery is

safe and effective in the treatment of atrial fibrillation associated with rheumatic heart valve

disease (Iranian Heart Journal 2006; 7 (4):6-12).</Conclusion>

<Keywords>radiofrequency ablation &lt;Maze&lt;atrial fibrillation, rheumatic heart valve disease</Keywords>

</Abstract>

<Abstract>

<AbstractID>102</AbstractID>

<Title>Relationship between Myocardial Blush Grade and LV

Function in Acute MI Patients after Primary PTCA</Title>

<Author>Morteza Safi, MD and Farah Naghashzadeh, MD</Author>

<Background>The primary objective of reperfusion therapies for acute myocardial infarction is not

only to restore the blood flow in the epicardial coronary artery but also to complete and

sustain the reperfusion of the infarcted part of the myocardium.</Background>

<Method>In this cross-sectional study on 50 patients who underwent primary coronary angioplasty,

we assessed the correlation between LV ejection fraction and angiographic evidence of

myocardial reperfusion (myocardial blush grade). The myocardial blush grade after the

angioplasty procedure was graded by two investigators, who were otherwise blinded to all

clinical data. On the 5th day after MI, left ventricular ejection fraction was assessed by 2D

echocardiography (Simpson s method).</Method>

<Result>This study showed that the myocardial blush grade was directly related to the left

ventricular function. Ten patients had MBG 0-1, 21 patients had MBG 2, and 19 patients had

MBG 3, the mean ejection fraction being 42±12.2 %. Severe LV systolic dysfunction was

found in six patients, moderate LV systolic dysfunction in 24 patients, and mild LV systolic

dysfunction in 14 patients; and the remaining 6 patients had normal LV function. Multivariate

analysis showed that there is a direct correlation between MBG and LV function (R=0.77,

p&lt;0.01).</Result>

<Conclusion>In patients after reperfusion therapy, the myocardial blush grade as seen on the

coronary angiogram is a predictor of left ventricular function and can be used to describe the

effectiveness of the myocardial reperfusion (Iranian Heart Journal 2006; 7 (4):13-16).</Conclusion>

<Keywords>myocardial blush, ejection fraction, myocardial infarction coronary angioplasty</Keywords>

</Abstract>

<Abstract>

<AbstractID>103</AbstractID>

<Title>Prediction of Left Ventricular Dysfunction on the Basis of

Ventricular Depolarization Time and Electrical Axis in

Patients with Left Bundle Branch Block</Title>

<Author>Farzad Jalali, MD, Seyyed Mohammad Miri, MD* and Pegah Karimi Elizei MD</Author>

<Background>Prolongation of ventricular depolarization time (QRS duration), particularly in left

bundle branch block (LBBB), is commonly associated with many cardiac diseases. We posit

that the QRS duration and degree of left-axis deviation (LAD) identify significant left

ventricular (LV) systolic dysfunction in patients with LBBB.</Background>

<Method>In this prospective study, 150 patients with diagnosis of LBBB were divided into two

groups (QRSe"160 and QRS&lt;160 milliseconds). Then the relationships between QRS duration,

left axis deviation (LAD: axis between  30° and  90°), and echocardiographic LV ejection

fraction (EF) were derived by t-test, chi-square, and linear regression analysis in a step-wise

method.</Method>

<Result>There was no significant difference in age and sex among the patients with or without

LAD and QRS duration less or more than 160 ms (p&gt;0.05). The EF of patients with LAD

(n=64) and without LAD (n=86) was 48.64±14.63% and 52.10±13.98%, respectively

(p=0.143). The mean±SD EF (54.5±10.54%) of the patients with a QRS duration of e"160

milliseconds (n=19) was significantly more than the mean ± SD EF (23.89±5.46%) of the

patients with a QRS duration of &lt;160 milliseconds (n=131, p&lt;0.001). The QRS duration also

had a significant (p&lt;0.001) inverse correlation with EF (R = 0.926, adjusted R2 = 0.857, SE of

estimate = 5.42). However, the QRS axis was not significantly correlated with EF and did not

have added predictive values.</Result>

<Conclusion>The QRS duration has a significant inverse relationship with EF. Furthermore, the

prolongation of QRS duration (e"160 milliseconds) in the presence of LBBB is a marker of

significant left ventricular systolic dysfunction. The presence of LAD in LBBB does not

signify a further decrease in EF (Iranian Heart Journal 2006; 7 (4):17-25).</Conclusion>

<Keywords>QRS duration, electrical axis, LV dysfunction, ejection fraction, left bundle branch block</Keywords>

</Abstract>

<Abstract>

<AbstractID>104</AbstractID>

<Title>Predictive Value of TIMI Risk Score Analysis for In-

Hospital and Long-Term Survival of Patients with Right

Ventricular Infarction</Title>

<Author>S. Ghaffari MD and J. Samadikhah MD.</Author>

<Background>Right ventricular infarction (RVI) is a common complication of inferior wall infarction

and usually leads to a greater mortality and in-hospital complications. This study aims to

evaluate the value of TIMI risk score in the prediction of in-hospital and long-term mortality in

RV infarction.</Background>

<Method>Five hundred patients with acute inferior infarction were surveyed in this study. Inhospital

complications and mortality of these patients were collected, and they were followed on

average for about 31 months.</Method>

<Result>RVI was diagnosed in 24% of the patients. In-hospital morbidity (RVI: 56.7% vs. non-

RVI: 34.4%; P&lt;0·001) and mortality (RVI: 28.3% vs. non-RVI: 8.9%; P&lt;0.001) were increased

in patients with RVI. Any one-point increase in TIMI risk score led to a 3.5±1.4 percent

increase in in-hospital mortality (P=0.001). Long-term mortality, however, did not reveal such a

correlation with TIMI risk score (P=0.1). Out-of-hospital mortality in a mean follow-up period

of about 31±8.7 months was 24.3% in the RVI and 12.1% in the non-RVI group (p=0.02).</Result>

<Conclusion>RV infarction significantly increases in-hospital complications and mortality of

inferior infarction. Any one-point increase in TIMI risk score leads to a parallel increase of inhospital

mortality but there is no such a correlation between TIMI risk score and long-term

mortality (Iranian Heart Journal 2006; 7 (4):26-30).</Conclusion>

<Keywords>myocardial infarction n right ventricular infarction n TIMI risk score n prognosis</Keywords>

</Abstract>

<Abstract>

<AbstractID>105</AbstractID>

<Title>A Study of Hypertensive Crisis and Precipitating Factors</Title>

<Author>A. Ali Rafighdoost MD, M. Shabestari MD, and T. Bostani MD</Author>

<Background>Hypertension is the most prevalent controllable lethal disease in the present century

and is one of the most common causes of visits in private offices and general clinics.1,2 In our

region, no extensive study has been done on the incidence and precipitating factors of

hypertensive crisis in patients with primary hypertension. Given the very large number of

patients referring for this reason to Mashhad and especially in Imam Reza (A.S.) Hospitals,

this study was conducted with the aim of determining the incidence of hypertensive crisis and

its precipitating causes and proposing plans to control these factors.</Background>

<Method>A prospective study was done on hypertensive patients referring for hypertensive crisis in

the cardiac emergency room of Imam Reza (A.S.) Hospital during an 18-month period from

August 2002 to March 2004. By definition, a diastolic blood pressure of 140 mmHg or higher

was set for choosing patients, and on this basis 192 patients entered the study. Study subjects

were selected from patients aged 30 to 75 years, and an effort was made to ensure that all the

subjects had primary hypertension.</Method>

<Result>Among the 192 patients, males comprised the higher percentage. Hypertensive crisis

occurred most commonly in patients aged 50 to 60 years, followed by those above 70. 75% of

the patients had stopped taking medications for a long time, and the most common reasons for

this were a feeling of improvement, growing tired of the long-run medications, being on a

journey with the drugs left at home, and side effects, respectively. This study proved

emotional stress and diet changes, especially taking excess salt, as important precipitating

factors.</Result>

<Conclusion>Hypertension is an important threat to general health in the developed countries, and

has the characteristics of being common, asymptomatic, and easily detectable and treatable. A

potentially fatal complication of hypertension is hypertensive crisis. This study was conducted

with the aim of determining the incidence and the causes of hypertensive crisis and proposing

ways to prevent its occurrence. It is recommended that the drugs should be taken life-long and

not stopped without doctor s permission. The patients should be careful to take along their

medications on trips and to continue to observe a low-salt diet (Iranian Heart Journal 2006;

7 (4):31-36).</Conclusion>

<Keywords>hypertensive crisis, primary hypertension, stress, anti-hypertensive drugs</Keywords>

</Abstract>

<Abstract>

<AbstractID>106</AbstractID>

<Title>Comparison of Extent of Coronary Artery Disease in

Angiography of Diabetics and Non-Diabetics</Title>

<Author>Mahdi Moosavi MD, Ebrahim Nematipour MD and Maryam Mehrpooya MD</Author>

<Background>Type 2 diabetes mellitus is associated with an increased prevalence of atherosclerosis

  and coronary heart disease. This study was performed to determine the severity and extent of

coronary artery disease in diabetics compared to non-diabetics.</Background>

<Method>Fifty type 2 diabetic patients and 50 sex- and age-matched non-diabetics, who were

candidates for angiography to diagnose coronary artery disease, were enrolled in the study.

Those patients with valvular heart disease, congenital heart disease and rhythm disturbances

were excluded from the study. Selective angiography was performed, and a single experienced

observer reported the angiograms and Gensini scores were calculated to determine the severity

of the atherosclerosis.</Method>

<Result>Sixty males and 40 females were included in the study, with a mean age of 57.3±8.4 (Mean

± SD). Diabetic patients had higher Gensini scores than non-diabetics (51.44 ± 44.6 vs. 34.12

± 29.9, P&lt;0.05). Categorical staging of various types of coronary artery disease significantly

differed in diabetic and non-diabetics (P&lt;0.05), and multi-vessel CAD (P&lt;0.05) was seen more

often in diabetics. Moreover, mono-vessel CAD (P&lt;0.05) was more common in non-diabetics,

but normal coronary arteries did not significantly differ between the two groups.

Hyperlipidemia and diabetes were associated with Gensini scores independently (P=0.02 and

P=0.04, respectively), and a trend toward a positive association was seen between family

history of coronary artery disease and Gensini score (P=0.06), but hypertension and cigarette

smoking did not show any significant association. Left main coronary artery disease, disease of

the proximal portion of left anterior descending artery, presence of occluded vessels, ejection

fraction, left ventricular end diastolic pressure, and catheter-based systolic and diastolic blood

pressure were not significantly different between diabetics and non-diabetics.</Result>

<Conclusion>According to our study, diabetics may have more extensive coronary artery disease at

presentation, hence care must be taken in the diagnosis and management of these patients, and

it is better to maintain a lower threshold for performing noninvasive and sometimes invasive

studies for the detection of coronary artery disease in diabetics (Iranian Heart Journal 2006;

7 (4):37-42).</Conclusion>

<Keywords>Atherosclerosis, coronary artery disease diabetes</Keywords>

</Abstract>

<Abstract>

<AbstractID>107</AbstractID>

<Title>Value of the New Doppler   Derived Myocardial

Performance Index in Predicting Subclinical Cardiotoxicity

in Children Treated with Anthracyclines</Title>

<Author>M. Y. Aarabi MD, A. Shahmohammadi MD, P. N. Davari MD,

M. Meraji MD, A. Tabib MD and H. Mortezaeian MD</Author>

<Background>There are many limitations to the use of conventional echocardiography indices for the

estimation of systolic and diastolic left ventricular (LV) function. Anthracycline chemotherapy

causes myocardial damage, leading to acute or chronic congestive heart failure during or soon

after treatment in a significant percentage of patients treated, depending on the total cumulative

dose used. The aim of this study was to determine the usefulness of myocardial performance index

(MPI) in evaluation of subclinical cardiotoxicity in patients undergoing chemotherapy with

anthracyclines.</Background>

<Method>Seventy-five patients (41 male, 34 female, mean age 9±3 years) with malignant solid tumors

and hematologic malignancy were randomly selected and evaluated before, during and after

therapy by 2-D, M-Mode and Doppler echocardiography; and the data were compared with 48

age- and sex-matched normal controls prospectively.</Method>

<Result>Twenty-three patients were taking high doses of anthracyclines (&gt;200mg/m2), whereas 52

patients were taking low doses of anthracyclines (&lt;200mg/m2). Mean dose of anthracyclines in all

the patients was 140±60mg/m2. IVCT was prolonged (42±11msec vs. 28±8msec, P-value=0.018)

compared with normal control subjects. ET was shortened (220±24msec vs. 234±14msec, Pvalue=

0.025), and MPI was increased in the anthracycline-treated patients compared with normal

control subjects (0.44±0.06 vs. 0.34±0.04, P-value =0.015). Also, we found no correlation

between MPI and cumulative dose of anthracyclines in 52 patients taking lower doses

(&lt;200mg/m2) compared with 23 patients taking higher doses (&gt;200mg/m2); MPI was 0.42±0.04

vs. 0.44±0.08, with P-value =0.062 between the two groups. No significant difference was found

in LVEF (0.58 ± 0.12 vs. 0.64±0.06, P-value=0.056) and LVFS (0.32±0.08 vs. 0.36±0.04, Pvalue=

0.068) between the patients and normal controls.</Result>

<Conclusion>The findings of this study suggest that anthracycline cardiotoxicity is subtle and subclinical

and systolic functions are preserved. MPI is helpful in the discrimination of early cardiac

involvement from anthracycline chemotherapy, especially in asymptomatic young patients with

normal limited systolic function. Moreover, MPI can enhance the accuracy of echocardiographic

diagnosis in early ventricular dysfunction. Cumulative dose of anthracyclines is not a suitable

parameter in the determination of the risk of the severity of anthracycline cardiotoxicity. Recent

advantages in diagnostic tests have allowed diagnosis at early stages of disease before massive

cell injury and irreversible changes occur (Iranian Heart Journal 2006; 7 (4): 43-48).</Conclusion>

<Keywords>myocardial performance index (MPI), isovolumic relaxation time (IVRT), isovolumic contraction rime

(IVCT),ejection time (ET), anthracycline.</Keywords>

</Abstract>

<Abstract>

<AbstractID>108</AbstractID>

<Title>The Role of P wave Duration in Prediction of Atrial

Fibrillation after Cardiac Surgery</Title>

<Author>Mehdy Hasanzadeh Delui MD and Paria Dehghanian, MD</Author>

<Background>Atrial arrhythmias occur frequently after cardiac surgery, and atrial fibrillation (AF)

was the most common atrial arrhythmia after cardiac surgery. It occurs in up to 40% of

patients primarily within 2 to 3 days, and it can compromise systemic hemodynamics and

increase the risk of embolization. Some clinical issues can predict the risk of atrial

fibrillation, like P wave duration. The aim of this study is to evaluate the role of P wave

duration in prediction of post cardiac surgery AF.</Background>

<Method>We measured P wave duration in 206 cardiac surgery patients the day before surgery and

followed the patients for 3 days to find the possible relation between P wave duration and the

risk of AF after surgery.</Method>

<Result>Our study showed the prevalence of AF after cardiac surgery was about 9% and there was

no relation between P wave duration before surgery and risk of AF after surgery.</Result>

<Conclusion>The risk of AF in our patients was less than other studies, and this study showed we

can not use P wave duration in surface ECG as a predictor of post-cardiac surgery AF

(Iranian Heart Journal 2006; 7 (4): 49-51).</Conclusion>

<Keywords>atrial fibrillation, cardiac surgery, P wave</Keywords>

</Abstract>

<Abstract>

<AbstractID>109</AbstractID>

<Title>Children s Arterial Blood Pressure Percentile Curves</Title>

<Author>Paridokht Nakhostin Davari MD, Akbar Shahmohammadi MD,

M.Yousef Aarabi MD, Mahmoud Meraji MD, and Habibollah Yadollahi Farsani MD</Author>

<Background>One of the most important tools for the evaluation of children's health is determining

the systemic arterial blood pressure (SABP), which is affected by weight, gender, stature, and

environmental conditions. The variation of children s SABP is between the 5th and 95th

percentile curves. Due to environmental conditions, some criteria may be different in other

countries.</Background>

<Method>We measured the SABP of 1000 7-12-year-old students who were selected randomly.

The SABP percentile curves are plotted on the basis of weight, stature, and sex; and they will

of course be affected by environmental conditions.</Method>

<Result>The results show that the most abundant systolic SABP was 100 mmHg (27%) and the least

abundant was 75 mmHg (1%). For diastolic SABP, the highest and lowest prevalences were

65 mmHg (28.2%) and 45 mmHg (0.1%), respectively. The correlation between age (p&lt;0.01),

weight, stature, and sex (p&lt;0.005) and the SABP of the children was determined: SABP

increased with an increase in age, weight, and stature. In addition, SABP in girls was higher

than that in boys in the same situation.</Result>

<Conclusion>In light of our results, it is necessary that children be protected against cardiovascular

diseases by laying emphasis on suitable nutrition and exercise in school curriculum (Iranian

Heart Journal 2006; 7 (4): 52-56).</Conclusion>

<Keywords>blood pressure, children, percentile curve, weight,age, gender</Keywords>

</Abstract>

<Abstract>

<AbstractID>110</AbstractID>

<Title>Surgical Repair of a Pseudoaneurysm of the Ascending

Aorta after Previous Aortic Valve Replacement and

Aneurysmorrhaphy</Title>

<Author>A. Sadeghpour MD, S. Arefi MD,* J. Vahedian MD, K. Raisee MD, N. Givtaj MD,

G. Omrani MD, S. Hosseini MD, R. Baghaee MD, B. Baharestani MD, M.

Gholampour MD, T. Babaee MD and A.H. Sadeghpour MD</Author>

<CaseReport>We report the case of a patient with a pseudoaneurysm of the ascending aorta. He was referred to

our hospital because of chest pain and dyspnea. A preoperative diagnostic evaluation revealed a

large pseudoaneurysm of the ascending aorta close to the proximal anastomotic site of the graft.

During surgery, the pseudoaneurysm originated from an intimal defect in the aortic wall on the right

side of the right coronary artery 1cm proximal to the suture line. Replacement of the ascending

aorta was successfully performed (Iranian Heart Journal 2006; 7 (4): 57-60).</CaseReport>

<Keywords>aortic pseudoaneurysm, aortic root replacement, Bentall operation, ascending aorta aneurysm</Keywords>

</Abstract>

<Abstract>

<AbstractID>111</AbstractID>

<Title>Intracardiac Leiomyomatosis</Title>

<Author>M. Esmaeilzadeh MD,* A. Tavakolli MD,** M. A. Yousefnia MD,***

and Safaei MD****</Author>

<CaseReport>Intravenous leiomyomatosis is a histologically benign smooth-muscle tumor arising from either a

uterine myoma or the walls of a uterine vessel with extension into veins. We describe

echocardiographic features of intravenous leiomyomatosis with spread into the right-sided cardiac

chambers. The patient was a middle-aged woman, with prior history of hysterectomy 2 years earlier

who presented with cardiac symptoms and signs. Echocardiographic features included: 1) elongated

mobile mass extending from the inferior vena cava, and 2) multiple masses in the right-heart

chambers (right atrium and ventricle).

Intracardiac leiomyomatosis should be considered in a female patient presenting with an extensive

mass in the right-sided cardiac chambers (Iranian Heart Journal 2006; 7 (4): 61-66).</CaseReport>

<Keywords>echocardiography, leiomyomatosis,cardiac tumor</Keywords>

</Abstract>

<Abstract>

<AbstractID>112</AbstractID>

<Title>Cardiac Echinococcosis: Surgical Treatment and

Results in 10 Cases</Title>

<Author>Rezayat Parvizi MD, Ahmad Reza Joudati MD, Vahid Montazeri MD,

Susan Hassanzadeh Salmasi PhD and Mojtaba Varshouchi, MD</Author>

<Background>Cardiac hydatid cyst is an uncommon disease, its prevalence being about 0.5 2%. 90%

of parasites which are digested orally are removed by the liver and lung, 10% enter the general

circulation and 1% enters the coronary arteries. Its cause is echinococcus, which is found in

animals such as sheep and dogs. The mortality rate of disease is 10.2%. The aim of this study

is to present the results of 10 cases with cardiac echinococcosis operated in Shaheed Madani

Heart Hospital in Tabriz.</Background>

<Method>From 1992 to 2004, ten cases of hydatid cyst of the heart underwent surgical excision. For

collecting data a questionnaire was used and statistical analysis was performed with SPSS

software and was done through descriptive statistical method.</Method>

<Result>There were 7 females and 3 males (F/M ratio = 2.3/1). The mean age of patients was 25.6

years old. All patients were operated through median sternotomy with CPB. Surgical treatment

included puncture of the cyst and sterilization with hypertonic saline solution and total cyst

extirpation. There was one perioperative mortality and one case with cerebral hydatid cyst one

year later. All patients received albendazole pre- and postoperatively.</Result>

<Conclusion>Surgical treatment of cardiac hydatid cyst is safe. It is recommended that patients

receive mebendazole or albendazole 30-40 mg/kg for 6-24 months postoperatively. Reduction

of serum levels or achievement of negative test results indicates positive therapeutic effects

(Iranian Heart Journal 2006; 7 (4): 67-71).</Conclusion>

<Keywords>hydatid cyst, cardiac tumor,cardiac surgery</Keywords>

</Abstract>

<Abstract>

<AbstractID>113</AbstractID>

<Title>Stent Implantation for Native and Recurrent Coarctation

of Aorta</Title>

<Author>H. Bassiri, MD and S. Abdi, MD</Author>

<Background>T</Background>

<Method>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.</Method>

<Result>The procedure was effective in all 19 cases. Immediately after stent implantation the mean

peak systolic gradient fell to 6±4 mmHg (P&lt; 0.001). Complications occurred in 2 patients

(stent migration in 1, edge dissection in another patient).</Result>

<Conclusion>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).</Conclusion>

<Keywords>coarctation of aorta, stent implantation, recurrent coarctation of aorta</Keywords>

</Abstract>

</Journal>