3 Zemestan 1387 Winter 2008 9 4 1 Amir Farhang Zand Parsa, MD Chronic total occlusion (CTO) of the coronary arteries includes a wide spectrum of lesions with a TIMI flow grade of 0 to 1 and more than four weeks’ duration. The procedural success rate of percutaneous coronary intervention (PCI) in CTO not only depends on the anatomy and morphology of the lesion but also, and most importantly, on the angiographic TIMI flow grade of the lesion. The aim of this study was to show the procedural success rate of PCI for different subtypes of CTO, according to the angiographic TIMI flow grade of lesions. From March 2000 to March 2001, PCI was performed in 60 cases with at least one CTO lesion. Forty-six of the patients were male (76.66%), and their mean (±SD) age was 53.3 (±10.37) years (range 35-72 years). Among these cases, 31 (51.66%) had complete total occlusion (TIMI flow grade 0) and were designated as Group I, and 29 (48.33%) had functional total occlusion (TIMI flow grade I) and were designated as Group II. The procedural success rate in complete total occlusion (Group I) was 64.5% and in functional total occlusion (Group II) was 96.6% (P=0.002, CI=95%). The total success rate was 80% (n=48) without any major procedural complications (MI, urgent CABG, or death). Although there are a few predictors for procedural success for PCI in CTO lesions, it seems that the TIMI flow grade (0 or 1) of the lesion is the most important and independent predictor for procedural success (procedural success was defined as final residual stenosis less than 50% with balloons and less than 20% with stents on visual assessment, and the absence of major complications (Iranian Heart Journal 2008; 9 (4): 6 -12). coronary artery disease ■ total occlusion ■ percutaneous coronary intervention ■ TIMI flow grade 2 A.Yousefi MD, H. R. Sanati MD, N. Salehi MD, M. Maadani MD, F. Shakerian MD, A. Firoozi MD and M. Esmaieli MD Left ventricular dysfunction is considered a high-risk condition for performing either percutaneous or surgical revascularization. The aim of this study was to evaluate immediate procedural and clinical outcomes and in-hospital complications of percutaneous coronary interventions (PCI) in patients with coronary artery disease (CAD) and ventricular systolic dysfunction. Four hundred consecutive patients with documented obstructive CAD and left ventricular systolic dysfunction (EF <45%) were selected. Left ventricular ejection fraction was assessed via transthoracic echocardiography at the time of hospitalization. Indications for PCI were made on the basis of clinical and non-invasive studies. The majority of the patients (75%) were males, and their mean age was 55.9±10.7 years. More than half of the patients (56.78%) had multi-vessel disease. Multi-vessel PCI was performed in 51 (12.85%) patients. A total of 397 stents were implanted (0.99 stent/patient). Technical procedural success was obtained in 96.75% of the patients. Procedural death was not seen. Non-Q wave acute myocardial infarction occurred in 12 (3%) patients, Q-wave AMI in four (1%), emergency coronary artery bypass grafting in six (1.5%), and cardiogenic shock in three (0.75%). Stroke did not occur in any cases. Major bleeding occurred in one (0.25%) patient, and 4.2% of the patients experienced minor bleeding. In patients with CAD and left ventricular systolic dysfunction, PCI can be performed with a good procedural outcome and acceptable in-hospital complications (Iranian Heart Journal 2008; 9 (4):13-18). coronary artery disease ■ left ventricular dysfunction ■ percutaneous coronary intervention 3 F. Noohi MD, M. Shojaeifard MD, G. Omrani MD*, F. Shojaeifard MD and H. Dehghani MD One of the most common surgical procedures performed today is open heart surgery, and with it comes complications. One of these complications is post-operative myocardial infarction (MI), and others are post-operative stroke, neurological problems, wound infection, respiratory complications, etc. This prospective study included 424 patients who underwent open heart surgery at our center between November 2005 and May 2006. All relevant clinical, electrocardiographic, echocardiographic, and laboratory data were gathered in all the patients, and the patients were observed for the development of MI after surgery. Post-operative MI occurred in 45 (10.8%) patients. By the univariate analysis, systemic hypertension, on-pump surgery, and increased serum levels of LDL cholesterol and triglycerides (TG) were significantly associated with the occurrence of post-operative MI (all P-values<0.05). The results of the present study demonstrated that systemic hypertension, on-pump surgery, and serum levels of LDL and TG were related to post-operative MI. Therefore, clinical data, laboratory data, ECG, and echocardiography may be useful in the risk stratification of high-risk patients for the occurrence of post-operative MI (Iranian Heart Journal 2008; 9 (4):19-22). myocardial infarction ■ cardiac surgery ■ regional wall motion abnormality 4 Anita Sadeghpour* MD, FASE, Majid Kiavar MD, Parisa Tayyebi MD, Hussein Ali Bassiri MD, Feridoun Noohi MD, FACC, Majid Maleki MD, FACC, Maryam Esmaielzadeh* MD, FCAPSC, Ahmad Mohebbi MD, Niloofar Samiei* MD, Zahra Ojaghi* MD and Hooman Bakhshandeh MD, PhD Filamentous fibrin strands (FSs) attached to valve prostheses have been well described in patients undergoing transesophageal echocardiography (TEE), but the frequency and clinical significance of these strands remain poorly defined. We aimed to determine the frequency of prosthetic valve strands and to assess their association with anticoagulant status, location, type, and number of prosthetic heart valves. In total, 300 consecutive patients with prosthetic heart valves, who were referred for clinically indicated TEE, were evaluated for the presence of FSs (defined as highly mobile, fine, filamentous masses with less than 1 mm thickness). FSs were found in 141 (47%) patients. Significant associations were observed between the presence of FSs and anticoagulant status (P-value < 0.001). The location and number of the prosthetic valves had no statistically significant associations with the strands. The FSs were found more frequently on mechanical than on bioprosthetic valves (P-value = 0.004). A logistic regression model showed that greater values of international normalized ratio, bioprosthetic valves, and daily intake of ASA, had negative associations with the strands. There were significant associations between FSs and patients’ anticoagulation status; we would, therefore, suggest intense anticoagulation and close follow-up for these patients (Iranian Heart Journal 2008; 9 (4):23-31). echocardiography ■ fibrin strands ■ heart valves■ bioprosthesis■ mechanical 5 Sepideh Sokhanvar MD, S. Nouraddin Mousavinasab PhD* and Mahmoud Hakami PhD** Physical inactivity has been recognized as one of the main risk factors for coronary heart diseases. This study analyzed occupational, commuting, and leisure-time physical activity in outpatients who referred to heart clinics. This is a descriptive study that evaluated 499 outpatients of heart clinics in 2003-2004. Occupational, commuting, and leisure-time physical activities were assessed based on questionnaire data, the validity and reliability of which had already been confirmed. The statistical package (SPSS) for Windows was used for statistical analysis. In this study, 59% of the individuals who were unemployed and retired had coronary artery disease. Also, 38% of the individuals who were spending leisure time in the sitting and sleeping positions had coronary disease and 23% of this group had hypertension. Moreover, 48% of the outpatients did not have proper morning exercise, and 98% of this group did not have informal exercise with supervision and also 67% did not have informal exercise. According to this study, occupational, commuting, and leisure-time physical activities of outpatients in heart clinics were low. Thus, encouraging physical activities should be on the top of the public health programs priorities (Iranian Heart Journal 2008; 9 (4):32-37). physical activity ■ occupational activity ■ leisure-time activity ■ heart disease 6 Mohsen Maadani MD, Behshad Naghsh Tabrizi MD,* Mehrdad Hajilooi MD,* Mohammadali Seif Rabiee MD,* Ali Zahedmehr MD* and Roya Amiraslani MD* Coronary artery disease (CAD) is one of the most common health problems facing health care services in all societies. Despite the established significance of the classic risk factors for CAD, a large number of patients present without them. It has recently been identified that elevated inflammatory markers and involved immunological mechanisms are associated with atherosclerosis. CD 28 is the main co-stimulatory receptor for secondary signals delivering for T-cell activation. The aim of this study was to evaluate the polymorphism of CD 28 gene as a probable risk factor for CAD. In total, 200 patients were classified into two equal groups: control group including persons with normal coronary arteries and case group who had at least single-vessel coronary disease. CAD was confirmed in the studied patients by coronary angiography. CD 28 genotype was analyzed via polymerase chain reaction (PCR). The frequencies of C and T alleles were 71% and 29% in the control group and 70.5% and 29.5% in the case group, respectively. There was no significant difference in the allele frequencies between the two groups. We concluded that CD 28 gene polymorphism was not associated with CAD (Iranian Heart Journal 2008; 9 (4):38-41). coronary artery disease ■ genes ■ polymorphis 7 M. Chinikar MD*, A. M. Sadeghi Meybodi MD**, and F. Hoseini MD*** Pseudoaneurysms of the left ventricle are a rare complication that may occur after myocardial infarction (MI), cardiac surgery, and trauma. Available data indicate that the most common presentation is by an incidental finding. This case of post-MI pseudoaneurysm presented herein was discovered by left ventriculography after two months following MI (Iranian Heart Journal 2008; 9 (4):42 -46). aneurysm ■ myocardial infarction ■ ventricle, left 8 Kambiz Mozaffari MD*, Faranak Kargar MD and Hossein Azami MD A 62-year-old man was referred to our hospital with dyspnea. Preliminary studies revealed multiple masses in the right ventricle, epicardium, and pericardium; no lymphadenopathy or organomegaly was, however, detected. The patient underwent a surgical operation with the diagnosis of a cardiac mass. Multiple, firm, whitish-yellow nodules with extension to the epicardial fat were excised, and the defect was repaired with an extensive pericardial patch. The myocardium was infiltrated by discohesive sheets of malignant round cells that had a high nucleocytoplasmic (N/C) ratio, scanty cytoplasm, and a coarse chromatin pattern. The diagnosis was further confirmed by a panel of immunohistochemistry markers; the neoplastic cells were positive for CD 45 and CD 20. Primary lymphomas originating from the heart and pericardium are extremely rare and constitute only 1.6 percent of cardiac neoplasms. They arise mainly from the right chambers and may be of low, intermediate, or high grade. The majority are of B-cell nature. No association with viruses has been established. Cytology is diagnostic in the effusions of the pericardium. Unfortunately, prognosis is grim due to delayed diagnosis (Iranian Heart Journal 2008; 9 (4): 47- 49). cardiac tumors ■ lymphoma ■ B-cell type 9 M. Golmohamadi MD and H. Mehdizadeh MD Wilms’ tumor is the most common pediatric renal tumor, but cardiac metastases from this tumor are rare. An 8-year–old boy presented with hematuria and lower extremity pain. Computed tomography revealed a left renal mass. In addition, pre-operative echocardiography revealed a large homogenous mass in the right atrium, extending from the inferior vena cava and protruding through the tricuspid valve into the right ventricle. The patient underwent combined radical nephrectomy and removal of the mass from the inferior vena cava and right heart chambers, followed by immunotherapy. Pathology confirmed undifferentiated Wilms’ tumor in both the left kidney and the right heart chambers. The extension of Wilms’ tumor to the great vessels and the heart chambers indirectly affects the final outcome. It seems in most cases, combination surgery and chemotherapy is the choice method of treatment, and the selection of chemotherapy or surgery as the primary line of treatment depends on tumor thrombus extension and the patient’s condition at the time of diagnosis (Iranian Heart Journal 2008; 9 (4): 50 -53). cardiac tumors ■ echocardiography■ cardiopulmonary bypass