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<Journal>

<JournalID>3</JournalID>

<PubDate_Fa>Zemestan 1387</PubDate_Fa>

<PubDate_En>Winter 2008</PubDate_En>

<Volume>9</Volume>

<Number>4</Number>

<Abstract>

<AbstractID>1</AbstractID>

<Title>Procedural Success of Percutaneous Coronary Intervention

in Complete Versus Functional Coronary Occlusion:

A Single-Center, Single-Operator Experience</Title>

<Author>Amir Farhang Zand Parsa, MD</Author>

<Background>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.</Background>

<Method>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.</Method>

<Result>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).</Result>

<Conclusion>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).</Conclusion>

<Keywords>coronary artery disease, total occlusion, percutaneous coronary intervention, TIMI

flow grade</Keywords>

</Abstract>

<Abstract>

<AbstractID>2</AbstractID>

<Title>In-Hospital Outcome of Percutaneous Coronary

Interventions in Patients with Left Ventricular Systolic

Dysfunction</Title>

<Author>A.Yousefi MD, H. R. Sanati MD, N. Salehi MD, M. Maadani MD,

F. Shakerian MD, A. Firoozi MD and M. Esmaieli MD</Author>

<Background>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.</Background>

<Method>Four hundred consecutive patients with documented obstructive CAD and left ventricular

systolic dysfunction (EF &lt;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).</Method>

<Result>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.</Result>

<Conclusion>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).</Conclusion>

<Keywords>coronary artery disease, left ventricular dysfunction, percutaneous coronary intervention</Keywords>

</Abstract>

<Abstract>

<AbstractID>3</AbstractID>

<Title>Incidence of Myocardial Infarction after

Open Heart Surgery</Title>

<Author>F. Noohi MD, M. Shojaeifard MD, G. Omrani MD*, F. Shojaeifard MD and

H. Dehghani MD</Author>

<Background>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.</Background>

<Method>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.</Method>

<Result>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&lt;0.05).</Result>

<Conclusion>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).</Conclusion>

<Keywords>myocardial infarction, cardiac surgery, regional wall motion abnormality</Keywords>

</Abstract>

<Abstract>

<AbstractID>4</AbstractID>

<Title>Frequency and Associations of Prosthetic Valve Fibrin

Strands</Title>

<Author>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</Author>

<Background>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.</Background>

<Method>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).</Method>

<Result>FSs were found in 141 (47%) patients. Significant associations were observed between the

presence of FSs and anticoagulant status (P-value &lt; 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.</Result>

<Conclusion>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).</Conclusion>

<Keywords>echocardiography, fibrin strands, heart valves, bioprosthesis, mechanical</Keywords>

</Abstract>

<Abstract>

<AbstractID>5</AbstractID>

<Title>Evaluation of Exercise, Occupational and Leisure-Time

Activities in Outpatient Heart Clinics</Title>

<Author>Sepideh Sokhanvar MD, S. Nouraddin Mousavinasab PhD* and

Mahmoud Hakami PhD**</Author>

<Background>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.</Background>

<Method>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.</Method>

<Result>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.</Result>

<Conclusion>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).</Conclusion>

<Keywords>physical activity, occupational activity, leisure-time activity, heart disease</Keywords>

</Abstract>

<Abstract>

<AbstractID>6</AbstractID>

<Title>CD 28 Gene Polymorphism is not Associated with

Susceptibility to Coronary Artery Disease</Title>

<Author>Mohsen Maadani MD, Behshad Naghsh Tabrizi MD,* Mehrdad Hajilooi MD,*

Mohammadali Seif Rabiee MD,* Ali Zahedmehr MD* and Roya Amiraslani MD*</Author>

<Background>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.</Background>

<Method>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).</Method>

<Result>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.</Result>

<Conclusion>We concluded that CD 28 gene polymorphism was not associated with CAD (Iranian Heart Journal

2008; 9 (4):38-41).</Conclusion>

<Keywords>coronary artery disease, genes, polymorphis</Keywords>

</Abstract>

<Abstract>

<AbstractID>7</AbstractID>

<Title>False Aneurysm (Pseudoaneurysm) of Lateral

Ventricular Wall</Title>

<Author>M. Chinikar MD*, A. M. Sadeghi Meybodi MD**, and F. Hoseini MD***</Author>

<CaseReport>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).</CaseReport>

<Keywords>aneurysm, myocardial infarction, ventricle, left</Keywords>

</Abstract>

<Abstract>

<AbstractID>8</AbstractID>

<Title>Primary Cardiac Lymphoma in a 62-Year-Old Man</Title>

<Author>Kambiz Mozaffari MD*, Faranak Kargar MD and Hossein Azami MD</Author>

<CaseReport>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).</CaseReport>

<Keywords>cardiac tumors, lymphoma, B-cell type</Keywords>

</Abstract>

<Abstract>

<AbstractID>9</AbstractID>

<Title>Right Ventricular Extension of Wilms  Tumor</Title>

<Author>M. Golmohamadi MD and H. Mehdizadeh MD</Author>

<CaseReport>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).</CaseReport>

<Keywords>cardiac tumors, echocardiography, cardiopulmonary bypass</Keywords>

</Abstract>

</Journal>