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<Journal>

<JournalID>11</JournalID>

<PubDate_Fa>Tabestan 1388</PubDate_Fa>

<PubDate_En>Summer 2009</PubDate_En>

<Volume>10</Volume>

<Number>2</Number>

<Abstract>

<AbstractID>62</AbstractID>

<Title>Echocardiographic Assessment of Ventricular

Dyssynchrony in Left Ventricular Systolic Dysfunction and

Valvular Heart Disease</Title>

<Author>Majid Kiavar MD, Fariba Bayat MD,

Anita Sadeghpour MD, FASE,

and Maryam Esmaeilzadeh, MD,

FCAPSC</Author>

<Background>Mechanical dyssynchrony is common in patients with heart failure and its presence predicts patient

response to cardiac resynchronization therapy (CRT).The quantification of left ventricular dyssynchrony using

tissue Doppler imaging (TDI) may improve the selection of these patients. We aimed to evaluate the prevalence

of dyssynchrony in patients with heart failure and valvular heart disease with either normal or prolonged QRS

durations.</Background>

<Method>Patients with left ventricular (LV) systolic dysfunction and significant organic valvular heart disease were

evaluated. Using conventional and tissue Doppler echocardiography, an interventricular mechanical delay &gt;40

ms was defined as significant interventricular dyssynchrony. Intraventricular dyssynchrony was evaluated using

the calculation of the septal-to-lateral wall delay, the SD of the time from the Q wave to the peak systolic wave

of 6 basal and 6 mid segments, and the maximum difference in the time from the Q wave to the peak systolic

wave of all 12 segments.</Method>

<Result>Forty-four patients (22 female, mean age 47 ± 15.2 years) were evaluated. Interventricular dyssynchrony was

present in 12 (27%) patients. Intraventricular dyssynchrony was present in 17 (39%) to 19 (43%) patients,

depending on the method used. Interventricular and intraventricular mechanical dyssynchrony had a significant

association with LV volume and QRS duration (independent of the type of valvular heart disease). We found

almost perfect agreement between maximum difference and total dyssynchrony index (kappa = 0.91), and the

overall agreement among septum-to-lateral delay, maximum difference, and total dyssynchrony index was good

(kappa = 0.72).</Result>

<Conclusion>Although ventricular dyssynchrony in patients with valvular heart disease and LV dysfunction is not

highly prevalent, it has a significant association with QRS duration and LV size (Iranian Heart Journal

2009; 10 (2):5-14).</Conclusion>

<Keywords>echocardiography, dyssynchrony, valvular heart disease</Keywords>

</Abstract>

<Abstract>

<AbstractID>63</AbstractID>

<Title>Evaluation of Mechanical Dyssynchrony in Idiopathic

Dilated Cardiomyopathy versus Non-compaction of Left

Ventricle</Title>

<Author>Maryam Moshkani Farahani MD, Maryam Esmaeilzadeh MD, FCAPSC,

Zahra Ojaghi Haghighi MD, Anita Sadeghpour MD, FASE, and Niloufar Samiei, MD</Author>

<Background>Left ventricular non-compaction (LVNC) is a reportedly uncommon genetic disorder of endocardial

morphogenesis and is being increasingly recognized. The purpose of this study was to evaluate the

echocardiographic features, including mechanical dyssynchrony indices of patients with LVNC versus idiopathic

dilated cardiomyopathy (IDC).</Background>

<Method>Between December 2004 and February 2006, we evaluated 116 patients with dilated cardiomyopathy

candidated for cardiac resynchronization therapy (CRT) at our institution. The patients were divided into LVNC

and IDC without LVNC groups, according to the diagnostic criteria for LVNC. Transthoracic echocardiography

was done for all the patients, and pre-ejection periods as well as inter- and intra-ventricular delays were measured

and the asynchrony index was calculated.</Method>

<Result>Seventy-seven patients were male. LVNC was diagnosed in 23% of the patients. There was no significant

difference in the patients  age and mean age of the patients (46±16.5 years in LVNC vs. 51.13±16.43 years in

IDC). Mean left ventricular ejection fraction in the LVNC group was 16.65%±6.6% and in the IDC group it was

18.91%±7.2%; mean age in the LVNC group was 46±16.5 years and 51.13±16.43 years in the IDC group, with

no significant difference between the two groups.</Result>

<Conclusion>LVNC is increasingly being reported and has become an important differential diagnosis in heart failure

patients. Our study showed that there was no significant difference in the mechanical dyssynchrony indices

between the two groups (Iranian Heart Journal 2009; 10 (2):15-19).</Conclusion>

<Keywords>ventricular non-compaction, cardiomyopathy, ventricular dyssynchrony</Keywords>

</Abstract>

<Abstract>

<AbstractID>64</AbstractID>

<Title>Detection of Non-obstructive Prosthetic Valve Thrombosis:

Clinical Significance and Associations</Title>

<Author>Hussein Ali Bassiri MD, Najmeh Reshadati MD, Anita Sadeghpour MD, FASE,

Majid Kiavar MD and Jafar Hashemi MD</Author>

<Background>The purpose of this study was to determine how frequently prosthetic valve nonobstructive

thrombosis is associated with prosthetic mitral and aortic valves and to assess their

correlation with the anticoagulant status and symptoms of patients.</Background>

<Method>From January 2006 to April 2007, all the patients with prosthetic heart valves who were

referred for clinically-indicated transesophageal echocardiography (TEE) were evaluated for

the presence of non-obstructive thrombosis. Clinical information was collected through patient

interviews. Non-obstructive thrombosis was defined as a distinct mass (more than 1 mm in

width and 2 - 15 mm in length) with abnormal echoes attached to the normally functioning

prosthesis and clearly seen throughout the cardiac cycle via two-dimensional, Doppler, and

cinefluoroscopy studies. Masses were classified according to their size as small (&lt;5 mm),

moderate (5-10 mm), and large (&gt;10 mm).</Method>

<Result>The study recruited 102 consecutive patients (64 female) with a mean age of 51 ±11.4

years with non-obstructive thrombosis. There were 132 prosthetic valves (PVs), of which 94

were prosthetic mitral valves (PMVs) and 38 were prosthetic aortic valves (PAVs). The mean

time between surgery and TEE examination (age of the prosthesis) was 12 ± 7 years. INR

value was less than 1.5 in 50 (49%) cases, between 1.5   2.5 in 42 (41.2%) patients, and more

than 2.5 in 10 (9.8%). Additionally, 34 (33.3%) patients had recent systemic emboli, 32

(31.9%) had exacerbation of dyspnea, and 14 (13.7%) were asymptomatic.</Result>

<Conclusion>Sub-therapeutic anticoagulation (INR values &lt; 2.5), systemic emboli, and dyspnea

are the key factors for the detection of non-obstructive thrombosis. Moreover, TEE is

particularly useful when the thrombus is not visualized by TTE (Iranian Heart Journal 2009;

10 (2):20-24).</Conclusion>

<Keywords>heart valve prosthesis, echocardiography, thrombosis</Keywords>

</Abstract>

<Abstract>

<AbstractID>65</AbstractID>

<Title>Doppler Echocardiographic Evaluation of Patients after

Aortic Coarctation Repair</Title>

<Author>Majid Kiavar MD, Anita Sadeghpour MD, FASE, Farshid Sharifi MD,

and Mahmood Meraji MD</Author>

<Background>We aimed to evaluate the accuracy of Doppler echocardiography indices in patients with

significant recoarctation of the aorta (ReCoA).</Background>

<Method>Thirty-nine consecutive patients (11 females) post-surgical repair of aortic coarctation

were included in the study. All the patients underwent complete Doppler echocardiography

and clinical evaluation and peak systolic instantaneous pressure gradient (PPG), mean

pressure gradient, velocity time integral (VTI) in the descending thoracic aorta, acceleration

time (AT), ejection time (ET), and AT/ET of the coarctation repair site were measured. All the patients underwent CT angiography; and in case of significant ReCoA, cardiac

catheterization was done.</Method>

<Result>Measured values of ET, AT, AT/ET, and VTI at the repair site and VTI in the descending

thoracic aorta were significantly greater in the patients with ReCoA. The average difference

between the echocardiographic and angiographic systolic PPG was 16 mmHg. The presence

of Doppler PPG greater than 35 mmHg, VTI in the descending thoracic aorta more than 40cm,

and AT at the repair site of more than 135 msec had high sensitivity and specificity for the diagnosis of significant ReCoA. Five (0.42) patients with recoarctation had significant

hypertension; compared to 7 (0.26) patients without recoarctation (P-value =0.32).</Result>

<Conclusion>After coarctation repair, Doppler PPG should be interpreted with caution but

considering other Doppler indices, Doppler echocardiography is a practical and accurate

screening method for an evaluation of significant ReCoA, with a low threshold for invasive of

aorta investigation if the Doppler PPG in the descending aorta exceeds 35mmHg (Iranian

Heart Journal 2009; 10 (2):25-30).</Conclusion>

<Keywords>Doppler, echocardiography, coarctation</Keywords>

</Abstract>

<Abstract>

<AbstractID>66</AbstractID>

<Title>A Case with Wrong Anastomosis of Left Internal Mammary

Artery to Great Cardiac Vein</Title>

<Author>M. H. Nezafati MD, M. Abbasi MD and G. Soltani MD</Author>

<CaseReport>Visually distinguishing artery from vein during coronary artery bypass grafting (CABG) can be occasionally

challenging and may result in errors in anastomosis. We report an unusual case of on-pump CABG surgery in which the

left internal mammary artery (LIMA) was anastomosed to an epicardial vein instead of the left anterior descending

(LAD) coronary artery erroneously (Iranian Heart Journal 2009; 10 (2):31-33).</CaseReport>

<Background>internal mammary artery, cardiac vein anastomosis error, coronary artery bypass graft</Background>

</Abstract>

<Abstract>

<AbstractID>67</AbstractID>

<Title>Experience with the Impella® 2.5 in a Patient with

Refractory Pulmonary Edema after Myocardial Infarction</Title>

<Author>H. R. Sanati MD, M. Kiavar MD, S. Abdi MD, M. Maadani MD, and A. Amin MD</Author>

<CaseReport>The Impella®2.5 is a percutaneously placed, left ventricular assist device which provides up to 2.5

liters per minute of flow from the left ventricular cavity directly into the ascending aorta. The 12 Fr.

pump is mounted on the distal end of a 9 Fr. catheter and connected to a mobile console.

We report a patient undergoing temporary left ventricular support with an Impella ®2.5 for the

treatment of refractory pulmonary edema and severe left ventricular dysfunction following

extensive myocardial infarction (Iranian Heart Journal 2009; 10 (2):34-36).</CaseReport>

<Keywords> ventricular assist device, pulmonary edema, myocardial infarction</Keywords>

</Abstract>

<Abstract>

<AbstractID>68</AbstractID>

<Title>Life-Saving PCI Leading to Successful CPR</Title>

<Author>M. Momtahen MD, S. Abdi MD, and H.R. Sanati MD</Author>

<CaseReport>Effective cardiopulmonary resuscitation (CPR) can sufficiently preserve vital organs even during

prolonged cardiac arrest. In the setting of acute myocardial infarction, accurate and wise strategy,

including primary percutaneous coronary intervention (PCI) of the culprit lesion can be life-saving, even

if complicated by prolonged cardiac arrest unresponsive to CPR.

We describe the case of a 53-year-old man who was successfully managed after prolonged refractory

cardiac arrest following acute myocardial infarction (Iranian Heart Journal 2009; 10 (2):37-39).</CaseReport>

<Keywords>cardiopulmonary arrest, primary percutaneous coronary intervention, cardiopulmonary resuscitation</Keywords>

</Abstract>

<Abstract>

<AbstractID>69</AbstractID>

<Title>Non-Compaction of the Ventricular Myocardium

Associated with Aortic Aneurysm and Severe Aortic

Insufficiency: Initial Description in Two Cases</Title>

<Author>Maryam Esmaeilzadeh MD, Maryam Moshkani Farahani MD, Firuzeh Abtahi MD,

Mahmoud Momtahen MD, and Mohammad Bagher Tabatabaei MD</Author>

<CaseReport>Left ventricular hyper-trabeculation (LVHT), also known as left ventricular non-compaction (LVNC), is a rare

myocardial abnormality of the apex and is characterized by multiple, myocardial cotyledon-like protrusions and

interwoven strings, all lined by the endocardium. It may occur without any other cardiac abnormality (isolated LVNC)

or may be associated with congenital cardiac malformations. In three quarters of cases, LVHT is associated with

neuromuscular disorders. LVHT usually is congenital, but it was found to also develop later in life (acquired LVHT).

We report two cases of aortic aneurysm and severe aortic insufficiency with incidentally-diagnosed LVNC. To the best

of our knowledge, there has been no previous report of LVNC associated with aortic aneurysm and/or aortic

insufficiency (Iranian Heart Journal 2009; 10 (2):40-44).</CaseReport>

<Keywords>left ventricle myocardium, non-compaction, heart failure, aortic aneurysm, aortic insufficiency</Keywords>

</Abstract>

</Journal>