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<Journal>

<JournalID>25</JournalID>

<PubDate_Fa>Tabestan 1390</PubDate_Fa>

<PubDate_En>Summer 2011</PubDate_En>

<Volume>12</Volume>

<Number>2</Number>

<Abstract>

<AbstractID>241</AbstractID>

<Title>Right Ventricular Dysfunction in Thiamine-Responsive

Megaloblastic Anemia Syndrome: A Case Report</Title>

<Author>Sedigheh Saedi MD ¹, Majid Maleki MD, FACC ² and Sepideh Pezeshki MD ³</Author>

<CaseReport>Thiamine or Vitamin B1 is an essential cofactor for many metabolic processes in numerous tissues.

Thiamine-Responsive Megaloblastic Anemia Syndrome is a genetic disorder affecting thiamine

transportation with consequent bone marrow, pancreatic, neurological, and cardiac functional and

developmental anomalies. There are limited reports of the cardiac manifestations of this syndrome.

Here, we present a case of this syndrome in a male patient with right ventricular dysfunction and

atrial dysrhythmias (Iranian Heart Journal 2011; 12 (2):6-9).</CaseReport>

<Keywords>Thiamine  %Responsive Megaloblastic Anemia Syndrome  % Right Ventricular Dysfunction</Keywords>

</Abstract>

<Abstract>

<AbstractID>242</AbstractID>

<Title>Assessment of Statistical Relationship of Ejection Time and

Acceleration Time with the Severity of Valvular Aortic

stenosis</Title>

<Author>N. Samiei MD,¹* D. Hajihoseini MD,² M. Esmaeilzadeh MD,³ ZM. Ojaghi Haghighi

MD, A. Sadeghpour MD, A. Tabib MD,¹ M. Parsaei MD, M. Shojaei Fard MD,¹

F. Noohi MD, FESC, FACC, Y. Mirmesdagh MD</Author>

<CaseReport>Valvular aortic stenosis is a relatively common disease among valvular heart diseases and can be rheumatic,

degenerative or congenital. Evaluation of the severity of the disease is sometimes challenging and problematic. Besides,

the use of more parameters of non-invasive methods for the assessment of valvular disease and its severity seems

attractive and helpful. Transthoracic echocardiography (TTE) is an appropriate modality for the evaluation of the aortic

valve.

In this study, TTE was performed for 80 patients with valvular aortic stenosis. The goals were to assess the statistical

relationships between ejection time (ET) and acceleration time (AT) and their ratio (AT/ET) with the four traditional

parameters of the echocardiographic severity of aortic valvular stenosis (aortic jet velocity, aortic valve area, mean

pressure gradient and LVOT VTI/aortic VTI ratio). There was a meaningful relationship between adjusted ET with the

four above-mentioned parameters. d. ET (ET-adjusted ET according to heart rate and stroke volume) was inversely

related with the aortic valve area (calculated with continuity equation).

AT/ET was significantly correlated with the four mentioned parameters. The regression equations were calculated. The

cut-off value of AT/ET for the echocardiographic diagnosis of severe valvular stenosis was 0.36 (with 95% level of

confidence) (Iranian Heart Journal 2011; 12 (2):10-15).</CaseReport>

<Keywords>Valvular aortic stenosis %Ejection time % Acceleration time % Echocardiography</Keywords>

</Abstract>

<Abstract>

<AbstractID>243</AbstractID>

<Title>Percutaneous Mitral Balloon Valvotomy; Single Center

Experience: A Review of Outcome</Title>

<Author>Feridoun Noohi MD, FESC, FACC 1; Hosseinali Bassiri MD2; Bahram Mohebbi

MD3; Golchehreh Alinaghimadah MD4; Mahdokht Rezaei MD4; Ahmad Mohebbi

MD FASC, FACC 1; Majid Kiavar MD FACC 2; S. Zahra Ojaghi Haghighi FACC,

MD 2; Maryam Esmaeilzadeh MD FACC, FCAPSC 2; Anita Sadeghpour MD FASE,

FACC2; Niloufar Samiei MD5, Hooman Bakhshandeh MD PhD 6</Author>

<Background>Percutaneous balloon mitral valvotomy (BMV) has been accepted as an alternative to

surgical mitral commissurotomy in the treatment of patients with symptomatic rheumatic

mitral stenosis. Despite the worldwide use of the BMV technique, no studies have been

hitherto designed to assess the outcome of the patients undergoing BMV in Iran. The present

study reports the outcome of 3138 BMV procedures at Shaheed Rajaei Cardiovascular,

Medical and Research Center during a 15-year time period.</Background>

<Methods>A total of 2531 patients underwent 3138 BMV procedures at Shaheed Rajaei

Cardiovascular, Medical and Research Center between 1992 and 2006. Seventy-three percent

(2278) of the cases were followed for 48±41 months.</Methods>

<Results>Recurrent stenosis in 802 (25.8%), mitral valve replacement (MVR) in 213 (6.9%),

immediate good result in 3110 (99.1%), and successful outcome in 2000 (72.9%) cases were

the outcome of the BMV procedures in the current study.</Results>

<Conclusions>Concordant to the similar studies, we concluded that BMV produces a good clinical

outcome in a high percentage of patients. The recent study demonstrated that the successful

outcome of BMV was multi factorial and the selection of patients with rheumatic mitral

stenosis is recommended to be based on both anatomic and clinical characteristics of the

individuals. The procedure-related variables must also be considered in order to predict the

outcome (Iranian Heart Journal 2011; 12 (2):16-22).</Conclusions>

<Keywords>Percutaneous % Balloon Mitral Valvotomy % Outcome</Keywords>

</Abstract>

<Abstract>

<AbstractID>244</AbstractID>

<Title>Fragmented QRS Complex in Acute Anterior Myocardial

Infarction and Coronary Sinus Blood Flow: Is There any

Relevance?</Title>

<Author>Azin Alizadeh Asl MD1; Bahram Mohebbi MD 2; Mehrnoush Toufan MD 3;

Maryam Esmaeilzadeh MD, FACC, FCAPSC, 4 Ali Hosseinsabet MD 2, Rasoul

Azarfarin MD5, Arash Hashemi MD</Author>

<Background>Patients with QRS fragmentation following myocardial infarction (MI) are at greater risk

of cardiac death. Transthoracic echocardiography (TTE) can be used as a method for evaluating

the coronary sinus blood flow (CSBF) and coronary sinus velocity time integral (CSVTI). The

present study reports measurement of CSBF and CSVTI by TTE in 100 acute anterior MI cases,

half of them with fragmented QRS.</Background>

<Methods>Our study included 100 patients with acute anterior MI in whom CSBF and CSVTI were

measured by the use of TTE. Fifty of all the patients had fragmented QRS complex and 50

patients were without fragmented QRS complex, while there was no difference in terms of LVEF

in both groups of study.</Methods>

<Results>CSBF (303 ±126 ml/min vs. 258 ± 121 ml/min; p=0.001) and CSVTI (14.45 ± 2.85 ml

vs.10.85 ±2.69 ml; p=0.003) were significantly lower in the acute anterior MI patients with

fragmented QRS in comparison with the patients with acute anterior MI without fragmented QRS.</Results>

<Conclusions>We conclude that CSBF and CSVTI can be measured by TTE in acute MI patients and

these variables are reduced in acute anterior MI patients with fragmented QRS(Iranian Heart

Journal 2011; 12 (2):23-25).</Conclusions>

<Keywords>Coronary Sinus Blood Flow % Fragmented QRS % Myocardial Infarction</Keywords>

</Abstract>

<Abstract>

<AbstractID>245</AbstractID>

<Title>Echocardiographic Assessment of Adults with Repaired

Tetralogy of Fallot: A Cardiovascular Magnetic

Resonance Comparison Study</Title>

<Author>Majid Kyavar1 MD, FACC, Anita Sadeghpour MD, FASE2*, FACC, Shabnam

Madadi1 MD , Leili Ebrahimi2 MD, Zahra Alizadeh Sani1 MD, Hooman

Bakhshandeh3 MD.</Author>

<Background>Surgical management of the tetralogy of Fallot (TOF) results in anatomic and functional abnormalities in

the majority of patients. Right ventricular (RV) dilation from pulmonary regurgitation (PR), residual atrial and/or

ventricular septal defect, tricuspid regurgitation, right ventricular outflow tract (RVOT) aneurysm, and

pulmonary artery peripheral stenosis are some of the abnormalities frequently encountered in patients with

repaired TOF. Cardiovascular magnetic resonance (CMR) can provide assessments of anatomical connections,

biventricular function, flow measurement, and more, without ionizing radiation. Echocardiography is the most

frequently used modality for the initial assessment and follow-up of most patients with CHD. We sought to

evaluate adult patients with repaired TOF by transthoracic echocardiography and compare them with CMR.</Background>

<Methods>156 patients (52 women, mean age= 23 ± 5.5 years) late after TOF repair with severe PR were evaluated.

Ventricular size and function and TOF -associated anomalies such as patent ductus arteriosus ( PDA),

peripheral pulmonary stenosis ( PPS), and persistent left superior vena cava ( LSVC) were evaluated by

transthoracic echocardiography and CMR separately.</Methods>

<Results>Mean of LV ejection fraction by CMR was 52 ± 9 % and by echocardiography was 47 ± 5.1 %. We found a

significant correlation between LVEF assessed by CMR and 2D visual assessment in multiple views. Mean of

RVEF by CMR was 37± 8 % and RV end diastolic volume index was 161± 57.3 mm3. Linear correlation

between CMR-RVEF and RVEF measured by echocardiography was weak. There was almost perfect agreement

between CMR and echocardiography for the diagnosis of LSVC (99.2%). Agreement was 88.3% in the diagnosis

of PDA, 66.4% in the diagnosis of PPS, and 93% in the diagnosis of the right aortic arch was.</Results>

<Conclusions>Adults late after repaired TOF have significantly reduced biventricular systolic function. Despite abnormal

LV geometry, visual assessment of LV systolic function by an expert echocardiologist has an acceptable

agreement compared to the quantitative measurement of LV systolic function by CMR. However, the correlation

between CMR-RVEF and RVEF measured by echocardiography is weak. We found incremental diagnostic value

of CMR in PPS and PDA. Atrial septal defect and ventricular septal defect are found more frequently by

echocardiography(Iranian Heart Journal 2011; 12 (2):26-33).</Conclusions>

</Abstract>

<Abstract>

<AbstractID>246</AbstractID>

<Title>Association between Periodontal Pathogens and Coronary

Artery Disease: A Case-Control Study</Title>

<Author>Mohammadreza Talebi Ardakani1, Farhad Sobouti2, Alireza Alizadeh Ghavidel3,

Maziar Gholampour Dehaki4, Mahsa Shariati5, Bahram Kazemi6</Author>

<Background>We sought to answer the questions about the role of inflammatory factors in the

formation of pathological lesions in the endothelium of the coronary vessels and also the role of hostbased bacteria, including chronic periodontitis, in the clot formation in the blood vessels, all of which

destabilize the atherosclerotic plaque.</Background>

<Methods>This case-control study was done on 40 patients who underwent elective coronary

artery bypass grafting surgery (CABG) with the need of coronary endarterectomy. In Group A,

patients had chronic periodontitis and group B consisted of patients without it. Both groups were well

matched regarding their demographic data. The subgingival plaque was collected by a sterile curette

from periodontal pockets e" 5mm and CAL e" 4mm. Also, atherosclerotic plaque was collected during

the coronary endarterectomy surgery from all of the 40 patients. The specimens were assessed using

the PCR technique to detect the specific bacteria responsible for chronic periodontitis such as

actinobacillus actinomycetemcomitans (Aa), prevotella intermedia (Pi), porphyromonas gingivalis

(Pg), Tanerella forsythensis (Tf), Treponema denticola (Td), and fusobacterium nucleatum (Fn).</Methods>

<Results>In the atherosclerotic plaque of group A patients, Aa was identified in 18 (90%), Pg in 16 (80%), Tf

in 13(65%),Td in 11 (55%), Pi in 10 (50%), and Fn in 6 (30%) specimens, whereas in group B the

incidence was significantly lower (p&lt; 0.0001). In the subgingival plaque of group A, Aa and Tf were

found in all 20 individuals and Pg, Pi, Td and Fn were identified in 19 specimens (95%). The

differences in the incidence of Aa and Pg in two plaque samples were not significant, but the two

plaque samples showed significant differences regarding the incidence of the other pathogens ( Pi :

p&lt;0.001, Tf : p&lt;0.008, Td: p&lt;0.003 and Fn :p&lt;0.0001).</Results>

<Conclusions>In the present study, the same organisms were found in both coronary atherosclerotic and

subgingival plaques. The findings support the potential role of the periodontopathogenic bacteria

species in some steps of the atherosclerotic process as a contributor that worsens this disease.

However, further studies are required to achieve more definite results regarding the role of periodontal

diseases in the atherosclerotic disease, focusing on patients' background variables(Iranian Heart

Journal 2011; 12 (2):34-40).</Conclusions>

<Keywords>Atherosclerosis % Coronary artery disease % Chronic Periodontitis</Keywords>

</Abstract>

<Abstract>

<AbstractID>247</AbstractID>

<Title>Long Sheaths for Endomyocardial Biopsy via Femoral

Approach</Title>

<Author>Nasim Naderi MD, Kambiz Mozaffari MD, Sepideh Taghavi MD, Ahmad Amin MD</Author>

<Background>Endomyocardial biopsy has long been a useful tool to evaluate myocardial diseases. It

is a gold standard in diagnosing cardiac rejection and certain types of myocarditis, but there is

always a risk for related complications. We have assessed the safety and feasibility of

applying long sheaths in endomyocardial biopsy via the femoral approach.</Background>

<Methods>We performed endomyocardial biopsy in 63 patients via the femoral approach and used a

long sheath to guide bioptome from the venous access to the interventricular septum and

evaluate the procedure success and complications.</Methods>

<Results>Success rate (acceptable endomyocardial specimen) was 96%, and there were no

complications (death, no death, urgent cardiac surgery, advanced cardiac life support,

hemothorax, and pneumothorax).</Results>

<Conclusions>Using long sheaths for the femoral approach seems to be safe and feasible; it confers

an acceptable room to grab the endomyocardial samples while obviating the possibility of

complications (Iranian Heart Journal 2011; 12 (2):41-45).</Conclusions>

</Abstract>

<Abstract>

<AbstractID>248</AbstractID>

<Title>Blue Color Vision as a Rare Sign of Digitalis Toxicity</Title>

<Author>Azin Alizadehasl MD*, Anita Sadeghpour MD**, Moussa Mirinazhad MD***</Author>

<CaseReport>We report a 73-year-old woman who had taken an amount of 0.25 mg/day of digoxin for an unknown

period of time because of chronic congestive heart failure and chronic atrial fibrillation. She was

admitted due to nausea, vomiting, abdominal pain, atrial fibrillation with a slow ventricular rate and

with a short corrected Q-T interval in an electrocardiogram of 345 milliseconds, high serum digoxin

level of 4.2 nmol/L, and interestingly color vision disturbances: blue colored vision. After

discontinuation of the digitalis treatment, all signs of digitalis toxicity, including blue color vision,

disappeared within five days(Iranian Heart Journal 2011; 12 (2):46-48).</CaseReport>

<Keywords>Digitalis toxicity % Color vision disturbance</Keywords>

</Abstract>

<Abstract>

<AbstractID>249</AbstractID>

<Title>Papillary Muscle Rupture after Benttal Operation: Is It

Necessary to Do CABG in High-Risk Patients?</Title>

<Author>Maryam Esmaeilzadeh MD, FACC, FCAPSC; Maryam Shojaeifar MD,

Hossein Ali Bassiri MD.</Author>

<CaseReport>Papillary muscle rupture following acute myocardial infarction (AMI),

which rarely occurs, leads to catastrophic outcomes. A 56-year-old man

with sudden dyspnea and palpitation, one episode syncope, and left sided

hemiparesis was admitted to our hospital and diagnosed as type A

dissection with extension to the aortic arch and descending aorta. The

patient underwent the Benttal and hemiarch procedure.

On the 16th postoperative day, he suddenly developed hypotension and

respiratory distress. Urgent echocardiography showed severe acute mitral

regurgitation due to the rupture of the posteromedial papillary muscle.

Urgent mitral valve replacement was done but unfortunately the patient

died two weeks after the second surgery because of sepsis. We propose

that during urgent cardiac surgery in a patient with coronary risk factors,

concomitant coronary artery bypass graft be performed as thoroughly as

possible(Iranian Heart Journal 2011; 12 (2):49-51).</CaseReport>

<Keywords>Aortic dissection %papillary muscle rupture % echocardiography</Keywords>

</Abstract>

<Abstract>

<AbstractID>250</AbstractID>

<Title>Spontaneous Recanalization of a Stenotic Lesion before

Stent Deployment</Title>

<Author>Hashemi Arash** MD, Maleki Majid MD FACC , Madani Mohsen MD</Author>

<CaseReport>Spontaneous recanalization of a stenotic atherosclerotic lesion is a rare finding. We report a 66-year-old

man with severe discrete stenosis at the distal part of the left anterior descending candidated for

percutaneous intervention. However, before stent deployment, the patient showed complete relief of the

stenotic lesion (Iranian Heart Journal 2011; 12 (2):52-54).</CaseReport>

<CaseReport>Spontaneous recanalization  % Percutaneous intervention</CaseReport>

</Abstract>

<Abstract>

<AbstractID>251</AbstractID>

<Title>Different Histopathological Appearances of Cardiac

Tuberculosis: Presentation of a Rare Case with Review of

Literature</Title>

<Author>Kambiz Mozaffari* MD, Neda Behzadnia MD</Author>

<CaseReport>Tuberculosis is caused by a mycobacterium and is a multipotential, omnipresent infectious disease. Generally, two

major categories, pulmonary and extrapulmonary exist. Whereas pericardial involvement is relatively common,

myocardial tuberculosis has been reported in not more than 0.3% of all tuberculosis patients post-mortem.

A 21-year-old woman sought medical attention due to progressive dyspnea upon exertion, weight loss, and general

weakness. She underwent a heart operation and a well-circumscribed, solid, and creamy egg-shaped mass with a

lobulated surface was seen in the right atrium. The histopathological study showed multiple well-formed granulomas

with multinucleated giant cells and extensive caseous necrosis. These were compatible with a diagnosis of tuberculoma;

however, the Ziehl-Neelsen stain failed to reveal the acid-fast bacilli. Her postoperative course was uneventful and soon

she was discharged with advice to continue her medical therapy(Iranian Heart Journal 2011; 12 (2)55-58).</CaseReport>

<Keywords>Mycobacterium tuberculosis % Tuberculoma % Tuberculous pericarditis</Keywords>

</Abstract>

<Abstract>

<AbstractID>252</AbstractID>

<Title>Successful percutaneous Transcatheter closure of coronary

artery fistulas (CAFs)</Title>

<Author>S.A. Abdolrahimi MD, S. Abdi MD, K. Mozafari MD, M. Dastani MD</Author>

<Background>Coronary artery fistulas (CAFs) are vascular anomalies which in rare cases can cause

hemodynamic problems with indication for intervention. Cogenital CAFs is a very rare

malformation that may involve any or all coronary artery branches and any cardiac chamber.

Elective closure of coronary artery fistulas by percutaneous transcatheter techniques is

generally accepted in the presence of symptoms, but controversies exist in the management of

asymptomatic patients.</Background>

<Methods>We described two patients: A 49 years old female developed episodes of increasing

exertional chest pain and dyspenea over 3 years, another 32 years old was referred for

coronary angiograph because of dyspenea on exertion with-increasing its severity since one

year age.</Methods>

<Results>Although non invasive imaging may be helpful, we demonstrated that cardiac

catheterization and coronary angiography is necessary for the precise delineation of coronary

anatomy and CAF</Results>

<Conclusions>As mentioned above treatment is advocated for symptomatic patients and for those

asymptomatic patients who are at risk for future complication. Form available data and our

results Transcatheter closure (TCC) of coronary artery fistula (CAF) is an acceptable

alternative to surgery in most patients(Iranian Heart Journal 2011; 12 (2):59-65).</Conclusions>

</Abstract>

</Journal>