International Cardiovascular Research Journal
Volume:14 Issue: 4, Dec 2020

Context: 

Sexual dysfunction is one of the challenges faced by heart patients. In Iran, because of the cultural structure, addressing sexual issues and problems is difficult in these patients and the follow-up of heart problems causes these patients’ sexual relations to be marginalized. Considering the fact that there is no general conclusion about the prevalence and types of sexual dysfunction in these patients in the Iranian society, in order to gain comprehensive knowledge about this phenomenon, this study was conducted as a systematic review to investigate the sexual dysfunction status in Iranian heart patients.

Evidence Acquisition: 

In this systematic review, articles published in Persian and English were retrieved from Web of Science, PubMed, Scopus, Medlib, Magiran, SID, Iranmedex, and Google Scholar databases using keywords without time limits. Then, the articles meeting the inclusion criteria were studied and analyzed. Out of the 1011 articles retrieved, 12 were reviewed and analyzed. To extract the data, two experienced researchers reviewed and analyzed the articles simultaneously, and the co-working professors of the research team evaluated the quality of the articles separately to increase the validity and reliability of the study.

All reviewed articles were quantitative studies. The results of extracting the findings indicated male sexual dysfunction, including erectile dysfunction, orgasmic function, sexual desire, sexual satisfaction, and marital satisfaction. In female patients, sexual satisfaction and marital satisfaction were impaired.

According to the results, heart diseases caused sexual dysfunction in heart patients. Patients with heart diseases had significant problems, such as lack of sexual desire, sexual dissatisfaction, and decreased frequency of sexual activity. Considering the severity of this disorder in the Iranian society, the treatment team is recommended to pay serious attention to sexual relations in these patients and consider the improvement of their sexual function as an integral part of the cardiac rehabilitation function.

The standard heart failure treatment in adult patients with Congenital Heart Disease (CHD) is a challenging issue. Biomarkers, such as N-Terminal pro- B-type Natriuretic Peptide (NT-proBNP), have been used, but soluble Suppression of Tumorigenicity-2 (sST2) has been able to bring prognostic value in patients with acute and chronic left heart failure.

The present study sought to evaluate the predictive value of sST2 and NTproBNP measurements in the assessment of the efficacy of treatment of adult patients with symptomatic CHD.

This case series was conducted using a before/after design on 80 consecutive adult patients with CHD who had never received treatment for symptomatic heart failure (New York Heart Association functional classes II, III). sST2 levels were measured before and six months after the standard drug regimen of cardiac dysfunction according to the American guidelines in order to assess the efficacy of the standard treatment on sST2. Cardiac function was assessed via echocardiography and functional capacity via the 6-Minute Walk Test (6MWT) and direct inquiry from the patients before and six months after the treatment. The data were entered into the SPSS 22 software and were analyzed using paired t-test, Wilcoxon, and chi-square test.

The mean age of the patients was 32 years. At the six-month follow-up, functional capacity showed a significant improvement based on the mean 6MWT compared to the pre-treatment state (P < 0.001). In addition, the standard treatment significantly decreased the sST2 level compared to the pre-treatment value (P < 0.001).

The measurement of biomarkers could help assess the efficacy of the treatment of adult patients with CHD and symptomatic heart failure.

Air pollution is one of the most critical environmental problems around the world.

This study aimed to estimate cardiovascular mortality related to NO2, PM10, SO2, and O3 concentrations in Arak in 2014.

This ecological study was performed on 599634 participants. Data about air pollutant concentrations, including NO2, PM10, SO2, and O3, in the urban population of Arak in 2014 were obtained from Arak Environment Department. Cardiovascular mortality related to air pollutant exposure was estimated using Baseline Incidences (BI) and Relative Risks (RR) based on the World Health Organization (WHO) databases and time-series and case-crossover studies about the association between air pollutants and health outcomes and using the AirQ2.2.3 software.

The results showed that the annual average concentrations of PM10, NO2, O3, and SO2 were 69, 38, 57, and 53 μg/m3, respectively during the study period. In addition, the number of excess cases for cardiovascular mortality in the central RR was 138, 100, 55, and 16 for PM10, SO2, O3, and NO2, respectively. The cumulative number of cardiovascular mortality due to exposure to NO2 (RR = 1.00, 1.002, and 1.004) was 16, while this measure was 55 for cardiovascular mortality due to O3 (RR = 1.00, 1.004, and 1.006).

This study showed that PM10 and SO2 had the highest adverse health effects in relation to cardiovascular mortality in Arak. This necessitates important and vital measures and planning by national and international officials.

Postoperative bleeding is a common problem, specially in cardiac surgery. The bone edges at the sternotomy site are one of the major sites of bleeding. Previously, some materials, such as vancomycin paste, have been applied to the sternum prior to the closure of sternum in order to reduce postoperative hemorrhage. In addition, fibrinolytic drugs, such as tranexamic acid, have been used locally to reduce postoperative bleeding.

This study aimed to assess the effect of vancomycin paste made with tranexamic acid on reducing postoperative mediastinal bleeding.

In this double-blind clinical trial, all patients undergoing on-pump coronary artery bypass graft surgery were included and divided into two groups by simple randomization method. In the control group, two grams of vancomycin paste were made with two mls of normal saline solution. In the intervention group, two grams of vancomycin paste were made with two mls (containing 200 mgs) of tranexamic acid. The paste in each group was applied to the sternal bone edges just prior to sternal closure. Both groups were compared in terms of demographic data, operation data, packed red blood cell transfusion, hemoglobin change, and amount of postoperative bleeding 12, 24, and 48 hours post-surgery. Postoperative sternal wound infection and dehiscence were also evaluated two months after the surgery. Comparisons were done using independent t-test, Fisher’s exact test, and Mann-Whitney test using the SPSS software, version 22.

Fifty patients completed the trial. Both groups were similar regarding the demographic data and operation data, such as pump time and operation duration. The amount of postoperative bleeding was respectively 268, 624, and 844 mls in the control group and 174, 362, and 485 mls in the invention group 12, 24, and 48 hours after the operation (P < 0.001). The results revealed no significant difference between the two groups concerning postoperative transfusion and hemoglobin changes. Postoperative sternal wound complications, including infection and dehiscence, were not seen in any of the study groups.

In comparison to vancomycin paste alone, vancomycin-tranexamic acid paste had a significantly superior effect on the reduction of post-coronary artery bypass graft surgery bleeding.

Pericarditis is an uncommon but important disease that can lead to severe symptoms and mortality.

This study aimed to evaluate the outcomes of constrictive pericarditis treated by conservative medical therapy in comparison to surgical pericardiectomy.

In this retrospective study, the records of the patients diagnosed with constrictive pericarditis in Rajaie Cardiovascular, Medical, and Research Center from October 2007 to December 2017 were reviewed. Among the patients, 38 were treated by medical therapy. Thus, 38 patients treated by surgical pericardiectomy were randomly selected to be compared to the medical therapy group. The two groups were compared with regard to the clinical outcomes. Intergroup comparisons were made using chisquare test. In addition, Wilcoxon’s signed-rank test was used to compare the patients’ New York Heart Association (NYHA) functional classes before and after the treatment. Statistical analysis was performed using IBM SPSS Statistics, version 16.

The mean age of the patients was 51.68 ± 16.37 years in the medical therapy group and 48.43 ± 17.04 years in the surgery group. The main symptoms were dyspnea and edema. Besides, the most common causes were idiopathic (64.4%) and tuberculosis (17.1%) followed by uremia (15.7%) and malignancy (6.5%). Moreover, 84.2% of the patients in the medical therapy group and 97.3% of those in the surgical pericardiectomy group experienced at least one NYHA functional class status, but the difference was not statistically significant. Edema was decreased in 15 out of the 24 patients in the medical therapy group (62.5%) and in 18 out of the 27 patients who had undergone surgical percardiectomy (66.6%), but this difference was not statistically significant (P = 0.74). Furthermore, nine patients in the conservative medical therapy group had been re-hospitalized within the first year of treatment (23.8%), while this measure was found to be six in the surgical pericardiectomy group (15.7%), and the difference was not statistically significant (P = 0.3783). Finally, the perioperative mortality rate was 2.6%, and long-term mortality rate was equal in the two groups (7.8%).

Conservative medical therapy based on the severity and cause of constrictive pericarditis could improve clinical outcomes, especially in patients with transient types of constrictive pericarditis as well as in those who were at a high risk for surgery.

Congenital Heart Disease (CHD) is a major health problem around the world. Several maternal and fetal risk factors have been mentioned to be associated with development of CHD. However, the epidemiological pattern is different in various parts of the world. Thus, the present study aimed to demonstrate the descriptive characteristics of a group of Iranian children with CHD.

The present study aimed to determine the regional distribution of CHD among 1000 Iranian hospitalized children during three years.

This cross-sectional study was conducted on 1000 Iranian children with CHD who were hospitalized in Rajaie Cardiovascular, Medical and Research Center, as a tertiary cardiovascular hospital (2017 - 2019). The participants were selected via convenience sampling. Clinical data were extracted from the patients’ medical records and questionnaires and then, a comprehensive evaluation was performed.

The median (IQR) age of the children was 18 (8 - 60) months. In addition, the mean ± SD of maternal age at pregnancy was 27.3 ± 5.92 years. Ventricular Septal Defect (VSD) was the most frequent CHD. Most of the patients were Fars (35.7%), Azeri (18.4%), and Kurd (10.7%). Besides, 58.7% of the patients lived in rural areas. The family history of CHD was present in 23.9% of the patients. Additionally, 41.4% of the patients’ parents had consanguineous marriages. Spotting was the most common (48.7%) complication during pregnancy followed by infectious disease (24.2%), toothache (12.9%), and diabetes mellitus (7.8%).

The present study demonstrated the baseline neonatal and maternal characteristics of the patients with CHD, which revealed that some risk factors were common in these individuals. Hence, it is necessary to provide preventive strategies for modifiable risk factors, monitor high-risk pregnant women at shorter intervals, raise awareness in the general population, and perform genetic counselling, as appropriated. This was the first report of the CHD frequency in Iran.

Atrial standstill is a rare cardiac arrhythmia, which may present with different clinical symptoms, including longstanding dyspnea, congestive heart failure, syncope, cerebrovascular accidents, and even sudden cardiac death. According to such various presentations, diagnosis of atrial standstill may be complicated despite a high level of suspicion.

The present report demonstrated a case of bilateral idiopathic atrial standstill in a young female patient. The initial presentation of the disorder was the prolonged history of dyspnea and reduced effort tolerance, which was complicated by an episode of ischemic stroke two years ago. The patient was discharged with oral anticoagulants and anti-convulsants, but she had discontinued medication arbitrarily and was diagnosed in an electrophysiological study prior to pacemaker placement because of the junctional rhythm and premature ventricular beats. She was finally diagnosed as a case of biatrial standstill, which was characterized by the absence of electrical and mechanical activity in both atrias. Single-chamber permanent pacemaker was successfully implanted and she was discharged with oral anticoagulants and was recommended for further evaluation for idiopathic or familial cardiomyopathy.

Atrial standstill could present in a silent manner as longstanding dyspnea and reduced effort tolerance, and remain misdiagnosed even after the development of cerebral ischemia in the absence of a high level of suspicion. These patients are eligible to receive oral anticoagulants life-long, and implanting PPM is almost indicated.

Treatment of patients with concomitant Patent Foramen Ovale (PFO), Atrial Septal Aneurysm (ASA), and multi fenestrated Atrial Septal Defects (mfASDs) is accompanied by many challenges. There may be even a need for different devices in the atrial septum, which is more challenging and costly.

This study aimed to report a case of PFO closure, which turned out to have ASAs and multiple small holes. A Uni occlutech device was used to close the PFO and fenestrations, which was done successfully and without complications.

It is important to have a thorough evaluation of the atrial septum to rule in or out the possibility of multiple defects. This is done by accurate interrogation of the atrial septum by color Doppler echocardiography, preferably by transesophageal or three-dimensional echocardiography at the time of catheterization. Multiple small defects or fenestrations nearby may be closed by a single device, which may cover several defects or fenestrations.