Iranian Heart Journal
Volume:4 Issue: 3, Winter 2003

Background: 

In a prospective, randomized trial, we compared intermittent antegrade ‎tepid blood (TB) with cold crystalloid (CC) cardioplegia in patients undergoing ‎coronary artery bypass grafting (CABG).‎ ‎‎

Methods: 

One hundred thirty-seven consecutive patients who were candidates for ‎CABG were randomized into two groups. Group I (n=65) received TB cardioplegia ‎and group II (n=72) received CC cardioplegia. In both groups during surgery, the ‎body temperature was maintained between 28-30^0C. Interval of delivery of tepid ‎blood and cold crystalloid cardioplegia was less than 20 and 20 - 25 minutes, ‎respectively‏.‏‎‎

Results: 

The number of grafts, duration of cardiopulmonary bypass and total aortic ‎cross clamp time in both groups were similar. Sustained electromechanical cardiac ‎arrest failed to occur in 8% of the patients with TB cardioplegia. After reperfusion, ‎spontaneous return to sinus rhythm was higher (P<0.02) and need for inotropic drugs ‎was lower (P<0.0001) in TB group than in CC group. In the intensive care unit, ‎creatine kinase-MB fraction was higher in the CC group. On the sixth day of ‎operation, pericardial effusion by transthoracic echocardiography was lower in the TB ‎group than in the CC group (P<0.0001).‎ ‎‎

Conclusion:

Intermittent antegrade tepid blood cardioplegia is clinically reliable and ‎could be used safely for protection of the myocardium (Iranian Heart Journal 2002, ‎‎2003; 3(4&4‎‏( ‏ ‏6-11).‏

Introduction:

Many series have demonstrated that women undergoing CABG appear ‎to have higher morbidity and mortality than men, therefore this study was designed to ‎answer the questions of whether such differences actually exist or not in the pre- and ‎postoperative period‏.‏‎‎

Material: 

This study was carried out from January to end of May 2000 at our cent.‎ ‏201 ‏consecutive patient undergoing CABG were selected. Exclusion criteria included ‎previous CABGS. We used antegrade and retrograde cardioplegia during surgery with ‎conventional anesthesia in all patients, any complication during the pre- and ‎postoperative and hospital stay were recorded, and data were evaluated statistically ‎using SPSS software‏.‏‎ ‎

Results:

201 patients undergoing CABG were evaluated. 46% were women and 54% ‎were men with mean age of 51 years. In comparison with men, women were older, ‎had higher incidence of hypertension, diabetes, but otherwise similar for early ‎complications. However the duration of hospital stay was different, with ‏13.9±0.4 ‏days for men and 18.4 ± 1 days for women, p<0.001‎‏.‏ ‎‎

Conclusion: 

In spite of similar postoperative complications and mortality in men and ‎women, the number of grafts and hospital stay was different (Iranian Heart Journal. ‎‎2002, 2003; 3(4)&4(1): 17-20)‎ ‏`‏

Background: 

Patients with coronary artery disease have a predilection for the ‎development of remote atherosclerosis and may be expected to be at greater risk of ‎renal artery stenosis. This study assesses the patients with high suspicion of coronary ‎artery disease who have high blood pressure (>140/90 mmHg) in spite of treatment ‎with anti-ischemic drugs (combination of beta-blocker, calcium channel blocker and ‎nitrate).‎ ‎‎

Methods: 

The severity of renal and coronary stenoses were quantified in 57 patients ‎‎(mean age 52.3 ± 3.5 y) with evidence of coronary artery disease and high blood ‎pressure who were on anti-ischemic drug therapy. These patients underwent selective ‎or nonselective renal artery angiography as part of a diagnostic cardiac catheterization ‎study at our center between March 1999 and March 2002‎‏.‏‎ ‎

Results:

Coronary artery disease was seen in 82.5% of these patients, which was ‎significant (>50%) in 66.7% of them. Renal artery stenosis of any degree was seen in ‎‎42% of the patients. 28% of the patients had significant (50%) renal artery stenosis. ‎There was a good correlation between the severity of coronary and renal artery ‎stenoses (p=0.016). Also, there was a correlation between the number of involved ‎coronary and renal arteries (p=0.019).‎

Conclusions: 

In patients with clinical evidence of coronary artery disease who have ‎high blood pressure in spite of treatment with combined anti-ischemic drug therapy, ‎renal artery study during cardiac cathetreization is a logical and useful decision ‎‎(Iranian Heart Journal 2002, 2003; 3(4)& 4(1): 21-24).‎

Background: 

Hemodynamic instability during anesthesia can affect circulation and ‎oxygenation of vital organs (e.g. brain, heart, kidney and liver). Each of the anesthetic ‎drugs has various hemodynamic effects, and the interaction of these drugs may cause ‎critical changes in‏ ‏patients hemodynamics‏.‏‎‎ Propofol is the most recent intravenous anesthetic to be introduced into clinical ‎practice. This drug has negative inotropic effects on the heart. Based on the ‎cardiovascular effects of propofol and to maintain hemodynamic stability during ‎anesthesia with this drug, it seems that selection of a muscle relaxant with positive ‎effects on the heart rate and especially blood pressure, such as pancuronium, is better ‎than atracurium. Therefore, we performed a study of the effects of pancuronium and ‎atracurium on hemodynamic parameters of patients undergoing CABG surgery, in ‎which these muscle relaxants are used in conjunction with propofol-sufentanil‏.‏‎

‎ Methods: 

A prospective randomized clinical trial analysis was performed on 100 ‎patients undergoing coronary artery bypass graft surgery in Shaheed Rajaei Heart ‎Center. Fifty of the patients received propofol -pancuronium and 50 of them received ‎propofol - atracurium. The selection of type and dose of premedication drugs and ‎intraoperative opioid use in the two groups was the same. Maintenance of anesthesia ‎in the two groups was achieved by the infusion of specific doses of these drugs‏.‏‎ ‎

Results:

Hemodynamic changes in the two groups were almost the same. There was ‎no statistically significant difference (p>0.05) in the two groups (Iranian Heart ‎Journal 2002, 2003; 3(4)&4(1): 25-28).‎

Objectives:

The aim of this study was a prospective evaluation to determine the ‎relative risks and complications of pediatric diagnostic and interventional ‎catheterizations‏.‏‎‎

Background: 

The role of the pediatric catheterization laboratory has evolved in the ‎last decade as a therapeutic modality, although remaining an important tool for ‎anatomic and hemodynamic diagnosis‏.‏‎ ‎ Methods- A study of 480 consecutive pediatric catheterization procedures was ‎undertaken prospectively during 6 months, from October 2001 to March 2002‎‏.‏

Results: 

Patient ages ranged from 4 days to 17 years (mean 4.5 years). Forty six ‎complications occurred (9.58% of all cases) and were classified as major ‎complications in 6 patients, (1.25% of all cases) and minor complications in 40 ‎patients. (8.33% of all cases)Arrhythmia (n=15) and vascular complications (n=10) ‎were the most common adverse events respectively. Death occurred in 2 patients ‎‎(0.41‎‏ ‏‎%).‎

‎‎ Conclusions:

The results are acceptable at our center, but efforts should be directed to ‎improving equipment for flexibility and size and improving techniques for decreasing ‎the mortality and morbidity rates (Iranian Heart Journal 2002, 2003; 3(4)&4(1): 29-‎‎33).‎

Background:

Ruptured congenital aneurysm of the sinus of valsalva (RASV) is a rare ‎cardiac defect, which without surgical repair usually leads to reduced cardiac ‎performance. We have evaluated an institutional experience with surgical repair and ‎follow- up results of RASV‏.‏‎‎

Methods: 

A retrospective analysis was carried out in 39 patients with RASV; all but ‎one of them underwent surgical correction over a 10-year period (1990-2000) at our ‎center. The age of the 25 male and 14 female patients ranged from 6 to 56 years ‎‎(mean 27.9 years).This represented 0.76% of all cardiac operations‏.‏‎ ‎

Results: 

The origin of RASV most commonly was the right coronary sinus, and ‎rupture of the aneurysm most commonly occurred into the right ventricle(32 cases), ‎followed by the right atrium (2), left ventricle (2) and pericardium in one‏.‏‎ ‎ Nine patients (23%) were asymptomatic and the most common clinical findings were ‎heart murmur (continuous), dyspnea and palpitation. The most common associated ‎cardiac defects were aortic insufficiency and ventricular septal defect‏.‏‎ ‎ There was no early (in hospital) and late mortality after a mean follow-up of 45.6 ‎months (1-9 years).‎ ‎‎

Conclusion: 

Although RASV is a very rare cardiac defect, surgical treatment is safe ‎and has satisfactory results (Iranian Heart Journal 2002, 2003; 3(4) & 4(1): 34-37).‎

Background:

Permanent abnormalities of the hearts conductive system may lead to ‎hemodynamic disturbances and require pacemaker implantation. Pediatric pacing ‎involves unique challenges because of the patients size, growth and development and ‎the frequent coexistence of congenital structural heart diseases‏.‏‎‎

Methods:

In this study, 97 patients, who received permanent pacemaker implantation ‎from 1991 to 2001, were reviewed retrospectively using patients records. Attention ‎was paid to the implantation type, etiology of pacemaker replacement and the ‎occurrence of any complication related to underlying cardiac structural anomaly‏.‏‎ ‎

Results: 

During a mean follow-up period of 5.3 years (range 1-14 years), 155 ‎operations were performed for pacemaker implantation or replacement. Etiologies for ‎pacemaker implantation acquired atrioventricular block in 55 patients (59.7%), ‎congenital atrioventricular block in 33 patients (34%), malfunction of sinoatrial node ‎in 6 cases, second-degree atrioventricular block in 6 patients and myocarditis in one ‎patient. Epicardial and endocardial pacemakers were implanted for 70 patients ‎‎(72.2%) and 27 patients (27.8%), respectively. Congenital heart disease was observed ‎in 62 patients (63.9%). In 44 patients, replacement was performed one to three times. ‎Lead malfunction was the reason of pacemaker replacement in 88.7%. Complications ‎were observed in 8% of epicardial and 15% of endocardial pacemaker implantations‏.‏‎ ‎‎‎

Conclusion: 

The 4-year survival rate of epicardial and endocardial pacemakers was ‎‎44.8% and 53.3%, respectively, but there appeared to be no statistical relationship ‎between the pacemaker type and its survival rate and also the prevalence of ‎complications. Also, congenital heart disease and a simultaneous implantation of ‎pacemaker at the time of corrective surgery did not play as a risk factor in decreasing ‎the pacemaker survival rate. (Iranian Heart Journal 2002, 2003; 3(4)&4(1): 38-43).‎

Background: 

Technical improvements in Doppler ultrasonography and MRI methods ‎have led to the diagnosis of many patients with renal artery stenosis. In patients with ‎coronary and peripheral arterial diseases, atherosclerotic renal artery stenosis is more ‎common. Severe stenoses in renal arteries may lead to hypertension (HTN) and ‎ischemic nephropathy. In cases with bilateral renal artery stenosis or severe stenosis ‎of the renal artery in single-kidney persons, renal dysfunction and ultimately renal ‎failure may occur.

‎ ‎ Patients: 

In this report, 10 cases with hypertension and renal dysfunction that ‎underwent renal angioplasty and stenting are presented‏.‏‎‎

Results: 

Clinical and para-clinical improvements after angioplasty were observed in ‎the follow-up period‏.‏‎

‎ Conclusion: 

Balloon angioplasty could be an appropriate replacement for renal artery ‎surgery in renal stenosis cases (Iranian Heart Journal 2002, 2003; 3(4) & 4(1): 44-46‎‏)

Background:

Cardiovascular diseases are the main cause of death in diabetic patients. ‎Various studies have shown simultaneous involvement of coronary artery disease ‎along with peripheral artery diseases (PAD).‎ ‎‎ The aim of this study is to evaluate the ability of Ankle/Brachial Index (ABI) to ‎foretell the possibility of ischemic heart diseases in diabetic patients‎ ‏.‏

Methods: 

The diabetic patients, who visited our diabetes research center between May ‎‎2000 and May 2001 and were, confirmed diabetics for the previous 2 or more years, ‎were enrolled in the study. The ABI was calculated for all of the patients and their Demographic specifications and ischemic heart disease risk factors were recorded. All ‎the patients referred to perform an exercise test according to the Bruce protocol. ‎

Results: 

Four hundred ninety- seven patients (52.4%) were women, and 451 patients ‎‎(47.6%) were men. The mean age was 55.25 ± 10.08 years. 10.2%of the patients had ‎an ABI <_ 1. ABI showed a significant reduction in patients > 60 years (P = 0.02). ‎Two hundred thirty- eight patients were in group I (25.1 %), 625 patients in group II ‎‎(65.9 %) and 85 patients in group III (9%). 52.8% of the 125 patients in Group I, ‎‎19.6% of the 107 patients in group II and 44.7% of the 47 patients in Group III had ‎positive exercise test. I, II (P=~ 0.00) - II, III (P = 0.05).A total of 108 patients out of ‎the 279 patients had positive exercise test (38%) and most of them were from groups I ‎&III. 72.2% of group I and 52.5% of group II had high blood pressure (P - 0.00‎‏(.‏

‎‎ Conclusion: 

Ankle Brachial Index (ABI) with cutoff point 51.1 & >_ 1.4 is an ‎independent predictor of coronary artery diseases in diabetic patients, especially in ‎those who are hypertensive (Iranian Heart Journal 2002, 2003; 3(4) & 4(1): 47-55‎‏).

Background: 

A small proportion of patients undergoing coronary artery bypass ‎surgery had endarterectomy of one or more vessels. Patients characteristics, early ‎postoperative outcome, and mid-term survival in endarterectomy bypass surgery ‎patients were investigated‏.‏‎‎

Methods: 

A total of 2339 consecutive patients undergoing isolated CABG from April ‎‎2002 to May 2003 were studied, 4% of whom had endarterectomy. Demographic and ‎periprocedural data were registered retrospectively in a computerized institutional ‎database.

Results: 

The endarterectomy CABG group was younger and included a ‎higher proportion of females, and patients with diabetes, hypertension, lower ejection ‎fraction, triple vessel disease and unstable angina. They required longer cross-clamp ‎and cardiopulmonary bypass times‏.‏‎ ‎ Intensive care unit and hospital stays were prolonged and blood product transfusions, ‎need for inotropic support and/or intra-aortic balloon-pump was higher in ‎endarterectomy patients‏.‏ Perioperative mortality (30 days) was 6.25% vs. 3.5%. Cumulative one-year survival ‎was 79% versus 86.2% (p<0.001).‎ ‎‎

Conclusions: 

Short-term mortality was almost two-fold in endarterectomy patients ‎after CABG and they had increased postoperative mortality in comparison with ‎regular CABG patients, particularly with regard to bleeding and infections. One-year ‎survival was impaired in endarterectomy patients, mainly because of a less-favorable ‎outcome and early closure of grafts (Iranian Heart Journal 2002, 2003; 3(4&4(t): 56-‎‎60). ‎

Background:

Data concerning the interrelationship of antiphospholipid antibodies ‎‎(aPL) and myocardial infarction (MI) in patients with acute myocardial infarction and ‎no evidence of overt autoimmune disease is conflicting.‎ The present study is to ‎determine the presence of aPL antibodies in a group of patients with acute myocardial ‎infarction (AMI), under the age of 45 year, and with no evidence of major risk factors ‎for coronary artery disease‏.‏‎‎

42 patients with acute myocardial infarction, under the age of 45 years, who ‎were admitted in cardiac care unit and 40 healthy subjects, as controls, were included ‎in this study. Sera were drawn both from the patients and control subjects for VDRL ‎test and antibodies against phospholipids‏ .‏‎‎

Antiphospholipid antibodies and false-positive VDRL were documented in ‎‎10 patients out of 42 studied subjects (23.8%). None of the control subjects had ‎positive aPL antibodies or false-positive VDRL (P value 0.001). This shows young ‎individuals (under 45 years) with AMI have a relative risk (RR) of 2.25 for aPL ‎antibodies compared with the normal population‏. .‏‎‎

There is a strong relationship between aPL antibodies and AMI in ‎individuals under the age of 45 years. The presence of a high aPL antibody titer is an ‎independent risk factor for AML Therefore in young patients (especially under the ‎age of 45 years) with AMI, screening tests for the presence of aPL antibodies is ‎recommended (Iranian Heart Journal 2002, 2003; 3(4&4(1): 61-64). ‎

Objective:

Acute coronary events are the major cause of death among patients with ‎ESRD and kidney transplant candidates. It has been determined that the plasma ‎homocysteine level is high in these patients. In addition, a large series of cross-‎sectional and retrospective studies indicate a positive relationship between mild and ‎moderate hyperhomocysteinemia and atherosclerosis‏.‏‎‎

Background:

classification of patients with ESRD into high risk and low-risk groups ‎for coronary events, based on defined clinical and laboratory criteria, is mandatory ‎before kidney transplantation. In respect to this classification, important diagnostic ‎and therapeutic approaches are planned to decrease the risk of coronary events during ‎kidney transplantation. The plasma homocysteine level has not yet been compared ‎between these two groups‏.‏‎ ‎

Method: 

In this cross-sectional study, 92 patients were enrolled and classified into ‎low and high-risk groups of coronary events and their homocysteine level was ‎measured. Inclusion criteria for this classification were age, hypertension, ‎hyperlipidemia, diabetes, smoking, ischemia in surface ECG, and clinical findings of ‎ischemic heart disease.

Results:

The average level of plasma homocysteine ‎wasl4.98±7.8µmol/L among all of the patients, 17.28±8.5 µ mol/L in the high risk ‎group and 11.46±3.7µmol/L in the low risk group. There was no significant ‎correlation between the plasma homocysteine level and other known risk factors ‎‎(P=0.564, rs=0.0697). In addition, there was no significant difference in dialysis type, ‎serum creatinine level, dialysis duration and adequacy of dialysis between the two ‎groups. However, there was a significant difference between the plasma homocysteine ‎level in the high risk and low risk groups (P=0.0003, V=3.585). ‎ ‎‎

Conclusion: 

The plasma homocysteine level has a significant correlation with the risk ‎of coronary events in end-stage renal disease (ESRD) patients. It seems that the ‎plasma homocysteine level, like other known ischemic heart disease risk factors, is a ‎predictor of coronary events before kidney transplantation (Iranian Heart Journal ‎‎2002, 2003; 3(4) & 4(1): 65-69). ‎

Background: 

Similar to the view that women are protected against cardiovascular ‎disease because of estrogen, it has been assumed that the increased incidence of ‎cardiovascular disease in men is in part related to androgen levels. However, studies ‎designed to examine this link have instead suggested that testosterone has a neutral or ‎perhaps even beneficial effect on cardiovascular disease in men. It is this relationship ‎that we studied‏.‏‎‎

Methods: 

Ninety male subjects (60 with positive and 30 with negative coronary ‎angiograms) were recruited. Early morning fasting blood samples were taken from ‎each patient and total testosterone, total estradiol, sex hormone binding globulin and ‎lipids were measured and free testosterone index (FTI) was calculated‏.‏‎ ‎

Results: 

Men with proven coronary artery disease had higher levels of total ‎cholesterol, triglycerides and low density lipoprotein (LDL) and a lower level of high ‎density lipoprotein, but this was only statistical significant for total cholesterol and ‎LDL, (p=0.004). Men with coronary artery disease had lower levels of serum total ‎testosterone, estradiol and free testosterone index but this difference did not reach ‎statistical significance‏.‏‎ ‎

Conclusion:

Considering the results of this study, we conclude that serum testosterone ‎and estradiol levels in men are not risk factors for coronary artery disease (CAD) ‎‎(Iranian Heart Journal 2002, 2003; 3(4&4(1): 71-73). ‎

We describe a rare case of LA mass in a 46-year-old man presenting to our service for ‎the evaluation of exertional dyspnea.‎ Echocardiography revealed a unilocular encapsulated large mass that was completely ‎embedded in the LA wall. Surgery was done and histological findings confirmed the ‎diagnosis of a bronchogenic cyst (Iranian Heart Journal 2002, 2003; 3(4) & 4(1): 74-‎‎76).‎