fariborz akbarzadeh

Autonomic changes play an essential role in the genesis of neurally mediated syncope (NMS). The aim of this study was to compare the changes of the autonomic nervous system (ANS) by measuring spectral indices of beat-to-beat systolic blood pressure and heart rate variability (SBPV and HRV) in ranges of low frequency (LF), high frequency (HF), and the LF/HF ratio during head-up tilt test (HUTT) in patients with and without a syncope response.

In this case-control study of 46 patients with a suspected history of unexplained syncope, data were recorded separately during the typical three phases of HUTT. Patients who developed syncope were designated as the case group and the rest as the control group.

Thirty one patients experienced syncope during HUTT. Resting HRV and SBPV indices were significantly lower in cases than controls. After tilting in the syncope group, both HF and LF powers of SBPV showed a significant and gradual decrease. LF/HF in HRV increased in both groups similarly during the test but in SBPV, mainly driven by oscilations in its LF power, it increased significantly more during the first two phases of the test in syncope patients only to paradoxically decrease during active tilt (P< 0.001).

Our findings show an abnormal autonomic function in patients with syncope, both at rest and tilting. Fluctuations of spectral indices of beat-to-beat SBPV, a potential noval index of pure sympathetic activity, show an exaggerated response during tilt and its withdrawal before syncope.

Literature has shown the effects of intravenous/intracoronary nicorandil on increased myocardial salvage in patients with ST-segment elevation myocardial infarction (STEMI) treated with mechanical reperfusion. However, the possible cardioprotective effect of oral nicorandil on the clinical outcome prior to primary coronary angioplasty is not well documented. Our aim was to assess the effect of oral nicorandil on primary percutaneous coronary intervention (PPCI).

A total of 240 patients with acute STEMI undergoing PPCI were randomly assigned to oral nicorandil (Intervention, n=116) and placebo (Control, n=124) groups. The intervention group received 20 mg oral nicorandil at the emergency department and another 20 mg oral nicorandil in the catheterization laboratory just before the procedure. The control group received matched placebo. Our primary outcome was ST-segment resolution ≥50% one hour after primary angioplasty. Secondary outcome was in-hospital major adverse cardiovascular events (MACE), defined as a composite of death, ventricular arrhythmia, heart failure and stroke.

In the patients of intervention and control groups, the occurrence of ST-segment resolution ≥ 50% were 68.1% and 62.9% respectively, (P=0.27). In-hospital MACE occurred less frequently in the intervention group, compared to placebo group (11.2% vs. 22.5%, P=0.012).

Although the administration of oral nicorandil before primary coronary angioplasty did not improve ST-segment resolution in patients with acute STEMI, its promoting effects was remarkable on in-hospital clinical outcomes.

Diabetic autonomic neuropathy is one of the most important complications of diabetes mellitus (DM) that ultimately occurs in most patients. The purpose of this study was to screen and diagnose latent cases of autonomic neuropathy between patients who have a history of over 10 years DM and recently diagnosed diabetic patients.

This cross-sectional study was performed on 104 patients (52 type 2 DM patients diagnosed in the last 6 months; and 52 type 2 DM patients with more than 10 years history) referred to outpatient Endocrine Clinic of Imam Reza Medical Center in Tabriz University of Medical Sciences between 2015-2016. Blood pressure, resting heart rate and corrected QT interval were evaluated according to standard methods. The history of gastrointestinal and urinary tract neuropathy was extracted from patients’ history and physical exam.

Of the 104 patients studied, 54 were male and 50 were female. Standing heart rate (p=0.02), resting (p<0.0002) and standing (p<0.0001) systolic blood pressure, and resting diastolic blood pressure (p=0.03) were significantly higher in chronic diabetic patients compared to newly diagnosed group. Additionally, blood glucose levels (p=0.03) and body mass index (BMI) (p<0.0001) were significantly higher in patients with neuropathy.

Overall, the results of this study showed that in patients with type 2 DM, cardiac autonomic dysfunction is more common in patients with a longer history of DM.

Radical prostatectomy is the preferred treatment for prostate cancer, and sexual dysfunction is one of its complications. Various causes, including ischemic heart disease, diabetes, and cigarette smoking, can also cause sexual dysfunction in healthy people. Concurrent study of these cardiovascular risk factors with Surgery on the degree of sexual dysfunction in any study in Iran was not performed. The purpose of this study was to compare the risk factors of ischemic cardiovascular disease in locally diagnosed prostate cancer patients with and without sexual dysfunction after radical prostatectomy.

In this longitudinal study, 96 patients underwent radical prostatectomy from 103 patients. The presence of risk factors for cardiovascular disease including cigarette smoking, diabetes, hypercholesterolemia, hypertention, history of heart attacks were asked from patients. Electrocardiogram findings, echocardiography, Exercise test and cardiac thalium scan were investigated by a cardiologist. Sexual function status of patients before and after 6 months of surgery was evaluated by Persian IIEF questionnaire. The qualitative variables of the frequency of reporting and comparing them were done using Fisher's exact test and Chi-square test. Subsequently, all data were analyzed with spss version 19.

The mean age of the patients was 63.37 ± 7.9 years. Patients with and without sexual dysfunction were 22 (22.9%) and 74 (77%), respectively. The number of cardiovascular risk factors was statistically significant between the two groups with and without sexual dysfunction (P = 0.001). 84 patients were tested for exercise and 12 patients underwent cardiac thalium scan. Of the 84 patients, 32 (40.7%) were positive for the test, 52 (59.3%) were negative. Comparison of the IIEF score in two groups was statistically significant (p = 0.003).

According to the results of this study, the risk factors of cardiovascular diseases and bad cardiovascular disease in patients undergoing radical prostatectomy surgery can affect the sexual potency of patients after surgery.

Heart failure (HF) is one of the major problems of health system in the countries. In a subgroup of these patients, cardiac resynchronization therapy defibrillator (CRT-D) improves the quality of life by enhancing the function of the left ventricle (LV) and preventing of arrhythmias. The present study intends to discuss the effect of CRT-D on the QRS dispersion, as a predisposing factor to arrhythmias.
45 patients treated with CRT-D during 2012-2015 were enrolled in this study. QRS dispersion in various V-V delays was measured and its association with the incidence of arrhythmias, at least six months after insertion, was assessed.
The results showed that QRS dispersion in the intrinsic mode was significantly lower than the other modes of the CRT-D device (P

QT dispersion (QTd) and Tp-e interval show controversial results in incidence of sustained ventricular arrhythmias (SVA) in patients with heart failure (HF). In patients with implanted cardiac resynchronization therapy (CRT) device, there is a unique opportunity to record SVAs. The aim of this study was to evaluate the effects of QTd and Tp-e interval on the incidence of SVAs after simultaneous biventricular (Biv) pacing.
In the present study, 31 consecutive patients with advanced HF and implanted CRT device were evaluated one year for possible SVAs, corrected QT (QTc), QTd, and Tp-e interval. Patients were divided into two groups; with (group 1) and without (group 2) SVAs.
Among the studied patients, 5 (16%) experienced SVAs. The intrinsic and Biv pacing QTd were 70.74 ± 18.00 and 89.26 ± 28.00 msec, and 95.09 ± 44 and 88.09 ± 33 msec in group 1 and group 2, respectively (P = 0.18 and P = 0.16, respectively). Tp-e was not different between the two groups. In group 1, QTc increased from 438.83 ± 64 msec to 488.24 ± 48 msec (P = 0.13), and in group 2, it decreased from 499.70 ± 65.00 msec to 480.00 ± 31.00 msec after simultaneous Biv pacing (P = 0.13).
QTd, Tp-e, and QTc did not differ significantly after Biv pacing to show any positive effect on the incidence of SVAs in part due to the severity of changes which already occur in patients with advanced HF. QTc, QTd, and Tp-e showed little changes after Biv pacing and probably do not have a significant role in the incidence of SVAs.

Many cardiovascular procedures such as temporary pacemaker insertion, electrophysiological studies, and percutaneous transmitral commissurotomy are carried through inferior vena cava (IVC). Its malformations such as its interruption with azygous/hemiazygous continuation, left-sided IVC, and double IVC can make some difficulties for cardiologists during these procedures. In this case report, we present the case of a 75-year-old male with recurrent episodes of syncope and bradycardia. Due to interrupted IVC, temporary pacing lead was difficultly advanced from the IVC to the accessory hemiazygos vein, left brachiocephalic vein, superior vena cava, right atrium, and right ventricle. Temporary pacemaker insertion is an invasive procedure and should be performed under the guidance of fluoroscopy. However, rarely, IVC malformations such as interrupted IVC make it difficult to do procedure in a short period of time. Rupture of IVC and some complications due to severe bradycardia can be prevented by understanding rare IVC malformations.

The aim of this study was to evaluate the effect of Premenstrual Syndrome (PMS) treatment with selective serotonin reuptake inhibitor (SSRI) on treatment response of refractory hypertension of the patients.
This was a triple-blind randomized clinical trial conducted on female patients suffering from refractory hypertension and PMS at the same time. We obtained informed consent from 40 patients who had inclusion criteria and selected 20 patients for the intervention (sertraline 50 mg daily) and 20 for the control groups. The study period was five weeks. The mean of systolic and diastolic blood pressure before and after intervention was measured separately for each individual in each group and the mean of blood pressure of the members of the two groups were compared with each other.
The mean age of the participants was 43.60 ± 4.57. In this study, systolic and diastolic blood pressure of both groups reduced after intervention. The mean of systolic blood pressure was reduced by 40.86 mmHg in the intervention group and this reduction was 16 mm Hg in control group after intervention (P Administration of sertraline is more effective in controlling diastolic blood pressure in women suffering from refractory hypertension and comorbid PMS.

To determine the type and pattern of arrhythmic events following the 2012 Ahar-Varzegan Earthquake among patients implanted with cardiac defibrillators (ICDs) in East Azarbaijan province.
In a prospective cohort study, conducted in East Azerbaijan Province of Iran, 132 patients were enrolled in two comparison groups according to the region of residence i.e., earthquake region (n= 98) and non-earthquake (n= 34) region in 2012. Data were collected for those meeting standard criteria for sustained ventricular arrhythmias (VAs), or supraventricular tachycardias (SVTs) and triggered ICD therapies, either shock or anti-tachycardia pacing (ATP). The state version of the State-Trait Anxiety Inventory (STAI-S) was used to assess general symptoms of anxiety in both groups.
Males comprised 81.1% of the participants. Mean age of the participants was 59.7 ±15 years. The frequency of patients with sustained VAs increased significantly after the earthquake (p=0.008). There were more VAs (mean 2.16 vs. 6.23; p=0.008) and they occurred earlier (6th vs. 16th day; p= 0.01) in the earthquake area. The mean frequency of SVTs and the total number of delivered ICD therapies were similar between groups. Differences in anxiety levels were not significant between groups but there was a trend for presence of greater number of patients with anxiety (p=0.07) and the relative severity of anxiety (p=0.08) in the earthquake area.
In the earthquake area, the mean frequency of VAs increased and they occurred earlier in the earthquake area. The stress of anxiety might have served as a trigger for these events.

Heart rate variability (HRV) is defined as variations in R-R interval with time. Dysautonomia is common in patients with psychiatric disorders such as depression and anxiety. Using HRV analysis, recent studies showed that in anxiety disorders, the vagal cardiac function decreases, and sympathetic function increases. This study aimed at investigating citalopram effects on HRV. This before and after study was conducted in 25 generalized anxiety disorder (GAD) patients. GAD was diagnosed based on clinical interview according to diagnostic and statistical manual of mental disorders IV-Text revised (DSM-IV-TR) criteria using Structured Clinical Interview for DSM Disorders-I questionnaire. A cardiologist studied 24 h ambulatory monitoring of the electrocardiogram (Holter) on all patients before the treatment. A volume of 20 mg of citalopram was administered to the subjects on a daily basis. Then, they were studied by Holter monitoring again after 1-month of administration of citalopram. The average age of participants was 35.32 ± 8.7. The average Holter monitoring time was 23.29 ± 1.14 h before treatment and 23.81 ± 0.68 after it. The 3 h low frequency/high frequency ratio was significantly different between 3 h segments of time before treatment (P < 0.001). This difference was even higher after treatment (P = 0.001). Data showed an increase in parasympathetic tone during sleep both before and after treatment. These patients showed some impairments of HRV indices that did not improve by citalopram in future, the clinical importance of such disturbances should be evaluated in details with prolonged follow-up and greater sample size.

Backgrounds and Congestive Heart Failure (CHF) is a prevalent disease and has a great economic impact on health systems. Cardiac Resynchronization Therapy (CRT)، which synchronize biventricular contraction، is one of the most important therapies in these patients. Despite the exact selection of patients about 30% of patients do not respond to CRT. The aim of this study was to evaluate the O2 saturation and the pressure level of right side of heart and Coronary Sinus (CS) vein to predict the response to CRT. In this descriptive study، 30 patients were candidate for implantation of CRT echocardiography. The 6 Minute Walk Test (6MW)، right side and CS O2 saturation and pressure study was done before implantation. Echocardiography and 6MW repeated 6 months later. Based on response to the CRT، patients were divided into two groups: “responder and non-responder”. Date were compared between groups. O2 saturation was significantly lower in responders than non-responders. In non-responder patients the Right Ventricular (RV) and Pulmonary Artery (PA) Pressure was significantly higher than responders. Desaturation of CS blood flow in responders was probably due to higher levels of viable tissue which involve in contraction. Increase in right side and PA pressure in non-responders might be due to severity of heart failure which made CRT not effective in these patients. Evaluation of O2 saturation of CS blood flow، RV and PA pressure can use as an index in predicting the response to CRT and can help as additional indices in selection of patients with borderline indications for implanting CRT.

Atrial fibrillation (AF) was recognized as a major cause of morbidity and mortality after coronary artery bypass graft surgery (CABGS). Finding an accurate method to identify patients with increased risk may prevent or lower the occurrence of the related complications.. This study aimed to evaluate the association between interval of P-wave initiation in surface electrocardiogram, a-wave initiation in doppler study of mitral valve, MV annular velocity by TDI and compare them with conventional echocardiographic findings to investigate the associated factors related to the occurrence of AF in the first 72 hours after the CABGS..Patients and Four hundred and four patients with sinus rhythm, who were candidate for CABGS between June 2010 and July 2012 were examined before the surgery by conventional echocardiography and Tissue Velocity Imaging Methods and were monitored for 72 hours after surgery. Data collection and analysis were done by SPSS statistical software.. The mean age of patients was 60 ± 9.9 years. Statistically significant relationship between the occurrence of AF with Mitral valve annulus, LA Volume Index (LAVI), Right ventricle function, and type of surgery (off pump or on pump) were detected in our study (P < 0.05). There was no statistically significant relationship between the occurrence of AF and time interval of P wave to A wave onset in conventional Doppler echocardiographic study (P-A), P-A′ onset and P-A’ peak in TDI examination (P > 0.05).. Based on our findings, MV annulus, LAVI, RV function and on pump CABGS were independent factors related to the occurrence of AF post CABGS. Echocardiographic study associated with clinical data could be helpful for risk stratification of occurrence of post-operative AF..

Wide spread availability of internet made the web based education as a real module for training under -graduate medical students. The aim of this study was to evaluate the efficacy of web based multimedia education in normal electrocardiography. In a semi-experimental study and based on the educational programs of medical students in their inpatient training courses, the normal electrocardiogram selected for web based multimedia education. The materials necessary to teach normal electrocardiogram were provided and multimedia was prepared for installing into computers. Two groups of medical students, 30 in each group in their cardiology service (senior and junior students) were selected. Mean while the intervention group studied the multimedia for an hour and for comparison group classroom - based education was done. At the end of study all students answered to atwenty question questionnaire about normal electrocardiogram. The percentage of correct answers in intervention and comparison groups was 72% and 71% respectively. The prevalence of correct answer for junior students in intervention and comparison group was 68% and 67% respectively. The percentage for senior students was 73% and 75%. Like other studies, this study showed the multimedia training can be as effective as the routine classroom based learning. Web based multimedia education is as efficient as classroom based education and can be used as a suitable alternative to conventional methods of training.

Backgrounds and Atrial fibrillation (AF) is one of the most common cardiac arrhythmias which apart from macro embolic complications may result in cerebral ischemic areas caused by micro emboli and end up in progressive cognitive impairments. The object of the research is a comprational study of cognitive impairment inpatient with atrial fibrillation and healthy subjects based on MMSE Test. research method was descriptive-comparative method and 60 subjects (30 AF cases and 30 healthy subjects) who referred to Tabriz Cardiology Clinic were evaluated in a discretional-analytical study with Mini Mental State Examination (MMSE) questioner. Results showed a significant differences between patients and healthy groups in Time Orientation، Place Orientation، registration، attention and Concentration، recall، Repetition، Writing and Copying subscales but there was no significant different between groups in Naming، 3-Stage Command and Reading. According to present results، it seems that atrial fibrillation predispose to patients cognitive impairment.

Double left anterior descending coronary artery originating from left main coronary stem and right coronary artery is a rare congenital coronary anomaly. In this case report, we are describing a patient with double left anterior descending coronary artery, one with normal origin, and the other originating from the right coronary artery. To the best of our knowledge, there are only a few reports resembling such case.

Probiotics are live microorganisms that have positive effects on the host when consumed in sufficient amounts. According to several studies، probiotics have beneficial effects on prevention and treatment of many diseases. The aim of this study was to review animal and human studies on the role of probiotics in reducing serum cholesterol، their mechanisms of action، and a brief explanation of functional probiotic foods. This review article focused on all papers indexed in scientific databases from 2000 to 2012 using the related keywords، including cardiovascular diseases، probiotics، and serum cholesterol. Probiotics are used both in dairy and non-dairy products. Nowadays، the role of many probiotic strains in health is confirmed. From the studies done in this field، it can be inferred that probiotics through several mechanisms، such as binding cholesterol to cell walls of probiotics in intestine، conversion of cholesterol into coprostanol، production of short chain fatty acids، and deconjugation of bile acids، reduce serum cholesterol. Certain strains of probiotics have demonstrated cholesterol-lowering properties and others are under study. Further studies are needed to identify other mechanisms involved in lowering serum cholesterol and determine their safety

Enhanced external counterpulsation (EECP) is a noninvasive circulatory assist device that has been recently emerged as a treatment option for refractory angina or left ventricular (LV) dysfunction. The aims of this study were to examine the effects of EECP on the elecrocardiographic parameters and the heart rate variability indices of patients with the coronary heart disease and function class II-III angina resistant to medication. In a descriptive study, the patients who presented with sever angina at function class II-III were studied. Those meeting the inclusion criteria were invited to participate and provided informed consent. The standard enhanced external counterpulsation treatment (35 one-hour procedures 5-6 times a week) was done. Thirty minute ambulatory electrocardiographic monitoring and electrocardiogram before starting and at the end of treatment sessions were done. Data entry and analysis of data was done finally. Twenty five patients with mean age 68±9 year including 21(84%) men and 4(16%) women were enrolled in this study. Electocardiogarphic parameters before and after treatment by EECP were not different statistically. Time domain indices of heart rate variability according to ambulatory monitoring findings were not changed significantly. Results of this study revealed that EECP didn’t improve the electrocardiographic and heart rate variability parameters of ischemic heart disease patients with refractory angina at function class II or III.

We describe a 70-year-old man who presented to our emergency department with worsening shortness of breath. His chest roentgenogram showed pulmonary congestion and his condition improved with heart failure treatment yet a repeat chest roentgenogram revealed an abnormality which had remained unnoticed in his first chest x-ray due to the underlying congestion in lung fields. Descending aorta was dilated and very prominent. Further work-up showed a type B dissection which seemed to be chronic. Considering the chronicity of the condition, the fact that it was actually asymptomatic and the patient’s fragile condition we decided not to proceed with surgery.

An 18-year-old otherwise healthy male presented with palpitation and dizziness following a football match. His blood pressure and heart rate was 90/70 mmHg and 200 beats per minute, respectively. Electrocardiogram (ECG) on admission showed a wide QRS tachycardia with typical AV dissociation and left bundle branch block pattern (Figure 1). Lidocaine and then amiodarone were administered but the arrhythmia persisted. Considering the refractoriness of the rhythm synchronized DC shock was applied to convert the rhythm. Post conversion ECG had sinus rhythm, right axis deviation, Q wave and T wave inversion in inferior leads and T wave inversion in leads V1-V3 with a typical epsilon wave (Figure 2). Chest radiography showed RV enlargement (Figure 3) and right ventricular (RV) enlargement with free wall thinning was evident on echocardiography (Figure 4). A diagnosis of arrhythmogenic RV dysplasia (ARVD) was made and an implantable cardioverter defibrillator (ICD) was implanted. Screening of his family members showed RV enlargement in one of his sisters.

Treatment of hypertension (HTN) as an important risk factor of cardiovascular disease (CVD) is for prevention of its mortality. The aim of the present study was to investigate risk factor distribution, prevalence and severity of CAD among hypertensive and normotensive patients undergoing elective coronary angiography in Tabriz Madani Heart Center. In a descriptive cross-sectional study, 976 out of 3000 patients who underwent coronary angiography (CAG) between February 1, 2005 and February 1, 2006 were randomly selected to enter the study. Demographic and angiographic data were collected. Data entry and analysis was done by SPSS software version 11.5 and EPI software version 6.4. Prevalence of hypertension in patients who underwent CAG was 60.5%. Prevalence of CAD was 84% and 87% in hypertensive and normotensive patients respectively (p = 0.2). Prevalence of diabetes mellitus and hyperlipidemia were more frequent in hypertensive patients (p = 0.001). Although the prevalence of three vessel disease was higher in hypertensive patients (32% vs. 28%) the difference was not significant statistically. The difference in prevalence of CAD among hypertensive and normotensive men was not statistically significant (91% and 92% respectively); but this difference among women was statistically meaningful (78% vs. 63%; p = 0.01). Three vessel disease in hypertensive women was more frequent than normotensive women (37% vs. 18%, p = 0.02). With regard to high prevalence of cardiac risk factors and severe CAD in hypertensive patients, prompt health measures are needed for control of HTN in general population especially in the hypertensive women.

Psychological problems like as anxiety in patients who are candidate for coronary artery bypass graft (CABGs) may increase mortality and morbidity. The effect of reassurance and preoperative information in decreasing of anxiety is uncertain. This study designed to address the effect of preoperative information and reassurance in decreasing of anxiety of patients who are candidate for CABGs. With experimental study and randomize sampling 85 (55male and 30 female) of 238 patients who were candidate for CABGs included and completed spilberger anxiety test on the day of admission. Preoperative information and reassurance done and test completed again on the day before surgery. Mean number of anxiety score in patients with mild anxiety disorder (21 patients) were 34± 4.2 before and 39±5.8 after intervention. In patients with moderate anxiety disorder (39 patients) the number decreased from 52.61±3.8 to 50.76±56. Twenty five patients had severe anxiety disorder before with number of 63.88±2.8 which decreased to 53.88±7.6. All of differences were significant statistically. In patients with mild anxiety preoperative information and reassurance resulted in increasing of anxiety but in patients with moderate or severe anxiety disorder, anxiety level decreased significantly.

The initial electrocardiographic evaluation of every tachyarrhythmia should begin by addressing the question of whether the QRS complex is wide or narrow. The most important cause of wide complex tachycardia (WCT) is ventricular tachycardia (VT). However, supraventricular tachycardia (SVT) can also manifest with a wide QRS complex. The ability to differentiate between SVT with a wide QRS due to aberrancy or preexcitation and VT often presents a diagnostic challenge. The identification of whether WCT has a ventricular or supraventricular origin is critical because the treatment for each is different, and improper therapy may have potentially lethal consequences. When all QRS complexes in the precordial leads are either upright or negative (positive or negative concordance, respectively), VT is strongly suggested. Negative concordance is virtually diagnostic of VT generated from the anteroapical left ventricle. We report an extremely rare case of SVT presenting with a WCT and negative concordance.

Backgraound: Presently, there is no apparent agreement on the effects of pregnancy on the durability of bioprosthetic valves (BPV). The study aim was firstly to assess the influence of pregnancy on survival of BPV; secondly, maternal and fetal outcomes of pregnancy with BPV. Between 1981-2008, of the total patients selected, 31 were assigned to the bioprosthetic valve replacement group who became pregnant (39 pregnancy) after surgery [PAS (+)]; a group of 26 bioprosthetic valve replacement patients were also included whom did not experience pregnancy till the time of study [PAS (-)]. We obtained information on type of repaired valves, outcome of pregnancies and valve surgery related complications survey of the patients by reviewing the follow up files of centers. The mean age of PAS (+) and PAS (+) subjects was 32. 19 ± 4. 42 (max=45, min=24) years and 33. 93 ± 6. 58 (max=43, min=23) respectively (p>0. 05). Gehan test shown that there wasn’t significant relation between valves durability in two groups (P= 0. 22، df = 1، χ 2 =1. 49, diagram 1). Reoperation rate, mortality rate between case PAS (+) and PAS (-) was not significantly different (p>0. 05). Live births were recorded in 30 (76. 9%) of pregnancies (1 fetal death). The average of newborns weight was 2200. 32 ± 1116. 6 gr. Upon our findings 21 (70. 0%) of newborns were term and 10 (30. 0%) were preterm. Although pregnancy does not have a significant influence on structural depreciation of bioprosthetic valves survival and maternal mortality, bioprosthetic valves might be associated with birth defects. (J Cardiovasc

We applied a modified Cox III Maze procedure using radiofrequency ablation in the treatment of atrial fibrillation associated with rheumatic heart valve disease and evaluated the outcome of 20 patients of atrial fibrillation associated rheumatic valve disease who underwent radiofrequency ablation Maze III procedure plus heart valve surgery. Demographic, echocardiographic, Electrocardiographic and Doppler study data were calculated before surgery, six month and one year after surgery.. No perioperative deaths occurred in the study group. Duration of additional time for doing radiofrequency ablation was about 22 minutes. Freedom from atrial fibrillation was 85% and 75% at six months and one year follow-up respectively... The addition of the radiofrequency ablation Maze procedure to heart valve surgery is safe and effective in the treatment of atrial fibrillation associated with rheumatic heart valve disease..