hamidreza pouraliakbar

A Calcified Amorphous Tumor (CAT) consists of calcified nodules embedded within an amorphous fibrous material and represents an uncommon non-neoplastic intracavitary cardiac mass. In this article, we present the case of a 38-year-old Iranian gentleman who experienced a sudden loss of consciousness and right hemiparesis. Brain imaging revealed acute infarction in the left basal ganglia. Echocardiography identified a large heterogeneous echodensity in the posterior AV groove, with central echolucency extending to the base of the posterior left ventricular (LV) wall and the basal posterior mitral valve leaflet (PMVL), findings consistent with CAT. Cardiac Magnetic Resonance Imaging (CMR) demonstrated an intramural calcified mass with a necrotic core located in the lateral annulus of the mitral valve, extending into the left atrium and ventricle. The mass was deemed responsible for the cerebral infarction, which was classified as cardioembolic. This case report highlights Calcified Amorphous Tumor (CAT) as a potential embolic source, underscoring the importance of early recognition through multimodality imaging. Comprehensive management, which may include regular follow-ups or surgical intervention, is crucial for patients diagnosed with CAT.

Kawasaki disease (KD) is an acute, self-limiting vasculitis that predominantly affects children under five years of age. It is recognized as the leading cause of acquired coronary artery disease in this age group.

This manuscript presents two cases of KD complicated by significant coronary artery abnormalities, which ultimately necessitated heart transplantation.

Emphasizing the importance of early diagnosis and treatment, this study underscores the critical need for continued research to improve outcomes for affected patients.

Mixed atrial septal defects (ASDs) involving inferior vena cava (IVC)-type sinus venosus and secundum types and mixed partial anomalous pulmonary, systemic, and hepatic venous drainage are rare. We describe a 3-year-old acyanotic boy who presented with a large mixed inferior sinus venosus and secundum-type ASD. He exhibited an abnormal connection between the right upper pulmonary vein and the right atrium. Additionally, the IVC and a hepatic vein drained abnormally into the left atrium. The patient also had valvular and supravalvular pulmonary stenosis, as well as a small patent ductus arteriosus.The ASD was surgically closed using a pericardial patch, positioned lower than usual to reroute the IVC and hepatic vein flow into the right atrium. The surgery was successful, with no residual lesions or complications. The patient recovered without issues and was discharged smoothly. At the 6-month follow-up, the child’s cardiac examination and oxygen saturation were normal. Furthermore, echocardiography confirmed normal drainage of the systemic and hepatic veins into the right atrium.

An anomalous aortic origin of coronary artery (AAOCA) is a rare congenital anomaly which reported in 0.1% to 1% of the population in the literature. The most common subtype is anomalous aortic origin of right coronary artery (AAORCA) deriving from the left side. In the present case report, the therapeutic approach of AAORCA and the ongoing clinical dilemma will be discussed. A 52-year-old man was admitted with prolonged exertional chest pain and increased troponin I without any changes in electrocardiogram. After percutaneous catheterization, it revealed an ectasia in all left system coronary arteries and we suspected AAORCA. Hence, a coronary computed tomography angiography confirmed that the right coronary artery originated from the left sinus of Valsalva with a malignant interarterial course and a significant lesion at the ostium of left anterior descending. Hence, a coronary artery bypass grafting (CABG) with reimplantation of the orifice of AAORCA to the right coronary cusp was performed as a therapeutic approach. In the 12-month follow-up, the symptoms were ameliorated and there were no complications. As recommended in the American College of Cardiology/American Heart Association guidelines, patients with AAORCA should be divided into asymptomatic and symptomatic (ischemic symptoms. The patients with AAOCA who are symptomatic such as chest pain due to ischemia, ventricular arrhythmia with syncope, or aborted sudden cardiac death should have offered surgical management including unroofing, CABG, or reimplantation approaches. However, in accompaniment of AAORCA and other coronary artery disease, both CABG and translocation of AAORCA with reimplantation into a suitable origin maybe an appropriate surgical strategy with an acceptable mid-term follow-up as represented in our case.

Aortic aneurysms are dilatations of the aorta that carry a potential risk of rupture. The most common type is the abdominal aortic aneurysm (AAA), while thoracic aortic aneurysms, particularly those in the ascending part, are also significant. Perivascular adipose tissue is an ectopic fat that affects vessels locally by producing bioactive substances. Additionally, central obesity is associated with local aortic diseases.

The current study aimed to measure periaortic adipose tissue and evaluate its association with the indexed aortic diameter based on multidetector computed tomography (CT) scan findings.

This retrospective and cross-sectional study was conducted in a tertiary center for cardiovascular diseases, continually recruiting 149 patients who had indications for thoracic and abdominal CT angiography. Patients with serious underlying diseases were excluded. The diameters of the aorta and adipose tissue, as well as Body Mass Index, were measured. Data analysis was performed using chi-square, Fisher exact, independent t -test, and Mann–Whitney test with SPSS software, version 16. Comparisons were performed using chi-square or Fisher exact tests for categorical variables, independent t -test for normally distributed data, and Mann–Whitney test for non-normally distributed data.

The study population consisted of 149 patients. The prevalence rates of thoracic aortic aneurysm and AAA were 8.7% and 24.8%, respectively. The prevalence of AAA was significantly higher in males (P = 0.025). Patients with AAA and an abdominal aortic diameter exceeding 30 mm were significantly older than the others (P = 0.003). There was a significant correlation between the fat volume around the aorta and the aortic diameter (P < 0.001, r = 0.504). Additionally, significant relationships were found between age and fat volume around both the thoracic and abdominal aorta (P < 0.001 and P < 0.007, r = 0.379 and r = 0.222, respectively), and between body mass index and fat volume around the abdominal aorta (P = 0.044, r = 0.165).

The correlation between the volume of periaortic fat tissue and aortic aneurysms was significant in both the thoracic and abdominal aortae. The volume of periaortic fat in AAA was correlated with indexed values, unlike in thoracic aortic aneurysms. In candidates for aortic CT angiography, meticulous measurement of periaortic adipose tissue provides additional valuable data for optimal management.

Left ventricular pseudoaneurysm (LVP) is a rare cardiac condition with a prevalence of approximately 0.05%. It is primarily associated with myocardial infarction or cardiac surgery, although it can also occur post-trauma, accounting for less than 0.1% of cases. The diagnostic process for LVP can be challenging due to its atypical presentation, requiring a comprehensive approach for accurate identification and intervention. Surgical repair is a cornerstone of LVP treatment, given the high risk of rupture and the associated mortality. The case presented here describes a 23-year-old man who developed symptomatic LVP 6 months after a traffic collision. Diagnostic imaging, including echocardiography and computed tomography angiography, identified a 2.2 cm defect in the LV wall, leading to a large pseudoaneurysm measuring approximately 6.0 cm × 5.5 cm. Surgical intervention was successfully performed via a median sternotomy. The timely surgical management in this case not only addressed the LVP but also highlighted the critical importance of prompt intervention in preventing potential complications associated with this condition. This case review provides a comprehensive appraisal of the literature surrounding LVP. This study offers valuable insights for clinical practice by examining the prevalence, etiology, diagnostic challenges, and advancements in surgical techniques. As clinicians encounter similar clinical scenarios, combining this case with a literature review provides a strong reference for informed decision-making and optimizing patient outcomes. (Iranian Heart Journal 2024; 25(4): 105-110)

Few cases of transcatheter aortic valve implantation (TAVI) following infective endocarditis (IE) have been reported. In this presentation, we discuss the feasibility of TAVI in a degenerated bioprosthetic valve affected by IE.We examine a rare case involving an elderly man with a degenerated bioprosthetic aortic valve complicated by IE 6 months after a COVID-19 infection. The patient was successfully treated with valve-in-valve intervention following antibiotic therapy for the acute phase of the infection. This resulted in excellent outcomes with no complications in the early postprocedural period and during follow-up visits.For patients with a destructed bioprosthetic aortic valve due to IE and residual dysfunction after healing, valve-in-valve intervention can be a safe and effective treatment option, particularly for those at high risk for surgery.

This study aimed to investigate the frequency and types of complications observed in computed tomography angiography (CTA) following thoracic endovascular aortic repair (TEVAR) and endovascular aneurysm repair (EVAR).
 
This cross-sectional study included 96 patients who underwent TEVAR and EVAR for thoracic and abdominal aortic aneurysm treatment at the Rajaie Cardiovascular Medical and Research Center. Two experienced radiologists evaluated CTA results and recorded the types of complications following TEVAR and EVAR.
 
The mean patient age was 17.82±56.56 years, with 86.46% male patients. Post-intervention complications occurred in 47.8% of cases, with the most common complications being endoleak (33.3%), occlusion (11.5%), pelvic ischemia (9.4%), hemothorax (3.1%), and hemopericardium (1%), respectively. Although complications were more frequent among women and elderly patients, no significant correlation was found between age, sex, and complication frequency.
 
Over one-third of our patients experienced complications following TEVAR and EVAR. Endoleak, occlusion, and ischemia were the most common complications. To ensure early detection of potential complications, performing at least 1 CTA within a month after the interventions is recommended. (Iranian Heart Journal 2024; 25(3): 51-57)

Penetrating cardiac trauma is a fatal condition and can result in the injury of various parts of the heart. Ventricular Septal Defect (VSD) following these traumas occurs only in 1-5% of cases. The patients' conditions depend on location, size, and concomitant injuries. One of the uncommon coincidences with the VSD is Mitral Regurgitation (MR) due to injury to sub-valvular structures. In this study, we report a case of concomitant traumatic-induced VSD and MR in a 14-year-old boy following a stab wound to his chest. The patient was a teenage boy coming to the Rajaei Cardiology Hospital emergency room following a stab wound to the anterior and left part of his chest. Despite primary urgent surgery, his breathlessness had continued for three more months. Evaluations with Transthoracic Echocardiography (TTE) revealed VSD with concomitant MR, but there was no papillary muscle rupture. Cardiac Magnetic Resonance Imaging (MRI) and angiographic evaluation confirmed the provisional diagnosis. The Amplatzer VSD occluder repaired the VSD, and the patient was discharged following the resolution of his symptoms. Although the MR has been present in the follow-up echocardiography, the patient has been asymptomatic. Since the initial presenting symptoms and signs of VSD and MR might be subtle or delayed, imaging modalities such as TTE and Transesophageal Echocardiogram (TEE) are beneficial in determining the diagnosis and the optimal treatment.

Takayasu arteritis (TA) is a rare granulomatous panarthritis, characterized by stenosis or obliteration of large and medium-sized arteries, such as the aorta. The onset of symptoms tends to lead to a delay in diagnosis that can range from months to years, during which time vascular disease may initiate and progress to become symptomatic. In this context, TA may present with various uncommon cardiovascular complications such as dilated cardiomyopathy, valvulitis, and myocarditis. Herein, we report on a 29-year-old female who initially presented with active myocarditis and was later incidentally diagnosed with TA.

This study examines the relationship of COVID-19 infection with demographic characteristics of the staff at Rajaie Cardiovascular Institute during the first six months of the epidemic.

The COVID-19 virus was first identified in December 2019 in China and then rapidly spread to other countries. One of the challenges that arose during the COVID-19 pandemic was human resource management. This led managers to prioritize protecting and managing employee health and safety.

This descriptive-analytical study was conducted on the staff of the Rajaei Cardiovascular Institute who were infected with COVID-19 between February and September 22, 2020. Demographic characteristics and clinical variables of the patients were collected using clinical records, interviews with the infected individuals, and phone calls. Data analysis was performed using SPSS software version 22.

Over six months, 448 individuals with a mean age of 38.86 years contracted COVID-19. Among them, 280 individuals (62.5 percent) were female. A total of 155 employees (67.1 percent) developed symptoms of the disease within one to five days after contact with an infected person. Additionally, 206 employees (48.4 percent) used all three protective measures—masks, gloves, and social distancing. Contact with an infected individual was observed as the most common method of disease transmission. The most common symptoms among the infected were myalgia, weakness, and fever, with only 3.5 percent requiring hospitalization.

Most patients, despite following health and personal protection guidelines, contracted COVID-19. Therefore, it seems that in addition to adhering to health guidelines,  vaccination is also an important necessity to prevent the spread of COVID-19. Other factors, such as changes in virus strains and people's failure in following health protocols, also contribute to the spread of the disease.

Mechanical complications following acute myocardial infarction (MI) are associated with very high morbidity and mortality. Left ventricular (LV) pseudoaneurysms constitute a rare complication after MI. Considered a contained rupture of the LV free wall, an LV pseudoaneurysm is more prevalent in older age, the female sex, hypertension, and inferior and lateral wall MI. Echocardiography, computed tomography, and cardiac magnetic resonance are considered good noninvasive imaging modalities for the diagnosis of LV pseudoaneurysms.

Case: 

A 39-year-old man with a history of anterolateral MI 18 months earlier, coronary stent insertion, and implantable cardioverter-defibrillator implantation presented for follow-up, but he was incidentally diagnosed with LV pseudoaneurysm in transthoracic echocardiography, which was confirmed by cardiac computed tomography.

Pseudoaneurysms must be diagnosed because of their high likelihood of rupture. However, as their clinical presentation is not specific, they are occasionally diagnosed incidentally. Clinicians should, therefore, always look for them in post-MI patients’ echocardiography.

We herein describe a 34-year-old woman with a persistent left superior vena cava (PLSVC) impinging on the posterior wall of the left atrium, subdivided by a membrane at the distal part of the impingement. In this patient, a much dilated coronary sinus due to the PLSVC resulted in a membrane-like structure in the posterior wall of the left atrium with the appearance of the cor triatriatum in transthoracic echocardiography (ie, a pseudo cor triatriatum). Although the PLSVC is a common malformation of the superior systemic vein, its aforementioned presentation is rare.

Blunt aortic trauma is a relatively rare fatal event with a high acute mortality rate of more than 80% on the scene. If the patient survives the primary injury, high clinical suspicion is necessary for diagnosis. The main mechanism of the trauma is reported to be deceleration injury or falling from a height. Herein, we describe a 37-year-old healthy male on a heavy weight lifting job for many years with a left upper mediastinum calcified mass incidentally discovered 18 years after blunt chest trauma. Transthoracic echocardiography and contrast-enhanced chest computed tomography scan revealed an aortic pseudoaneurysm just after the isthmus without descending aortic flow limitation, which was subjected to endovascular repair. High clinical suspicion is necessary for the diagnosis of aortic injury during blunt chest trauma. Atypical symptoms late after a traumatic event may be a manifestation of missed traumatic aortic rupture. Surgical repair, percutaneous intervention, or hybrid approaches are proposed for the management of this ominous scenario. (Iranian Heart Journal 2022; 23(4): 115-119)

Unilateral absence of the pulmonary artery (UAPA) is a rare congenital cardiovascular anomaly with a wide array of symptoms. An 18-year-old man was referred to our hospital with dyspnea on exertion and central cyanosis. Transthoracic and transesophageal echocardiographic examinations revealed severe right ventricular enlargement, large main and left pulmonary arteries, severe pulmonary hypertension, and a large patent ductus arteriosus (PDA). The right pulmonary artery could not be seen; consequently, UAPA was considered. Computed tomography angiography confirmed the diagnosis. Our case is a rare condition with UAPA associated with patent ductus arteriosus, diagnosed in adulthood. It underscores the need for awareness of this anomaly for early diagnosis and treatment. (Iranian Heart Journal 2022; 23(4): 125-130)

Ebstein’s anomaly (EA) is a congenital heart disorder characterized by abnormal function of the tricuspid valve. There are several ways to study tissue composition using magnetic resonance imaging (MRI). One of the most accurate methods is strain calculation using the feature tracking (FT) technique. Due to the novelty of the FT technique in cardiac magnetic resonance (CMR) imaging, there is a lack of comprehensive guidelines to conduct FT-MRI and to present a quantitative report. The current study is aimed to evaluate the FT technique in EA patients and to compare the obtained numerical values with those of healthy individuals. 

A total of 33 individuals were enrolled in a study conducted in 2018-2019 at Shahid Rajaei Hospital, Tehran, Iran. Radial, longitudinal, and circumferential strain patterns of the left and right ventricles were determined in both the patients and the controls using the FT technique. Data were analyzed using SPSS software, version 22.0.

The results showed a significantly lower left ventricular (LV) radial strain in EA patients compared to the control group (P=0.002). In addition, the right ventricular (RV) global longitudinal strain (GLS) in EA patients was significantly lower than in the controls (P=0.001). Other parameters (LV global longitudinal strain, RV radial strain, LV circumferential strain, and RV circumferential strain) did not differ significantly between the two groups.

Determination of strain patterns using cardiac MRI is a promising method for the diagnosis of EA. Markers such as LV longitudinal strain and RV-GLS are the most suitable parameters for the early diagnosis of heart dysfunction.

In the coronavirus disease 2019 pandemic era, clinical programs and mandatory hands‑on activities have been supplanted by remote teaching to maintain the fundamental capabilities of medical training and to furnish medical students with quality education. Nonetheless, the satisfaction of faculty members with this training method in the current pandemic has yet to be assessed. The aim of this study was to design a Persian questionnaire with appropriate validity and reliability on cardiology professors’ satisfaction level with virtual education.

In this cross‑sectional study, a questionnaire was devised drawing upon scientific sources and Iranian medical educators’ expertise. Seventeen faculty members in various specialties evaluated the questionnaire concerning face and content validity. Content validity was assessed through the calculation of the content validity ratio (CVR) (values >0.62 were considered acceptable) and the content validity index (CVI) (values >0.79 were considered acceptable), construct validity was evaluated through principal component factor analysis by the Kaiser–Meyer–Olkin (KMO) statistic and Bartlett’s sphericity test, internal reliability was measured through the calculation of Cronbach’s alpha coefficient, and consistency was appraised through the use of test‑retest reliability at two different time points.

The questionnaire had a reliability rate of 95%, indicating high internal validity. Concerning test‑retest reliability, the intraclass correlation coefficient was 0.96 (P < 0.001), demonstrating relatively good stability. The CVI was 0.81, and the CVR was 0.85. The KMO measure of sampling adequacy was 0.954, indicating the acceptability of the degree of common variance among the all items.

This Persian questionnaire on virtual education aimed at cardiology faculty members in the current pandemic with its low question count and appropriate domains had high reliability and validity. By knowing the level of professors’ satisfaction with the new method of education, it is possible to take steps to better provide specialized medical education to cardiology residents.

Intrapericardial hematomas are mostly found in association with traumas, cardiac surgical operations, and coronary interventions. In the case of open-heart surgeries, intrapericardial hematomas usually resolve without complications. However, in rare cases, they could be chronic or mimic the features of other lesions. We herein introduce a case of pericardial hematoma late after coronary artery bypass surgery with a cystic-like appearance. (Iranian Heart Journal 2022; 23(1): 237-239)

Acute pulmonary thromboembolism (PTE) is the most common manifestation of venous thromboembolism (VTE). Due to the physiological response of circulating leukocytes to stress, circulation neutrophils increase and lymphocytes decrease. Therefore, the neutrophil-to-lymphocyte ratio (NLR) and the platelet-to-lymphocyte ratio (PLR) can be important measures to assess the severity of systemic inflammation. We sought to study NLR and PLR and their relationships with the severity of VTE and mortality.

The study enrolled 331 patients with VTE from 2014 through 2018. Based on the complete blood count obtained from the peripheral blood samples of the patients on admission, NLR and PLR were calculated. The incidence of VTE with or without PTE, as well as its severity, was determined based on computed tomography angiography findings and the patients’ clinical status.

A positive relationship was observed between PTE and NLR (P=0.01). There was a significant relationship between the NLR and PLR values and PTE based on computed tomography angiography findings (NLR: P=0.001, PLR: P=0.012), but no relationship was detected between the ratios and the patients’ PTE severity based on clinical status. A significant relationship was also observed between NLR and the main pulmonary artery and segmental involvement (P=0.009), while no such association was seen with PLR. Additionally, the results revealed a significant relationship between NLR and mortality (P=0.030).

Our results demonstrated a significant relationship between the NLR and PLR values and PTE severity based on computed tomography angiography results and also mortality in patients with PTE. (Iranian Heart Journal 2022; 23(1): 65-73)

Pulmonary embolism (PE) is a major public health concern, with a considerable mortality rate. In the present study, we have evaluated the impact of registry implementation on PE management.

In the present single-center study, composed of two distinct cohorts, we have evaluated the impact of registry implementation (prospective arm-September 2015 to August 2018) on patient management and survival, and compared it with the same duration when no registry was implied (retrospective arm-September 2012 to August 2015).

One hundred and seventy and 182 patients were recruited in the prospective and retrospective arms, respectively. Guideline‑recommended risk stratification was significantly overlooked before the introduction of PE registry (100% vs. 45.6% prospective and retrospective arms, respectively [P < 0.001]). Atrend toward higher administration of thrombolytic therapy was noted in patients admitted during the registry time (20 [64.5%] vs. 3 [37.5%], P = 0.166). The registry had also significant impact on length of hospital stay (6.72 ± 4.39 days versus 9.35 ± 5.55, P = 0.001, in prospective and retrospective arms, respectively). No significant difference was detected on the 6‑month all‑cause mortality. However, re‑venous thromboembolism was significantly reduced during registry time (2 [1.2%) vs. 22 [12.2%], P < 0.001). Finally, significantly more patients underwent guideline‑recommended follow‑up during the registry time (107 [72.3%] vs. 30 [16.5%], P < 0.001).

Our study showed the implementation of registry had significant effect on PE‑related outcome and might have direct impact on burden of pulmonary emboli on the healthcare system.

Infective endocarditis can cause several major complications, including valvular destruction, aneurysm formation, and aortic ring abscesses, and pseudoaneurysm formation in left ventricular outflow tract (LVOT) is quite a rare complication of infective endocarditis. Here, we present a rare case which had two simultaneous LVOT pseudoaneurysms, a bicuspid aortic valve (BAV) and abscess formation along with the presence of anerobic bacteria (Peptostreptococcus) in the tissue culture. We describe echocardiographic, computed tomography angiography findings, and the result of surgical repair. This is a unique case with 2 LVOT pseudoaneurysms, a BAV, and anerobic bacteria in the tissue culture which became complicated as a result of delayed intervention due to fear of coronavirus disease 2019.

It is crucial to define the normal ranges of echocardiographic parameters and their relationships with age, sex, race, and geographical differences given the failure of the existing literature to reflect the diversity of the world’s populations. This study aimed to determine the normal ranges of echocardiographic systolic and diastolic values and the incidence of valvular heart lesions with or without rheumatic involvement in a sample of Iranian population.

The Echocardiography Heart Assessment and Monitoring in Rajaie Hospital study is a population-based investigation conducted in Rajaie Cardiovascular Medical and Research Center. Atotal of 2229 Iranian individuals between 30 and 75 years of age without clinical cardiovascular diseases were invited through a multistage random sampling process, and they underwent two‑dimensional and Doppler echocardiography. The left ventricular (LV) ejection fraction, the interventricular septal thickness, the ascending aortic size, the LV diastolic function, the valvular heart disease (VHD) severity, and rheumatic valvular involvement were assessed.

The study population comprised 2229 patients: 882 men (40%) and 1347 women (60%) at an age range of 39–58 years and a mean age of 48 years. The average body mass index was 28.8 kg/m2 (25.9–32 kg/m2 ), and the median body surface area was 1.86. Mildsystolic dysfunction was reported in 119 patients (5.7%) and moderate systolic dysfunction in 19 (0.9%). LV systolic dysfunction was significantly correlated with the male sex, age, and hypertension (P < 0.001). The mean interventricular septal thickness was 8 mm. Mild LV hypertrophy (LVH) was detected in 5.5% of all the patients and moderate LVH in 0.4%. The mean interventricular septal thickness significantly increased with age (P < 0.001), and it was higher in the men than in the women (8.2 mm [7.8–9.2] vs. 8 mm [7–8.25]; P < 0.001). Mild LVH and moderate LVH were significantly correlated with hypertension, diabetes mellitus, hyperlipidemia, chronic kidney disease, and diastolic dysfunction (P < 0.001). Diastolic dysfunction was found in 29% of the patients (28.6% mild and 0.2% moderate). Significant correlations were found between LV diastolic dysfunction and age, the female sex, diabetes mellitus, hypertension, hyperlipidemia, and hypercholesterolemia (P < 0.001). The mean ascending aortic size was 31 mm in the men and 29 mm in the women. The ascending aortic size exceeded 37 mm in 5% of the men and 3.5% of the women. The indexed ascending aortic size was 1.54 cm/m2 in the men and 1.66 cm/m2 in the women. Valvular heart lesions were diagnosed in about half of the study population. The most common findings were mild regurgitation in the mitral and tricuspid valves. Multiple valvular disorders were found in 55% of the patients. Among significant (moderate and more‑than‑moderate) VHDs, tricuspid regurgitation (36%), mitral regurgitation (33%), and aortic regurgitation (19%) were the most frequent VHDs. Rheumatic valvular involvement was diagnosed in 31 (1.4%) patients.

Echocardiographic parameters vary with age, sex, and race, and they should be population adjusted. We recommend further research in different areas of Iran to obtain sufficient data for the creation of an applicable guideline regarding echocardiographic parameters.

We herein present the preliminary results of our center’s chronic thromboembolic pulmonary hypertension (CTEPH) registry of the tertiary outcomes of patients diagnosed with CTEPH and treated with pulmonary endarterectomy (PEA), balloon pulmonary angioplasty (BPA), or medical treatment.

The present retrospective cross-sectional study was conducted on patients who received treatment for CTEPH in Rajaie Cardiovascular Medical and Research Center over the past four years, from 2016 to 2020. The data were obtained from routine hospital admission and outpatient visit records. The patients were divided into PEA, BPA, and medical treatment groups, and the outcomes and complications of the procedures were reported.

Twenty-eight patients, at a median age of 40 (33–59) years were included in our study and were followed for approximately 20.0 (16.2–23.7) months. PEA was performed on 13 (46%) patients, BPA on 10 (35%), and medical therapy only on 5 (17%). Death occurred in 4 (30%) patients after surgery, and 10 (77%) had a surgical complication. There were no deaths or recorded complications in the other two groups, but the rates of postprocedural pulmonary hypertension (30% vs. 91%; P = 0.006) and rehospitalization (7% vs. 73%; P < 0.001) were significantly lower in the operated patients. The 1‑year survival rate among the entire study population was 85.7%.

The possibility of CTEPH incidence, especially in high‑risk patients with dyspnea, should always be borne in mind given its large morbidity and mortality rate and its chances of curability with early diagnosis and proper treatment.

Spontaneous coronary artery dissection (SCAD) is a well-documented cause of acute coronary syndrome and could have life-threatening consequences. We report the case of young female with a prior history of cardiac surgery due to congenital aortic stenosis presenting with multi-vessel SCAD. She was successfully managed with medical treatment.

Computed tomography (CT) is currently known as a versatile imaging tool in the clinic used for almost all types of cancers. The major issue of CT is the health risk, belonging to X-ray radiation exposure. Concerning this, Monte Carlo (MC) simulation is recognized as a key computational technique for estimating and optimizing radiation dose. CT simulation with MCNP/MCNPX MC code has an inherent problem due to the lack of a fan-beam shaped source model. This limitation increases the run time and highly decreases the number of photons passing the body or phantom. Recently, a beta version of MCNP code called MCNP-FBSM (Fan-Beam Source Model) has been developed to pave the simulation way of CT imaging procedure, removing the need of the collimator. This is a new code, which needs to be validated in all aspects.

In this work, we aimed to develop and validate an efficient computational platform based on modified MCNP-FBSM for CT dosimetry purposes.

In this experimental study, a setup is carried out to measure CTDI100 in air and standard dosimetry phantoms. The accuracy of the developed MC CT simulator results has been widely benchmarked through comparison with our measured data, UK’s National Health Service’s reports (known as ImPACT), manufacturer’s data, and other published results.

The minimum and maximum observed mean differences of our simulation results and other above-mentioned data were the 1.5%, and 9.79%, respectively.

The developed FBSM MC computational platform is a beneficial tool for CT dosimetry.