shahrooz yazdani

 Mycoplasma pneumoniae is a common cause of community-acquired pneumonia (CAP) in children and adolescents. Identifying the incidence and severity of this infection in individuals under the age of 18 can assist in improving the treatment and prevention process.

The present study aimed to evaluate the frequency of M. pneumoniae infection in young patients through a systematic review and meta-analysis.

Three major databases (Medline (via PubMed), Embase, and Web of Science) were searched for research about M. pneumoniae infection in children. STATA (version 14) software was used to interpret the data.

Seventy-seven studies fulfilled the eligibility criteria to evaluate the prevalence of M. pneumoniae infection among children. The prevalence of this infection in young patients was 22.5%. The results revealed that children and adolescents in the age range of 10‒18 years old had the highest prevalence of M. pneumoniae (23.1%, 95% confidence interval [CI]=6.7‒39.4), followed by the 5‒10-year-old age group (21.6%, 95% CI=17.9‒25.3] and the under 5-year group (20.9%, 95% CI=16.7‒25.1).

The global rate of M. pneumoniae infection has been gradually increasing since 2001. Finally, more extensive studies on the prevalence of M. pneumoniae infections in children throughout the world are needed to assess its exact prevalence and antibiotic resistance trend.

Introduction and goal:

 With the aging of the population, hip fracture in the elderly has become a growing medical and social concern. Whether early surgery is beneficial in such patients is a long-standing debate and a constant clinical concern in the management of patients with hip fracture. Is What seeming necessary is to review the guidelines on how to deal with such patients in different health care systems. Therefore, this study was conducted with the aim of investigating factors affecting the delay in surgery and the increase in one-month mortality of patients with proximal femur fractures in patients referred to Shahid Madani Alborz Hospital during 2020-2021.

This cross-sectional analytical study was conducted on 126 patients in Shahid Madani Hospital in Karaj city during the years 2013-1400. Patients were divided into six groups according to the time taken until surgery (less than 24 hours to more than 120 hours). After that, the death and its cause in one month after the surgery were investigated by phone calls and examination of patients' files in the clinic. Data were collected using pre-designed forms and information recorded in patients' files, as well as using the same device and operator for each patient.

Among the 126 patients included in the study, 103 (81.74) were women and 13 (18.26) were men. 4 patients (2.5%) underwent urgent surgery. 17 patients (13.8%) underwent surgery within 24 hours after admission and 82 patients (64.9%) underwent surgery more than 48 hours after admission. The results showed that the mortality rate increases significantly with a delay of more than 120 hours. Lack of available operating room for planned surgery (60.3%) was the most common cause of surgical delay. Older age, dementia, and the need for assistance with activities of daily living before the fracture were also associated with higher rates of medical complications.

In summary, our study showed that very long delays increase the patient's stay in the hospital and thus may increase the risk of mortality and some medical complications.

We aimed to investigate the existence of unnecessary demand for angiography and the factors affecting it to provide evidence for decision makers.

This longitudinal panel study was conducted in public hospitals in Tehran, Iran by using 2458 patients' records that were undergoing angiography for suspected coronary artery disease 2013-2015. To modeling the physicians' behavior based on physician-induced demand (PID), the patients were classified as appropriate, uncertain, and inappropriate and then Hierarchical Linear Modeling (HLM) model besides the physician ethic index was developed and finally the existence of PID showed based on three scenarios.

Angiographies were performed inappropriately in 23.8% of 2458 patients as well 46.7% were uncertain, and 29.5% were appropriate. According to the HLM model, the physician-to-population ratio (δ0= - 0.161) and the interaction variable coefficient are higher than zero and significant (δ1 = 253). The results of the physician ethic index showed that most physicians were at a moderate rate, meaning that their utility was a combination of both pecuniary and non-pecuniary profits (0< │εpδ │<1). Considering the HLM model and the medical ethics index together has almost shown the condition of PID (the necessary condition δ1> 0 and the sufficient condition (1 ≤│εpδ│)) existed for about 26% of all studied physicians who had pure profit maximizer.

To reduce induced demand and improve medical ethics adherence in cardiologist, policy makers should develop native guidelines, rules, and instructions besides policies related to education, and increasing patients' awareness.

Currently, epicardial coronary angiography is still the only diagnostic tool for Coronary Slow Flow Phenomenon (CSFP). This study aimed to systematically review studies that compared Electrocardiogram (ECG) findings between patients with and without CSFP.

Using relevant key terms, we systematically searched MEDLINE, Scopus, Embase, and Web of Science to find relevant studies up to February 5th, 2023. Effect sizes in each study were calculated as mean differences and crude odds ratio; then, random-effect models using inverse variance and Mantel-Haenszel methods were used to pool standardized mean differences (SMD) and crude odds ratios, respectively.

Thirty-two eligible articles with a total sample size of 3,937 patients (2,069 with CSFP) were included. CSFP patients had higher P-wave maximum (Pmax) (SMD: 1.02 (95% confidence interval (CI): 0.29 - 1.76); p=0.006) and P-dispersion (Pd) (SMD: 1.63 (95% CI: 0.99 - 2.27); p<0.001) compared to the control group. CSFP group also showed significantly longer QT wave maximum duration (SMD: 0.69 (95% CI: 0.33 - 1.06); p<0.001), uncorrected QTd (SMD: 1.89(95% CI: 0.67 - 3.11); p=0.002), and corrected dispersion (QTcd) (SMD: 1.63 (95% CI: 1.09 - 2.17), p<0.001). The frontal QRS-T angle was significantly higher in the CSFP group in comparison with the control group (SMD: 1.18 (95% CI: 0.31 - 2.04; p=0.007). While CSFP patients had a significantly higher T-peak to T-end (Tp-e) (SMD:1.71 (95% CI: 0.91, 2.52), p<0.001), no significant difference was noted between groups in terms of Tp-e to QT (p=0.16) and corrected QT ratios (p=0.07).

Our findings suggest several ECG parameters, such as P max, Pd, QT, QTc, QTd, QTcd, Tp-e, and frontal QRS-T angle, may be prolonged in CSFP patients, and they could be employed as diagnostic indicators of CSFP before angiography.

Laboratories, on average, allocated for about 4 percent of Hospital's budget and are often considered the main focus of health care spending. There is a wide range of laboratory automation options available today that Designed to improve the quality and efficiency of laboratory tests. The aim of this study was to investigate The effect of Implementation of Automatic Stop Order  program on the management of the request and the cost of frequent and costly tests in Shahid Rajaei Educational and medical center.

This research is analytical and comparative. In terms of time, the work is cross-sectional-longitudinal. After of data collection of before and after of Implementation of Automatic Stop Order  program,  analysis was carried out with the SPSS 19&Excel softwares.

In order to establish the Auto Stop Order program to control the amount of requests and the cost of frequent tests, first the number of requests and the total cost of tests in Shahid Rajaei Medical Training Center were examined and all the laboratory services requested in the hospital, 27 laboratory services were selected to apply in the Auto Stop Order program. The total number of requests after the implementation of the Auto Stop Order program decreased by 11% and 8100 laboratory services. Also, after the implementation of the Auto Stop Order program on 27 costly tests, the cost of the tests was reduced by 16% and the amount was 445,004,725 Rials.

Using the Auto Stop Order program can lead to rational prescribing of tests according to clinical guidelines, reducing the cost of patients' and resource control, and saving hospital laboratory costs. Therefore, managers and policy makers of the health system should create a suitable platform to use this program as a way to reduce costs in the laboratories of public hospitals in the country.

The coronavirus disease 2019 (COVID-19) caused the outbreak of viral pneumonia in Wuhan, China, in December 2019. It is principally identified with respiratory disease and pulmonary manifestations. However, based on various reports, COVID-19 infection not only affects the respiratory system but also infects other organs. Cardiac manifestations, gastrointestinal complications, liver dysfunction, musculoskeletal disorders, ocular findings, and hematological manifestations are among the published extrapulmonary clinical manifestations. Lack of awareness and attention to these extrapulmonary features might result in misdiagnosis, delayed diagnosis, incorrect treatment, and eventually an increase in the spread of the virus by unidentified individuals to others in the community. Therefore, the current study comprehensively reviews and discusses the extrapulmonary manifestations of COVID-19 in mild or severe patients.

The coronavirus disease 2019 (COVID-19) caused viral pneumonia in Wuhan City in China in December of 2019. Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) primarily targets the lungs with severe hypoxia, which usually results in death. COVID-19 is highly heterogeneous regarding severity, clinical phenotype, and more importantly, global dispersal. The respiratory system in all aspects such as respiratory airways, endothelium of pulmonary vessels, conducting airways, the alveoli, neuromuscular breathing structure, and pulmonary circulation are affected by this virus. A comprehensive concept of the source and dynamic action of the SARS-CoV-2 and the possible causes of heterogeneity in COVID-19 is required for predicting and managing the illness in acute and chronic stages of the pulmonary sign.

Methanol is the simplest yet toxic alcohol found in many households and industrial materials. Exposure to methanol can be hazardous, and if left untreated, can result in mortality or severe morbidity. Methanol poisoning is mostly accidental, but it can result in mortality and severe morbidity. Due to the high prevalence of ECG changes in patients with methanol poisoning, this study aimed to evaluate the relationship of these ECG changes with methanol poisoning in determining the prognosis of the patients. This cross-sectional study was conducted on 114 patients with acute methanol poisoning at the Shahid Rajaei Hospital in Karaj, Alborz Province, Iran. Clinical, laboratory and ECG variables were evaluated. Furthermore, the gathered data were analyzed with SPSS software. 1.8% of patients had a PR interval of less than 121ms, and 3.5% had more than 200ms. Among various ECG changes, only PR intervals of more than were significantly associated with mortality. Patients with short QT intervals had the highest PCO2, PH, and HCO3. On the other hand, people with long QT had the lowest amount of PCO2, PH, and HCO3, which was statistically significant. Laboratory tests showed significant differences in serum potassium level and blood PH between died and survived patients.Discussion and In our study, the most common finding in ECG was sinus tachycardia, and short QT was the second most common finding, which is consistent with other studies. Our study found that in ECGs, only PR intervals more than 200 have a significant relationship with mortality, which supports previous studies. Finally, it was that mortality in patients with methanol poisoning is significantly associated with PR interval prolongation, acidosis, and hyperkalemia.

The coronavirus disease 2019 (COVID-19) pandemic, along with recurrent severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) mutations and unavailability of specific treatment indicates the need for effective treatments. In this regard, supportive therapies can be highly beneficial and essential. Gastrointestinal microbiome balance has long been considered a vital factor in human health. The use of probiotics has been suggested to treat diseases in which the gut microbiome is imbalanced. Gastrointestinal symptoms are present in some patients with COVID-19, and experiments have shown microbial imbalance in these patients. The inhibition of neutrophil elastase (NE) and an increase in butyrate can help improve and recover COVID-19 by inhibiting virus entry and its proliferation, boosting the immune system, performing antimicrobial functions, and preventing hypercoagulability. Therefore, the possibility of using a combination of Bifidobacterium longum NCC2705, Odoribacter, and Butyricicoccus pullicaecorum 25-3T was proposed for this purpose. In this review article, we discussed the association between the gut microbiome and COVID-19 infection and evaluated the potential of modulating the balance of the gut microbiome in preventing adverse events during SARS-CoV-2 infection.

The severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) rapidly spread worldwide and infected multiple age groups. The best way to reduce the risk of spreading new coronavirus (coronavirus disease 19, COVID-19) is the rapid and accurate identification of carriers and infected patients in society. Although several diagnostic tests are available, reverse transcription-polymerase chain reaction (RT-PCR) testing is commonly used for this purpose. In this review, various methods were introduced for the identification of COVID-19 patients using clinical manifestations, gastrointestinal symptoms, and molecular and serological diagnostic techniques. Finally, the advantages and disadvantages of diagnostic tests, including molecular and serological tests, were evaluated to identify the novel coronavirus.

The common variable immune deficiency (CVID) is known as the most prevalent symptomatic primary immune deficiency (PID) diseases, which is characterized by hypogammaglobulinemia with variable infectious and noninfectious manifestations. In this study, the researchers aimed to evaluate the frequency of cardiac disorders and investigate its association with other manifestations in CVID patients.

A total of 337 CVID patients registered in the Iranian Primary Immunodeficiency Registry were evaluated in this study. The questionnaire was completed for all patients to collect the participants’ demographic data, clinical manifestations and laboratory finding. The analysis was performed between the two groups of the study including CVID patients with cardiac manifestation and those without it.

The prevalence rate of cardiac manifestation was calculated to be 9.1%. pericardial and myocardial diseases and pulmonary hypertension were the most prevalent complications. CVID patients with a history of cardiac problem had significantly higher prevalence rates of otitis media, lymphoproliferative disorders, splenomegaly, hepatomegaly, failure to thrive and lower numbers of CD8+ T cells and CD19+ B cells compared to the patients without cardiac disorders. Notably, no significant differences were observed in immunoglobulins serum levels, CD3+ and CD4+ T cells between the patients with and without cardiac manifestation.

Regular echocardiographic evaluation and of CVID patients for cardiac complications especially for inflammatory cardiac disease, heart failure and pulmonary hypertension, is critical to reduce the risk of heart disease.

Inflammation plays an important role in the pathogenesis of diseases such as atherosclerosis and other inflammatory disorders. The inflammatory markers impose a considerable cost on the health system. Recently, neutrophil to lymphocyte ratio (NLR) has been shown to be involved in the prediction of coronary artery disease (CAD).

This study was conducted to clarify the potential relationship between NLR and the inflammatory extent of CAD.

Patients with ST-elevation myocardial infarction (STEMI) or stable angina who underwent primary or elective percutaneous coronary intervention (PCI), respectively, were included in this cross-sectional study. Patients with hematologic disorders, recent or active infectious or inflammatory diseases, history of malignancy, and history of treatment with immunosuppressive drugs were excluded from the study. Gensini and SYNTAX scores were calculated for each patient as an indicator of the extent of CAD. Demographic and clinical characteristics were obtained through a questionnaire and NLR was calculated using laboratory results.

A total of 446 patients (223 patients in each group) fulfilled the inclusion criteria. NLR had a significant relationship with Gensini score in both stable angina and STEMI patients. Gensini and SYNTAX scores correlated significantly with NLR; however, the correlation was weaker for SYNTAX score. After adjustment for confounding factors, including age and hypercholesterolemia, only one trend remained for the Gensini scores.

NLR showed a stronger correlation with Gensini score than SYNTAX score. Our findings are in accordance with previous studies, which show that NLR has a relationship with the extent of CAD. Further studies are required for reaching a definite conclusion. The idea of this study may be useful for the investigation of other inflammatory diseases.

The pandemic of the novel human coronavirus disease 2019 (COVID‐19) has become an evolving global health issue due to the high morbidity and mortality rate. Patients who have comorbidities (e.g., diabetes, hypertension, obesity, cancer, and cardiovascular disease) are significantly at increased risk for admission into the intensive care unit, and this situation could affect the survival of the infected patients. Among the various comorbidities in this review, we focused on the diabetic patients who were highly affected because of increased viral entry into the cell via angiotensin-converting enzyme 2 (ACE2) in the respiratory system, leading to decreased immunity. Furthermore, several studies have been conducted on the beneficial effects of metformin in diabetic patients with COVID-19, but other studies have demonstrated the severe course of COVID-19 disease. Hence, further comprehensive studies are necessary in this regard. For these reasons, the prevention and management of COVID-19 in diabetic patients are essential and play a key role in reducing the fatality rate.

in this study, we examined the risk factors and the effects of substance abuse on the incidence of ischemic heart disease in patients less than 40 years old in Shahid Rajaei Hospital in Karaj from 2019-2020.

This case-control study was done on 70 patients in the cases and 70 cases in the control groups. All demographic data, including age, gender, place of residence, weight, height, body mass index, Cardiovascular (CVD) risk factors, including hypertension, high levels of blood fats, diabetes, a history of smoking cigarettes, tobacco, crystal meth, and cocaine, alcohol consumption, as well as a history of taking supplements for bodybuilding, and sex-enhancing drugs were obtained. Afterward, blood levels of glucose and fats were evaluated and urine analysis for the presence of drugs, such as amphetamine, methamphetamine, buprenorphine, benzodiazepines, cannabinoids, cocaine, morphine, methadone, tramadol, and Tricyclic Antidepressants (TCA) was done. SPSS software v. 22 was used for data analysis.

Among the studied underlying factors and drugs, family history, high blood pressure, diabetes, smoking, and Low-density Lipoprotein (LDL) levels above 130 mg/dL were significantly associated with a higher risk of acute Myocardial Infarction (MI) (P<0.05). Interestingly, alcohol consumption and the use of tobacco, opium, methadone, heroin, cocaine, cannabis, amphetamines, methamphetamine, tramadol, benzodiazepines, TCA, buprenorphine, and anabolic steroids were not significantly associated with acute MI under 40 years (P>0.05).

according to the results of the present study, it seems that a positive family history of MI under the age of 55, hypertension, diabetes, smoking, and LDL levels above 130 mg/dL are more significant risk factors for acute MI in patients under 40 years of age in comparison with the consumption of alcohol and the use of hookah, opium, methadone, heroin, cocaine, cannabis, amphetamine, methamphetamine, tramadol, benzodiazepines, TCA, buprenorphine, and anabolic steroids. It should be noted that further studies in this area are recommended

Medicine students must learn clinical skills besides learning theory in classes. Skill lab is a safe place for students to achieve that goal with educational facilities under observe of a master. The purpose of this study was to investigate the effect of simulation training in clinical skill lab center on clinical knowledge and practice of medical interns in Alborz University of Medical Sciences in 1397.

The present study is a semi-experimental study with 46 medical interns in the field of gynecology. In this study, all trainees first attended routine workshops at the Clinical Skills Center and were trained in lectures, slides and practical work in the 8 core skills of the gynecologist, They received a quadruple written pre-test and an OSCE Practical Assessment (OSCE). Then students were randomly divided into two groups of case and control. The control group was referred to the womenchr('39')s ward for training and the case group participated in simulated training workshops then they were introduced to the womenchr('39')s ward for training. After completing the course, the written and practical tests were repeated for both groups and compared.

There was no significant difference between the mean scores of pretest in case and control groups before intervention. But after the intervention and the establishment of simulated workshops and completing an internship,the mean scores after the written test showed a significant difference in the case and control groups(P-value= 0.027). In the performance evaluation section, there was no significant difference between the mean scores of pre-test OSCE in the case and control groups but after intervention, the mean of OSCE scores in case and control groups showed a significant difference(P-value= 0.009). The results showed that in the basic knowledge, the mean increase in post-test scores in the written test was 2.39 more in the case group than in the control group, and in the practical part the mean increase in the mean scores of the case group was 19.48 higher than the control group.

By examining the findings and paying attention to the increase of the written and practical test scores in the case group it is found that the teaching of obstetrics and gynecology skills by simulation method has more effect on increasing the level of basic knowledge and enhancing studentschr('39') abilities in the field of gynecology.

Behçet’s disease (BD) is a multisystem inflammatory disorder. Physicians should be alerted to the possibility of BD in a patient with a carotid artery pseudoaneurysm and no clear predisposing factor such as neck trauma or surgery. Endovascular repair of carotid pseudoaneurysms is technically feasible with excellent midterm follow-up results. Administration of immunosuppressive therapy before endovascular intervention is mandatory to reduce the chance of vascular complications accompanied by BD.A 40-year-old man presented with a painful and pulsatile neck mass with 2 episodes of transient ischemic attacks. The patient also complained of recurrent urogenital ulcers and aphthous lesions together with painful rashes. Ultrasonography and computed tomography angiography revealed 2 aneurysmal dilations in the left common carotid artery at the bifurcation level. He was referred to a rheumatologist, who made the diagnosis of BD. High-dose corticosteroids and cyclophosphamide were commenced. One week later, 2 overlapping self-expanding stent grafts were deployed. The final angiogram showed no residual endoleak, and the flow of the carotid and cerebral arteries was satisfactory. The patient was discharged with no neurological complications. Follow-up ultrasonography and computed tomography angiography 6 months later showed no endoleak, as well as significant shrinkage of the aneurysm sac.

The second annual meeting of Clinical Case Report (CCR) has been held in Karaj, Iran from the 26th to the 27th of December, 2018 (Figure 1). The congress was organized by the Clinical Research Development Center of Shahid Rajaei Educational and Therapeutic Center, Alborz University of Medical Sciences together (Figure 2), with a Scientific Committee including some of the faculty members of the university (Table 1). The conference program was organized into the following sessions: · Cardiovascular · Nursing · Pediatrics · Obstetrics and Gynecology · Internal Medicine · Surgery · Urology · Neurology and Neurosurgery · Orthopedics · Psychiatry · Laboratory Sciences · Infectious diseases · Traditional Medicine This meeting brought together clinician and researchers from several prestigious universities and research centers throughout Iran including Rasht, Torbat Heidarieh, Qazvin, Neyshahpour, Ardebil, Isfahan, Khorramabad, Tabriz, Hamedan, Marand, Bushehr, Mashhad, Ahvaz, Sanandaj, Bojnourd, Sabzevar, Kashan, Gorgan, Ilam, Dezful, Yazd, Tehran, Urmia and Semnan, as well as leading researchers from countries such as Turkey. Participants were invited to submit scientific contributions, as oral presentations or posters. After evaluation of the 858 abstracts received, the Scientific Committee selected 40 of them for oral presentations, and accepted 231 as posters.

In patients with cardiac resynchronization therapy (CRT), loss of left ventricular (LV) stimulation occurs chiefly because of LV lead dislodgement. The occurrence rate of LV lead dislodgement in different reports is between 2% and 12% of patients. LV lead dislodgement precludes clinical improvement. We describe 2 patients with heart failure, fulfilling the criteria for CRT implantation. In both patients, right ventricular and right atrial leads were implanted via the left subclavian vein in the right ventricular apex and the right atrial appendage, respectively. Repeated LV lead implantation was unsuccessful and each time after the fixation, the LV lead was dislodged with the heart motion during systole and diastole. In order to stabilize the LV lead, we decided to benefit from coronary sinus stenting and lead entrapment behind the deployed stent. LV lead stabilization was accomplished by the deployment of bare-metal stents (Multi-Link 3.5 × 8 mm and Multi-Link 3 × 8 mm, Abbott Vascular) in order to entrap the LV lead. The stents were deployed at a nominal pressure (10 atm). The pacing performance of the LV leads was satisfactory and stable at midterm in our experience. Stenting within the coronary sinus seems to be a safe method for LV lead stabilization and can substantially boost the success rate of CRT. Our device analysis during short- and midterm follow-up (4 months after implantation) revealed acceptable LV lead threshold and impedance.

Thromboembolism occurs commonly in general practice and leads to significant health burden. Apart from cardiac sources, aortic atherosclerotic plaques contribute considerably to thromboembolism. A 63-year-old diabetic hypertensive woman referred to our center due to exertional chest pain unresponsive to optimal medical therapy and underwent coronary angiography. Owing to resistance during guide-wire advancement, an aortography was performed. Aortic arch injection demonstrated a large suspended mass distal to the left subclavian artery with free movement in the descending thoracic aorta. Echocardiography revealed widespread atherosclerotic changes in the aortic arch with a large hypermobile mass. Dual-source multi-slice (2 × 128:256) computed tomography angiography of the whole aorta revealed a large floating mass (in favor of a thrombus) in the distal portion of the arch. The patient underwent coronary artery bypass grafting due to severe coronary artery disease. The intra-aortic mass, which was actually a large atherosclerotic plaque, was resected at the same session. She was discharged uneventfully and during a 1-year follow-up, she had no embolic events.

After early successful experience with transcatheter aortic valve replacement (TAVR), concept of transcatheter implantation of a new valve within a failing bioprosthetic valve emerged. Valve-in-valve (ViV) implantation seems to be a simpler option for high risk surgical patients.
We performed five ViV procedures in different valve positions. We included patients with failing bioprosthetic valves with high surgical risk due to concomitant comorbidities. We performed 2 transapical ViV procedures for failing mitral bioprosthetic valves, 1 transfemoral procedure for failing pulmonary valve and 2 transfemoral ViV implantation for failing tricuspid bioprosthetic valves.
The procedures were successfully completed in all 5 cases with initial excellent fluoroscopic and echocardiographic verification. There was no valve embolization or paravalvular leakage in any of the cases. Transcatheter valve function was appropriate with echocardiography. Post procedural clinical adverse events like pleural effusion and transient ischemic attack were managed successfully. In midterm follow up all cases remained in appropriate functional class except from the transcatheter pulmonary valve which became moderately stenotic and regurgitant.
As the first Iranian all-comers case series with midterm follow up for ViV implantation, we had no mortality. Interestingly none of our patients had neurologic sequelae after the procedure. Midterm follow up for our patients was acceptable with good functional class and appropriate echocardiographic findings. Due to high surgical risk of the redo procedure after failing of a bioprosthetic valve especially in elderly patients with comorbidities, ViV implantation would be a good alternative to surgery for this high risk group.

Cardiac manifestations of the hydatid cyst are relatively uncommon. Cardiac involvement may lead to the compression of vital organs, pulmonary hypertension, pericardial effusion, and even anaphylaxis. A 45-year-old woman presented to the Emergency Department of Tehran Heart Center with chest pain. Cardiac examination revealed relatively muffled heart sounds. Echocardiography demonstrated a round echolucent well-defined mass (47 × 25 mm) on the base and the mid lateral wall of the left ventricle (LV) without septation. Computed tomography angiography and cardiac magnetic resonance imaging revealed a large (52 mm) exophytic mass originating from the lateral wall of the LV with upward growth between the left anterior descending artery (LAD) and the left circumflex artery with no LV cavity obliteration. Coronary angiography showed upward displacement in the LAD with significant compressive narrowing. The patient underwent mass resection and grafting of the LAD. During surgery after the incision of the pericardium, the hydatid cyst entity of the mass was revealed. Hydatid cysts covered the anterolateral surface of the LV with adhesion to the pericardium. The patient recovered from the surgery uneventfully. Pathology report and immunological assays confirmed the diagnosis. During a 6-month postoperative follow-up period, she remained asymptomatic with complete recovery and no recurrence.