- Volume:6 Issue: 1, 2015
- تاریخ انتشار: 1394/06/06
- تعداد عناوین: 15
Total Arterial Revascularization Based on LIMA Flow, the Impact of Composite Grafting on LIMA to LADPage 1Total arterial revascularization (TAR) with joining arteries together as a composite graft with the LIMA as the main source of blood inflow has proved to have advantage over the conventional technique at least in long term; we assessed the flow hemodynamics in this type of surgery with focus on changes in LIMA to LAD flow patternKeywords: Total Arterial
Ventricular Septation and Management of Straddled ValvesPage 2ventricular septation is an alternative for TCPC in certain patients with univentricular anatomy. Different results has been reported in literature and superiority of any of those procedures in cases with possible both options in not clear. We present ou experience with two septation procedures in two patients who were not candidate for univentricular repair. The technique and the literature history will be reviewedKeywords: Ventricular Septation
Minimally Invasive Aortic Valve Replacement, technique and resultsPage 3Aortic valve surgery can be performed by various types of approaches including Sternotomy, upper mini-sternotomy and right anterior thoracotomy. We present our experience with the mini-sternotomy approach for AVR.Keywords: Minimally Invasive
Opened Chest after Cardiac Surgery, Is it Justified?Page 4Masih Daneshvari Medical Center, Darabad, Niavaran, Tehran, Iran
Closing the sternum causes 25% reduction in cardiac output. In critical patients closing the sternum may be enough for decreasing blood pressure and initiation a viscous cycle for subsequent adverse effects. In the new era ECMO and other mechanical circulatory supports are the best way to prevent this adverse effect. But in our country due to inavailability of ECMO at all times and high cost of it, the sternum was kept open for 24-48 hours and the results was compared with the patients undergone ECMOKeywords: Opened Chest
First Experience of ECMO in IranPage 5Transplant Research Center, ShahidBeheshti University of Medical Sciences Extra Corporeal Membrane Oxygenation (ECMO) although is a routine management of temporary circulatory or respiratory failure in the western countries, but due to high cost was not applicable in our country.
In a tertiary center with high load of patients with respiratory failure and also an active heart and lung transplant program, this program was started since 1386, but became active from 1390. From Farvardin 1386 till Day 1393, 40 patients were undergone ECMO. The mean ages of the patients were 28.77 ±21 (Max. 68 and Min. 3) and the duration of ECMO was 42.92 ±3.67 hours. Successful weaning of ECMO was in 29 cases (72.5%), but alive discharges were in 20 cases (50%). ECMO were used in Alveolar Proteinosis (12), Lung transplant (11), ARDS (8), Post heart transplant (3), Post Pulmonary Embolectomy (1), Post Pulmonary Endarterectomy (3), and Post CABG (3).
It was most effective in Alveolar Proteinosis and lung transplant patients and least effective in ARDS, Post heart transplant and Post CABG patients. The cause of failure in those patients may be late application of ECMO. The cause of mortality in alive patients after successful weaning of ECMO was Sepsis and multiorgan failure and in one the heart transplant patients were rejectionKeywords: ECMO
Electrophysiologc Study and Ablation in Children, the State of the ArtPage 6Rajaie Cardiovascular Medical and Research Center, Iran University of Medical Sciences, Tehran, Iran Interventional electrophysiology (EP) procedures are approved for treating some types of arrhythmia. The method is available and routine for adult patients in numerous cardiology centers worldwide. For children, however, interventional EP procedures are more restricted both because of the technique and the nature of pediatric arrhythmias. So, pediatric EP procedures only done in few tertiary centers worldwide.
In Iran, since 2010 we started the first national academic center for pediatric arrhythmia. Many hundred pediatric patients including infants and neonates were managed and treated in Rajaie Cardiovascular Medical and Research Center. Of them several cases had complex cardiac lesions and some had rare types of arrhythmia. We had several reports and publications based on our experience in medical literature. Hereby I will talk about the tips, tricks, and results of pediatric EP proceduresKeywords: Electrophysiologc Study
Evaluation of the Cardiac Function by MRI in ChildrenPage 7Cardiac MRI is generally considered the reference standard for the assessment of ventricular dimensions, function, and mass in terms of accuracy and reproducibility, and this is reflected by class III recommendations for the clinical use of cardiac MRI by recent consensus panels. However, a general problem in the interpretation of such data is the fact that cardiac growth is known to be allometric, that is, the relation between the size of the heart and the body changes from infancy to adulthood .Moreover, such allometric growth is likely to be different between the sexes.
This renders any age group definition somewhat arbitrary because sex differences in the speed of maturation and cardiac growth are not accounted for, thus limiting the scientific and clinical value of age group based reference data. The relation between the size of the heart and the body is known to be allometric, which means that this relation changes from infancy to adulthood. This makes the generation of normative data challenging. However, the ability to accurately measure volumetric and mass parameters of right and left ventricular function, adequately scaled to body size, is of critical importance both for clinical care and for cardiovascular health researchKeywords: Evaluation
Transcatheter VSD Closure by Different DevicesPage 8Defects are classified according to their location within the septum (muscular, perimembranous, or supracrystal). The most common type is the perimembranous VSD (around 70%).
Indications for VSD closure are symptoms of heart failure, signs of left heart chambers volume overload, or a history of endocarditis. In patients with a volume overload of the left heart, closure is necessary to prevent pulmonary arterial hypertension, ventricular dysfunction, and arrhythmias.
The surgical approach is considered to be the gold standard, but it is associated with morbidity and mortality and the use of CPB. Percutaneous techniques have been developed to reduce the impact of such drawbacks of surgery. The attractiveness of percutaneous closure lies in the avoidance of cardiopulmonary bypass and sternotomy, a shorter hospital stay, and decreased cost.
The most significant complication is complete atrioventricular block (4-5%). The only variable significantly associated with the occurrence of this complication was age at the time of the procedure. In contrast, iatrogenic complete heart block after surgical VSD closure occurs in less than 1%. Equally, periventricular device closure of VSDs without cardiopulmonary bypass (CPB) under trans esophageal (TEE) or epicardial echocardiography guidance yields a low risk for rhythm disorders.
Different devices have been used for transcatheter VSD closure: AMPLATZER perimembraneous or muscular VSD occluders, Cardio -SEAL devices. Other devices have been used «off-label» to close muscular as well as perimembranous VSDs, including the buttoned device, detachable coils and the Amplatzer Septal Occluder.
However, these devices as well as the approved Cardio-SEAL device were designed for different indications and as such are not generally adapted to suit the very different anatomical and morphological parameters (such as septal thickness) that are encountered with muscular VSDsKeywords: Transcatheter VSD
Ductal Stenting in Complex Cardiac LesionsPage 9Children''s Medical Center, Tehran University of Medical SciencesChildren with diminished pulmonary blood flow (different forms of severe pulmonary stenosis or atresia) suffer from severe life-threatening cyanosis and need interventions to increase this flow. The classic way is a surgical modified BT shunt. However, this operation carries a 10% risk of death and a higher risk of morbidities like chylothorax, phrenic nerve palsy, and others .
A substitute to the surgery is ductal stenting. In many neonates, ductus arteriosus can be left open with the aid of prostaglandins and then by coronary or small peripheral stents to provide enough pulmonary blood flow. The procedure is less traumatic and equally successful. Based on the angle of ductus to the aorta and cardiac anatomy, it can be done via venous or arterial approach. The most fearing complication of the arterial approach is vascular injury which can be reduced almost to nil using small radial sheaths. Heart block is a frequent complication of the venous approach which may fail the procedure. Turtuosity of the ductus with acute angles may hamper its stenting. The whole length of the ductus should be stented; otherwise the unstented areas will contract and diminish the flow. Origin stenosis of the branch pulmonary arteries is a relative contraindication as ductal stenting may obliterate one or both branches.
In summary, ductal stenting is a reliable substitute to surgical shunt in many neonates with diminished pulmonary flow.Keywords: Ductal Stenting
Heart Transplant Survival Rate in Iran: A Single-Center Registry ReportPage 10to determine I-month and I-year survival rate in recipients of heart transplants in Imam Khomeini Medical Center.Methodswe analyzed the outcomes of 69 patients who underwent heart transplantation between 2007 and 2010. The 1-month and 1-year survival rates were calculated, and we assessed prognostic factors such as donor and recipient age and sex, graft ischemic time during surgery, and liver and kidney function tests.Resultsincreased donor age had a significant negative effect on survival rate (p=0.005). Sex differences between donor and recipient had no association with transplant outcome and survival rate. The overall 1-month and 1-year survival was 82.6% (n=54) and 70% (n=48), respectively.Conclusionheart transplantation is a lifesaving procedure for and-stage heart disorders. Mortality after heart transplantation depends on numerous factors, and thus survival rates differ among centers. The 1-month and 1-year survival rates after heart transplantation in our center currently stand at 82.6% and 70% respectivelyKeywords: Heart Transplant
The Tricuspid Valve Annular Geometry and Dynamics - A Clinical Experiment in PigsPage 11T forskning, PalleJuulJensens Boulevard, Aarhus N, Denmark
Background Tricuspid annuloplasty rings are routinely applied clinically. An optimal ring should reconstruct the valve annulus to its original configuration and adapt natural annular motion. However, there is still a lack of knowledge for a rational design. The aim of this study was to investigate the correlation between tricuspid valve annular geometry and deformational forces out-of-plane (substudy 1) and in-plane (substudy 2) using a porcine modelKeywords: The Tricuspid Valve
Post Cardiac Surgery Arrest Mortality in ICU among 3343 Patients, a Six Year StudyPage 12IntroductionThe prevalence of post cardiac surgery arrest in adult patients is 0.7-2.9%. The main causes of cardiac arrest following cardiac surgery are ventricular fibrillation, tamponade and major bleeding. The aim of this study is to determine the mortality rate of post cardiac surgery arrest and its causes.MethodA total of 3342 patients that have undergone cardiac surgery in Sina hospital, Isfahan, Iran between 2009-2014 were studied. Those who experienced cardiac arrest in ICU were included. Those subjects who were discharged and had arrest were excluded. The data were obtained via Sinas electronic database which is based on European association of cardiac surgery database. The statistical analyses were carried out by SPSS 16.0. Data were shown as frequency (%). For comparing qualitative variables between groups Chi square test was used. Logistic regression was used to determine single and multiple effects. The variables are sex, age, and procedure group, cause of cardiac arrest and rate of mortality.Keywords: Mortality in ICU
Surgical Science of OPCABPage 13Bachground: OPCAB, though as old as coronary surgery, simplicity, low cost, better outcome and its unique life saving quality in certain cases has not become the universal operation. The reason might be the original presentation which was technical withoutadequate science of its own but base on the background of CABG science. Therefore concern about inadequate revascularization was a reality from the beginning.
Material &MethodsOur efforts which helped to overcome the above concerns led to the discovery that inspection of the beating heart is an accurate way to diagnose possible local ischemia associated with coronary occlusion, positioning and stabilization during OPCAB. Visible changes in color and contractility were tested& proved to be accurate tools in predicting the need for cardio pulmonary bypass before global mal function and severe hemodynamic deterioration occurs.ResultsPracticing such a training protocol resulted in 1: avoidance of crash conversion. 2: created a safe and stress free environment and resulted in a overall mortalityConclusionTraining in visual diagnosis of cardiac changes during OPCAB provides the ability to predict the course of the operation& timely information about the need for cardio pulmonary bypass. The intra operative complication are avoided& presence of safe and stress free environment provides for complete revascularizations. Therefore we recommend this practice to everybody.Keywords: OPCAB
Surgical AF ablation THC experince in 216 case and demo of techniquePage 14Objectie: Treatment of permanent AF in cases which are candidate of open heart surgery is a mandatory step in care. Diffrent ways for this topic are available.
Material &Methodsince 2009 216 case of valve surgery concomitanly treated by radiofrequenc LT. ATRIAL OR BIATRIAL AF ablation short term and 6 month results are presented.Results100% procedural sucess 85% in hospital convertion to NSR 64% 6 month sinus rhythm. No procedure related complication at the end presentation of video of surgical procedureKeywords: THC experince
Are All Flexible Mitral Annuloplastic Rings the Same? An in Vivo StudyPage 15ObjectivesThe overall purpose of this experimental study is to assess the biomechanical properties of two different flexible mitral annuloplasty rings (Medtronic Simulus and Medtronic Duran) in comparison to a completely rigid annuloplasty ring and the native valve. The evaluation and comparison of the rings will be based on 3D geometry of the mitral annulus, leafletcoaptation geometry and leaflet curvature during the heart cycle. Force quantification and distribution on the valve will also be evaluated.
Material andMethodsThe two different types of annuloplasty bands and the rigid ring will be surgically implanted and tested in an acute porcine model. Twenty animals (80kg) will be used for testing, equally distributed into 4 groups; a Duran group (flexible), a Simulus group (flexible), a Classic group (fully rigid) and a native group. Before and after ring implantation, the dynamic 3D geometry and leaflet coaptation will be assessed by sonomicrometry and by 2D echocardiography, respectably. Dedicated force transducers attached directly to the annuloplasty rings will measure annular deformational forces in the septal-lateral and commissural dimensions. A comprehensive analysis of the impact of flexible properties of the annuloplasty rings on mitral leaflet motion and stress distribution will be performed from simultaneous recordings and calculations of the mentioned parameters throughout the cardiac cycle.ResultsPending.ConclusionWe hypothesize that the Medtronic Simulus ring, compared to the Medtronic Duran Ring, provide better support of the mitral annulus by reducing annular motion and the resulting deformational forces of mitral annulus during the cardiac cycle.Keywords: All Flexible Mitral