فهرست مطالب

Tehran University Heart Center - Volume:12 Issue:1, 2017
  • Volume:12 Issue:1, 2017
  • تاریخ انتشار: 1395/11/30
  • تعداد عناوین: 11
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  • Nikoo Hamzeh, Fatemeh Ghadimi, Rojin Farzaneh, Seyed Kianoosh Hosseini Pages 1-5
    The incidence and prevalence of obesity are fast increasing worldwide. Various indices have been used to measure and assess obesity. The body mass index (BMI) is the most common and practical of these indices. Overweight and obesity exert considerable adverse effects on the cardiovascular system. These effects are mediated through various neurohormonal and cytokine pathways, most of which are inflammatory mediators. Systolic and / or diastolic heart failure is more prevalent among obese and overweight individuals than among normal weight people. The concept of the “obesity paradox” has been proposed by some previously published studies, in which the prognosis of obese patients with established cardiovascular diseases, especially heart failure, is better than that of their leaner counterparts. In this review, we discuss the obesity paradox and its possible pathophysiologic mechanisms.
    Keywords: Obesity, Heart failure, Overweight
  • Pi, Nar TÜrker Duyuler, Serkan Duyuler, Mehmet İ., Leri, MevlÜt Demir, Abdullah Kadir Dolu, Funda BaŞ, YiĞ, It Pages 6-10
    Background
    Blood viscosity and aortic sclerosis (AS) are strong predictors of cardiovascular events. The effects of blood viscosity on AS have not been studied adequately. We aimed to investigate the potential connection between whole blood viscosity (WBV) and AS.
    Methods
    AS was detected by transthoracic echocardiography. The estimation of WBV was carried out at both high shear rate (HSR) (208/s) and low shear rate (LSR) (0.5/s) by previously validated formulae using hematocrit (HcT) and total protein (TP) in g/L. WBV at HSR (208/s) is: (0.12 × HcT) 0.17 (TP - 2.07) and WBV at LSR (0.5/s) is: (1.89 × HcT) 3.76 (TP - 78.42). Comparisons of WBV at both HSR and LSR were made between patients with and without AS.
    Results
    We included 94 patients with AS (male = 30.9%, mean age = 67.5 y) and 97 control subjects without AS (male =26.6%, mean age = 69.1 y). Almost all of the clinical, echocardiographic, and biochemical characteristics were similar, but TP values were significantly higher in the AS group than in the control group (72.9 ± 5 g/L vs. 75.8 ± 6.1 g/L; p value
    Conclusion
    We found higher WBV in patients with AS than in patients without AS at both LSR (0.5/s) and HSR (208/s). WBV at both LSR and HSR was independently associated with AS.
    Keywords: Aortic valve sclerosis, Blood viscosity, Atherosclerosis
  • Kasra Moazzami, Elena V. Dolmatova, Thomas P. Cocke, Elie Elmann, Pranay Vaidya, Arthur F. Ng, Kumar Satya, Rajeev L. Narayan Pages 11-14
    Background
    Venoarterial extracorporeal membrane oxygenation (ECMO) provides systemic arterial support without directly unloading the left heart, which causes an elevated left ventricular (LV) pressure. The aim of the present study was to investigate the adjunctive application of the Impella device for LV unloading in patients during ECMO.
    Methods
    This retrospective cohort study included patients who received Impella support in addition to venoarterial ECMO between April 2012 and December 2015. ECMO cannulation was performed peripherally or centrally, while the Impella device was surgically inserted into the femoral artery or the right axillary artery.
    Results
    Among 62 patients, 10 (16.1%) received an Impella device during ECMO support. Following Impella support, right atrial pressure improved from a median of 18 (IQR, 14–24) mmHg to 13 (IQR, 10–15) mmHg and pulmonary wedge pressure improved from 30 (IQR, 26–35) mmHg to 16 (IQR, 12–19) mmHg in all the patients (p value
    Conclusion
    The findings of the present study indicate that the application of the Impella device during ECMO support is effective in LV unloading and confers optimal hemodynamic support.
    Keywords: Heart-assist devices, Extracorporeal membrane oxygenation, Heart ventricles, Treatment outcome
  • Noor Mohammand Noori, Iraj Shahramian, Alireza Teimouri, Behrooz Keyvani, Maziar Mahjoubifard Pages 15-22
    Background
    Levels of anti-inflammatory cytokines in blood have a positive relationship with congenital heart disease (CHD). We sought to assess the difference in serum cytokines levels between children with and without CHD.
    Methods
    We recruited 60 patients with CHD and 30 healthy children, from 2013 to 2014. Patients with primary pulmonary hypertension; metabolic diseases; renal, endocrine, and chronic inflammatory diseases; fever; infection in the preceding 3 weeks; and malnutrition were excluded. Participants’ demographic data were measured, and their cardiac diseases were diagnosed via echocardiography. Serum levels of tumor necrosis factor (TNF)-α, interleukin (IL)-6, and IL-18 were measured via ELISA.
    Results
    Mean age of the participants was 4.28 ± 3.44, 3.12 ± 3.87, and 3.30 ± 3.61 years in the cyanotic, acyanotic, and control groups, respectively (p value = 0.414). Mean values of TNF-α (p value
    Conclusion
    The present study showed a differed serum cytokines levels between children with and without CHD.
    Keywords: Tumor necrosis factor-alpha, Interleukins, Child, Heart defects, congenital
  • Atefe Esmaili, Saeed Farzanefar, Alireza Emami Ardakani, Mehrshad Abbasi Pages 23-26
    Background
    The implications of cardiac risk stratification before orthotopic liver transplantation (OLT) are not well established. We studied the usefulness of myocardial perfusion imaging (MPI) in this scenario.
    Methods
    MPI data of 24 patients (9 females), candidates of OLT, were collected. They underwent MPI as part of their preoperative risk assessment. MPIs were interpreted by 2 nuclear physicians, who had access to clinical data, scan, and semi-quantification results (i.e., quantitative perfusion single-photon emission tomography (SPECT) [QPS] and quantitative gated SPECT [QGS]). A 3rd nuclear physician, blinded to the clinical history of the subjects, re-reviewed the scans. The visual interpretations of MPI (i.e., normal vs. abnormal), ejection fraction, and transient ischemic dilation index derived from QPS and clinical and follow-up data were collected and analyzed.
    Results
    The follow-up period was 231.0 ± 86.0 days. The MPIs were normal in 16 (66.7%) patients and abnormal in 8 (i.e., 5 mild [20.8%], 1 [4.2%] moderate, and 2 [8.3%] severe). Out of 4 patients who died during the follow-up, 1 had mild ischemia and 2 had severe ischemia. A patient who had a normal MPI died due to noncardiac reasons. A patient with abnormal MPI had 3-vessel disease on angiography. Out of the 5 patients who died or had significant coronary angiographic abnormalities, 4 had abnormal MPIs (negative predictive value = 93.8%; sensitivity = 80.0%) The MPIs of 4 patients without perioperative mortality or cardiac morbidity were abnormal (specificity = 78.9%).
    Conclusion
    MPI seems to be remarkable in discriminating high-risk OLT patients preoperatively.
    Keywords: Tomography, emission-computed, single-photon, Liver transplantation, Risk assessment
  • Seyed Mohsen Mirhosseini, Ali Sanjari Moghaddam, Paritash Tahmaseb Pour, Ali Dabbagh Pages 27-31
    Postoperative vasoplegic syndrome (VS) is characterized by low systemic vascular resistance, normal or elevated cardiac output, and poor response to volume expansion. The incidence of VS after cardiac surgery requiring cardiopulmonary bypass is about 20%. Sometimes, VS becomes refractory and initial treatments do not work, rendering treatment a great challenge. In this study, we describe a young male patient with endocarditis undergoing tricuspid valve replacement. When being weaned off cardiopulmonary bypass, the patient experienced VS. The patient’s blood pressure did not increase after the administration of a high dose of epinephrine and norepinephrine. Therefore, he was commenced on a low dose of vasopressin and gradually his blood pressure reached the normal range. Although the standard management of VS is a high dose of vasopressors, this patient was refractory to a combination of epinephrine and norepinephrine; only a vasopressin infusion was able to treat the patient. Eventually, he was weaned from bypass and the operation was terminated satisfactorily. Thereafter, the patient passed the recovery period in the cardiac intensive care unit and was discharged. It seems that vasopressin is an excellent option in refractory vasoplegia with minimal response to other vasopressors.
    Keywords: Endocarditis, Syndrome, Vasopressins
  • Mahmood Hosseinzadeh Maleki, Moein Aboobakri Makouei, Farbod Hatami, Reza Zeinabadi Noghabi Pages 32-34
    Primary cardiac sarcomas are rare clinical entities with an incidence rate of 0.0001% in collected autopsy series and are regarded as very aggressive tumors. We herein describe a 21-year-old woman presenting with syncope, dyspnea, and abdominal distention. She suffered from massive ascites, plural effusion, and liver congestion demonstrated by abdominal sonography and chest X-ray. Transthoracic echocardiography revealed a heterogeneous solid mass located in the right atrium; therefore, the patient underwent radical surgical excision of the tumor and 3 cycles of adjuvant chemotherapy. Fifteen months after surgery, she was having a favorable life quality without any evidence of recurrence.
    Keywords: Heart neoplasms, Sarcoma, Echocardiography, Cardiac surgical procedures
  • Reza Mollazadeh, Masoud Eslami Pages 35-38
    A 29-year-old woman was referred to our hospital due to exacerbation in dyspnea on exertion and easy fatigability. A known case of congenitally corrected transposition of the great vessels and congenital complete heart block, she had already received a permanent single-chamber pacemaker. Decision was made to implant a biventricular pacemaker for the treatment of the failing heart. Excellent coronary sinus lead implantation was done, conferring amelioration of symptoms, QRS narrowing in the electrocardiogram, and improvement of systemic ventricular systolic function in echocardiography. Over a 15-month follow-up period, she had no dyspnea on exertion. This case highlights the significance of upgrading pacemakers in patients with heart failure.
    Keywords: Cardiac resynchronization therapy, Heart defects, congenital, Congenitally corrected transposition of the great arteries
  • Bahieh Moradi, Farideh Roshanali Pages 39-41
    Ebstein's anomaly is defined as the significant apical displacement of the tricuspid valve causing tricuspid regurgitation. Although a variety of concomitant lesions have been previously described, we herein introduce an unusual presentation. Our patient was an 86-year-old man with a primary presentation of typical chest pain in the setting of recently diagnosed coronary artery disease with concomitant Ebstein’s anomaly. We found mild-to-moderate tricuspid regurgitation, bicuspid aortic valve, persistent left superior vena cava, and patent foramen ovale. The patient had suffered from chest discomfort on exertion for 2 months with good functional capacity prior to diagnosis. Coronary angiography revealed two-vessel disease. The patient refused surgery. He was treated with medical anti-ischemic therapy. He had good exercise tolerance with relief of chest pain at the latest follow-up.
    The features demonstrated in this case report suggest that there may be several adult survivors of complex congenital heart diseases requiring individualized surgical treatment plans.
    Keywords: Ebstein anomaly, Tricuspid valve regurgitation, Life expectancy
  • Tahereh Davarpasand, Ali Hosseinsabet, Kyomars Abbasi Pages 42-45
    A ruptured sinus of Valsalva aneurysm rarely accompanies the aortic and tricuspid valve endocarditis. A 36-year-old woman presented with low-threshold dyspnea on exertion and fever. Transthoracic and transesophageal echocardiography showed a ruptured noncoronary sinus of Valsalva aneurysm with large vegetations on the tricuspid and aortic valves, resulting in moderately severe tricuspid regurgitation and severe aortic regurgitation. Blood culture was negative. The patient was initially treated with antibiotics and then subjected to the surgical repair of the sinus of Valsalva aneurysm and the tricuspid and aortic valve replacement. The patient's postoperative period was uneventful, and she was discharged healthy.
    Keywords: Endocarditis, Sinus of Valsalva, Aortic valve, Tricuspid valve
  • Yousef Rasmi, Maryam Majidinia, Fariba Khosravifar, Fatemeh Kheradmand Pages 46-48