International Cardiovascular Research Journal
Volume:11 Issue: 3, Sep 2017

Although acute type-A aortic dissection (AAOD) is more common in males, the course of the disease may differ in females.
We aimed to investigate the gender-related differences in patients with AAOD with regard to clinical presentation, short-term and long-term mortality.
Patients and Medical records of 192 patients with a confirmed diagnosis of AAOD in a University Heart Center from March 2004 through October 2015 were evaluated. Clinical information, hospital mortality, and long-term survival were explored with regard to gender. Propensity matching was performed to adjust for baseline differences. Kaplan-Meier survival analysis was used to determine the impact of gender on long-term mortality.
Among 192 patients, 71 (37.0%) were females. The women were older (65.7 ± 13.8 vs. 53.9 ± 15.1 years, P In patients admitted with AAOD, there was no gender-related differences in clinical presentation and type of management. Similarly, hospital and long-term mortality did not differ with regard to gender.

Surgical Aortic Valve Replacement (SAVR) is the gold standard method for treatment of symptomatic severe senile Aortic Valve Stenosis (AS). For inoperable patients, due to severe co-morbidities, Transcatheter Aortic Valve Implantation (TAVI) has been suggested as a new and safe alternative with significant follow up superiority to medical treatment; recently, it was suggested for patients at intermediate risk, as well. Since its introduction in 2002, TAVI has well developed in more than 40 countries.
We made an attempt to transfer this technology to Tehran University for the first time and then evaluated the feasibility and safety of this new technique with midterm closed clinical and echocardiographic follow up.
Patients and Eight patients (5 males), with a mean age of 77 ± 6.7 years old underwent transfemoral TAVI from 2010, as the first sequential patients in Tehran University, by Balloon expandable bioprosthetic Edwards SAPIEN transcatheter heart valve, under general anesthesia in hybrid operation room.
There were 7 tricuspid valves and one bicuspid aortic valve (AV). All the patients had symptomatic severe senile valvular AS with severe co-morbidities so that the surgeons did not agree with open SAVR. Closed preprocedural, procedural, in hospital, one and 6 months clinical and echocardiographic assessments and follow up were done. Procedural success rate was 100% with good implantation of the valve. A decrease in the AV mean gradient (MG) from preprocedural mean AVMG 52.2 ± 19.7 mm Hg to 9.8 ± 3.7 mm Hg was observed in the 6 month follow up. One patient had procedural papillary muscle damage and moderate mitral regurgitation (MR), which needed hemodynamic support. No in hospital mortality or major complications were seen. In the follow up period, one patient had unexplained sudden death in sleep 3 weeks after the discharge. The other 7 patients had good 6 months of follow up with improvement of Functional Class (FC) and Left Ventricle Ejection Fraction (LVEF) from mean 43 ± 13.5 % preprocedural to 50.7 ± 7.8% within 6 months.
Inoperable symptomatic senile valvular AS could be treated safely with TAVI. In- hospital results of the first sequential experience of TAVI in Tehran University of Medical Sciences were successful. TAVI in bicuspid AS and concomitant MR patients needs more caution in the procedure and follow up.

The Coronary artery disease (CAD) occurs as a result of atherosclerotic plaque formation. The interferon gamma (IFNγ) as a multifunctional cytokine is involved in inflammatory processes in atherosclerosis.
We investigated the relationship between IFNγ (ᏼ) SNP with CAD. Moreover, we compared IFNγ mRNA expression in CAD patients and healthy controls.
Patients and This case-control study with randomized sampling included 300 patients with CAD and 301 normal controls. The SSP-PCR method was used for genotyping IFNγ (ᏼ) gene polymorphism. Quantitative Real-Time PCR was performed to measure IFNγ mRNA expression. All data was analyzed by GraphPad software. The chi-square and ordinal logistic regression tests were used to analyze differences in genotype frequencies.
In this study, there was a significant association between male genders with CAD (P IFNγ gene functional polymorphism can be associated with incidence and severity of CAD. IFNγ mRNA level was also increased in CAD patients in comparison with controls. Therefore, IFNγ may play a role in predisposition to CAD.

Implantable Cardioverter Defibrillator (ICD) is an acceptable treatment method in patients suffering from life-threatening ventricular dysrhythmias. In spite of many advantages, ICD can lead to many challenges in living for these patients. Therefore, understanding these experiences can lead to improvement of holistic care and treatment of these patients.
This study aimed to identify and describe the patients’ experiences of living with ICD.
This qualitative study was conducted using interpretative phenomenological approach. The participants who were selected through purposive sampling included 4 women and 6 men (mean age: 43.1 ± 1.6 years). The data were gathered through semi-structured interviews and field notes from November 2013 to December 2014. The data were also analyzed simultaneously using Van Manen’s proposed stages.
Analysis of the data resulted in emergence of 4 themes and 11 subthemes representing the dimensions of the patients’ lived experiences with ICD. These themes included “compromised self-identity”, “crossing the border of the unknown”, “fluctuation in the adjustment path”, and “surrounded by changes”. Compromised self-identity was manifested through “loss of prestige”, “changes in body image”, and “being hurt by the battery label”. “Unpredictable situation”, “rise and fall”, and “internal turmoil” were the main axes of crossing the border of the unknown. In addition, fluctuation in the adjustment path included “wandering to cope with ICD” and “institutionalization of ICD in life”. Considering the patients’ descriptions of surrounded by changes, “family changes”, “social role changes”, and “change in manifestation of routines” were of great importance.
This study allowed in-depth identification of aspects of living with ICD. The results also promoted the ability of nurses to understand and interpret the views of patients about living with ICD. In this way, the quality of patient care becomes more favorable, resulting in improvement of the patients’ satisfaction. It can also provide a basis to conduct further researches on different aspects of prevention, care, treatment, and rehabilitation of these patients, leading to strengthening of the nursing research body.

Repair of tetralogy of fallot (TOF) is associated with diffuse myocardial fibrosis. Cardiac magnetic resonance imaging (CMR) can visualize the areas with myocardial fibrosis. Presence of fragmented QRS (fQRS) implies the presence of the underlying myocardial scar. Despite the strong association between fQRS and myocardial pathologies, the impact of fQRS with myocardial fibrosis in post-TOF correction is unknown.
Here, we evaluated the possible predictive role of fQRS in repaired TOF cases and its relationship with cardiac function.
Patients and Thirty two patients with previous history of repaired TOF were enrolled. The extent of fQRS was evaluated according to the number of leads with fQRS. After electrocardiographic evaluation, the participants underwent CMR.
Results showed a significant relationship between the right ventricular (RV) systolic diameter and fQRS (P = 0.014). Also, an inverse linear relationship was found between the number of fQRS edges and RVEF (r = 0.77, P = 0.0001). The mean QRS duration in those with positive and negative fQRS was 132 mm and 115.8 mm (P = 0.0001). Furthermore, a linear correlation was observed between the number of edges and the percentage of scar tissue (r = 0.88, P = 0.001). However, no relevance between gender and fQRS was detected (P = 0.26), and the relationship between RV diastolic diameter and fQRS was not significant (P = 0.1). Thus, fQRS could be used as a marker of RV systolic dysfunction in patients with tetralogy of fallot.
We suggested the fQRS as a surrogate indicator of RV dysfunction in repaired TOF patients and showed that diagnostic and prognostic information of the patients were available by fQRS.

Isolated Unilateral Absent Pulmonary Artery (UAPA) is a rare congenital anomaly. It is usually associated with congenital heart defects. A 45 year old male patient presented with complaints of fever with cough and expectoration for 15 days and retrosternal chest discomfort for the previous 2 days. ECG showed diffuse ST segment depression with T wave inversion in the inferior and lateral leads. Coronary Angiogram done through the right femoral approach revealed diffusely diseased Left Anterior Descending (LAD) artery that was totally cut off at the mid segment. The Left Circumflex (LCx) artery was providing blood supply to the right middle and lower lung areas. There was another collateral arising from the Left Subclavian Artery supplying the right middle and lower lung areas. The left pulmonary artery was normal, but branches supplying the middle and lower lobes of the right lung were absent and the upper lobe branch had pulmonary stenosis. UAPA is a rare clinical entity; collaterals from coronaries are extremely rare in this condition and till now there has not been any case report of unilateral absent branch pulmonary artery with peripheral stenosis of other branches, on the affected side and associated coronary artery disease.