فهرست مطالب

Cardio Vascular and Thoracic Research - Volume:10 Issue: 4, 2018
  • Volume:10 Issue: 4, 2018
  • تاریخ انتشار: 1397/09/13
  • تعداد عناوین: 13
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  • Salik Nazir*, Saroj Lohani , Niranjan Tachamo , Muhammad Sohail Khan , Bidhya Timilsina , Faraz Khan Luni , Anthony Donato Pages 182-186
    Introduction
    Transcatheter mitral valve-in-valve (ViV) & valve-in-ring (ViR) are relatively novel therapeutic alternatives for patients with degenerated bioprostheses or failed annuloplasty rings whose reoperative risk is too high. The predominant procedural access for both procedures is transapical or transseptal. However, whether there are differences in outcomes of this procedure using transseptal versus transapical access has not yet been defined.
    Methods
    We conducted a systematic review of all published articles from MEDLINE and EMBASE to explore the outcomes of these two procedural approaches.
    Results
    A total of 55 studies including 183 patients (154 ViV and 29 ViR) were included. Patients that underwent ViV (101 transapical and 53 transseptal) using the transseptal approach required more iatrogenic atrial septal defect (ASD) closure (19% versus 0.0 %; P < 0.001) and hence had a lower device success rate (68% versus 89%; P = 0.001). However, there was no significant difference between the two groups in procedural success and all-cause mortality at 30 days. Overall severe bleeding complications (major or life threatening) were not different the two groups (3.7% versus 7.9%; P = 0.321). In the ViR group (19 transapical and 10 transseptal), no difference in procedural success, device success or 30-day outcomes were identified between transseptal and transapical groups, although sample size was small.
    Conclusion
    In conclusion, mitral ViV and ViR using the two different procedural approaches appear to confer equal and reasonable 30-day outcomes.
    Keywords: Transcatheter, Transapical, Transseptal, Mitral Valve
  • Mustafa Akbulut*, Ozgur Arslan , Adnan Ak , Serpil Tas , Davut Cekmecelioglu , Mesut Sismanoglu , Altug Tuncer Pages 187-191
    Introduction
    Our experience in minimally invasive procedures and improvement of graft technology enables easy and successful operation carried out even with complex thoracic aortic diseases from limited surgical area. However, it should be more than one incision or cannulation site for such intervention. We aimed to present our experience and results of 23 patients who has ascending aorta and aortic arch pathologies of which we operated with J-shaped partial sternotomy and innominate vein cannulation.
    Methods
    From January 2014 to January 2016, 23 patients with aorta and aortic valve pathologies who underwent aortic surgery with J-shaped partial sternotomy and innominate vein cannulation included. Operation findings, cardiopulmonary bypass (CPB) values, postoperative results, surgical mortality and morbidity rates, late conversion to full sternotomy rates, ICU and hospital length of stay were evaluated.
    Results
    The mean age of the patients was 53.7±12 (range 19-68) and 18 (78.2%) were males. Arcus aorta debranching applied to 4 patients (17.3%) and one of these procedures was frozen elephant trunk procedure (%4.3). Neither mortality nor cerebrovascular accident occurred. Mean CPB peak flow was 4.6±0.4 L/min, mean flow index calculated as 2.01±0.38 L/min/m2 and there was no CPB problem intraoperatively. Innominate vein ligation was carried out in 5 patients but no complication was seen except one who had left arm swelling treated with elevation.
    Conclusion
    Innominate vein cannulation with J-shaped partial sternotomy is a reliable and easily applicable method providing effective utilization of limited operative field not only in ascending aorta and aortic arch operations but also with the advancements of hybrid systems used in descending aorta pathologies.
    Keywords: Innominate Vein, Cannulation Technique, Minimally Invasive
  • Masoud Tarbiat , Maryam Davoudi , Sayed Ahmadreza Salimbahrami* Pages 192-196
    Introduction
    Percutaneous subclavian vein catheterization via infraclavicular approach is one of the most widely used cannulation techniques for inserting catheters into a central vein. The aim of this study was to evaluate influence of arm position during infraclavicular subclavian vein catheterization with landmark-based technique in coronary artery bypass graft (CABG) surgery.
    Methods
    Between September 2017 and June 2018, this prospective randomized clinical trial was performed in 320 patients. The patients were randomly assigned to the Neutral group (the arms kept by the side) or Abduction group (the arm was abducted to 90°). The success and complication rates were compared in the two groups. The data were analyzed using SPSS software.
    Results
    In the first attempt of subclavian vein cannulation, the success rate had no significant difference between the two groups (P = 0.185). In the second attempt of catheterization, the success rate in Abduction group (40.5%) was lower than Neutral group (81.2%). The overall success rate in two attempts were (84.4%) in the Abduction group and (96.2%) in the Neutral group. There was a significant difference between two groups in the second and overall success rates (P = 0.0001). In 34 (10.6%) patients, subclavian artery puncture occurred, 30 (18.8%) in the Abduction group and 4 (2.5%) in the Neutral group. There was a significant difference between two groups (P = 0.0001). Pneumothorax was occurred in 15 (9.4%) in the Abduction group and 3 (1.9%) in the Neutral group. There was also a significant difference between two groups (P = 0.004). The differences in other complications on two groups were statistically insignificant.
    Conclusion
    Compared with Abduction group, the Neutral group resulted in higher success rate and fewer subclavian artery puncture and pneumothorax. The incidences of other complications were similar on both groups.
    Keywords: Catheterization, Complications, Coronary Artery Bypass, Subclavian Vein
  • Tatiana N. Enina*, Vadim A. Kuznetsov , Anna M. Soldatova , Tatiana I. Petelina , Dmitriy V. Krinochkin , Alexander Yu. Rychkov , Olga Yu. Nochrina Pages 197-202
    Introduction
    Gender differences in cardiac resynchronisation therapy (CRT) response are not clear enough. This study aimed to assess gender influence on systemic inflammation, neurohormonal activation, fibrosis in patients with congestive heart failure (CHF) and CRT.
    Methods
    We compared group I (61 men) and group II (16 women) of patients undergoing CRT. Plasma levels of Nt-proBNP, interleukin (IL)-1β, IL-6, IL-10, tumor necrosis factor alpha (TNF-α), C-reactive protein, galectin-3 (Gal-3), metalloproteinase-9 (MMP-9), tissue inhibitors of metalloproteinase 1 and 4 (TIMP-1, TIMP-4), ratio MMP-9/TIMP-1, MMP-9/TIMP-4 were measured. According to dynamics of left ventricular end-systolic volume patients were classified into non-responders, responders, super-responders.
    Results
    Women more likely had left bundle branch block (81.3 vs 47.5%, P = 0.016), were more super-responders (66.7 vs 30.5%). Both groups showed decrease of IL-6 (P < 0.05), TNF-α (P < 0.001; P < 0.05), NT-proBNP (P = 0.001; P < 0.05), Gal-3 (P < 0.05). In women there was decrease of IL-6 by 44.4 vs 23.5% in men (P = 0.029), TNF-α by 41.4 vs 30.9%, NT-proBNP by 73.3 vs 46% (P = 0.002), Gal-3 by 82.3 vs 64.9% (P < 0.05). Group I also showed decrease of IL-10 by 34.2% (P < 0.05). Group dynamics of TIMP-1 was opposite: men showed tendency to reduction of TIMP-1 (P = 0.054), women showed increase of TIMP-1 (P < 0.05). Besides, men showed decrease of MMP-9 (P < 0.05) and ratio MMP-9/TIMP-4 (P < 0.05).
    Conclusion
    The best response to CRT is associated with female gender explained by greater decrease of neurohormonal activation, systemic inflammation and fibrosis. The revealed opposite dynamics of TIMP-1 in the groups can demonstrate the existence of gender features of matrix metalloproteinase system activity and their tissue inhibitors.
    Keywords: Cardiac Resynchronisation, Therapy, Gender Differences
  • Samira Nozari , Nazila Fathi Maroufi , Mohammad Nouri*, Mirhamid Paytakhti Oskouei , Javad Shiralizade , Farshid Yekani , Mina Mamipour , Yousef Faridvand Pages 203-208
    Introduction
    Lipid metabolism disorder or hyperlipidemia is known as a risk factor for cardiovascular disease, the increase in serum homocysteine and leptin are associated with atherosclerotic disease. The purpose of the present study was to examine the effects of bovine lactoferrin (bLF) on serum homocysteine (Hcy), apolipoproteinA-I (ApoA-I) and B (ApoB), leptin and lipid profile changes in high-cholesterol-diet (HCD) fed rats.
    Methods
    The Healthy Adult Sprague-Dawley (SD) male rats were randomly assigned into three experimental groups. Each group consisted of eleven male rats including control group, HCD rats and hypercholesterolemic rats, which were treated with bLF (HCD+bLF). bLF was given by gavage (200 mg/kg/d). After 4 weeks of feeding and overnight fasting, total blood samples were collected.
    Results
    The results showed the elevated level of Hcy, leptin, total cholesterol, low density lipoprotein cholesterol (LDL-C), ApoB and decrease in ApoA-I in non-treated HCD group compared to the control rats. Administration of bLF significantly ameliorated the Hcy and leptin levels with decrease in LDL-C and total cholesterol in rats fed with a high-cholesterol diet. bLF also tended to increase low serum concentration of ApoA-I and high density lipoprotein cholesterol (HDL-C) in HCD rats. Meanwhile, upon bLF-treated rats, there was a significant decrease in ApoB in HCD group.
    Conclusion
    The findings indicated that bLF can improve the alteration of serum Hcy, leptin, apolipproteins and lipid changes in male rats fed with high-cholesterol diet. So, bLF can counteract with HCD elicited hyper-homocysteinemia and hyper-leptinemia, suggesting it to have the useful therapeutic potential in patients with atherosclerosis and lipid disorder.
    Keywords: Bovine Lactoferrin, High-Cholesterol-Diet, Homocysteinemia, Leptin, Apolipoprotein
  • Mohsen Khosravani, Rudpishi , Adel Joharimoghadam*, Elham Rayzan Pages 209-213
    Introduction
    Although coronary tortuosity is relatively common in coronary angiograms, there is much debate over the significance of this anatomical variation. So in this study the relation between significant coronary tortuosity (SCT) and coronary artery disease (CAD) was examined.
    Methods
    The cross-sectional study included 737 patients (57% male) who were admitted to the hospital for a coronary angiography, based on their symptoms or non-invasive imaging. Coronary arteries defined as SCT are in the presence of either ≥3 consecutive curvatures of 90◦ to 180◦ or ≥2 consecutive curvatures of ≥180◦ measured at the end-diastole, in a major epicardial coronary artery ≥2 mm in diameter.
    Results
    29.17% of the patients had SCT of which females (64.7% vs. 34.1%, P< 0.001) and higher aged persons (62.9±8.4 vs. 57.8±10.7 years ± SD; P < 0.001) were significantly associated with SCT compared to non-SCT. Left anterior descending artery (LAD), left circumflex artery (LCX) and right coronary artery (RCA) with SCT in comparison to non-SCT, had lesser probability of CAD with stenosis severity of ≥50% (34.5% vs. 46.1%; P = 0.019 and 17.7% vs. 31.1%; P = 0.001 and 27.9% vs. 43.5%; P = 0.013 respectively) and also had significant lower Gensini scores (4.1±5.3 vs. 8.4±11.9; P = 0.011; 2.1±3.4 vs. 5.2±9.5; P = 0.01 and 1.2±1.9 vs. 5.03±8.9; P < 0.001 respectively) but higher TIMI frame count (15.7±5.3 vs. 11.9±4.6; P < 0.001 and 17.1±4.4 vs. 12.7±4.4; P < 0.001 and 15.2±3.9 vs. 11.6±4.8; P < 0.001 respectively).
    Conclusion
    SCT is negatively correlated with CAD and there is a significant association between SCT and reduced coronary flow rate.
    Keywords: Female, Coronary Angiography, Coronary Artery Disease, Diastole
  • Ramin Heshmat , Zeinab Hemati , Mostafa Qorbani*, Laleh Nabizadeh Asl, Mohammad Esmaeil Motlagh , Hasan Ziaodini , Majzoubeh Taheri , Zeinab Ahadi , Gita Shafiee , Tahereh Aminaei , Hooman Hatami , Roya Kelishadi Pages 214-220
    Introduction
    Metabolic syndrome (MetS) is one of the common metabolic disorders seen in children and adolescents. This study aims to assess the rate of the MetS and its associated factors in a nationally-representative sample of Iranian pediatric age groups.
    Methods
    This nationwide cross- sectional study was designed in 2015 in 30 provinces of Iran. Participants consisted of 4,200 school students, aged 7-18 years, studied in a national school-based surveillance program (CASPIAN-V). Physical examination and laboratory tests were performed using standard protocols. Blood samples were drawn from 3834 students for biochemical tests.
    Results
    The participation rate for blood sampling was 91.5%. MetS was significantly more prevalent among students in urban than in rural areas (5.7% vs. 4.8%, P value < 0.01). MetS was more prevalent in students with obese parents than in those with non-obese parents (6.4% vs. 4.5%, P value < 0.05). Significant association existed between moderate level of healthy nutritional behaviors and MetS after controlling for potential confounders (odds ratio [OR]: 0.62, 95% CI: 0.40-0.98). Students with high unhealthy nutritional behaviors showed an increased risk of MetS in crude (OR: 1.6, 95% CI: 1.05-2.44) and adjusted model (OR: 1.65, 95% CI: 1.05-2.63).
    Conclusion
    High rate of MetS and associated risk factors was observed in Iranian pediatric age groups, with higher rates among boys. These findings provide useful information for effective preventive strategies based on diet, exercise, and lifestyle modification rather than therapeutic modalities.
    Keywords: Metabolic Syndrome, Obesity, Pediatric
  • Hashem Jarineshin , Maryam Sharifi , Saeid Kashani * Pages 221-226
    Introduction
    The present guidelines recommend placing the catheter tip in the superior vena cava (SVC) above the pericardial cephalic reflection. The aim of this study was to compare the accuracy of two different approaches in locating the tip of the Central venous catheter (CVC) at the suggested vascular zone.
    Methods
    This was an interventional study on two hundred patients undergoing Coronary artery bypass surgery (CABG) operation who required a central venous cannulation. They were randomly assigned into two groups. In the first group catheter placement was applied through using the conventional 15 cm method. In the second group a C-length method was applied for measuring the depth of catheter tip placement from the preoperative chest radiographs. For statistical analysis Chi-square test and T-test were used.
    Results
    In the first group (15 cm) 100% of the patients had their catheters placed below the C-line (Carina line) and the average distance between the catheter tip and the C-line was +4.22±2.10 cm. In the second (C-Length) group 52% of the catheters were below C-line with an average distance of +0.77±0.5 cm. There was a meaningful difference between the two groups in respect to the catheter location depth and zone of placement (P<0.001).
    Conclusion
    The C-Length approach in comparison to the conventional 15 cm approach resulted in a considerable higher number of catheters above the recommended C-line, thus it can provide a more reliable and safe mode for CVC placement in the SVC.
    Keywords: Catheterization, Central Venous, Vena Cava Superior, Radiography
  • Gholamhossein Alishiri , Maryam Moshkani Farahani*, Ali Sadr , Mahmood Salesi , Mostafa Rahemi , Bahador Rezapoor Pages 227-230
    Introduction
    Coronary Artery Disease (CAD) is known as the major cause of morbidity and mortality in the world with a growing trend, especially in some developing countries. CAD commonly observed in elderly cases, however; recently it is usually found in young adults. In this study, we aimed to evaluate the prevalence of anti-phospholipid antibody syndrome (APS) in patients with premature CAD.
    Methods
    The cross-sectional study was conducted in Baqiyatallah hospital from April 2012 to April 2016. Patients with premature CAD were included in the study. The data regarding the laboratory tests, echocardiography, and angiography were obtained from all cases.
    Results
    Overall 133 eligible patients were included in the study. In the first set of the laboratory test, 18 patients were recognized to have APS (13.53%). The second confirmatory APA test was showing 3 of 18 patients were considered to have APS (2.25%).
    Conclusion
    The results showed there is an association between the risk of developing Premature CAD and APS could potentially. The APS may have significant effects on the risk of coronary heart disease, especially in young adults.
    Keywords: Anti-phospholipid Syndrome, Premature Coronary Artery Disease, Risk Factors
  • Farahnaz Nikdoust , Elham Bolouri , Seyed Abdolhussein Tabatabaei*, Mahdi Goudarzvand , Seyedeh Tahereh Faezi Pages 231-235
    Introduction
    Systemic lupus erythematosus (SLE) myocarditis occurs in between 5% and 10% of patients with lupus. Global longitudinal strain (GLS) via speckle tracking echocardiography can detect cardiac involvement in patients suffering from SLE. We decided to determine the echocardiographic features and subsequent early diagnosis of cardiac involvement in patients with SLE utilizing the GLS index via speckle tracking echocardiography.
    Methods
    In this cross-sectional study, we compared female patients with SLE of at least 2 years’ duration and healthy controls in terms of the left ventricular (LV) GLS via speckle tracking echocardiography. After data collection in both groups, the GLS index and the ejection fraction were evaluated.
    Results
    We analyzed and compared the LV echocardiographic parameters of 33 patients with SLE (mean age=25.45±0.63 years) with those of 35 healthy controls (mean age=27±0.45 years). The apical 2-chamber view indicated a significant decrease in the LV GLS in the case group by comparison with the healthy controls (P=0.005). The LV GLS in the apical 3-chamber view was significantly lower in the case group than in the control group (P=0.006). The LV GLS in the apical 4-chamber view revealed no significant difference between the case and healthy control groups (P=0.2). While there was a significant difference between the case and control groups vis-à-vis the LV GLS (P=0.02), the LV ejection fraction measured with the Simpson method showed no significant difference between the 2 groups (P=0.96).
    Conclusion
    GLS speckle tracking echocardiography is a noninvasive method with diagnostic and prognostic values; it may, therefore, be a sensitive marker for the diagnosis of myocarditis and other cardiac involvements in patients with SLE.
    Keywords: Systemic Lupus Erythematosus, Global Longitudinal Strain, Doppler Echocardiography, Left Ventricle
  • Mehrnoush Toufan Tabrizi , Roghaieh Rahimi Asl , Soheyla Nazarnia , Leili Pourafkari * Pages 236-242
    Introduction
    Morphology of bicuspid aortic valve (BAV) may have implication in the associated pathologies including aortic stenosis (AS), aortic insufficiency (AI) and aortic dilation. The aim of this study is to investigate the frequency and patterns of valvular dysfunction and aortopathy associated with different phenotypes of BAV in a referral center in northwest of Iran.
    Methods
    In this prospective study patients who presented to our echocardiography lab between January 2014 and December 2015 and were diagnosed with BAV were assessed. Frequency of various BAV phenotypes and their association with valvular dysfunction and aortopathy was evaluated. A P value less than 0.05 was considered statistically significant.
    Results
    The average age of the study patients was 40±16 years, with predominance of male sex (72%). Patients with anteroposteriorly located BAV (BAV-AP) phenotype constituted majority of our cases with prevalence of 62.7%, while 37.3% of cases had right-left (BAV-RL) located valves. BAV-RL patients when compared to BAV-AP patients had higher frequencies of dilated aortic arch (25% vs. 4.3%, P < 0.001), AS (56.3% vs. 31.4%, P < 0.001), mass or vegetation on aortic valve (14.3 vs. 6.4%, P = 0.023) and lower frequencies of dilated aortic root (42.9% vs. 57.4%, P = 0.01), aortic insufficiency (68.8% vs. 79.8%, P = 0.034) and co-arctation of aorta (3.6% vs. 11.7%, P = 0.01).
    Conclusion
    There seems to be a relationship between various BAV phenotypes, and frequency and pattern of aortic valve dysfunction and aortopathy. These findings suggest that examining leaflet morphology in BAV might help in risk stratification of these patients.
    Keywords: Bicuspid Aortic Valve, Valvular Dysfunction, Aortopathy
  • Muzaffer Kahyaoglu*, Murat Velioglu , Cetin Gecmen , Arzu Kalayci , Ender Ozgun Cakmak , ?brahim Akin Izgi Pages 243-245
    Carotid artery stenting is a method used in the treatment of extracranial carotid artery stenosis that is becoming increasingly more common. Acute carotid thrombosis following CAS is a very rare and devastating complication that can be lethal for the patient unless treated immediately. We report a case of acute carotid stent thrombosis occurring immediately after emergent revascularization, and that was treated with intraarterial tissue plasminogen activator and intravenous tirofiban infusion.
    Keywords: Thrombosis, Carotid Stent, t-PA, Tirofiban
  • Shailesh Kumar , Devyani Thakur , Ritesh Kumar Gupta , Alka Sharma * Pages 246-247
    Amlodipine is a dihydropyridine calcium channel blocker which is widely used as an anti-hypertensive drug. Amlodipine overdose has been infrequently reported with the occurrence of serious complications and even death in a few cases. We report an interesting case of a young lady who presented with refractory shock with acute kidney injury, which did not respond to therapy despite optimal fluid replacement and vasopressor support. The etiology of shock could not be ascertained and the patient was questioned again to elucidate the missing clue in the history. It was finally revealed that the patient had consumed 900 mg of amlodipine in a suicide bid, for her poor performance in academics. The targeted therapy in the form of IV calcium and hyperinsulinemia-euglycemia therapy (HIET) was started and the patient dramatically improved with shock reversal and improvement in renal function.
    Keywords: Vasopressor, Shock, Vasopressor, HIET