فهرست مطالب

Iranian Heart Journal - Volume:21 Issue: 3, 2020
  • Volume:21 Issue: 3, 2020
  • تاریخ انتشار: 1399/04/11
  • تعداد عناوین: 16
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  • Alireza Tavanai, Gholamreza Asadikaram, Mohammad Masoumi * Pages 6-14
    Background

    It has been reported that opium can deteriorate the complications of acute myocardial infarction (AMI). Apelins are molecules whose protective roles against cardiomyocytes have been documented previously. The aim of this study was to evaluate the effects of opium on the serum apelin levels in patients with AMI.

    Methods

    This study was performed on 60 patients with AMI (30 addicted and 30 nonaddicted). The serum levels of apelins, low-density lipoprotein, high-density lipoprotein, triglyceride, cholesterol, total creatine phosphokinase (CPK), and CPK-MB were evaluated using commercial kits.

    Results

    The results showed that although the serum level of apelins was not different between the addicted and nonaddicted patients, it was significantly associated with heart rate and CPK levels in the addicted patients.

    Conclusions

    Considering our results, opium addiction may be associated with increased damage to cardiomyocytes. Additionally, the positive association between apelins and CPK may indicate the protective roles played by these molecules during AMI. (Iranian Heart Journal 2020; 21(3): 6-14)

    Keywords: Opium, Acute myocardial infarction, apelin
  • Alireza Abdollahi Moghadam, Hoda Raffiei Jelodar * Pages 15-24
    Background

    The inter-lead variations in the measurements of the QT interval reflect regional variations in ventricular repolarization. This increased dispersion results in susceptibility to ventricular arrhythmias.  

    Methods

    We reviewed the medical records of 60 patients with ST-segment-elevation myocardial infarction (STEMI) over the last 6 years who received thrombolytic therapy (30 cases) or underwent primary percutaneous coronary intervention (PCI) (30 cases) in Ghaem Hospital and Emam Reza Hospital in Mashhad, Iran. The patients’ demographic characteristics, risk factors, treatment success, QTd and QTcD before and 24 hours after treatment, arrhythmias, and echocardiographic information were analyzed. Statistical analysis was conducted using the SPSS software, version 22, and a P value of less than 0.05 was considered statistically significant.  

    Results

    The success rates (50% reduction in ST-segment elevation) of primary PCI and thrombolytic therapy were 66.66% and 33.33%, respectively. In addition, QTd and QTcD were significantly decreased in both successful procedures (P = 0.04 and 0.03, respectively). However, no significant difference in the variations of QTd and QTcD was seen between the 2 successful procedures (P = 0.91 and P = 0.87, respectively). Further, ventricular arrhythmias were evident in 36.6% of the patients with thrombolytic therapy, but no ventricular arrhythmia was observed in those who underwent primary PCI.  

    Conclusions

    QTd and QTcD were identified as useful predictors of ventricular arrhythmias. A significant reduction in QTd and QTcD in both successful procedures was evident, leading to a decrease in ventricular arrhythmias. Moreover, the success rate of primary PCI was higher than that of thrombolytic therapy. Therefore, primary PCI was identified as a more appropriate procedure for STEMI. (Iranian Heart Journal 2020; 21(3): 15-24)

    Keywords: QTcD, QTd, Myocardial Infarction, Primary PCI
  • Maryam Rajabi, Seyed Reza Borzou, Aliasghar Moeinipour, Hamid Hoseinikhah, Gholamreza Safarpoor * Pages 25-32
    Background

    Atrial fibrillation (AF) is the most common cardiac dysrhythmia; it occurs following coronary artery bypass graft (CABG) surgery. The occurrence of this dysrhythmia causes hemodynamic disorders, prolongs the duration of hospitalization, and increases costs.

    Methods

    The present retrospective cohort study was conducted using the census method on 330 patients. Data were extracted from the records of patients undergoing CABG and were used to fill in the data collection form. The data were analyzed using the independent samples t-test and the χ2 test in SPSS, version 21, at the alpha level of 0.05.

    Results

    The mean age of the patients was 61.76 ± 9.2 years, and 70.1% were male. The incidence of AF was significantly associated with mean age, the body mass index, creatinine, and the consumption of diuretic medications (P < 0.05). However, sex, paraclinical results (ie, sodium, potassium, and the ejection fraction), clinical history (ie, hypertension, hyperlipidemia, diabetes, smoking, a history of myocardial infarction, and anterior myocardial infarction), medications (ie, beta-blockers, calcium channel blockers, angiotensin receptor blockers, and statins), and the number of involved arteries did not affect the incidence of AF (P > 0.05).

    Conclusions

    Considering the prevalence and importance of AF, effective preoperative risk factors can be decreased or eliminated through interventions, thereby reducing the incidence of this cardiac dysrhythmia. (Iranian Heart Journal 2020; 21(3): 25-32)

    Keywords: Atrial Fibrillation, CABG, Preoperative risk factors, Postoperative AF
  • Ziae Totonchi, Mehdi Harorani, Mokhtar Mahmoudi, Hadi Jafarimanesh, Rezvan Ghafarzadegan, Hooman Bakhshandeh Abkenar, Mohamad Golitaleb * Pages 33-39
    Background

    The endotracheal tube (ETT) cuff pressure must be kept within the range of 20 to 30 cmH2O in order to prevent tube displacement and air leakage, maintain the circulation of the tracheal capillaries, and prevent the aspiration of oral and gastric contents to the lower parts of the respiratory tract. This study aimed to determine the ETT cuff pressure and appropriate intervals for measuring it in patients admitted to intensive care units (ICUs).

    Methods

    This descriptive cross-sectional study was conducted on 100 patients after cardiac surgery with general anesthesia admitted to ICUs between May and November 2017. For each research unit, the ETT cuff pressure was measured twice at a 6-hour interval using a cuff pressure manometer. Descriptive (ie, mean, standard deviation, and frequency distribution) and inferential (ie, t-test, Pearson, and ANOVA) statistics were used to describe the data. All the ETT cuff pressure measurements were performed with a calibrated manometer. The data were analyzed using the SPSS software, version 22.0.

    Results

    The mean ETT cuff pressure was 38.3 ± 24.9 cmH2O. In the first measurement, the ETT cuff pressure was normal in only 17% of the subjects, while this figure increased to 78% after the 6-hour control period and cuff-pressure correction. There was a significant relationship between the number of days of intubation and the ETT cuff pressure in both first (P = 0.003) and second (P = 0.01) measurements.

    Conclusions

    The ETT cuff pressure often exceeds the recommended normal range, which can serve as a reminder that it may be necessary to control it at shorter intervals to avoid complications caused by increases or decreases in the cuff pressure. (Iranian Heart Journal 2020; 21(3): 33-39)

    Keywords: Endotracheal tube, Cuff pressure, Intensive Care Units, Cardiac Surgery
  • Niloufar Samiei, Mohammad Kasaei, Mahmood Salesi, MohammadReza Eftekhari * Pages 40-47
    Background

    Echocardiography has a widespread role in measuring cardiac function and hemodynamics. Nevertheless, the evaluation of right ventricular (RV) function is a puzzle, especially by 2D echocardiography, because of the complex anatomy of this chamber. Tetralogy of Fallot (ToF) is the most common cyanotic congenital heart disease, and an accurate evaluation of RV function is important for planning the time for pulmonary valve surgery after initial correcting surgery. Although cardiovascular magnetic resonance imaging (CMR) is the gold standard tool for measuring the right ventricular ejection fraction (RVEF), we sought to determine which classic factor for the evaluation of RV function by 2D echocardiography matched relevant CMR findings the most.

    Methods

    All patients (N = 26) with corrected ToF referred for CMR in Rajaie Cardiovascular Medical and Research Center between June 2018 and January 2019 were evaluated by 2D echocardiography. The findings relating to RV function by the 2 methods were analyzed using the SPSS software, version 22.

    Results

    Of the 4 classic parameters for the evaluation of RV function by 2D echocardiography, only fractional area change had a statistically significant correlation with RVEF by CMR (AUC for the evaluation of RVEF ≥ 45%: 0.813, P = 0.012; the Spearman correlation coefficient: 0.40, P = 0.04). Additionally, tricuspid annular plane systolic excursion, S’, and the RV index of myocardial performance could not predict RVEF in our patients with corrected ToF.

    Conclusions

    Fractional area change is a suitable parameter for the evaluation of RVEF in patients with ToF; nonetheless, the other classic parameters of RV function in 2D echocardiography cannot predict RV function in these patients. (Iranian Heart Journal 2020; 21(3): 40-47)

    Keywords: Right ventricular function, TETRALOGY OF FALLOT, 2D ECHOCARDIOGRAPHY
  • Mohamad Golitaleb, Rezvan Ghafarzadegan, Azin Alizadehasl, Faranak Kargar * Pages 48-54
    Background

    Pulmonary complications after cardiac surgery are a major source of morbidity and mortality, as well as increased lengths of hospital stay and resource utilization. Pleural effusion following coronary artery bypass graft surgery (CABG) has been reported in 65% to 89% of cases. The present study was designed to determine the prevalence of pleural effusion after open-heart surgery.

    Methods

    This study evaluated 600 patients who underwent open-heart surgery. The study population was divided into 3 groups: group A consisted of 200 patients who underwent CABG, group B comprised 200 patients who underwent aortic valve replacement (AVR) and mitral valve replacement (MVR), and group C encompassed 200 patients who underwent    valve surgery and CABG. Chest radiography was performed before surgery and afterward on the first, third, and seventh postoperative days.

    Results

    The study population was comprised of 330 (55%) men and 270 (45%) women. The size of the pleural effusion was small in a large proportion of the patients (45%, n = 270). Additionally, 90 (15%) patients had moderate effusion, occupying between 20% and 40% of the hemithorax, and 84 (14%) patients had large effusion.

    Conclusions

    Pleural effusion was detected in 37% of the patients after CABG, 25% after valve surgery (MVR+AVR), and 20% after CABG and valve surgery. Most of the cases of effusion after cardiac surgery were left-sided. (Iranian Heart Journal 2020; 21(3): 48-54)

    Keywords: Pleural Effusion, Open cardiac surgery, complication, Cardiopulmonary bypass
  • Hooman Bakhshandeh, Feridoun Noohi, Parham Sadeghipour, Sadaf Esfahani, HosseinAli Basiri, Ali Zahedmehr, Omid Shafe, Ahmad Tashakori Behesht, Sanam Alilou, Zahra Behroozifar, Hamid Sedigh, Jamal Moosavi * Pages 55-63
    Background

    The fractional flow reserve (FFR)-guided percutaneous coronary intervention (PCI) has proven effective in decreasing cardiac events by comparison with all-comers stenting. In this study, we aimed to evaluate the cost-effectiveness of this method in an Iranian population.  

    Methods

    In this prospective cohort, patients with moderate stenosis (50%–70% severity) were included, while those with acute coronary syndrome were excluded. The patients were divided into 2 groups: the FFR group, for whom revascularization was performed based on FFR results, and the control group, for whom revascularization was performed based on the interventionist’s assessment. An FFR of less than 0.80 was considered ischemic in this investigation.  

    Results

    A total of 188 patients with moderate coronary artery lesions scheduled for elective PCI were included: 98 patients were assigned to the FFR group and 90 to the control group. Readmission and major adverse cardiac events (MACE) were decreased significantly in the FFR group (24.4% vs 11.2%; P = 0.017 and 25.6% vs 12.2%; P = 0.019, respectively). The quality-adjusted life-year (QALY) value was improved in the FFR group in comparison with the control group (0.8643 ± 0.0961 vs 0.7449 ± 0.10139, respectively; P < 0.001), resulting in a lower cost for each QALY in the FFR group than in the control group (131 395 349 QALY/rials vs 210 666 667 QALY/rials, respectively; P < 0.001). Additionally, our calculation of the incremental cost-effectiveness ratio showed that the cost-effectiveness of the FFR utilization was at least 409 million rials and at most 431 million rials for each QALY, depending on the inclusion of the cost of the FFR catheter.

    Conclusions

    Our results demonstrated the effectiveness of FFR in diminishing MACE. The method was cost-effective according to various calculation methods in an Iranian population. (Iranian Heart Journal 2020; 21(3): 64-72)

    Keywords: Percutaneous Coronary Intervention, Fractional flow reserve, Cost-Effectiveness
  • Fatemeh Seid Abadi, Majid Kyavar, Akbar Nikpajouh *, Saeed Malih Al Zakerini, Hassan Ahadi Pages 64-77
    Background

    This study aimed to determine the relationship between executive functions and the percentage of artery blockage as mediated by the big 5 personality characteristics in patients with cardiovascular disease (CVD). Accordingly, we used structural modeling to test a hypothesized model.  

    Methods

    The research method was descriptive and correlational, and the statistical population was comprised of 183 patients with CVD selected via the available sampling method from those who referred to Rajaie Cardiovascular Medical and Research Center in Tehran, Iran. The percentage of artery blockage was recorded by coronary angiography. The measuring instruments were the Subjective Neurocognition Inventory (SNI) and the NEO Five-Factor Inventory (NEO-FFI). The data were analyzed using structural equation modeling. In this regard, the data were calculated using the Spearman correlation coefficient among the factors (the SPSS software) and the path analysis (the LISREL software).  

    Results

    The results showed that the personality mediated the relationship between executive functions and the percentage of artery blockage.  

    Conclusions

    Executive functions were associated with the percentage of artery blockage, and a part of this relationship was mediated by the big 5 personality characteristics. Therefore, personality traits should be considered in treating patients with CVD. (Iranian Heart Journal 2020; 21(3): 73-86)

    Keywords: Executive Functions, Percentage of artery blockage, Big five personality characteristics
  • Zahra Alizadeh Sani, Zahra Khajali, Fatemeh Mirrazeghi, Mostafa Rouzitalab, Mohaddeseh Behjati, Behshid Ghadrdoust, Shahin Rahimi *, Niloufar Samiei, Maryam Bayat, Delara Gholamipoor Pages 78-88
    Background

    Right ventricular (RV) restrictive physiology is a condition caused by the chronic elevation of systolic pressure in the RV, which is typically found in patients with tetralogy of Fallot (ToF) who had undergone total surgical correction and can be diagnosed either via cardiac magnetic resonance imaging (CMR) or finding the RV end-diastolic forward flow (EDFF) via echocardiography. We aimed to assess the relationship between RV restrictive physiology with myocardial fibrosis and functional indices on CMR, along with exercise capacity and diastolic dysfunction indicators measured by transthoracic echocardiography (TTE).  

    Methods

    All patients with a history of the total correction of ToF at childhood who referred to our center for the evaluation of postoperative severe pulmonary regurgitation were included. All the patients were examined using electrocardiography, the exercise test, TTE, and late gadolinium enhancement (LGE) CMR.  

    Results

    Among the study population, 17 (56.7%) patients were found to have RV EDFF on their echocardiograms, while 18 (60.0%) had RV restrictive physiology on their CMR. The 2 diagnostic modalities had a moderate significant agreement for the diagnosis of RV restrictive physiology (Kappa = 0.521, P= 0.004). There was a significant difference between the patients with or without RV restrictive physiology based on CMR findings regarding the QRS duration (P = 0.015), Sm (P = 0.045), and the RV end-diastolic volume index (P = 0.036).  

    Conclusions

    TTE may be a good alternative for the evaluation of RV restrictive physiology after the total correction of ToF. However, RV restrictive physiology measured by CMR and RV EDFF measured by echocardiography could not correlate with quantitative RV myocardial fibrosis measured by LGE CMR. (Iranian Heart Journal 2020; 21(3): 87-97)

    Keywords: Right ventricular restrictive physiology, TETRALOGY OF FALLOT, echocardiography, Cardiac magnetic resonance imaging
  • Niloufar Samiei, Reza Zolfaghari *, Hamidreza Sanati, Reza Rezaei Tabrizi, Ali Zahedmehr, Ata Firouzi Pages 89-95
    Background

    Mitral valve area (MVA) and other indices of the severity of mitral stenosis poorly reflect the functional status, systolic pulmonary artery pressure, and cardiac output in patients with severe mitral stenosis. In the present study, we aimed to compare the strength of conventional stenosis indices and N-terminal pro B-type natriuretic peptide (NT-proBNP) levels in the prediction of major functional and hemodynamic consequences of mitral stenosis in a group of patients with a severe form of this disease.  

    Methods

    Patients with severe symptomatic rheumatic mitral stenosis (MVA< 1.5 cm2) were enrolled. Comprehensive echocardiography and catheterization were performed for all the patients. MVA was measured via the 2D planimetry method, and NT-proBNP levels were measured during admission.  

    Results

    Forty-one patients, 88% of whom were female, were enrolled in our study. The NT-proBNP level and MVA had a significantly negative correlation (ρ= −0.450 and P =0.003). The NT-proBNP level had a significant correlation with systolic pulmonary artery pressure (ρ= −0.423 and P = 0.006) and MV resistance (ρ= −0.506 and P = 0.001); however, the mean transmitral pressure gradient and the NT-proBNP level did not show a significant relationship. The strongest relationships were found between the NT-proBNP level and stroke volume and cardiac output, which were negatively significant (P = −0.601 and P = 0.000) and (ρ= −0.587 and P = 0.000), respectively.  

    Conclusions

    It appears that the NT-proBNP level can be a good predictor of patients’ hemodynamic status such as cardiac output in addition to the echocardiographic features of mitral stenosis. (Iranian Heart Journal 2020; 21(3): 98-104)

    Keywords: Mitral stenosis, Brain natriuretic peptide, echocardiography, Cardiac output
  • Naser Kachoueian, Saeed Taiyari *, Mohammadreza Mirza Aghayan, Ziae Totonchi, Ali Sadeghpour Tabaei, Farhad Gorjipour, Ali Sadeghi, Seyyed MohammadTaghi Razavi Tousi, Meysam Mortazian, Pouya Farokhnezhad Afshar, Sara Taiyari, Farnoosh Elmi Pages 96-108
    Background

    Hypothermic perfusion is widely used in pediatric cardiac surgery units. The present study evaluated the effects of hypothermia severity on the serum levels of lactate during cardiopulmonary bypass (CPB) in the surgical repair of congenital heart defects in children.  

    Methods

    A total of 185 pediatric patients candidated for the elective surgical repair of congenital heart diseases were recruited. The patients’ arterial serum lactate, central venous pressure, diuresis, glucose level, and arterial blood gases were measured and recorded at 4 time points: before CPB, in the cooling stage, in the warming stage, and after CPB and upon admission to the intensive care unit (ICU).  

    Results

    The mean age of the patients was 28.1 ± 19.6 months. The lactate level was significantly increased more quickly in the patients with hypothermia less than 30 °C than in those with hypothermia of 30 °C or greater (P < 0.001). These 2 groups were significantly different in terms of the duration of CPB (P < 0.001), the duration of cross-clamping (P < 0.001), and the volume of the blood filtered (P < 0.001). No statistically significant difference in the volume of the red blood cell transfused was observed between the 2 groups (P = 0.12).  

    Conclusions

    Deep hypothermia is associated with higher blood lactate levels, which may be associated with poor outcomes during and after CPB. It is recommended that normothermia or mild hypothermia be used during CPB in pediatrics. When the use of deep hypothermia is inevitable, patients should be strictly monitored and screened for adverse outcomes associated with hyperlactatemia. (Iranian Heart Journal 2020; 21(3): 105-117)

    Keywords: Cardiac Surgery, Congenital defects, lactate, HYPOTHERMIA, Cardiopulmonary bypass
  • Sepideh Taghavi, Seyed AmirHooman Qoreishi *, Nasim Nadri, Ahmad Amin, Farzaneh Futuhi, Siroos Kordrostami, Hooman Bakhshandeh, Hadi Khalaj Pages 109-118
    Background

    The role of micronutrients such as selenium is linked to the different types of cardiomyopathies. Given the paradoxes and limitations of previous studies, we designed a descriptive-analytic study with a greater sample size and more variables in Iran.  

    Methods

    Fifty-five patients suffering from heart failure (HF) with glomerular filtration rates of 60 mL/min or higher were selected. At the onset of admission, the serum levels of selenium, proBNP, magnesium, calcium, potassium, and iron, as well as the variable of estimating prognosis (ie, 5 years’ survival based on the Seattle Heart Failure Model calculator), and also a history of diabetes mellitus, hypertension, cerebrovascular accidents, cigarette use, atrial fibrillation, and previous admissions for HF, were registered. Three months later, the New York Heart Association (NYHA) functional class, the left ventricular ejection fraction, and the proBNP level were rechecked.  

    Results

    Selenium deficiency (≤ 45µg/L) was detected in 25.4% of the patients. The mean serum level of selenium was 62 ± 24.9 µg/L, and it had no significant relationship with etiology; prognosis; the left ventricular ejection fraction; the proBNP level; the NYHA functional class; the dose of furosemide before admission; the consumption of angiotensin-converting-enzyme inhibitors/angiotensin II receptor blockers, beta-blockers, statins, and allopurinol; laboratory variables; age; sex; diabetes mellitus; hypertension; cerebrovascular accidents; atrial fibrillation; and cigarette use. Nonetheless, the mean serum level of selenium had significant reversed relationships with previous admissions for HF and potassium-sparing diuretic use (P = 0.012 and P = 0.026, respectively) (confidence interval = 95%).  

    Conclusions

    The prevalence of selenium deficiency in our patients with HF was considerable. The mean serum level of selenium was similar in both ischemic and nonischemic groups; nevertheless, the level had no significant relationship with the majority of clinical and paraclinical variables of HF severity and prognosis. Future studies should investigate the relationship between the serum level of selenium and the precise cumulative dose of diuretics at the end of the admission process and the interaction between selenium and mineralocorticoid receptors.(Iranian Heart Journal 2020; 21(3): 118-127)

    Keywords: Micronutrients, selenium, Cardiomyopathy, Heart failure, Diuretic
  • Atoosa Mostafavi, MohammadHossein Mottaghi, Seyed AbdolHussein Tabatabaei * Pages 119-127
    Background

    Controversy continues surrounding the relationship between methadone and coronary artery disease (CAD). Given the evidence regarding methadone overdose and elevated high-sensitivity troponin I (hs-TnI) levels, we sought to determine whether elevated hs-TnI was associated with subtle CAD.  

    Methods

    This cross-sectional study was conducted on 100 cases with methadone overdose. Electrocardiography (ECG) was performed on day 1 after admission, and QTc intervals and ST-T segment changes were recorded. The venous level of hs-TnI was checked thrice. Patients aged below 20 years with no risk factors for atherosclerosis were evaluated by stress echocardiography, and the rest underwent coronary angiography.  

    Results

    The mean age of the study population was 41.51 ± 17.82 years. ECG was normal in 48% of the patients, despite elevated levels of hs-TnI. Extensive myocardial infarction was reported in 3% of the study population, and 49% showed ST-T changes. The mean QT-interval was 422.50 ± 77.35 ms in women and 434.28 ± 67.28 in men (P = 0.578). Patients with torsades de pointes had a QT-interval of greater than 500 ms. The mean left ventricular ejection fraction was 55.41 ± 9.85%. All the stress echocardiographic examinations were normal. Twenty-four patients had stenosis exceeding 50% in coronary angiography. The entire study population was older than 40 years of age with more than 1 coronary artery risk factor.  

    Conclusions

    Methadone elevated hs-TnI with and without ST-T changes. Most of our patients had normal coronary arteries in angiography and stress echocardiography. Indeed, even the patients with ST elevation in the anterior leads, combined with a reduced ejection fraction, were ultimately diagnosed as Takotsubo cardiomyopathy. We conclude that elevated hs-TnI in methadone toxicity should not be considered non–ST-segment elevation myocardial infarction. (Iranian Heart Journal 2020; 21(3): 128-136)

    Keywords: Methadone, Troponin, Coronary Angiography, QT-interval
  • Mohammad Dalili, Faramarz Ajri Khamesloo, Shabnam Madadi *, MohammadYusef Arabi Moghaddam Pages 128-135
    Background

    Arrhythmia is an uncommon but serious cause of the admission of neonates and infants to emergency wards. The rarity of the condition creates challenges in the diagnostic and therapeutic process.

    Methods

    The study was conducted in Rajaie Cardiovascular Medical and Research Center, Tehran, Iran.  All infants (aged ≤ 12 mon) with tachyarrhythmias admitted within a 2-year period between September 2014 and August 2016 were included. Stepwise drug therapy based on the mechanism of the arrhythmia was selected for the whole study population. In cases refractory to drug therapy, catheter ablation was performed.

    Results

    Of 55 cases, 47 infants were treated with antiarrhythmic drugs, 3 (with atrial flutter) received cardioversion, and 3 were treated with catheter ablation. In 1 case (atrial tachycardia), the arrhythmia was eliminated after a single dose of adenosine, and in another (atrial tachycardia), the arrhythmia was eliminated spontaneously. No mortality was reported.  

    Conclusions

    Most infantile arrhythmias are controllable with available antiarrhythmic drugs. Catheter ablation is a good choice for refractory cases.(Iranian Heart Journal 2020; 21(3): 137-144)

    Keywords: Infantile tachyarrhythmia, Ablation, Antiarrhythmic drugs
  • Hamid Hoseinikhah, Shima Sheybani, Majid Ghodsi, Aliasghar Moeinipour * Pages 136-140

    CASE PRESENTATION Metastatic cardiac masses have different primary sites. On rare occasions, uterine tumors are responsible for such masses. We herein describe a woman with a metastatic cardiac mass originating from a benign uterine leiomyoma. The patient had severe and chronic abnormal uterine bleeding, for which she finally referred to our hospital. On admission, she had acute respiratory distress. Echocardiography showed a huge right atrial mass that had occupied most of this atrial space. The mass originated from the inferior vena cava (IVC) and extended across the tricuspid valve to the right ventricle. The mass was successfully resected under cardiopulmonary bypass. Subsequent evaluations, including a pathologic examination, revealed a metastatic uterine leiomyoma extending to the right atrium after invasion into the IVC. (Iranian Heart Journal 2020; 21(3): 145-149)

    Keywords: Cardiac mass, Cardiac Surgery, leiomyoma
  • Sepideh Taghavi, Nasim Naderi, Ahmad Amin, Maryam Chenaghlou *, Marzieh Mirtajaddini, Elahe Zare Pages 141-144

    Muscular dystrophies constitute a group of disorders characterized by muscular weakness and the involvement of the other systems such as the cardiovascular system. In some patients, cardiac involvement is severe and necessitates heart transplantation. Although there are some concerns regarding heart transplantation in these patients due to post-transplantation complications and the deleterious side effects of immunosuppressant drugs, there are several cases of heart transplantation in these patients worldwide. There is, however, no reported case in our country, Iran. Herein, we present 3 successful heart transplantations in patients with muscular dystrophies in Iran. (Iranian Heart Journal 2020; 21(3): 150-153)

    Keywords: Muscular dystrophy, Heart failure, Heart transplantation