International Cardiovascular Research Journal
Volume:14 Issue: 3, Sep 2020

Context: 

The COVID-19 pandemic has involved several millions of people around the world and has dragged thousands of individuals to death. Unfortunately, it seems to be unstoppable for the near future. This review aimed to have a comprehensive appraisal on the latest studies conducted on different aspects of myocardial injury related to COVID-19. Evidence Acquisition: The researchers searched for accredited international investigations, whether original, review, letters, or commentaries or any other published data, in Pubmed/Medline, Google Scholar, Web of Science, Wiley Online Library, and Research Gate databases.

Although the dominant manifestation of the disease was related to the respiratory system, a growing body of evidence has suggested that the cardiovascular system was also a target for SARS-CoV-2. In this regard, myocardium suffered injury by possible direct and indirect mechanisms. Two patterns of myocardial injury were seen particularly in critical cases of COVID-19; presentation with acute myocardial injury and development of myocardial injury with escalation of the viral illness. In the case of myocardial damage, a cascade of life-threatening adverse events will deteriorate the functions of the cardiovascular system as well as other vital organs. Cardiac biomarkers are helpful for early diagnosis of myocardial injury. Hypertension, previous cardiovascular diseases, and diabetes have been considered to be the foremost clinical risk factors in the setting of COVID-19. The jeopardy of arrhythmia, thrombotic complications, acute myocardial infarction, and myocarditis are also anticipated in patients with COVID-19. Thrombolytics have been found to contribute substantially to life-saving treatment regimen.

Cardiovascular damage in terms of myocardial injury has been assigned a considerable share in patients with COVID-19, which is of paramount importance due to the elevation of the fatality rate. While there is no exclusive medication for this viral uninvited guest, much attention should be paid to maintenance of cardiovascular health, which plays a critical role in the battlefield with COVID-19.

Tetralogy of Fallot (TOF) is the most common cyanotic congenital heart disease. Most studies have focused on Right Ventricular (RV) dysfunction, while the left ventricle has received less attention in patients with TOF.

This study aimed to investigate the Left Ventricular (LV) function after surgical Pulmonary Valve Replacement (sPVR) in patients with repaired TOF (rTOF) by Speckle Tracking Echocardiography (STE).

This single-center, observational, cross-sectional study was conducted on 58 volunteers (age: 15 - 31 years) divided into three groups as follows: 22 PVR patients (mean age: 18.96 ± 7 year), 16 patients with rTOF, and 20 healthy controls who were matched regarding the PVR age range. 2D echocardiography (including Doppler and M-Mode indices of the right and left ventricles) and Speckle Tracking Echocardiography (STE) (Global Longitudinal Strains (GLS) and 18 segment analyses) were performed for all patients. All analyses were done using the SPSS software and P < 0.05 was considered to be statistically significant.

2D echocardiography showed normal LV Ejection Fraction (LVEF) in all study groups (64% in sPVR, 60% in rTOF (P = 0.127), and 62.5% in the control group). However, the mean GLS of the left ventricle significantly reduced in both sPVR (-17.5 ± 2.5%) and rTOF (-17.1 ± 4.7%) patients in comparison to the control group (-20.2 ± 0.7%) (P = 0.003). Yet, no significant difference was observed between the rTOF and sPVR groups regarding the GLS (P = 0.9). Segmental analysis of the Longitudinal Strain (LS) indicated a significant decrease in the sPVR and rTOF groups in basal anterior, basal septal, basal anterolateral, mid-anterior, and anterolateral segments. Except for the lower LS in the apical-anteroseptal segment, this level was mostly spared in both sPVR and rTOF patients.

LVEF was within the normal range among the sPVR patients, but the pattern of impaired segmental LS and GLS did not change compared to the rTOF group. In conclusion, sPVR might not have a significant effect on the improvement of LV function assessed by STE in patients with rTOF. LV damage occurring during the surgical correction of TOF might have a permanent deteriorating effect on LV function.

Mitral valve is the most frequent valve that is affected by rheumatic heart disease. Abnormalities of Right Ventricular Function (RVF) play an important role in the development of clinical symptoms and the overall prognosis of patients with Mitral Stenosis (MS). Previous studies have shown discordant findings regarding the effect of Percutaneous Transvenous Mitral Commissurotomy (PTMC) on RVF.

This study aimed to evaluate the immediate and short-term impacts of PTMC on RVF using two-dimensional and tissue Doppler echocardiographic indices.

RVF was measured using transthoracic echocardiography indices (Tricuspid Annular Plane Systolic Excursion (TAPSE) and Peak Systolic Myocardial Velocity by DTI (RVSm)) in 75 patients with isolated severe MS presented to Rajaie Cardiovascular, Medical and Research Center between March 2016 and February 2019 before, after, and six months after PTMC.

All procedures were done successfully. The echocardiographic mean Mitral Valve Area (MVA) increased significantly from 1.0 ± 0.2 to 1.4 ± 0.2 cm (P < 0.001) and the mitral valve mean gradient decreased significantly from 10.2 ± 5.3 to 6.3 ± 2.8 mmHg after successful PTMC (P < 0.001). Systolic Pulmonary Artery Pressure (SPAP) also decreased significantly from 44.7 ± 11.3 to 35.9 ± 8.4 mmHg after PTMC (P < 0.001) and to 35.1 ± 6.7 mmHg after the six-month follow-up (P < 0.001). RVSm was 11.3 ± 2.5 cm/s before PTMC, which did not change immediately after that, but decreased to 12.1 ± 1.9 cm/s after the six-month follow-up (P < 0.003). TAPSE was 19.5 ± 4.3 mm before PTMC, which significantly increased to 21.1 ± 3.2 mm six months after PTMC (P < 0.005).

This study suggested that successful PTMC could improve RVF and decrease pulmonary artery pressure.

Coronary Artery Bypass Grafting (CABG) has been considered as the complete treatment of Ischemic Heart Disease (IHD). Cardioplegic (extracellular and intracellular) solutions have been suggested to reduce the cross-clamping duration. It was hypothesized that the combination of the two intra- and extra-cellular solutions, namely Del Nido (DN) and custodiol, could result in beneficiary clinical and economic outcomes.

The present study aimed to compare the myocardial protection of custodiol alone and in combination with modified DN in patients undergoing cardiac surgery.

This prospective, double-blind, clinical trial was conducted on 50 patients undergoing redo CABG surgery. Aortic clamping was performed using custodiol (20 cc/kg) in group A. In group B, custodiol 1000 cc was combined with 15 cc/kg cold DN and was injected using the antigrade method. The two groups were compared regarding the levels of Creatinine Kinase-MB (CK-MB) and troponin at the time of anesthesia induction and two hours and 48 hours after the surgery, intraoperative and postoperative variables, and 48–hour mortality rate.

The results showed similar CK-MB levels in the two groups at the induction time (P = 0.12). However, a significant difference was observed between the two groups in this regard two hours (P = 0.018) and 48 hours after the surgery (P = 0.021). Within-group comparisons revealed significant changes in CK-MB and troponin levels in both groups, with a steep increase from induction until two hours after the surgery and a decrease from two hours until 48 hours after the surgery (P < 0.001). The results indicated no significant difference between the two groups regarding CK-MB and troponin levels, frequency of intraoperative and postoperative dysrhythmia, need for intraoperative defibrillation, ischemic time, and 48-hour mortality rate (P > 0.05). However, the costs were two-folds higher in group A than in group B (P < 0.001).

The present study findings showed that the selected solution was appropriate in terms of clinical aspects for the patients undergoing CABG surgery with long surgical duration or low Ejection Fraction (EF) and reduced the costs to half. Considering the significant difference in the CK-MB level and the lower troponin level in the combined group (not statistically significant), further studies are required to confirm the clinical priority of the combined solution.

Ostium secundum Atrial Septal Defect (ASD) is one of the most common congenital heart diseases. Right Anterior Minithoracotomy (RAMT) is a promising technique for surgical closure of ASD.

This study aimed to assess the safety of minimally invasive RAMT with peripheral cannulation and compare it to full median sternotomy (Conventional Median Sternotomy, CMS) regarding clinical outcomes and Health-Related Quality of Life (HRQOL) in surgical ostium secundum ASD closure.

In this quantitative, cross-sectional study, all clinical records of 51 patients (30 RAMT and 21 CMS) who underwent ASDII closure between March 2016 and November 2019 were collected. The patients’ HRQOL was evaluated using a Short Form-12 (SF- 12) questionnaire. The two groups’ clinical outcomes and HRQOL were compared using IBM SPSS Statistics for Windows, version 23.0 (IBM Corp., Armonk, NY, USA).

This study was conducted on 30 patients (23 females and 7 males) with RAMT and 21 patients (10 females and 11 males) with CMS ASD closure. The two groups were similar with respect to age, left ventricular ejection fraction, preoperative hemoglobin (Hb), family status, level of education, and employment status. However, operation length, Cardiopulmonary Bypass (CPB) time, and mean aortic cross clamp time were significantly lower in the CMS group (P < 0.001). The mean amount of chest tube drainage in the first 24 hours after surgery was 148.27 ± 122.82 mL in the RAMT group and 217.50 ± 134.04 mL in the CMS group (P = 0.02). The results showed no significant difference between males and females regarding the mean CMS and total score of HRQOL. Yet, the mean score of PCS was significantly better in the female patients in the RAMT group (P = 0.03).

Despite the longer operation and cardiopulmonary bypass time, RAMT procedure was associated with similar mortality and lower postoperative bleeding. Moreover, female patients in the RAMT group showed better physical component of HRQOL.

Detecting the suitable non-invasive Blood Pressure (BP) measurement method is a quandary in clinical settings for accurate diagnosis of Hypertension (HTN) status.

This study aimed to evaluate the efficiency of indirect BP measurement methods in comparison to the gold standard among Iranian patients admitted for Coronary Angiography (CAG).

This observational study was conducted on 150 CAG candidates randomly selected using the computerized random numbers from March 2019 to September 2019. The participants’ BPs were measured via three different non-invasive methods, including brachial and wrist oscillometric cuffs plus brachial sphygmomanometer, and the results were compared to simultaneous intra-arterial reading as the gold standard. The associations between different non-invasive BP measurements and direct arterial BP reading were assessed using different statistical analyses, including correlation coefficient, chi-square, independent and paired t-test, and Analysis of Variance (ANOVA), as appropriated.

The mean age of the participants was 60.56 ± 11.16 years. Both Systolic BP (SBP) and Diastolic BP (DBP) were positively correlated to the gold standard reading in all measurement methods (P < 0.001). After adjustment for potential confounders, the findings revealed no significant difference between the pre-defined BP measurement methods, including brachial sphygmomanometer, brachial oscillometric, and wrist oscillometric, and intra-arterial BP reading regarding the means of SBP and DBP (P > 0.05).

The present study findings showed that the selected solution was appropriate in terms of clinical aspects for the patients undergoing CABG surgery with long surgical duration or low Ejection Fraction (EF) and reduced the costs to half. Considering the significant difference in the CK-MB level and the lower troponin level in the combined group (not statistically significant), further studies are required to confirm the clinical priority of the combined solution.

Paravalvular leak after prosthetic valve operation affects up to 27% of all prosthetic heart valves implanted by conventional surgery, which can be the cause of serious complications like hemolysis and congestive heart failure. Surgical reintervention is the conventional treatment of choice for severe cases, but it is associated with significant morbidity and mortality and is not always successful because of underlying tissue fragility. Over the last decade, transcatheter treatment of paravalvular leaks has emerged as an attractive alternative to surgery for high-risk patients and is now favored as the initial approach in some experienced centers. Significant paravalvular leaks are not common following a pulmonary valve replacement and may be more complex anatomically than left‐sided paravalvular leak due to the variability in implant location and technique in the trabeculated and often dilated and fibrotic right ventricular outflow tract.

This study aimed to report two patients with successful transcatheter closure of a complex paravalvular leak utilizing Ventricular Septal Defect (VSD) and Patent Ductus Arteriosus (PDA) occluder devices following mechanical and bioprosthetic Pulmonary Valve Replacement (PVR). The cases included a 34‐year‐old and a 26-year-old man who were known cases of tetralogy of Fallot with a history of total correction operation (TFTC).

The results showed that paravalvular leak could be a hemodynamically serious complication of surgical PVR and that transcatheter device closure was an acceptable way for the relief of these defects. However, the best approach for the closure of pulmonary paravalvular leak depends on specific anatomic structures and the origin or course of the coronary arteries that must be evaluated before device implantation.