The Journal of Tehran University Heart Center
Volume:3 Issue: 3, Jul 2008

Over the last 50 years, significant progress has been made in the surgical repair of thoracoabdominal aortic aneurysms (TAAA). Improvements in perioperative care and surgical techniques have resulted in reductions in complication and mortality rates. Adjunctive use of distal aortic perfusion and cerebrospinal fluid drainage has been especially helpful, reducing the incidence of neurological deficits to 2.4%. Current research is aimed at improving organ preservation. This review focuses on the current diagnosis and management of TAAA.

Closure of patent ductus arteriosus (PDA), ventricular septal defect (VSD) and atrial septal defect (ASD) can be done surgically or by device. This study was designed to compare the total cost of surgical or device closures of PDA, ASD or VSD for Iranian patients. This is a cross-sectional study, conducted from January 1, 2005 until January 1, 2006 in two large heart centers of Tehran. The study population consisted of 91 patients with isolated PDA, ASD or VSD who underwent either surgical or device closure. PDA device closure either with the Amplatzer device or coil was less costly than that via surgery. VSD closure with the Amplatzer device was more costly (17.6%). Although ASD closure was also more expensive (15.4%), the difference was not statistically significant. It can be concluded that PDA closure is cheaper than surgery in Iran. ASD and VSD device closures are more expensive, but the added cost can be affordable in view of the advantages of device closure.

We compared the outcomes in patients with a low ejection fraction (EF) and multivessel coronary artery disease (CAD) who either underwent coronary artery bypass grafting (CABG) or received medical treatment (MT) after a viability study via dobutamine stress echocardiography (DSE) We considered patients with CAD and left ventricular ejection fraction (LVEF) <40% who were referred for DSE, and enrolled 106 patients (89% male, mean age: 55.8±9.7 years) with ≥4 viable segments. According to DSE, all the 106 patients were suitable for revascularization. We compared the outcomes between the patients who underwent CABG and those who received MT at a mean follow-up time of 8 months. Both groups had similar baseline characteristics and rest EF. Thirty-three (31.1%) patients underwent CABG and 73 (68.9%) received MT. There was no significant difference between the CABG and MT groups in terms of mortality rate (9.1% vs. 11.0 %) and improvement in New York Heart Association functional class at follow-up. In the CABG group, patients with LVEF ≤25% had higher mortality compared to patients with LVEF >25% (100% vs. 40%, P< 0.05). The patients with CAD and a low EF had the same survival rate after both CABG and MT at mid-term follow-up. Long-term follow-up is needed to show the survival benefit of CABG in such patients with an acceptable extent of viable myocardium.

The transcatheter closure of patent ductus arteriosus has advanced rapidly with improvements in device designs. The aim of this study was to analyze the safety, efficacy, and early and intermediate follow-up results of the percutaneous closure of persistent ductus arteriosus (PDA) with the Amplatzer ductal occluder (ADO) in children. Between May 2004 and March 2007, fifty patients between 7 months and 20 years of age underwent the transcatheter closure of PDA, using the ADO. The mean PDA diameter at its narrowest segment (pulmonary end) was 7.35±2.57 mm (range: 4 to 16mm). Follow-up evaluations were performed via echocardiography at 24 hours, and 1, 3, 6, and 12 months and then yearly after implantation. Successful immediate occlusion of PDA was achieved in 42 (84%) of the 50 cases. In 5 cases, there were trivial intraprosthetic residual shunts. In addition, there was a small residual shunt in one case, left pulmonary artery narrowing in one case, and embolization of the device immediately after the procedure in one case. At 24 hours, color Doppler flow mapping revealed complete closure in all except one case with a small shunt. At 3 months’ follow-up, occlusion was complete in all the patients. At a median follow-up of 17 months (range: 3 months to 32 months), all the patients had complete closure. We conclude that although the transcatheter closure of PDA using the ADO is a highly effective and safe treatment for most patients, several complications including embolization and left pulmonary artery narrowing may occur in certain cases.

This study was done to assess the efficacy and adverse effects of the different doses of adenosine in the pediatric age group with respect to multiple patient variables. Over a period of 1 year, 86 occasions of supraventricular tachycardia (SVT) were treated with adenosine in 81 infants and children aged between 18 days and 12 years (median of 1.3 years, SD=3). Adenosine efficacy was evaluated in terms of the patients’ demographics, SVT rate, electrocardiogram characteristics, and route of drug administration. The dose of 50μg/kg was effective only in 24% of the SVT cases, and the additional doses of 100μg/kg, 150μg/kg, and 200μg/kg were effective in another 29% of the cases. The drug efficacy was higher in the infants than that in the older children. There were no predictors other than age for the estimation of the efficacy of the drug. Our findings showed that the current recommended doses of adenosine are ineffective in the vast majority of children and infants with SVT. No patient-related factor other than age seems to affect the efficacy of the drug.

The potential role of lipoprotein (a) changes and also inflammation in coronary artery disease (CAD) have rendered these processes one of the most interesting objects of study in patients affected by type 2 diabetes mellitus. The aim of the current study was to evaluate lipoprotein (a) and other lipid profiles and also C-reactive protein (CRP) as the predictors of cardiovascular disease severity in non-insulin dependent diabetic subjects in comparison with non-diabetic CAD patients. Between June and September 2004, 372 patients with CAD were enrolled at Tehran Heart Center. Non-insulin dependent diabetics accounted for 102 of the cases, and the remaining 270 were non-diabetics. The severity of CAD was evaluated using the Gensini score, and the effect of patient variables such as serum lipid concentrations and CRP on CAD severity in the diabetics was investigated and compared with that of the non-diabetics. The mean of the Gensini score, CRP, and serum concentrations of all the lipid profiles were similar between the diabetic and non-diabetic patients. In the diabetic group, a high CRP concentration (β=0.200, Rs= 0.040; P=0.046) was effective on the Gensini score, whereas lipoprotein (a) and lipid profiles did not influence CAD severity. In the non-diabetics, no significant relationships were found between the Gensini score and all the studied laboratory indices. A high CRP level is an important predictor of the severity of CAD in diabetic patients with CAD

This study was done to test the notion that opium can reduce serum lipids and decrease the risk of ischemic heart disease (IHD) in opium addicts; we made a comparison between the lipid profiles of opium addicts and non-addicts. In this study, we compared 100 male opium addicts (according to the ICD-10 criteria) who had referred to addiction treatment centers with 75 healthy male non-addicts. The subjects filled out our research questionnaire and had their fasting serum lipid profile (total cholesterol, low density lipoprotein, high density lipoprotein, and triglyceride) evaluated. Among those with a body mass index (BMI) between 18 and 25, the total cholesterol level in the opium addicts was less than that in the control group; there was, however, no difference in terms of LDL, HDL, and TG between the case and control groups. There was a significant difference in BMI between the two groups, which requires further studies to investigate the reason. Opium does not seem to have any impact on triglyceride, low density lipoprotein, and high density lipoprotein. Despite the lower total cholesterol levels in opium addicts (as a known side effect of opium on different body systems), it is not advisable that opium and its extracts be recommended to decrease the risk of IHD.

This is a case of severely stunned left ventricle which occurred after a non-ST elevation myocardial infarction in a 76-year-old woman who was a known case of three-vessel disease. Her symptoms and cardiac function responded well to revascularization.