Iranian Heart Journal
Volume:3 Issue: 1, Fall 2003

Cardiac disorders are the most common cause of death in thalassemia major patients; therefore, efforts should be made for an early diagnosis of cardiac disorders. In this study, common arrhythmias in thalassemia major patients were evaluated using Holter monitoring and their relationship with serum ferritin concentration was assessed.
In a descriptive cross-sectional study, 30 patients with thalassemia major and no evidence of cardiac disorder were enrolled. Arrhythmias in patients were recorded by 24- hour Holter monitoring and other data were obtained based on hospital records from previous admissions.
2.5 sec. and ventricular tachycardia were not recorded in any of the patients. None of the arrhythmias except bigeminal PVCs proved to have a significant relationship with serum ferritin concentration.
While a negative Holter recording does not assure the absence of risk, screening and follow- up with this method are warranted in the care of thalassemia major patients, but serum ferritin concentration cannot be used to predict cardiac status in these patients

To avoid the fetal and maternal risks associated with anticoagulant therapy during pregnancy, the use of bioprostheses has been advocated for young women with cardiac valve disease who may later wish to bear children. The aim of this historical cohort study was to evaluate pregnancy outcome in women with bioprosthetic heart valves.
Fifteen women who became pregnant after bioprosthetic heart valve replacement were followed during 28 pregnancies. Eleven had undergone isolated mitral, 3 had aortic and 1 had tricuspid valve replacement. Their ages at the time of surgery ranged from 14 to 1 years (mean 19.85±5.54).
All the women were in sinus rhythm at the time of gestation. No embolic episodes ccurred either after surgery or during pregnancy, labor or the puerperium.
B>Results- Fetal loss occurred in 7 of the 28 pregnancies (25%), and was due to abortion (N=5), re-maturity and neonatal death (N=2). No congenital malformation was seen. The mean irth weight in 21 pregnancies was 3082c, and only 1 newborn had low birth weight 2100gr). Two cases of rapid degeneration of bioprosthetic valves leading to reoperation ccurred in two patients, one in the 7th month of pregnancy and the other 4 months after elivery.
Bioprosthetic valves can be considered the most suitable prosthetic heart valve mployed in women of childbearing age because anticoagulants can be avoided, so the isk of embryopathy following the use of anticoagulant drugs is omitted.

One hundred ninety six patients in two groups were studied on a non randomized basis in order to compare their operational results after using the two methods. In the antegrade-retrograde method (group A), 15 ml/kg of cold blood infusion of antegrade cardioplegia was followed by 8 ml/kg of retrograde infusion. The antegrade-retrograde route of infusion was repeated every 20 minutes (10 ml/kg and 8 ml/kg respectively). In the antegrade group (group B), 15 ml/kg of cold blood cardioplegia was followed by 10 ml/kg in repeated doses every 20 minutes. Important variables of myocardial performance were compared in the two groups.
The two groups had similar preoperative characteristics (age, sex, body mass index, severity of coronary artery disease and ejection fraction). Postoperative
ejection fraction either did not change or increased 5 to 15% in 51.1% of group A. Inotropic agent was needed in 8.2% of this group, while post operative ejection fraction reduced 5 to 20% in 76.9% of group B and inotropic agent was needed in 24.5% of this group (P<0.001 and P<0.002 respectively). The mortality rate was more in the control group, but was not statistically significant. The ventilatory support time was longer in the control group (P<0.01).
In view of our findings, we conclude that there is a significantly better postoperative myocardial performance following antegrade-retrograde cardioplegia and we recommend it as a routine method for myocardial protection in coronary artery bypass graft.

Purulent mediastinitis is an unusual complication of median sternotomy. This complication often occurs shortly, usually within two weeks, after surgery. This study has been planned to clarify the situation of life-threatening infectious complications after surgical operations at our center and to better the ways of prevention as much as possible.
In this study, all the patients who had undergone median sternotomy were observed over a 4-year period. The documentation of the diagnoses was completed, information about the patients including demographic characteristics, type of surgery, pre-, intra- and postoperative risk factors, clinical and laboratory findings, etiological diagnoses, responsible organisms, management methods and finally the outcome of the patients were collected and analyzed by a statistical software (SPSS-Win).
1.2, and 15% needed preoperative intra aortic balloon pump. The mortality rate was 31%.
This complication is distinguished by its clinical manifestations and positive culturing from the mediastinum. Microbial etiology is influenced by the source of contamination and must be recognized for any center separately. A combination of antimicrobial therapy and surgical intervention has better results. A better evaluation of the patients’ preoperative conditions, promotion of surgical techniques and preventive measures, and an early diagnosis of mediastinitis will be effective in the reduction of this
complication

In recent years، twelve studies have indicated that a vegetarian diet could reduce the progression of atherosclerosis. Because of its applicability in our society، this study was performed to evaluate the effects of a vegetarian diet on atherosclerosis progression during a period of 12 to 31 months (average 17. 2 months).
The case group was a vegetarian one (15 subjects) ، which was compared with a control group with a normal diet (17 subjects). Coronary angiography was done before and after the study. In each group، lesion number and average maximum stenosis were determined and compared in both coronary angiograms. A statistician analyzed the acquired data with T- test and Chi-square.
In the case (vegetarian) group، there was a 40% progression، a 27% stabilization and a 33% regression، while in the control group، there was a 100% progression of atherosclerosis.
The preventive effects of a vegetarian diet on coronary stenosis lesion progression and the regression of atherosclerotic lesion were observed. Its beneficial
clinical effects on reducing angina، total cholesterol، LDL-C، and BMI were established too.

In recent years، twelve studies have indicated that a vegetarian diet could reduce the progression of atherosclerosis. Because of its applicability in our society، this study was performed to evaluate the effects of a vegetarian diet on atherosclerosis progression during a period of 12 to 31 months (average 17. 2 months).
The case group was a vegetarian one (15 subjects) ، which was compared with a control group with a normal diet (17 subjects). Coronary angiography was done before and after the study. In each group، lesion number and average maximum stenosis were determined and compared in both coronary angiograms. A statistician analyzed the acquired data with T- test and Chi-square.
In the case (vegetarian) group، there was a 40% progression، a 27% stabilization and a 33% regression، while in the control group، there was a 100% progression of atherosclerosis.
The preventive effects of a vegetarian diet on coronary stenosis lesion progression and the regression of atherosclerotic lesion were observed. Its beneficial
clinical effects on reducing angina، total cholesterol، LDL-C، and BMI were established too.

With the progressive aging of western populations، cardiac surgeons are faced with treating an increasing number of critically ill and elderly patients. Controversy exists as to whether the ordinary mid-sternotomy approach to these malfunctioning mitral
valves will do the job or a new right thoracotomy approach without cross clamping the
aorta is better suited to take care of the problem. The potential to avoid mid-sternotomy
surgery in redo patients with little chance of survival and poor quality of life postoperatively would spare unnecessary suffering، reduce operation mortality، and enhance the use of resources.
We managed 52 cases of severely ill patients admitted to our department on referral from rural areas with malfunctioning prosthetic mitral valves from July 15، 2000 through June 20، 2002. Four patients were women. Preoperatively most of the patients were not moribund، but 67% had hemodynamic instability and 23% experienced cerebral ischemia. All the patients had prosthetic mitral valves. Hospital mortality and morbidity models، based on our overall experience with 52 patients operated on for malfunctioning mitral valves during the period of the study، were developed by means of multivariate logistic regression with preoperative and intraoperative variables used as independent predictors of outcome.
Overall hospital mortality was 14%. There was no intraoperative mortality. All the patients who survived had one or more postoperative complications. Mean hospital stay was 17 days with an average of 11 days and median of 10 days in the intensive care unit. All of the survivors (6 patients) discharged from the hospital were able to function independently and their survival at 6 months was 100%. Statistical analysis of the overall experience with this new operation for malfunction of prosthetic mitral valves confirmed that via right thoracotomy، the cross - clamping of the aorta is the most important independent patient risk factor associated with 30-day mortality and morbidity.
Operations for critically ill patients involve increased hospital mortality and morbidity. Short-term survival is unfavorable and is associated with a poor quality of life. With additional corroborative studies to endorse the present findings، the use of right
thoracotomy approach to have access to malfunctioning mitral valve without the crossclamping of the aorta remains a substantiated concept. In the context of these critically ill patients، the hypothesis that right thoracotomy approach without the cross-clamping of the aorta should be advocated for surgical intervention to save these patients and to conserve resources is supported by the presented data.

Several studies have been performed to analyze the significance of atrial fibrillation (AF) following acute myocardial infarction (AMI). In this study, we evaluated the prognostic significance of AF considering timing of its occurrence after the first AMI. Methods- This investigation is a prospective multivariate study (cohort type); among 500 consecutive first infarct survivors who were admitted to our heart center over a 2-year period (1998-2000).
Among 500 consecutive patients (pts), 66 pts (13.2%) had AF. These pts were divided into two groups A (n=36) and B (n=30), who developed AF within and after 24 hours of onset of AMI, respectively. The infarct occurred mainly (62.8%) in the proximal right coronary artery in A group (p<0.05), left ventricular ejection fraction was more decreased in B group (p<0.05); and also mitral regurgitation was more frequent in this group (p<0.05). According to multivariate analyses; older age, female sex, hypertension, ventricular hypertrophy, ventricular tachycardia, ventricular fibrillation, pericarditis, atrioventricular block (AVB) especially complete AVB, intraventricular conduction disturbance, high admission Killip class, pulmonary congestion, heart failure in hospital and 1 year follow-up mortality were higher in both groups compared to the sinus rhythm group. AF was an independent predictor of cardiac death (in-hospital and 1 year followup) in A group (odds ratio 2.29, 95% confidence interval 1.1 to 4.1, p<0.05), and B group (odds ratio 4.21, 95% confidence interval 2.1 to 7.9, p<0.05), respectively.
The appearance of AF within or after 24 hours of first AMI is a useful parameter for evaluation of the cardiac status and prognosis of patients with AMI. We also found that emergence of AF is more common in right coronary artery lesions.

An evaluation of the effect of vitamin C on blood pressure is very important because hypertension is a major risk factor for cardiovascular, cerebral and renal diseases. We studied the effect of vitamin C on the blood pressure of patients between 35-50 years old with mild primary hypertension in Kerman.
We conducted a prospective one-year double-blind, placebo controlled parallel trial on 42 middle aged patients with mild primary hypertension at the hypertension clinic inKerman University of Medical Sciences. Following a 2-week run-in phase, two age and sex matched groups of untreated hypertensive subjects received 8 weeks oral treatment with either vitamin C, 250 mg twice daily (n=21; 8 M/13F, mean age 42.7 ± 5.3 years) or lacebo one tablet twice daily (n=21; 10 M/11F, mean age 42.7 ± 5.9 years). Bloodpressure was measured in the sitting position on three occasions during the run-in phase,and again at 1, 2, 4 and 8 weeks after commencing treatment. Venous blood samples forthe measurement of plasma ascorbic acid were measured at baseline and at 1, 2, 4, 8weeks after treatment.
Plasma ascorbic acid level in vitamin C group significantly changed from 8.8 ± 3umol/l at baseline to 32.3 ± 12 umol/l at 8 weeks, but in placebo-treated group, it changedfrom 13.8 ± 6 umol/l at baseline to 9.01 ± 4.1 umol/l at 8 weeks during the study period.A more significant fall in mean blood pressure was observed in the vitamin C group thanthe placebo-treated group such that the mean systolic blood pressure decreased from153.1± 5 to 144±5.3 mmHg in vitamin C group and from 154.1±4.9 to 149±4.9 mmHg inthe placebo group. The mean diastolic blood pressure decreased from 95.7±1.4 to91.4±1.7 mmHg in the vitamin C group and from 96.2±1.6 to 94.0±1.6 mmHg in theother group.At 8 weeks, the significant difference in the reduction of systolic blood pressure (p<0.05)and diastolic blood pressure (p<0.001) between the two groups became apparent.
Vitamin C intake has a useful effect on lowering blood pressure. (Iranian Heart

Pulmonary artery banding (PA banding) ، part of a two stage- repair strategy popular in the 60s and 70s، is now largely reserved for critically ill infants with multiple ventricular septal defects (VSDs) or those with associated anomalies such as straddling atrioventricular valves. 1 Because of our limitations for total surgical correction in infants، we had to do PA banding in patients with VSD-pulmonary hypertension (PH) or VSD and atrial septal defect (ASD) -PH. Consequently، we decided to report our surgical experience during a ten-year period. To assess these results، we reviewed our ten-year experience with 108 patients with the diagnosis of VSD-PH or VSD - ASD-PH who had undergone PA banding in our institution. Twentythree of these patients، however، were excluded from the study because of a lack of information and follow-up.
Based on the age at which PA banding was performed، we divided patients in three groups. In the first group، there were 11 (13%) patients، on whom PA-banding was performed when they were under 6 months of age. There were 38 patients (44. 5%) in the second group، who had undergone PA banding when they were between 6-12 months of age. And finally، 36 (42. 5%) patients made up the third group، who had had PA band performed on them when they were over one-year old. Effective PA banding was performed in 64% of Group I، 75% of Group II and 64% of Group III.
In this study، we showed that the best time for PA banding in patients with VSD-PH or VSDASD- PH in our institution is between 6-12 months of age، and that age more than one year is not an absolute contraindication for PA banding. ;

There are several reports of pacemaker migration from the site of implantation. Pacemakers can erode the skin and become exposed, migrate toward the axilla or breast and protrude from the abdominal wall into the peritoneal cavity. Intraabdominal migration of an epicardial pacemaker generator is a rare but potentially life-threatening complication. We report a case of a 53- year-old woman in whom the generator silently migrated from the sheath of the rectus abdominis muscle in the upper abdominal wall down into the peritoneal cavity.

We present a case of the so-called mesothelial monocytic incidental cardiac excrescences (MICE) of the heart and a brief review of related literature. The patient was a 74- year- old woman. She had no history of previous cardiac instrumentation and underwent pericardial drainage and biopsy due to cardiac tamponade. A tissue sample was submitted as thrombus attached to the pericardium. Histologically، these lesions were composed of a mixture of plump histiocytoid cells، a papillary and strip rrangement of cuboidal cells، and various sized vacuoles and fibrin. The nests of cuboidal ells resembled cancer cells but showed features of mesothelial cells. mmunohistochemically، histiocytic cells were positive for CD68 but negative for ytokeratin. The cuboidal cells were positive for cytokeratin but negative for CD 68. These esions were probably reactive because of their heterogeneous components. The significance f MICE is its possibility of being misdiagnosed as metastatic carcinoma.

A 28- year- old woman was admitted because of uncontrolled hypertension following
delivery. Aortography showed severe coarctation of the aortic arch, and a large- sized
aneurysm that was located in the aortic arch distal to the left common carotid artery. The
patient was scheduled for surgery. The coarctation was removed and the aortic arch was
replaced with a 28-mm Dacron tube, and the left subclavian artery was reimplanted to the
Dacron tube. The patient tolerated the procedure well and was discharged from hospital 15 days later.

We report a case of idiopathic aneurysm of the pulmonary trunk associated with moderate
insufficiency of the pulmonary valve in a 5-year-old girl. The patient was asymptomatic. The results of echocardiography and angiocardiography showed a pulmonary trunk aneurysm. The aneurysm was excised and the pulmonary valve regurgitation was repaired using cardiopulmonary bypass. The postoperative course was uneventful. (Iranian Heart Journal.