Iranian Heart Journal
Volume:5 Issue: 3, Fall 2004

Normalization of ST segment elevation after thrombolytic therapy for acute myocardial infarction (AMI) is accepted as an indirect method for reperfusion. In
this study, we found that further ST elevation during the first hour of thrombolytic therapy is accompanied with better left ventricular (LV) function and patency of infarct-related artery (IRA) than cases without further ST elevation.
From Sept. 2000 to Aug. 2002, one hundred patients who had AMI (60% anterior, 37% inferior and/posterior, 3% combined anterior and inferior) and
received streptokinase (SK) were evaluated for ST segment changes, LV function and IRA residual stenosis. 76% of them were male, and their mean age was 56.59±11.84 years.
Further ST elevation occurred in 46 patients (Group 1), and 54 patients
exhibited no additional ST segment elevation (Group 2). LV ejection fraction (LVEF) was higher in Group 1 than in Group 2 (48.58±6.72% vs. 41.75±8.91%,
p<0.001). It was more significant in patients with anterior MI (48.21±6.83% vs.
39.68±8.12%, p<0.001) than in patients with inferior MI (50±5.86% vs. 46±8.52%, p=NS). Group 2 had more severe IRA residual stenosis than Group 1 (83.33±18.21% vs. 67.08±25.44%, p=0.034).
This study indicates that further ST elevation during the first hour of thrombolytic therapy in patients with AMI is in favor of reperfusion and a better outcome

Atrial fibrillation (AF) is the most common sustained cardiac arrhythmia. Drug treatment of AF usually leads to an unsatisfactory rate of recurrence. The Cox-maze III procedure for atrial fibrillation has been effective in restoring sinus rhythm in patients with mitral valve disease.
From September 2000 to September 2002, 10 consecutive patients with rheumatic mitral valve disease and chronic AF underwent the Cox-maze III procedure concomitantly with mitral valve replacement. Associated procedures were tricuspid valve repair in 4 patients and aortic valve replacement in 2 patients. Our indications to perform the Maze-III procedure were chronic AF, medical history of previous thromboembolic events and large left atrium on preoperative transthoracic echocardiography.
There were 2 men and 8 women with a mean age of 40±8 years. Mean aortic cross- clamp and cardiopulmonary bypass times were 90±11 and 144 ± 18 minutes, respectively. There was no in-hospital mortality. Normal sinus rhythm was restored early post-operatively in 60% and late in 80% of the patients. Right atrial and left atrial contractility was found in 80% and 70% of the patients in transesophageal
echocardiography 6 months postoperatively.
The maze III procedure associated with mitral valve replacement is a safe and effective surgical technique for conversing AF to sinus rhythm and restoring atrial contractility in rheumatic heart disease

The role of transthoracic echocardiography and the sensitivity rate of blood culture in the early diagnosis of infective endocarditis(IE) are not defined accurately in Iranian childhood population.
Thirty-six episodes of IE were evaluated in 36 children admitted to hospitals affiliated with Tehran University of Medical Sciences during a 5-year period (1996-
2000). The patients’ major complaints, clinical findings, the medication they had been receiving and their tests and echocardiographic data were studied.
The average age was 10.38±3.348 years. Overall, the male/female ratio was 2:1; fever was the most common complaint (100%). Sixty-six percent of the patients had fever more than 7 days. Congenital heart disease was the most common underlying disease (66%), followed by rheumatic heart disease (RHD, 22%). Congestive heart failure (CHF) was present in 30.5% of the cases. Blood cultures were positive in 42%, and vegetations were seen in 83.4% by 2-dimensional echocardiography (echo). Blood culture and echo sensitivity and specificity were 45 vs. 90.5 (p<0.001) and 60 vs. 75 (p<0.05), respectively. The most common site of vegetation was the aortic valve area,
followed by the tricuspid valve. Staphylococus aureus was the most common infecting
microorganism. There were 6 deaths (16.6%) due to different causes. Indicators for
mortality include negative cultures, infection with S. aureus, large vegetation and CHF.
All mortalities had left-sided vegetations (p<0.05).
In contrast to the high sensitivity of blood cultures in IE in developed countries, in the developing countries the result of blood culture is not reliable.
Therefore, echocardiography can play a major role in the early diagnosis of IE and can
Role of TTE in Diagnosis of IE A.A. Zeinaloo, MD, et al. change the outcome of this potentially serious illness

In recent decades, advances in congenital heart surgery have dramatically increased the survival of infants with critical congenital heart disease.
To determine the outcomes after the Fontan and total cavopulmonary connection (TCPC) procedures, we investigated 51 patients with single ventricle who underwent the Fontan (27 cases) and TCPC (24 cases) procedures between 1991 and 2001.
Five patients (9.8%) died after surgery. Forty-six patients were followed for a period of 42.9±32.1 months. Thirty-eight of them (82.6%) were alive with a better New York Heart Association functional classification than preoperatively. Ejection fraction was more than 60% in 28 cases (84.4%) one year after the operation. Complications were seen in 23 patients after surgery: 8 with early complications, 12 with
late complications and 3 with both early and late complications. Overall arrhythmia was detected in 34.8% of our patients during their follow-up. Reoperations were necessary for 15.2% of our patients.
The surgical approach to congenital heart defects continues to involve a series of complicated operations with significant associated mortality and morbidity

Balloon angioplasty of aortic coarctation has been growing in recent years. In this study, we reviewed and evaluated results of balloon angioplasty of aortic coarctation in nine adults 6 months after operation.
Nine documented coarctation cases with an average age of 23 years were chosen. Eight cases were male and one case was female. Balloon angioplasty of the aorta was performed with number 15 pulmonary balloons. The patients were followed up for 6 months with echocardiography in order to document residual gradients and possible complications.
Balloon angioplasty was performed without any acute vascular complication. After six months, the patients were re-evaluated for complications. Fluctuations in blood pressure levels were also taken into consideration. Average systolic blood pressure dropped immediately from 180 ± 20 to 127 ± 8 (mmHg). Average diastolic blood pressure decreased from 110 ± 10 to 86 ± 7 (mmHg). Average systolic and
diastolic blood pressures were 120 ± 10 and 85 ± 3 mmHg after six months. Coarctation gradients dropped immediately from 60 ± 15 mmHg to 13 ± 5 (mmHg) after balloon inflation. Average gradient was 16 ± 5 (mmHg) after six months. All the patients were free of anti-hypertensive drugs at the end of the follow-up.
Balloon angioplasty of aortic coarctation without stents could be performed in adults with acceptable results without significant vascular complications and excellent blood pressure control after six months’ follow-up ).

To reevaluate sensitivity, specificity and predictive value of dipyridamole thallium scanning in detecting myocardial ischemia, this study was performed.
The study was carried out on 162 patients with typical chest pain and intermediate to high probability for CAD, who underwent coronary angiography and dipridamole thallium scanning. 96 patients had coronary artery disease and 105 patients had positive scans for ischemia. In the coronary artery disease group, 82 patients had positive thallium scan and in normal coronary group, 23 patients had positive scan.
The calculated sensitivity of the test for detecting CAD was about 85% and the specificity was about 64%. Positive and negative predictive values were about 75% and 78%, respectively. The sensitivity and specificity of the test for detecting LAD, RCA and LCX disease was 89% and 61%, 80% and 59% and 54% and 60%, respectively.
this study reveals that although dipyridamole thallium scan is sensitive for detection of myocardial ischemia, the specificity of the test is not remarkable

The aim of this study was to determine the significance of peripheral monocytosis in the early progression to congestive heart failure (CHF).
Peripheral leukocytosis and monocytosis occur after AMI, especially at the 3rd day, reflecting infiltration of monocytes and macrophages into the necrotic myocardium. The relationship between peak 3rd day monocytosis with the progression to AMI complications was established earlier. However, the prognostic significance of the 1st day monocytosis after AMI remains to be determined.
From a total of 165 patients with first Q-wave AMI, studied after admission from 2002 to 2003, 101 patients were selected. The CBC H1 test at the first 24 hrs, echocardiographic study and physical exam in the first 4 days of the onset of AMI were evaluated. The association between peripheral monocytosis and progression to CHF after AMI was assessed.
Of all the patients (101cases), 40 (39.4 percent) patients had monocytosis equal or more than 620. Forty-seven (46.5 percent) patients were CHF-positive. The patients with CHF had 13085±4095/mm total WBC count, whereas the others had 10428±3256/mm (p<0.001). PMN count in the CHF and normal
groups was 10927±4205/mm and 8299±3137/mm, respectively (p<0.01). The mean of monocyte count in the CHF-positive group was 740.8±334/mm in comparison with that in the CHF-negative group, 516±26/mm (p=0.0001). The mean of the EF in the CHF-positive patients was 33.8±10.3 percent versus the 40.7±7.7 percent in the CHF-negative patients (P=0.0001).
Peripheral monocytosis in the first 24 hrs after AMI is associated with CHF, suggesting a possible role of monocytosis as the bedside marker of CHF evolution in the hospitalization period. Clinical markers that can predict which patients are prone to develop adverse LV structural remodeling and post- MI complications, therefore, would be very useful in the prevention of them

This study was performed to report on the data of transcatheter Amplatzer occlusion of the persistent arterial duct under echocardiographic guidance.
This prospective study was conducted on 39 Iranians, who underwent 39 transcatheter Amplatzer occlusions of arterial ducts. Echocardiography was performed in all of the patients versus aortography in 5 patients for the evaluation of residual shunts across the duct immediately and after 10 minutes of Amplatzer implantation.
The results showed the advantages of echocardiography over aortography; consequently, the former is a useful, non-invasive tool for patients having their PDAs closed

Although over the last decade smoking rates have decreased, hookahs seem to have proved increasingly popular in some eastern countries. It has been demonstrated that smoking increases the plasma fibrinogen level, which is an independent risk factor for cardiovascular disease. Our objective was to investigate the extent to which hookah smokers in comparison with cigarette smokers and non-smokers have their fibrinogen level increased.
The difference in the mean fibrinogen level among the three groups was statistically significant by oneway ANOVA test (P<0.001). Mean difference was 53.21 for hookah smokers compared with nonsmokers (t=8.2, P<0.01). It was 39.47 when hookah smokers were compared with cigarette smokers (t=7.24, P<0.01). In subjects aged less than 55 years, the proportion of people with fibrinogen level
included in higher tertile to lower tertile was 2 for hookah smokers, 0.16 for cigarette smokers and 0.19 for non-smokers. In subjects aged 55 or more, this proportion was calculated to be 13 for hookah smokers, 3.5 for cigarette smokers and 0.33 for non-smokers; the difference was statistically significant. The difference for being included in low tertile or not was significant for both the hookah smokers and cigarette smokers when compared separately with non-smokers. It was found that higher tertile to lower
tertile proportion was 24 in those who smoked hookahs more than three times a day and in those who had smoked hookahs for 10 years or more (P<0.001). In those who had smoked hookahs for less than 10 years or less than 3 times a day, the proportion was 1.47 compared to non-smokers at 0.19.
Hookah smokers (especially, those smoking for more than 10 years) suffer a dramatic increase in their plasma fibrinogen in comparison with cigarette smokers and non-smokers

Carotid intima – media thickness (IMT) is a marker of early atherosclerosis, its anatomic extent and progression. IMT is increased in subjects with several risk factors and is a predictor of cardiovascular events and target organ damage (TOD). Some studies show an association between serum lipoprotein(a) [Lp(a)] and coronary artery disease and target organ damage in hypertensive patients, yet little is known about the association of serum LP(a) elevation with TOD in essential hypertensive patients. Some studies suggest a possible role of Lp(a) in the genesis of essential hypertension. We, therefore, aimed to investigate the association of serum Lp(a) elevation with carotid- IMT as target organ damage in a group of essential hypertensive patients.
Our total of 134 subjects consisted of 39 control subjects and 95 essential hypertensive patients, whose lipids (cholesterol, triglyceride, HDL-C and LDL-C), FBS, BUN, Creat, Ca, K and Na as well as lipoprotein (a) were measured. Carotid IMT was measured byB-mode ultrasonography, and carotidfemoral plaque occurrence (plaque score) was assesed.
There were significant differences in the IMT and plaque scores between the two groups of hypertensive and normal subjects; however, there was no significant difference in LP(a) between the two groups. There were no significant correlations between serum LP(a) with IMT or plaque scores in the hypertensive group. There was no significant correlation of carotid IMT, serum LP(a) and plaque scores
with stages of hypertension.
We could not show clearly the elevation of serum LP(a) in essential hypertensive patients, nor could we find any clear association between serum lipoprotein(a) with IMT as target-organ damage in essential hypertensive patients

We describe the case of a 52-year-old male patient who presented with acute anterior MI in another center and was subsequently referred to our department because of an LA mass. Echocardiography data revealed a large mobile mass in the mitral annulus without attachment to the IAS. Angiography data showed that the LAD was totally cut off after the first large diagonal branch with poor run off. Emergent surgical procedures and pathological studies of the mass revealed a myxoma of the LA in an unusual position and coronary artery embolism due to myxoma. Intracardiac myxomas are the most frequent benign tumors of the heart. While most cases are located in the left atrium, myxomas are also found in the right atrium (18 percent), right ventricle (4 percent) and left ventricle (4
percent). Cardiac myxomas usually originate from the region of the fossa ovalis, but may arise from a variety of locations within the atria. Although myxomas have been reported as originating from the mitral annulus, the mitral valve itself, the aortic valve, and the inferior vena cava, coronary artery embolism associated with myxoma is very rare
and has been documented by both angiography in living patients and histology at post mortem study. Myocardial infarction is sometimes the first manifestation of a myxoma1

There are a number of systemic-to-pulmonary artery shunts being performed by various surgeons. Currently the most widely used systemic-pulmonary shunt is the modified Blalock-Taussig shunt. This shunt is highly effective even in neonates with small pulmonary arteries. We report the case of a 15-years-old girl in whom the internal thoracic artery was used to create a systemic-pulmonary artery shunt after the failure of a previous Blalock-Taussig shunt. This is the first report of such a case in which the internal mammary artery was used to establish systemic to pulmonary arterial flow in Iran

A case with renovascular hypertension due to fibromuscular dysplasia (FMD) was associated
with cerebral aneurysm. This patient was a twelve-year-old girl with cerebral aneurysm and complete obstruction of the right renal artery. The patient’s cerebral aneurysm was successfully clipped with successful right side nephrectomy, and pathologic changes corresponded to FMD. After nephrectomy, the patient’s blood pressure became normal without need for medical therapy. This report suggests that FMD should be considered to be a systemic angiopathy, including the cerebral artery as well as the renal artery (Iranian