Iranian Heart Journal
Volume:8 Issue: 3, Fall 2007

Left ventricular ejection fraction (LVEF) is an important clinical index in diagnosis and treatment of myocardial diseases. There are three major methods for measurement of LVEF: echocardiography, angiography and ECG-gated SPECT. The first method is economical, safe and rapid. The second one is more accurate, however invasive and the third one lies somewhere in between. Multi-gated SPECT usually suffers from low reproducibility compared to other methods. This is due to variation in processing factors, mainly reconstruction methods and filtration. Up to now, there is no standard method of processing of cardiac SPECT.
In this study, we attempted to find the optimum processing protocol in which the results are consistent with the angiographic results. Forty patients (referred to our department for myocardial perfusion SPECT) who had angiography within 2 weeks of the test were included in the study. All the patients had a positive history of myocardial infarction. All imaging performed with a single head GE gamma camera SPECT system model DSX using 99mTc- MIBI. Two commonly used reconstruction methods i.e., filtered back projection and ordered subset expectation maximization with different parameters were used and the results compared with that of echocardiography and angiography.
In filtered back projection technique, maximum correlation between ECG-Gated SPECT and angiography (r = 0.775) was observed when using Metz filter with psf FWHM=5 and order=5. In OSEM reconstruction technique, the maximum correlation (r = 0.706) between ECG-Gated SPECT and angiography was found using iteration of 2 and subset of 12.
Angiography is usually assumed the standard method for calculation of LVEF. However, techniques such as ECG-gated SPECT can be equally accurate if the method of processing is selected optimally. We optimized the method of processing in our department in correlation with the results of angiography

We evaluated the early and mid-term surgical outcomes and complications of intra-atrial lateral tunnel and extracardiac conduit total cavopulmonary connection to clarify the clinical superiority.
Forty patients underwent total cavopulmonary connection (TCPC), 26 with lateral tunnel (LT) and 12 with extracardiac conduit (EC) repair, from July 1992 to June 2004 in two centers. Survival, incidence of reoperation and early complications were compared.
The hospital survival was 94.7% in the lateral tunnel group and 100% in the extracardiac conduit group. Seven reoperations were performed in the lateral tunnel group as opposed to three in the extra cardiac conduit group. Functional status of all survivors improved postoperatively. Significant enhancement of O2 saturation was seen after these operations (mean 72.3% preoperatively, reaching 91.7%). Surgical bleeding in the lateral tunnel repair group was 5.2% and 3.8%% for extracardiac conduit repair. Pericardial and pleural effusion was seen in 22% in the lateral tunnel and 17% in the extracardiac conduit group. In addition, Surgical Results of TCPC Yaghoubi A. MD, et al.
whereas chylothorax occurred in 11% in the lateral tunnel, it was not seen in the extracardiac conduit group.
The early survival and complications are similar and satisfactory in both lateral tunnel and extracardiac conduit groups. However, the incidence of “cardiac-related” events was significantly less frequent in the extracardiac conduit group. We recommend these procedures, especially EC-TCPC, as an alternative method for patients with complex heart abnormalities who are not candidates for total surgical repair

Tetralogy of Fallot (TOF) is one of the most common forms of cyanotic congenital heart disease (CHD). The aim of this study is determination of demography, associated anomalies, peripheral pulmonary stenosis (PPS), blood group, Rh type, operation results and complications in TOF.
The records of 270 patients were reviewed. These patients had been admitted during 10 years (from 1993 to 2003).
60.37% of patients were male and 39.63% were female. Incidence of patent foramen ovale (PFO), right aortic arch (RAA), coronary artery (CA) anomalies and other anomalies were 44.81%, 21.11%, 9.25% and 36.30%, respectively. Single ostium coronary artery (SOCA) was the most CA anomaly. The most common PPS was bifurcation stenosis. TOF was more common in blood group O patients. The mean age at the first palliative operation was 5.21 years and for total correction (TC), it was 7.19 years. Postsurgical mortality rate was about 3% and morbidity rate was 12.18% (excluding right bundle branch block, RBBB). Tetralogy of Fallot in Iran H. yadollahi Farsani MD, et al.
The trend toward earlier total correction and single stage early total correction of TOF should be recommended as the preferred management strategy

Echocardiography has evolved as a well-established part of the evaluation of global myocardial function. Tissue Doppler echocardiography is a novel technique with wide applications, including estimation of myocardial systolic function. We hypothesized that velocity time integral (VTI) of systolic mitral annular velocity had a better correlation with systolic function in comparison to peak velocity. Consequently, for the first part of our investigation, we selected a population with near normal systolic function to show initially the linear correlation and secondly to obtain the normal values.
We conducted a cross-sectional study at the echo lab with prospective simple nonrandom data collection on 50 consecutive patients (26 % normal, 38% CAD, 20% HTN, 10% MVP and 6% miscellaneous), mean age 45.6 yrs. (range: 18-80 yrs.) and 42% female. The exclusion criteria were prosthetic valves, LV systolic dysfunction, and/or severe regional wall motion abnormality, significant regurgitation (MR and/or AR), severe mitral annular calcification (MAC), non-sinus rhythm, paradoxical septal motion and poor endocardial line definition. All underwent complete echocardiographic study including TDI; some of the indexes of PW-TDI, with special attention to the systolic velocity of mitral annulus (Sm), were correlated with three different methods of EF measurement.
The mean ejection fraction and VTI of Sm were 61.68% and 1.6594, respectively. Of TDI indices, linear regression analysis showed that VTI of Sm had the strongest statistical correlation with EF measured by Simpson’s method (p=0.014, EF= 50.1 6.96 X VTI). Assessment of LV Function with Tissue Doppler A. A. Dadgar MD, et al.
Despite some inevitable limitations, our preliminary data suggest that peak velocity and particularly VTI of Sm in PW-TDI can be considered as reliable, rapid and reproducible indicators of preserved LV systolic function. However, we are currently conducting another complementary study to compare PW-TDI of Sm in patients with LV systolic dysfunction with or without mitral regurgitation.

Hematuria associated with sports activity is a well-recognized entity in subjects who participate in a variety of sports. This study was designed to determine the incidence of postexercise hematuria in patients participating in exercise test.
120 patients who were referred by cardiologists from August to October 2003 to participate in treadmill exercise tests were randomly selected. The first urine sample was taken before exercise and the second urine sample after the completion of the exercise test. In those patients who had post-exercise hematuria, ultrasound studies were performed to rule out other potential causes of hematuria.
.05). Post-Exercise Test Hematuria H. Babalhavaeji MD, et al.
The incidence of post-exercise hematuria is high, and it is very important to be familiar with this entity in patients who participate in treadmill exercise tests to properly deal with them and avoid unnecessary work-ups, especially if they are young and have transient hematuria

Takayasu arteritis (TA), an inflammatory disease of unknown origin, frequently affects major aortic branch vessels and causes many symptoms, including brain and retinal ischemia and hypertension.
Four patients with Takayasu arteritis (TA) underwent angioplasty and stent placement in the renal arteries due to uncontrolled hypertension. Complications of the procedure include transient bradycardia and mild hypotension, probably due to contrast agent; however, there was no major complication.
No restenosis has been reported in the six-month follow up of the patients with angiography. Serum creatinine levels remained unchanged in the four patients. The difference between pre- and post-interventional arterial blood pressures was measured. Mean systolic blood pressure changed from 227.5mmHg to 150mmHg and mean diastolic pressure dropped from 122mmHg to 85mmHg.
The stenotic lesions in TA can be managed successfully with angioplasty and stent placement. Short-term follow up showed stenting had increased the success rate of the procedure, achieved larger luminal diameters and it seemed to decrease the incidence of restenosis. However long-term follow up is suggested to determine the restenosis rate

Elevated levels of anticardiolipin antibody may be associated with the high prevalence of coronary artery disease. In this study, we measured the anticardiolipin antibody level in patients with acute coronary syndrome (ACS) and a control group.
63 patients with ACS (unstable angina - U/A, and acute myocardial infarction - AMI) presenting to our department were studied. Diagnosis of ACS was confirmed by clinical exam, history, ECG and cardiac enzyme determinations. Anticardiolipin antibody level was measured with the ELISA method in 63 patients with ACS and 130 healthy controls matched for sex and age, and samples were analyzed using SPSS and t-test.
The mean age of the patients and control group were 61.59 and 51.27 years, respectively. Mean anticardiolipin antibody level in patients with ACS was higher than that in the control group (P = 0.038). In men with ACS, the mean anticardiolipin antibody level was also higher than that in the control group (P= 0.002). In patients above 45 years of age, the mean anticardiolipin antibody level was higher than that in the control group (P = 0.012).
Our study shows that there are higher anticardiolipin antibody levels in patients with ACS compared to controls. Thus, the evaluation of anticardiolipin antibody level in patients with ACS is necessary

Currently little is known about the prevalence of high blood pressure among Iranian children. Early identification of children at risk for hypertension is a key approach to prevent serious complications. Our goal in this study is to determine the prevalence of hypertension in primary school children of Alvand city, Iran.
In this cross-sectional study, the levels of systolic and diastolic blood pressure were measured and the prevalence of hypertension among 840 primary school children (7-12 years) determined. The children were selected through a double-stage randomized sampling method while divided into six different age groups. The blood pressure was measured by means of standard equipment. Data were analyzed using statistical methods.
Out of 840 children, 410 (48.8%) were male and 430 (51.2%) female. The average systolic and diastolic blood pressure among both sexes increased with increasing age. Except in one age group, there was no significant difference between the systolic blood pressure between the two genders; however, a significant difference was found when the diastolic pressure in 4 age groups was compared (P<0.05). The prevalence of systolic and diastolic hypertension among boys and girls was 6.15% and 3.4%, respectively.
This study revealed that the prevalence of hypertension in primary school children in the city of Alvand is noticeable. Hence, it is necessary to measure the blood pressure on a regular basis for early detection of hypertension

Cardiac myxomas are benign tumors of the heart with a surgical incidence of about 0.5/million population/year. They usually present during the 4th to 6th decades and are more commonly seen in females. About 75% arise in the left atrium (LA) and most are singly pedunculated, although multiple and villous forms have been described. Echocardiography has greatly facilitated the diagnosis of cardiac tumors. We report a case of left atrial myxoma as a source of emboli and an incidental finding of localized descending aortic dissection subsequent to a remote traumatic deceleration injury of the thoracic aorta. This is the first case of coexistence of LA myxoma and aortic dissection .

The syndrome of superior vena cava (SVC) compression is not an uncommon entity, but acute SVC syndrome presenting in surgical patients is relatively uncommon. The case of a 64-year-old male who developed acute SVC syndrome due to mediastinal lymph node enlargement is presented here and management and special considerations are discussed

Coronary arteritis is a rare but potentially fatal condition either by itself or in conjunction with other diseases in all age groups. Coronary arteritis is most closely associated with the polyarteritis syndromes and other collagen vascular diseases, immune system dysfunction, Mediterranean fever, Kawasaki disease, fibrous pericarditis and staphylococcal septicemia.
Isolated left main coronary arteritis may be associated with specific and non-specific aortoarteritis or in some cases after mediastinal irradiation. In this young woman, with regard to her age of 22 years old, sex, absence of familial and personal risk factors, and elevated CRP and ESR and the report of severe left main stem inflammation at open heart surgery and negative response to intracoronary injection of nitrate during angiography, the diagnosis of isolated left main stem coronary arteritis is very high in probability

Interrupted aortic arch (IAA) is a rare congenital malformation of the aortic arch, which occurs in 3 per million live births. This anomaly is defined as a loss of luminal continuity between the ascending and descending portions of the aorta which entails a very poor prognosis without surgical treatment. In most cases, IAA is associated with intracardiac malformations such as VSD, PDA, bicuspid aortic valve, left ventricular outflow tract obstruction or aortopulmonary window. We report a 16-year-old boy with IAA associated with double inlet left ventricle, aneurysmal dilatation of pulmonary artery, giant PDA and severe pulmonary hypertension. To our knowledge, there is no previous report of IAA associated with complex congenital heart disease such as that seen in our
case (Iranian Heart Journal 2007; 8 (3): 60-63).