فهرست مطالب

International Cardiovascular Research Journal
Volume:1 Issue: 1, Jul 2007

  • تاریخ انتشار: 1389/03/01
  • تعداد عناوین: 10
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  • Jw Roos, Hesselink, Y. Karamermer Page 2
    Mitral stenosis is the most common cardiac valvular problem in pregnant women with rheumatic heart disease being the most important cause. As a result of hemodynamic changes associated with pregnancy, previously asymptomatic patients develop symptoms or complications during pregnancy. Pregnancy in women with mitral stenosis is associated with a marked increase in maternal morbidity and adverse fetal outcome. Treatment of symptomatic mitral stenosis during pregnancy consists of bedrest, beta-blockers and diuretics. If symptoms persist despite optimal medical treatment, percutaneous mitral valvulotomy should be considered. If possible, surgery should be postponed until after delivery. It is recommended to treat women with symptomatic mitral stenosis in a tertiary centre with interventional possibilities.
  • Jm Juliard, P. Aubry, M. Mazighi Page 8
  • Masood Bazrgar, M. Karimi, F. Peiravian, M. Fathzadeh, Mj Fattahi Page 13
    Background
    Left ventricular (LV) failure is the main cause of death in halassemia. Iron overload in these patients leads to formation of oxygen free radicals. Apolipoprotein (ApoE) E4 allele is the least efficient in oxidative stress condition compared with apoE2 and apoE3 alleles. This study was performed to determine the association of three different ApoE alleles with LV dysfunction in thalassemia major patients in southernIran.
    Methods
    The present study comprised 202 patients with thalassemia major divided into three groups according to echocardiographic
    Findings
    Group 1 (n=135) had no cardiac impairment; Group 2 (n=38) exhibited LV dilatation but normal LV systolic function and Group 3 (n=29) showed LV systolic dysfunction.DNA was obtained from all patients and 198 healthy control subjects for ApoE genotyping.
    Results
    Frequency of both apoE3/E4 genotype and apoE4 allele in Group 3 were higher than the control group with corresponding values of P<0.05, Odds Ratio=2.97, 1.061.15controls and patient groups in relation to other genotype and allele frequencies. Interventricular septum thickness and LV end diastolic diameter in apoE4/- patients were more than those of apoE3/E3 patients.
    Conclusion
    ApoE4 allele increases the risk of LV impairment in thalassemia major.
  • A. Sadeghpour-Tabaee, A. Rostami, S. Arefi Page 20
    Background
    Excellent long-term patencies of arterial grafts are considered, superior to those of vein grafts. In this study, we present our 6 years experience in using radial artery as a conduit for myocardial revascularization. The aim of the present study was to assess the safety and early and mid term results of using radial artery in coronary artery bypass graft.
    Methods
    The radial artery used as a conduit in 308 cases was evaluated during past 6 years, and the results obtained were processed and analyzed.
    Results
    The operative morbidity comprised re-operation for bleeding in 3.2%, MI in 5%, with paresthesis and stitch abscess of the hand in 10% in and 3.5% respectively. Hospital mortality included 2 patients, one case being directly due to complication of harvesting radial artery.
    Conclusion
    The results of present study were satisfactory with acceptable morbidity and mortality and favored the application of this conduit to CABG patients.
  • Fariborz Mansour-Ghanaei, R. Jafarshad, R. Joukar, Ah Bagherzadeh, F. Tareh Page 25
    Background
    Hirschsprung’s disease (H.D) is a congenital disease in which intestinal ganglionic cells are absent and can cause intestinal obstruction. The disease has various clinical manifestations and different lengths of bowel may be involved. Our aim was to study Hirschsprung’s clinical presentations and its rate of intestinal involvement in hospitalized patients in a 6-year course study in Guilan, north Province of Iran.
    Methods
    We studied the patients with Hirschsprung’s referred to Guilan surgery referral center, Poursina Hospital, from 1995 to 2001. In this cross sectional descriptive- analytic study all data were collected from patients’ files and questionnaires including demographic data, clinical presentations, diagnostic methods, involved segments, surgical procedure techniques, surgical complications.
    Results
    We detected 58 cases of HD during these 6 years, who underwent surgery. 19 patients were female and 39 were male with age range from one day to 18 years old. Clinical findings were variable such as: constipation, abdominal distension, failure to pass mecunium, diarrhea and other less common manifestations.We found 3 different pathological types: rectosigmoid, ultra short-segment and total–colonic involved segment. There wasn’t any difference between presentations of disease in these 3 groups. Surgical procedures which were performed were: Swenson, Soave–Boley and Lynn. Early complications, which occurred during the first month after operation, contain anastomotic leakage, wound infection, hemorrhage and stenosisof anastomosis. Late complications, occurring at least one month after operation, comprise long-term constipation, enterocolitis, incontinence, obstruction due to adhesion. We didn’t find any significant difference between the complications of these surgical procedures and any accompanying anomalies except 3 ones.
    Conclusions
    most of patients had a chronic course of constipation and abdominal distension. without any difference between types of involvements and age and clinical presentations. There are few associated anomalies in the patients. In some cases, surgical complications were less than those in other studies; so, it seems that the performed procedures had fewer complications or they may have been performed in appropriate time.
  • S. Ghaffari, N. Rajabi, A. Alizadeh, R. Azarfarin Page 32
    Background
    Patients with coronary artery disease and concomitant left bundle branch block have increasing cardiovascular mortality rates in comparison with those with coronary artery disease but without left bundle branch block. In patients with left bundle branch block, therefore, the delineation of the severity of coronary artery disease may be helpful in providing prognostic information. This study was performed to assess clinical and demographic predictors of coronary artery disease and left ventricular (LV) dysfunctionin patients with left bundle branch block.
    Methods
    In this cross-sectional study 219 patients with left bundle branch block and suspected coronary artery disease that underwent coronary angiography, were assessed for coronary artery disease and left ventricular dysfunction. Clinical and demographic variables that might help identify these patients were recorded.
    Results
    Coronary artery disease was present in 124 (56.3 %) of patients and left ventricular ejection fraction < 50% was seen in 147 (67.1%) of cases. Advanced age (p=0.001), male gender (p=0.027, OR=1.94), history of chest pain (0.015) and left ventricular ejection fraction<50% (0.026, OR=3.04) were predictors of CAD. In addition, older age (p=0.004), male gender (p=0.017), history of diabetes (0.043, OR=1.45) andangiographically documented CAD (p=0.001, OR=3.41) were predictors of left ventricular dysfunction.
    Conclusion
    Certain clinical and demographic characteristics may help ifferentiate left bundle branchblock patients with concomitant coronary artery disease and left ventricular dysfunction from other cardiac disorders.
  • Page 37
    Background
    The striking similarities between signs and symptoms of digoxin intoxication and clinical picture of primary congestive heart failure (CHF) make their diagnosis relatively difficult. Narrow therapeutic window of digoxin and increasing mortality and morbidity due to its intoxication make serum digoxin measurements an essential point of concern.
    Objectives
    The aims of present investigation were to study digoxin therapeutic and toxic levels in Iranian patients and to evaluate the applicability of most clinical findings in relation to digoxin toxic levels.Patients and
    Methods
    Serum digoxin levels of 195 patients with heart failure, who used digoxin for at least 10 days, were evaluated by radioimmunoassay. Patients’ clinical and electrocardiographic (ECG) manifestations of digoxin toxicity were evaluated and compared with serum digoxin level. Therapeutic range of digoxin in patients to be used as a reference was 0.9 to 2.3 ng/ml.
    Results
    Twenty-one patients showed both clinical and ECG signs of digoxin toxicity, 19 patients had only a single manifestation and 155 did not present with any of these manifestations. Although the serum digoxin level in patients was of great importance, our results showed that clinical manifestation was not completely related toserum digoxin level.
    Conclusion
    Considering the narrow therapeutic window of digoxin, periodical monitoring of serum digoxin levels must be conducted in all patients receiving digoxin. Nevertheless, clinical manifestation of digoxin toxicity was not sufficient to be used for evaluation of drug toxicity.
  • Maryam Rayatpisheh, S. Rayatpisheh, M. Kaviani Page 42
    Background
    Cardiovascular surgery provides especial challenges, and specific conditions, for optimizing the weaning process. Earlier extubation after heart operations was shown to be both safe and cost-effective. Early extubation is performed 1 and 6 hours after arrival in the Intensive Care Unit (ICU) and associated with shorter ICU stays, and accordingly lower costs. The present retrospective study was conducted to assess immediate and early extubations in regard to postoperative complications, and cost-effectiveness in patients undergoingopen cardiac surgeries.Patients and
    Methods
    The medical records of 2126 patients who had undergone cardiac operation between March 2003 and February 2005 were reviewed in relation to two distinctive extubation protocols. Group A consisted of 1833 patients undergoing either immediate or early extubation. Group B comprised 293 patients whounderwent late extubation. Four major types of surgeries were performed in patients.
    Results
    Among 2126 patients, 71.8% were male and 28.2% were female. There were no significant differences in risk factors between the two groups. The mean age of patients in group A was 56±13, and in group B 50±17 years. Extubation time in group A was 2.06 hours compared with 13.22 hours in group B (P<0.05). The meanof post-op bleeding in the first 12 hours between the two groups did not differ significantly, and were 482.4 and 426.4 ml respectively (P>0.05). Reintubation had been performed in 2.6% of group A and 1.6% of group B, a difference that was not significant (P>0.0 5). The mean ICU stay in group A and B were 2.79 and 3.42 days,respectively (P<0.05). The respective mortality in groups A and B were 2 % and 4.7% (P<0.05).
    Conclusion
    Immediate extubation after open heart surgery can be performed safely for most of the patients. This would probably lead to a decrease in costs and prevent artificial ventilation problems without increasing post-op complications. It also reduces the duration of ICU and Hospital stay. We therefore recommend that earlyand immediate extubation be used more frequently in cardiac surgeries.
  • Maryam Esmaeilzadeh, A. Khaledifar, A. Usefi, Gh Omrani Page 50
    Coronary artery fistula is an uncommon but hemodynamically significant anomaly of the coronary arteries,occurring as an incidental finding in 0.1% to 0.2% of coronary angiograms. Although half of the patients with a coronary artery fistula remain asymptomatic, the other half develops CHF, infective endocarditis, myocardial ischemia, or rupture of an aneurysm. This report is illustrative of the right coronary artery fistulato the right pulmonary artery in a 57-year-old male. The definitive diagnosis was made during transesophageal echocardiography and confirmed at operation.
  • Ali Sadeghpour-Tabaee, Ar Rostami, R. Ghafari, Ah Sadeghpour Tabaee Page 53
    Coronary artery fistula is an uncommon but hemodynamically significant anomaly of the coronary arteries, occurring as an incidental finding in 0.1% to 0.2% of coronary angiograms. Although half of the patients with a coronary artery fistula remain asymptomatic, the other half develops CHF, infective endocarditis, myocardial ischemia, or rupture of an aneurysm. This report is illustrative of the right coronary artery fistulato the right pulmonary artery in a 57-year-old male. The definitive diagnosis was made during transesophageal echocardiography and confirmed at operation.