Iranian Heart Journal
Volume:12 Issue: 2, Summer 2011

Case Report Thiamine or Vitamin B1 is an essential cofactor for many metabolic processes in numerous tissues. Thiamine-Responsive Megaloblastic Anemia Syndrome is a genetic disorder affecting thiamine transportation with consequent bone marrow, pancreatic, neurological, and cardiac functional and developmental anomalies. There are limited reports of the cardiac manifestations of this syndrome. Here, we present a case of this syndrome in a male patient with right ventricular dysfunction and atrial dysrhythmias

Valvular aortic stenosis is a relatively common disease among valvular heart diseases and can be rheumatic, degenerative or congenital. Evaluation of the severity of the disease is sometimes challenging and problematic. Besides, the use of more parameters of non-invasive methods for the assessment of valvular disease and its severity seems attractive and helpful. Transthoracic echocardiography (TTE) is an appropriate modality for the evaluation of the aortic valve. In this study, TTE was performed for 80 patients with valvular aortic stenosis. The goals were to assess the statistical relationships between ejection time (ET) and acceleration time (AT) and their ratio (AT/ET) with the four traditional parameters of the echocardiographic severity of aortic valvular stenosis (aortic jet velocity, aortic valve area, mean pressure gradient and LVOT VTI/aortic VTI ratio). There was a meaningful relationship between adjusted ET with the four above-mentioned parameters. d. ET (ET-adjusted ET according to heart rate and stroke volume) was inversely related with the aortic valve area (calculated with continuity equation). AT/ET was significantly correlated with the four mentioned parameters. The regression equations were calculated. The cut-off value of AT/ET for the echocardiographic diagnosis of severe valvular stenosis was 0.36 (with 95% level of confidence).

Background Percutaneous balloon mitral valvotomy (BMV) has been accepted as an alternative to surgical mitral commissurotomy in the treatment of patients with symptomatic rheumatic mitral stenosis. Despite the worldwide use of the BMV technique, no studies have been hitherto designed to assess the outcome of the patients undergoing BMV in Iran. The present study reports the outcome of 3138 BMV procedures at Shaheed Rajaei Cardiovascular, Medical and Research Center during a 15-year time period. Methods A total of 2531 patients underwent 3138 BMV procedures at Shaheed Rajaei Cardiovascular, Medical and Research Center between 1992 and 2006. Seventy-three percent (2278) of the cases were followed for 48±41 months. Results Recurrent stenosis in 802 (25.8%), mitral valve replacement (MVR) in 213 (6.9%), immediate good result in 3110 (99.1%), and successful outcome in 2000 (72.9%) cases were the outcome of the BMV procedures in the current study. Conclusions Concordant to the similar studies, we concluded that BMV produces a good clinical outcome in a high percentage of patients. The recent study demonstrated that the successful outcome of BMV was multi factorial and the selection of patients with rheumatic mitral stenosis is recommended to be based on both anatomic and clinical characteristics of the individuals. The procedure-related variables must also be considered in order to predict the outcome.

Patients with QRS fragmentation following myocardial infarction (MI) are at greater risk of cardiac death. Transthoracic echocardiography (TTE) can be used as a method for evaluating the coronary sinus blood flow (CSBF) and coronary sinus velocity time integral (CSVTI). The present study reports measurement of CSBF and CSVTI by TTE in 100 acute anterior MI cases, half of them with fragmented QRS. Methods Our study included 100 patients with acute anterior MI in whom CSBF and CSVTI were measured by the use of TTE. Fifty of all the patients had fragmented QRS complex and 50 patients were without fragmented QRS complex, while there was no difference in terms of LVEF in both groups of study. Results CSBF (303 ±126 ml/min vs. 258 ± 121 ml/min; p=0.001) and CSVTI (14.45 ± 2.85 ml vs.10.85 ±2.69 ml; p=0.003) were significantly lower in the acute anterior MI patients with fragmented QRS in comparison with the patients with acute anterior MI without fragmented QRS. Conclusions We conclude that CSBF and CSVTI can be measured by TTE in acute MI patients and these variables are reduced in acute anterior MI patients with fragmented.

Background Surgical management of the tetralogy of Fallot (TOF) results in anatomic and functional abnormalities in the majority of patients. Right ventricular (RV) dilation from pulmonary regurgitation (PR), residual atrial and/or ventricular septal defect, tricuspid regurgitation, right ventricular outflow tract (RVOT) aneurysm, and pulmonary artery peripheral stenosis are some of the abnormalities frequently encountered in patients with repaired TOF. Cardiovascular magnetic resonance (CMR) can provide assessments of anatomical connections, biventricular function, flow measurement, and more, without ionizing radiation. Echocardiography is the most frequently used modality for the initial assessment and follow-up of most patients with CHD. We sought to evaluate adult patients with repaired TOF by transthoracic echocardiography and compare them with CMR. Methods 156 patients (52 women, mean age= 23 ± 5.5 years) late after TOF repair with severe PR were evaluated. Ventricular size and function and TOF -associated anomalies such as patent ductus arteriosus (PDA), peripheral pulmonary stenosis (PPS), and persistent left superior vena cava (LSVC) were evaluated by transthoracic echocardiography and CMR separately. Results Mean of LV ejection fraction by CMR was 52 ± 9 % and by echocardiography was 47 ± 5.1 %. We found a significant correlation between LVEF assessed by CMR and 2D visual assessment in multiple views. Mean of RVEF by CMR was 37± 8 % and RV end diastolic volume index was 161± 57.3 mm3. Linear correlation between CMR-RVEF and RVEF measured by echocardiography was weak. There was almost perfect agreement between CMR and echocardiography for the diagnosis of LSVC (99.2%). Agreement was 88.3% in the diagnosis of PDA, 66.4% in the diagnosis of PPS, and 93% in the diagnosis of the right aortic arch was. Conclusions Adults late after repaired TOF have significantly reduced biventricular systolic function. Despite abnormal LV geometry, visual assessment of LV systolic function by an expert echocardiologist has an acceptable agreement compared to the quantitative measurement of LV systolic function by CMR. However, the correlation between CMR-RVEF and RVEF measured by echocardiography is weak. We found incremental diagnostic value of CMR in PPS and PDA. Atrial septal defect and ventricular septal defect are found more frequently by echocardiography.

Background We sought to answer the questions about the role of inflammatory factors in the formation of pathological lesions in the endothelium of the coronary vessels and also the role of hostbased bacteria, including chronic periodontitis, in the clot formation in the blood vessels, all of which destabilize the atherosclerotic plaque. Methods This case-control study was done on 40 patients who underwent elective coronary artery bypass grafting surgery (CABG) with the need of coronary endarterectomy. In Group A, patients had chronic periodontitis and group B consisted of patients without it. Both groups were well matched regarding their demographic data. The subgingival plaque was collected by a sterile curette from periodontal pockets? 5mm and CAL? 4mm. Also, atherosclerotic plaque was collected during the coronary endarterectomy surgery from all of the 40 patients. The specimens were assessed using the PCR technique to detect the specific bacteria responsible for chronic periodontitis such as actinobacillus actinomycetemcomitans (Aa), prevotella intermedia (Pi), porphyromonas gingivalis (Pg), Tanerella forsythensis (Tf), Treponema denticola (Td), and fusobacterium nucleatum (Fn). Results In the atherosclerotic plaque of group A patients, Aa was identified in 18 (90%), Pg in 16 (80%), Tf in 13(65%),Td in 11 (55%), Pi in 10 (50%), and Fn in 6 (30%) specimens, whereas in group B the incidence was significantly lower (p< 0.0001). In the subgingival plaque of group A, Aa and Tf were found in all 20 individuals and Pg, Pi, Td and Fn were identified in 19 specimens (95%). The differences in the incidence of Aa and Pg in two plaque samples were not significant, but the two plaque samples showed significant differences regarding the incidence of the other pathogens (Pi: p<0.001, Tf: p<0.008, Td: p<0.003 and Fn: p<0.0001). Conclusions In the present study, the same organisms were found in both coronary atherosclerotic and subgingival plaques. The findings support the potential role of the periodontopathogenic bacteria species in some steps of the atherosclerotic process as a contributor that worsens this disease. However, further studies are required to achieve more definite results regarding the role of periodontal diseases in the atherosclerotic disease, focusing on patient's background variables.

Background Endomyocardial biopsy has long been a useful tool to evaluate myocardial diseases. It is a gold standard in diagnosing cardiac rejection and certain types of myocarditis, but there is always a risk for related complications. We have assessed the safety and feasibility of applying long sheaths in endomyocardial biopsy via the femoral approach. Methods We performed endomyocardial biopsy in 63 patients via the femoral approach and used a long sheath to guide bioptome from the venous access to the interventricular septum and evaluate the procedure success and complications. Results Success rate (acceptable endomyocardial specimen) was 96%, and there were no complications (death, no death, urgent cardiac surgery, advanced cardiac life support, hemothorax, and pneumothorax). Conclusions Using long sheaths for the femoral approach seems to be safe and feasible; it confers an acceptable room to grab the endomyocardial samples while obviating the possibility of complications.

Report We report a 73-year-old woman who had taken an amount of 0.25 mg/day of digoxin for an unknown period of time because of chronic congestive heart failure and chronic atrial fibrillation. She was admitted due to nausea, vomiting, abdominal pain, atrial fibrillation with a slow ventricular rate and with a short corrected Q-T interval in an electrocardiogram of 345 milliseconds, high serum digoxin level of 4.2 nmol/L, and interestingly color vision disturbances: blue colored vision. After discontinuation of the digitalis treatment, all signs of digitalis toxicity, including blue color vision, disappeared within five days.

Report Papillary muscle rupture following acute myocardial infarction (AMI), which rarely occurs, leads to catastrophic outcomes. A 56-year-old man with sudden dyspnea and palpitation, one episode syncope, and left sided hemiparesis was admitted to our hospital and diagnosed as type A dissection with extension to the aortic arch and descending aorta. The patient underwent the Benttal and hemiarch procedure. On the 16th postoperative day, he suddenly developed hypotension and respiratory distress. Urgent echocardiography showed severe acute mitral regurgitation due to the rupture of the posteromedial papillary muscle. Urgent mitral valve replacement was done but unfortunately the patient died two weeks after the second surgery because of sepsis. We propose that during urgent cardiac surgery in a patient with coronary risk factors, concomitant coronary artery bypass graft be performed as thoroughly as possible.

Case Report Spontaneous recanalization of a stenotic atherosclerotic lesion is a rare finding. We report a 66-year-old man with severe discrete stenosis at the distal part of the left anterior descending candidated for percutaneous intervention. However, before stent deployment, the patient showed complete relief of the stenotic lesion

Report Tuberculosis is caused by a mycobacterium and is a multipotential, omnipresent infectious disease. Generally, two major categories, pulmonary and extrapulmonary exist. Whereas pericardial involvement is relatively common, myocardial tuberculosis has been reported in not more than 0.3% of all tuberculosis patients post-mortem. A 21-year-old woman sought medical attention due to progressive dyspnea upon exertion, weight loss, and general weakness. She underwent a heart operation and a well-circumscribed, solid, and creamy egg-shaped mass with a lobulated surface was seen in the right atrium. The histopathological study showed multiple well-formed granulomas with multinucleated giant cells and extensive caseous necrosis. These were compatible with a diagnosis of tuberculoma; however, the Ziehl-Neelsen stain failed to reveal the acid-fast bacilli. Her postoperative course was uneventful and soon she was discharged with advice to continue her medical therapy.

Background Coronary artery fistulas (CAFs) are vascular anomalies which in rare cases can cause hemodynamic problems with indication for intervention. Cogenital CAFs is a very rare malformation that may involve any or all coronary artery branches and any cardiac chamber. Elective closure of coronary artery fistulas by percutaneous transcatheter techniques is generally accepted in the presence of symptoms, but controversies exist in the management of asymptomatic patients. Methods We described two patients: A 49 years old female developed episodes of increasing exertional chest pain and dyspenea over 3 years, another 32 years old was referred for coronary angiograph because of dyspenea on exertion with-increasing its severity since one year age. Results Although non invasive imaging may be helpful, we demonstrated that cardiac catheterization and coronary angiography is necessary for the precise delineation of coronary anatomy and CAF Conclusions As mentioned above treatment is advocated for symptomatic patients and for those asymptomatic patients who are at risk for future complication. Form available data and our results Transcatheter closure (TCC) of coronary artery fistula (CAF) is an acceptable alternative to surgery in most patients.