Iranian Heart Journal
Volume:12 Issue: 3, Fall 2011

This an in-depth investigation of the relationship between some new aspects of positive family history (FH) of coronary artery disease (CAD) and other risk factors related to CAD in patients with acute myocardial infarction (AMI). The data of 200 patients with AMI and positive FH of CAD (FH Pos.)- as case group- and 200 AMI patients without FH of CAD -as control group- (FH Neg.) were collected. Information about first and second-degree relatives was obtained, including age, occurrence of MI, and other risk factors related to CAD. We also covered procedures such as coronary angiography (CAG), percutaneous intervention (PCI), and coronary artery bypass grafting (CABG) surgery. AMI with ST-segment elevation in ECG (69.61% vs. 26.76%), heart block (19.47%. vs. 6.34%), and low EF (mean 43±3.4% vs. 47±35%) were higher in the FH Pos. group than the FH Neg. group. As well as diabetes (42.71% vs. 11.27%), dyslipidemia (42.19% vs. 14%), and hypertension (73.74% vs. 64.79%) in the FH Pos. group were higher than those in the FH Neg. group. CAG (79.9% vs. 39.9%) and CABG (34.8% vs14.79%) were higher in the FH Pos. group (all p values<0.05). More patients in the FH Pos. group were male and younger. In the FH Pos. group, there was 65% positive finding in the second-degree relatives; most of these second-degree relatives came from the father’s side (56%). Also, there were 1.35 times more events in brothers than in sisters. Subjects with a positive family history of CAD were younger and more susceptible to CAD and needed frequent interventional procedures. Also, there was a difference in the power of various kinds of positive FH. In the FH Pos. arm, there was a stronger relationship between the patient and his/her brothers than with sisters and 56% incidence in the second-degree relatives (especially from the father’s side) (Iranian Heart Journal 2011; 12 (3):6-11).

Long-segment reconstruction of the diffusely diseased left anterior descending artery (LAD) with left internal thoracic artery (LITA) is one of the methods offered in order to deal with complicated, multiple, and long-segment lesions in the LAD. In this prospective study, we analyzed the results obtained with this technique. Between Feb. 2007 and Feb. 2009, 56 patients underwent surgery via this technique. The LITA was used as a patch along the opened narrow segment of the LAD from 2 to 8 cm. Data on all the patients were collected, and all the patients were worked up for postoperative complications such as postoperative myocardial infarction, ECG changes, NIHA class, enzymatic changes, and postoperative bleeding. CT-Angiography was performed between 6 to 18 months after surgery in some cases. Fifty-six cases, comprising 42 (75%) men and 14 (25%) women between 43 and 78 years of age (mean age= 59.8±9.3 years) with multiple and long-segment lesions in the LAD were included in this study. Preoperative risk factors were hypertension (66.1%), diabetes (57.1%), hyperlipidemia (50%), cigarette smoking (50%), renal failure (1.8%), and positive family history (7.1%). Twenty-three (41.1%) patients had remote and 9 (16.1%) had recent myocardial infarction. Significant left main lesions were found in 7 (12.5%) patients, peripheral vascular disease in 3 (5.3%), and preoperative arrhythmias in 2 (3.6%). The mean number of grafts was 2.85 ±1.5. Postoperative complications were arrhythmias in 10 (17.8%) patients, postoperative myocardial infarction in 1 (1.8%), surgical bleeding in 7 (12.5%), infections in 3 (5.3%), plural effusion in 3 (5.3%), tamponade in 2 (3.6%), and pericardial effusion in 1 (1.8%); there was no mortality amongst the patients. CT-angiography, performed in 6 patients between the six and eighteenth postoperative months, revealed patent anastomoses in all the patients. Long segment and multiple lesions in the LAD pose a challenge for cardiac surgeons. The results of long-segment LAD reconstruction using the LITA are very encouraging

Echocardiography-derived strain rate and strain may provide new insights into right ventricular (RV) function in repaired tetralogy of Fallot (rTOF) patients in whom evaluation of RV function and functional capacity has an important role in further management. In 45 rTOF patients with severe pulmonary regurgitation, the routine echocardiography-derived indices for evaluation of RV function (TAPSE, RVOT Excursion and eyeball method) and longitudinal strain rate and strain were acquired from basal, mid and apical segments of RV free wall (RVFW) and interventricular septum; functional capacity was measured by standard Bruce protocol exercise testing. All patients had some degrees of RV dysfunction with no correlations between results of routine indices and functional capacity. Reduced RVFW average systolic strain was correlated directly with reduced functional capacity (r = 0.86[P <0.001]), this was also true for peak systolic strain of basal and mid segments of RVFW. Derivation of ROC curves showed that a cut-off value of 15.8% for average RVFW systolic strain predicts good exercise capacity (?10 METs) with a sensitivity of 91.2% and a specificity of 100%. Although routine echocardiography indices are not accurate tools in rTOF patients, systolic strain of RVFW seems to be reliable in estimation of RV function and functional capacity.

Obesity is a common public health problem reaching epidemic proportions in recent decades. Increased BMI imposes a pro- inflammatory state, releasing factors such as high sensitivity-C reactive protein which is strongly associated with plaque rupture and acute cardiovascular events. Also the prevalence of type 2 diabetes has reached epidemic level. A total of 400 consecutive patients recruited in this cross sectional study from April 2009 to December 2009 who was candidate for coronary angiography. Baseline clinical characteristics and coronary angiography data collected. Data analysis performed using 2-sided independent-sample t-tests. Out of 400 patients recruited in the study 253 were male. Obesity and diabetes observed in 65.7% and 32.5% of these patients respectively. Hypertension was more prevalent in obese patients (p=0.013) while dyslipidemia was not significantly different. The severity of coronary artery lesions were significantly associated with diabetes but not related to obesity (pvalue=0.0001 and 0.316 respectively). The main finding of this preliminary study was that diabetes is significantly related to severity of coronary artery disease and hypertension and hyperlipidemia is more prevalent in diabetic patients. Moreover, obesity is not significantly related to severity of coronary artery lesions

The relation between hematologic variables and insulin resistance has been reported previously; however, there is still debate about the correlation between hematologic variables and the metabolic syndrome (MetS). This study aimed to evaluate the relationship between MetS and white blood cells (WBC) and red blood cells (RBC). his cross-sectional study recruited 11974 participants over 19 years old who participated in the Isfahan Healthy Heart Program (IHHP) in Najafabad and Arak, Isfahan. Participants were selected using multi-stage random sampling. A questionnaire about demographic variables, including age, sex, and past medical history, was filled for each participant by a trained nurse, and the participants’ blood pressure, height, weight, waist circumference, and other anthropometric variables were recorded by physicians using standard methods. After 12 hours fasting, laboratory parameters, including RBC, WBC, hemoglobin (Hb), and hematocrit, (Hct) together with such biochemical variables as glucose, triglyceride (TG), and HDL-cholesterol were measured. MetS was defined according to the ATP-III criteria. The data were entered in SPSS-11 and analyzed using the t-test and correlation analysis. From the 11974 participants, 6132 (51%) were female. Mean age was 35.6±3.8 years in the females and 35.9±32 years in the males. In general, 23.1% of the subjects had MetS: 35% in the females and 10.6% in the males (p<0.05). WBC and RBC were higher in the subjects with Mets. Regarding the correlation between the hematologic variables and the MetS components, the most significant correlations were seen between TG and WBC (r: 0.195, p<0.001) and HDL-C and RBC (r: -0.245, p<0.001). According to our findings, high counts of RBC and WBC were observed in those with MetS. The predictive use of these parameters needs further longitudinal studies

Cardiac hydatid cysts usually involve other organs and in different sites of the heart. Treatment of heart hydatid cysts is usually surgical, followed by continuous medical therapy. We present a male patient with a hydatid cyst in the interventricular septum with compression effect on the left anterior descending artery (LAD); the cyst was diagnosed with echocardiography, CT imaging, and angiography. The patient was treated via surgical excision of the cyst under cardiopulmonary bypass, and the treatment was continued with medical therapy. A follow-up, the patient was in good physical condition. Cardiac echinococcosis is uncommon, accounting for 0.5% to 3% of all hydatid infestations in human beings1. All the heart walls and cavities can be the site of hydatid development but hydatid cysts of the heart are located most often in the left ventricle. Involvement of the interventricular septum is rare and can cause symptoms arising from the compression of the atrioventricular conduction pathway and obstruction of the right or left ventricular outflow tract1,5. Diagnosis is with echocardiography, CT imaging, and occasionally angiography 1,2,4. There is always the lethal hazard of cyst perforation. Early diagnosis and an integrated treatment strategy are crucial. The results of the surgical treatment of heart echinococcosis are better than those of the conservative strategy only. Extraction of the cyst combined with chemotherapy perioperatively or postoperatively is aimed at decreasing recurrence2

Case Report: We present two women who lived in a rural community. The presence of a semi-solid mass, a hydatid cyst or tumor, in the heart was diagnosed by echocardiography, computed tomography, and Magnetic Resonance Imaging. The hydatid cyst was seen during surgery. Pathological examination confirmed an infected hydatid cyst

Case Report: A 53-year-old man with a history of coronary artery bypass graft surgery 4 years previously was admitted to our hospital with dyspnea on exertion (New York Heart Association class II) 1 of three months’ duration, lower extremities edema of two weeks’ duration, and pulmonary edema of two weeks’ duration. Transthoracic and transesophageal echocardiographic examinations revealed pseudoaneurysm of the ascending aorta with fistulization to the left atrium. He was, therefore, scheduled for surgery, during which repair of the ascending aorta with a pericardial patch in conjunction with repair of the aortic valve and removal of the fistulization between the left atrium and ascending aorta was performed. The patient was discharged ten days after admission in very good physical condition. Postoperative echocardiography demonstrated only mild aortic regurgitation and no residual connection between the left atrium and ascending aorta, with the latter having a normal size

Case Report: A 20-year-old man was referred to us for further evaluation due to infective endocarditis. He had mirror-image dextrocardia with visceral situs inversus. He had a history of dyspnea on exertion (NYHA class II) of several years’ duration with no new onset symptoms. On physical examination, he had no peripheral stigmata of infective endocarditis. Laboratory examination showed a normal erythrocyte sedimentation rate with normal hemoglobin. Three separate sets of blood cultures obtained over a 24-hour period and cultures were negative in aerobic and anaerobic media. Transthoracic and transesophageal echocardiographic studies showed mirror-image dextrocardia with total situs inversus as well as accessory mitral valve tissue with chordal attachment to the posteromedial papillary muscle with no significant LVOT obstruction (Figs. 1,2) but resulting in mild to moderate aortic insufficiency (Fig.3). There was also aneurysmal dilation of the membranous part of the interventricular septum with a residual pouch and no residual ventricular septal defect according to computational fluid dynamics and contrast studies (Fig 4). There was no other concomitant abnormality. The patient was discharged in good physical condition

Case Report: We are reporting a case of 73 year- old gentleman with atypical chest pain and history of hypertension who underwent clinical evaluation at our center. He was ultimately diagnosed with rare presentation of pericardial cyst. His echocardiographic data and Chest CT scan data were unique because most pericardial cysts are seen in right side of the heart unlike our patient who had suffered from large left sided form of the disease which is very rare