Iranian Heart Journal
Volume:13 Issue: 1, Spring 2012

A great revolution happened in coronary intervention after the invention of drug eluting stents (DES). Different types of DES have been made. Stents with biocompatible polysulfone polymer and paclitaxel drug is newly introduced. In this study we aimed to evaluate the efficacy of this new drug eluting stent. All consecutive patients underwent coronary angioplasty with paclitaxel eluting stents from January to March 2009 were enrolled. Data was collected in answer sheath and analyzed with SPSS 18. One hundred patients were included in this study, with mean age of 55.21±10.00. Most of the patients were male (70%). The most common risk factor was hyperlipidemia (47%). Most of the lesions undergone angioplasty was in B2/C ACC/AHA class, and LAD was the most common vessel. In this study the rate of technical and procedural success was 100%. There was not any early or late thrombosis, and death, myocardial infarction and stroke (major adverse cardiovascular events, MACE) was similar to other drug eluting stents. Stenting with paclitaxel eluting stents is safe. Regarding its biocompatible polymer it doesn''t have any added hazard compared to bare metal stents. Further studies needed for other aspects

Atherosclerosis is a dynamic and progressive disease arising from the combination of endothelial dysfunction and inflammation. So, inflammatory mediators are important causative and progressive factors in atherosclerosis. Interleukin-18 (IL-18) is a pleiotropic cytokine which may have a key role in atherosclerosis, because the results of recent studies indicated that IL-18, either directly as a pro-inflammatory factor or indirectly as an interferon inducing factor, has central role in the inflammatory cascade. In present study, we evaluated the relation between blood concentration of IL-18 with atherosclerosis and its severity and also the relation of this cytokine with the other known risk factors of coronary artery disease (CAD).138 patients who underwent diagnostic cardiac catheterization and had the inclusion criteria for this study, were selected. In the beginning, a questionnaire containing personal information and medical history was completed for each of them and blood samples were collected 24 hours before catheterization. We measured blood level of IL-18 and CRP in all samples. The results of these tests and the angiography were entered in the questionnaire and then information was analyzed using regression analyzing, K2 and statistical T test. P values of <0.05 were considered statistically significant. By using the results of angiography, patients were divided in two groups. 1- Control group or normal coronary arteries (32 people) 2- Case group (106 people) or patients who were suffering from CAD. In second group, 6 patients (5.6%) had minimal CAD, 44 patients (41.5%) had single-vessel disease (SVD), 27 patients (25.4%) had 2VD and 29 patients (27.5%) had 3VD. In the laboratory tests, the mean IL-18 blood level in patients with CAD was 258.1 pgr/ml but in normal coronary arteries group it was 216.6 pgr/ml. The average blood level of IL-18 in patients who had minimal CAD was 235.5 pgr/ml, in SVD was 247.2 pgr/ml, in 2VD was 263.7 pgr/ml and in patients with 3VD was 274.1 pgr/ml. Also average CRP blood level in normal group was 8.9 mgr/L while in patients with CAD it was 20.4 mgr/L.The results of this study indicated that there was a direct and significant correlation between blood IL-18 level with existence (P<0.001) and severity of CAD(P<0.01) and IL-18 can be an independent predictor risk factor of atherosclerosis

Slow Coronary Flow (SCF) is defined as a condition in which in spite of no evidence of coronary occlusion or stenosis in angiography, there is delayed opacification of the vessels after the injection of a radiocontrast agent. First endothelial dysfunction and later on inflammation and platelet dysfunction have been proposed in the pathogenesis of this phenomenon. Because of a lack of enough studies about this disorder and controversy in reports, in the present study the prevalence rate of SCF and the probable role of inflammatory factors were investigated in order to identify the etiology of SCF and improve the treatment process of patients.This descriptive-analytic study was performed by studying the angiograms of 1162 patients with a probable diagnosis of coronary vessels stenosis who underwent coronary angiography in Shafa Hospital (Kerman/Iran). Angiography was performed by standard method of Judkins technique and statistical analysis was done to find the cut-off point value for the selection of the SCF group. After the angiograms had been examined by two cardiologists, 40 individuals with SCF and 40 ones with normal coronary flow (NCF) were investigated. The prevalence rate of SCF in the subjects that underwent angiography was 4.13% and 60% of them were male. Plasma level of hs-CRP in both study groups was slightly higher than the normal and there was no significant difference between the two groups.The role of inflammatory factors as an underlying factor in the incidence of SCF was not confirmed.

The association of the metabolic syndrome with idiopathic or secondary deep vein thrombosis (DVT) remains uncertain. In addition, the relevance of the different features of the metabolic syndrome as an independent or pivotal risk factor for DVT is controversial. We aimed to evaluate the prevalence of the metabolic syndrome in patients with idiopathic or secondary DVT and also compare the prevalence of the different components of this syndrome in the two clinical etiological conditions of DVT. In a cross-sectional study, 115 consecutive patients with a recent objective diagnosis of DVT (idiopathic in 87 patients and secondary to a known risk factor in 28 patients) who were referred to Rajaei Heart Center between April 2009 and January 2010 were enrolled in the study. In all the patients, DVT was diagnosed by means of compression Doppler ultrasonography. The metabolic syndrome was defined according to the ATP III recommendations. Overall prevalence of the metabolic syndrome in the study participants was 9.6%, and the prevalence of the metabolic syndrome in patients with idiopathic or secondary DVT was 9.2% and 10.7%, respectively, which was not different between them. Relative to the presence of the different numbers of the metabolic syndrome features, no difference was found between the groups with idiopathic or secondary DVT. The presence of no feature was found in 6.9% and 7.1%, the presence of one feature was seen in 51.7% and 42.9%, and the presence of two features was found in 32.2% and 39.3%, respectively. Regardless of the etiology of DVT, the overall prevalence of the metabolic syndrome in our DVT subjects ranged from 9.2% to 10.7%, and this prevalence was independent of the etiology.

The use of large doses of opioid analgesics to treat pain after cardiac surgery can prolong the time to tracheal extubation and interfere with the recovery of the bowel and bladder function in the postoperative period. Therefore, we sought to investigate the efficacy of a continuous infusion of Bupivacaine 0.5%, at the median sternotomy site, for 48 hours after cardiac surgery in reducing the opioid analgesic requirement and improving the recovery process.In this prospective, randomized, placebo-controlled, double-blind clinical trial, 36 consenting patients undergoing open heart surgery with a standardized general anesthetic technique had two indwelling infusion catheters placed at the median sternotomy incision site at the end of surgery. The patients were randomly assigned to receive normal saline (control), Bupivacaine 0.5% via an elastomeric infusion pump at a constant rate of 4 ml/h for 48 hours. In addition, the postoperative opioid analgesic requirements and opioid-related adverse effects were recorded. The patients’ satisfaction with their pain management was assessed at specific intervals during the postoperative period. Duration of mechanical ventilation and time of ventilation were assessed in the two groups.Compared with the control group, there was a statistically significant reduction in ambulatory time 13.7+/-2.5 vs. 16.5+/-4.6 hours (P=0.03). Hospital stay was also shorter in the case group (5+/-0.6 vs. 6.1+/-0.9 with P= 0.01). Extubation time and ICU stay were not statistically significant (P= 0.93 for extubation time and P=0.70 for duration of ICU stay), and also patient satisfaction in the two groups was not statistically significant. Opioid dose, used in the case group, was 1.1+/-0.8 and in the control group was 3.7+/-1.3, with the difference being statistically important (P = 0.02).A continuous infusion of Bupivacaine 0.5% at 4 ml/h is effective for decreasing pain and the need for opioid analgesic medication as well as for improving patient satisfaction with pain management after cardiac surgery. Patients in the Bupivacaine-0.5% group were able to ambulate earlier, leading to a reduced length of hospital stay.

The Brugada syndrome is a heterogeneous genetic disease that predisposes one to lifethreatening ventricular tachyarrhythmia and sudden cardiac death (SCD). In this study, we sought to compare the efficacy of intravenous Procainamide versus oral Flecainide to unmask the typical electrocardiographic changes of this syndrome.Brugada syndrome/ Flecainide challenge test / IV procainamide challenge testFrom October 2001 to December 2010, we evaluated patients with the Brugada Type Electrocardiographic (ECG) pattern. In these patients, 104 patients (83%) were male. The mean age of the participants was 39.16±7 years (16 to 75), and the mean follow-up was 48±3 months. All of the subjects underwent IV Procainamide and oral Flecainide challenge test. Among these patients 19 patients had positive results. Nineteen patients had positive responses (15%); 18 of them were male (94.7%) and one of them was female. These 19 patients all had a positive Procainamide challenge test. Only 9 of these patients had a positive Flecainide test. In the diagnosed Brugada Syndrome patients, IV Procainamide had a 100% positive response rate in comparison to a 47.4% positive rate in oral Flecainide. Different Brugada challenge tests have different sensitivities in the diagnosis of BS. IV procainamide is more sensitive than oral Flecainide and the latter cannot be used solely to rule out BS.

Vitamin D deficiency has been associated with many cardiovascular diseases and mortality. In this study, we aimed to investigate whether low levels of 25 hydroxy vitamin D concentrations associate with ischemic heart disease (IHD) in patients who referred for coronary angiography.We included 293 subjects: 133 without IHD (normal reported angiography) and 163 with ischemia (70% or more stenosis of at least one coronary artery documented by angiography). Basal concentrations of serum vitamin D, fasting blood sugar, triglyceride, cholesterol, LDL, and HDL were measured in both groups. The two groups had no significant difference in respect to their age 56.55 vs. 61.45 years), blood pressure (123.03/73.88 vs.123.68/73.98 mm Hg), fasting blood sugar (114.97 vs. 121.49 mg/dl), and lipid profile (P< 0.05). The medians of vitamin D concentration in the case and control groups were 40.80 and 40 nmol/lit, respectively, with the difference not constituting statistical significance (P< 0.05). After adjusting for other risk factors (age, sex, blood pressure, fasting blood sugar, and lipid profile), the association between vitamin D and ischemia remained non-significant (adjusted OR: 0.83, 95% CI: 0.37-1.85). This study was unable to demonstrate an association between low levels of vitamin D and IHD.

Hypertrophic osteoarthropathy is one of the rheumatologic complications in cyanotic heart disease. The severity of involvement depends on the degree and duration of a right-to-left shunt. The mechanism is related to the bypass of mediators from the lung and entrapment in the limbs. These mediators induce local cell proliferation in the bone and soft tissue. Herein, we report a cyanotic patient with severe involvement and deformity in his knee.

A 45-year-old man was referred to our hospital for angina pectoris 2 days after an anterolateral myocardial infarction. On admission, he had a blood pressure of 100/70 mm Hg and holosystolic murmur at the left sternal border. Transthoracic echocardiography showed akinesia in the apicoseptal, apicoinferior, and apicoposterior regions of the left ventricle, with large apical aneurysm and clot. There was also a large apical ventricular septal defect (VSD) with a significant left-to-right shunt. During cardiac catheterization, the only abnormality found beside the VSD was myocardial bridging in the mid part of the left anterior descending coronary artery and ostial lesion in the first diagonal artery. The patient was scheduled for bypass surgery and VSD closure.

Isolated tricuspid stenosis (TS) is a very uncommon finding. There are some reports of isolated TS in the setting of systemic lupus erythematous, but its presence in scleroderma has never been reported before. We report a 48-year- old female with isolated TS with a background of scleroderma, diagnosed by echocardiography

Severe cardiovascular disorders, including aortic dissection and aneurismal dilation of the aorta, are the main life-threatening complications of the Marfan syndrome1. Approximately two thirds of individuals who have this syndrome have chest wall deformities such as pectus excavatum or pectus carinatum2. When a patient with pectus excavatum needs aortic surgery, the surgeon may face a major clinical challenge in choosing the optimal surgical approach3. We present a case of the Marfan syndrome with severe pectus excavatum who underwent aortic surgery.