Iranian Heart Journal
Volume:13 Issue: 2, Summer 2012

The purpose of this study was to determine whether there is any association between the optimal increase in mitral valve area and mitral transvalvular gradient decrement and pulmonary arterial pressure decrement after balloon mitral valvuloplasty (BMV) in patients with mitral stenosis. The study population consisted of 49 patients (47 women, 2 men; mean age = 43.7±13.35 years) with symptomatic rheumatic mitral stenosis who underwent balloon mitral valvuloplasty. Optimal immediate outcome of BMV is defined as a valve area increment of 50% or more or a final mitral valve area of? 1.5 cm2 and mitral regurgitation Sellers'' grade? 2. Mitral valve area, mitral transvalvular peak pressure gradient, mitral transvalvular mean pressure gradient, and pulmonary arterial pressure were measured before and 24-48 hours after balloon mitral valvuloplasty, and differences were compared between patients with successful and unsuccessful optimal outcomes. There was a direct relationship between mitral valve area enhancement and amount of reduction in mitral transvalvular peak and mean pressure gradient and pulmonary arterial pressure. After BMV, mitral transvalvular peak pressure gradient, mitral transvalvular mean pressure gradient, and pulmonary arterial pressure reduction were significantly higher in patients with optimal outcome compared with those with suboptimal outcome. (Iranian Heart Journal 2012; 13 (2):6-11). Mitral stenosis? Balloon mitral valvuloplasty? Transvalvular gradient? Pulmonary artery pressure

Coronary artery disease (CASD) is the most common cause of mortality and morbidity in the world. Given the increasing prevalence of CAD in Iran, it is essential to determine its trend. In this retrospective study, angiography reports of all patients admitted for coronary angiography due to stable angina or acute coronary syndromes in Noor and Sina Hospitals from 2005 to 2009 were included in this study. All of the results were evaluated by 3 expert cardiologists, and recorded in one format. Data on age, sex, angiography, and coronary artery involvement were collected and analyzed using the ANOVA model. We evaluated 33388 angiography reports. The mean age of the patients was 59.48±10.49 years in 2005, 59.94±10.66 years in 2006, 60.17±10.49 years in 2007, 60.37±10.64 years in 2998, and 61.25±10.58 years in 2009, respectively. Significant involvement of coronary arteries was found in 21.7% of the males and 33.5% of the females with a mean age of 63.45 vs. ± 59.17 years, respectively (p value?0.001). The mean age of CAD increased from 2005 to 2009 significantly (p value =0.002). Given the increased prevalence rate of CAD, we need broad primary and secondary CAD prevention programs. Furthermore, the early occurrence of CAD in women requires more extensive preventive plans to control their risk factors. (Iranian Heart Journal 2012; 13(2):12-19).

Intraoperative trans-esophageal echocardiography (TEE) and Saline injection pressurization of the left ventricle are the most popular methods to evaluate the repaired mitral valve during mitral valve repair surgery. We describe a simple and reliable intraoperative saline injection leak test method for mitral valve repair which has multiple benefits over the conventional method. Twenty patients with mitral regurgitation who met the inclusion criteria for mitral valve repair were enrolled in the study. When the repair procedure is done, a balloon catheter (12 Fr Foley catheter) is inserted into the left ventricle through the site of cardioplegia cannula on ascending aorta and inflated at the level of left ventricular outflow tract inferior to the aortic valve. The valve’s competency is then evaluated by saline injection into the left ventricle through the balloon catheter. Intra operative TEE revealed trivial and mild MR in 12 and 7 patients and moderate MR in one patient. No significant discrepancy was found between the intra-operative TEE findings and the described intra-operative leak test results (p value >0.05). The intraoperative saline leak test described here is a simple, safe and reliable method to assess the efficacy of mitral valve repair before chest closure. (Iranian Heart Journal 2012; 13(2):20-23).

One of the typical problems of cell savers is the retransfusion of the heparin added to the system. The aim of this study was to determine whether or not heparin, remaining in the prepared sample of retransfusion blood, might be responsible for disturbance in coagulation and increase in blood loss. Fifty patients undergoing coronary artery bypass grafting surgery (CABG) were randomly divided into two groups: group C (n=25) received cell-saver blood and group H (n=25) received homologous blood. Volumes of the intraoperative autologous and homologous transfusion, activated clotting time (ACT) of the transfused bloods, and ACT and amount of blood loss in the patients were measured intra and postoperatively. There was no statistical difference between the groups in terms of demographics, preoperative characteristics, or operative details. Cell saver was used in 25 cases, and the average volume of blood autotransfused was 504± 158 mL. A significant statistical difference was observed in the mean volumes (460±200 vs. 80±160 mL; P = 0.0001) of perioperative allogeneic blood transfusions between groups H and C. Despite significant further cell-saver blood transfusion (504± 158 cc vs. 338±123 cc; P=0.001) and a significantly longer ACT of cell-saver blood than homologous blood (959±85 sec vs. 478±58 sec; P =0.0001) intraoperatively, there was no significant difference between the two groups in terms of postoperative blood loss (510 ± 270 cc in group H vs. 454 ± 150 cc in group C; P =0.362). Utilization of a cell saver was safe, with no increased risk of bleeding despite heparin added to the system. (Iranian Heart Journal 2012; 13(2):24-34).

Thyroid hormone and its metabolism have been shown to be abnormal in patients with non-thyroidal illnesses such as those with advanced heart failure. Free T3/Reverse T3 ratio is believed to be associated with a reduced ejection fraction and poor short-term outcomes in patients with advanced heart failure. We sought to evaluate the effects of Enhanced External Counter Pulsation Therapy (EECP) on the thyroid hormone profile of heart failure patients. Our study group consisted of 30 patients referred for the management of heart failure. Each patient underwent treatment by EECP, and free Triiodothyronine (T3) level alterations were monitored before the commencement of treatment and once again after the completion of standard EECP treatment. Thirty patients with advanced heart failure symptoms at a median age of 65 (46-77) years were enrolled. After EECP therapy, the ejection fraction was improved significantly. The median ejection fraction after EECP treatment was 46.5% (p value <0.001). T3 levels increased to 4.01 +/-1.46 (ng/dl); this, however, was not a significant finding (p value =0.44). Treatment of heart failure by EECP may have some effects on thyroid hormone milieu and metabolism insofar as T3 levels rose after EECP in our study, although this effect was not statistically significant. More thorough investigations are needed before any conclusion could be made on this matter. (Iranian Heart Journal 2012; 13(2):35-39).

Heart rate progressively increases with exercise through the function of sympathetic and parasympathetic nerves. These nerves control the performance of sinoatrial node. Lack of heart rate increase proportionate to the exercise is associated with poor prognosis. Moreover, exercise capacity (EC) is considered as a predictor of cardiac events. The current study compares these two indices in individuals with and without metabolic syndrome in Isfahan. The study was performed on 203 people without metabolic syndrome and 123 patients with metabolic syndrome registered in the Isfahan Cohort Study. The demographic data, abdominal circumference, blood pressure, height, and weight of the participants were recorded. Moreover, the serum triglyceride, fasting blood sugar, total cholesterol, high density lipoprotein (HDL), and low density lipoprotein (LDL)levels were measured. Exercise test was carried out according to the Bruce standard protocol and heart rate reserve (HRR) and exercise capacity (EC) were determined and recorded. The age-adjusted data were analyzed using SPSS software, version 15, by the generalized linear model. The two groups were not significantly different with regard to HRR (p= 0.27). The level of EC in the metabolic syndrome group was significantly lower than that observed in the group without metabolic syndrome (p= 0.022). We could not find relationship between HRR and metabolic syndrome or lack of the syndrome. However, the relationship between metabolic syndrome and the EC level indicates that in individuals with metabolic syndrome, when EC decreased, HRR did not change significantly. (Iranian Heart Journal 2012; 13(2):40-48).

Case Report: A persistent left superior vena cava is a frequent variation of the thoracic venous system and is explained by the persistence of the left superior cardinal vein. However, in most cases, it drains into the coronary sinus. It sometimes terminates directly into the left atrium but this anomaly is usually associated with the absence of the coronary sinus. To our knowledge, only rare cases of a persistent left superior vena cava terminating into the left atrium with a normal coronary sinus have been described. In this article, we present a case with a direct connection between the left superior vena cava and the left atrium, diagnosed by saline contrast echocardiography, and describe the contribution of echocardiography in the diagnosis of a persistent left superior vena cava. Echocardiography is a reliable and easy diagnostic tool that allows a bedside approach in a patient in whom there is suspicion of a persistent left superior vena cava, without the administration of radiographic contrast. (Iranian Heart Journal 2012; 13(2):49-53).

Case Report: We present a 29-year-old female, who was hospitalized because of dyspnea and generalized edema. The patient had a history of splenectomy due to resistant idiopathic thrombocytopenia purpura (ITP) and also a history of smooth muscle tumor of the uterus with uncertain malignant potential (STUMP). Echocardiography revealed large pericardial effusion and an elongated mass inside the inferior vena cava and right atrial cavity. The patient underwent only cardiac surgery procedure under monitoring by transesophageal echocardiography. The inferior vena cava and right atrium were exposed and the large mass was removed. Histological examination revealed a spindle cell tumor. (Iranian Heart Journal 2012; 13(2):54-58).

Case Report: Severe aortic valve insufficiency is a common valvular heart disease that is characterized by left ventricular (LV) volume overload. A 40-year-old woman with a history of exertional dyspnea of four years'' duration was referred to us for evaluation. The patient''s symptoms had worsened to NYHA functional class III in the previous months. Catheterization showed severe aortic insufficiency (AI) and normal coronary arteries, but there was aneurysmal outpouching formation in the base of the LV, into which the regurgitation jet did not enter directly. The patient underwent cardiac magnetic resonance imaging (CMR), which clearly showed that the AI jet entered the LV aneurysm. CMR is now an established tool to assess aortic regurgitation and to rule out concurrent pathologies. Determination of the anatomical configuration of the aortic valve is another great merit of preoperative evaluation with CMR compared to echocardiography alone. (Iranian Heart Journal 2012; 13 (2):59-61).

Case Report: Variant angina (VA), first described by Prinzmetal in 1959, is caused by transient and recurrent coronary spasm and leads to repetitive episodes of transmural myocardial ischemia. A 59-year-old man with a history of hyperlipidemia and anterior myocardial infarction, which had occurred three months previously and was being treated with fibrinolytics, referred to our hospital with acute substernal chest pain and ST elevation in the anterior leads. Coronary angiography showed coronary spasm, and the patient was relieved after nitrate administration. (Iranian Heart Journal 2012; 13 (2):62-64).