Iranian Heart Journal
Volume:14 Issue: 4, Winter 2014

Sphingosine kinase is a key enzyme in modulating the levels of lipids and is emerging as an important and regulated enzyme. The aim of this study was to determine sphingosine kinase 1 (SK1) relative gene expression in the liver, small intestine, and kidney. Twenty Wistar rats (6- 8 weeks old, 125-135 g) were used. Animals were randomly assigned into saline-control (SC), saline-training (ST), Bene-control (BC), and Bene-training (BT). Training groups was given exercise on a motor-driven treadmill at 25 m/min (0% grade) for 60 min/day and 5 days/week for eight weeks. Subjects were fed orally with Bene extraction and saline for four weeks. SK1 relative gene expression was detected via the Real-time PCR method. Results demonstrated that exercise and Bene extraction significantly increased SK1 relative gene expression in the liver, small intestine, and kidney (p value < 0.006, p value < 0.007, and p value < 0.023, respectively); the increase, however, was not significant in visceral fat tissue.

Coronary artery disease (CAD) is one of the most common types of heart disease and the leading cause of death in the United States in both men and women. Coronary artery bypass grafting (CABG) has been used for patients with significant CAD. Successful CABG depends on many factors and one of them is the choice of graft conduit. The aim of this study is to report a descriptive analysis of endoscopic (EVH) versus traditional open vein harvest (OVH) technique for CABG from 2010 to 2011 in Mashhad, northeast of Iran This is a cross-sectional study conducted on 1974 CABG operations in Javad-al-Aeme Hospital in Mashhad, from January 2010 to July 2011. Totally, 989 patients underwent the traditional OVH and the other 985 patients had the EVH. Data analysis (including demographical and operational) in addition to parametric and nonparametric tests were undertaken using the SPSS 16 software. A P value < 0.05 was regarded as statistically significant. Mean age of the EVH group was 62.1±3.5 years in comparison with 64.2±3.9 years in the OVH group, which means no significant difference was revealed between the two groups. A significant difference between the groups in hospital stay days was detected, with the EVH and OVH groups being 5.6±1.2 and 6.5±1.8 days, respectively (P=0.041). Patient''s Pain was measured by the use of a visual analog scale (VAS); we found significant differences between the groups at 2nd day, 5th day, and 40th day after CABG (P<0.05). We also found a noticeable difference in cosmetic satisfaction and less wound complication in the EVH group in comparison with the OVH group (P<0.05). In this study, we found that EVH brings fewer postoperative wound complications and less postoperative pain and could reduce analgesic usage after the operation. It also results in shorter hospital stay and of course better cosmetic outcome in the patient''s view.

Lack of myocardial reperfusion after an ischemic period despite reperfusion therapy is called the no-reflow phenomenon.This study aimed to compare no-reflow phenomenon outcomes (ECG and enzyme changes) in Adenosine injection and thrombosis aspiration methods. A quasi-experimental study was performed on patients undergoing percutaneous coronary intervention in three selected Tehran hospitals (April 2011 to June 2012). Forty patients (24 men and 16 women) were included in the study. ST-segment elevation and cardiac enzymes changes were compared in Adenosine injection and thrombus aspiration in patients with the noreflow phenomenon 24 hours after percutaneous coronary intervention. The Adenosine and thrombus aspiration groups did not show significant differences in cardiac enzyme changes (positive troponin, or CKMB elevation). Also, the Adenosine and thrombus aspiration groups did not show significant difference in ST-segment elevation (P>0.05). This study confirms the results of positive restore coronary perfusion in Adenosine infusion and thrombosis aspiration. Now the question is why enzyme and ECG changes have been reported more in the thrombus aspiration method despite the improvement in cardiac perfusion to Adenosine injection? The response seems to be related to more aggressiveness of the thrombus aspiration method, but this explanation should be confirmed by more investigations.

The most significant consequence of coronary artery disease is myocardial infarction (MI), which accounts for most cardiac deaths. Differences between premature and nonpremature MI based on the inflammatory enzyme, myeloperoxidase (MPO), have not been fully elucidated. Therefore, we sought to investigate whether plasma MPO could differentiate patients with premature or non-premature MI as compared to control subjects. The participants included 42 patients with premature MI, 42 patients with non-premature MI, and 84 control subjects. The plasma concentration of MPO was determined with an enzyme immunoassay. Data were entered into SPSS-16 and analyzed by ANOVA, chi-squared, and Pearson correlation tests. Plasma MPO levels were significantly elevated in both premature and non-premature MI groups as compared to the control subjects (P < 0.01), but there were no differences between the patients and the controls by themselves (P > 0.05). Our findings demonstrated that plasma MPO levels could not differentiate between premature and non-premature acute MI, although it could differentiate patients from control subjects.

Iron overload contributes to cardiac dysfunction in patients with beta thalassemia major. T2* magnetic resonance is the gold- standard test for detecting iron overload in myocardial cells. Tissue Doppler imaging (TDI) has been developed to evaluate ventricular function in beta thalassemic patients. We aimed to assess the efficacy of TDI in predicting myocardial iron load in beta thalassemic patients using T2* magnetic resonance imaging (MRI) as the gold standard test. During a period of one year (2011- 2012), 27 known beta thalassemic patients were included in the study to be evaluated by TDI and T2* MRI. There were 15 females and 12 males at an age range of 18 to 39 years (23.89±5.19). Patients in the age group of 18-25 years old comprised 63% of the subjects. Serum ferritin level ≤1500 ng/ml was observed in 20 (74%) cases. T2* MRI > 20 ms was detected in 22 (81.5%) patients. Abnormal T2*MRI (T2*≤ 20 ms) had a significant correlation with increased serum ferritin levels (P = 0.007), increased left ventricular end diastolic dimension (P = 0.039), decreased E/A filling ratio (P = 0.022), and decreased early and late diastolic myocardial velocities at the lateral left ventricular wall (P = 0.028, and P = 0.023, respectively). The present study findings suggested that even in a population of young, asymptomatic, and well-chelated thalassemic patients; impairment of myocardial function can be observed and this damage can be detected by echocardiographic techniques.

Despite the success of on-pump coronary artery bypass grafting (CABG) in the treatment of coronary artery disease, morbidity and mortality due to renal failure is a wellknown complication of this method. Currently, it is believed that off-pump CABG can be done with the same result and fewer adverse renal effects due to a lack of the use of the cardiopulmonary bypass machine. The aim of this study was to compare postoperative renal function between off-pump CABG and on-pump CABG. Sixty-seven consecutive candidates for elective isolated CABG were enrolled in this study and randomized into two groups. The on-pump group consisted of 34 patients and the off-pump group included 33 patients. All the patients were operated on via the same technique and surgeon. Blood samples were obtained before surgery and 6, 24, and 48 hours after surgery to measure the serum creatinine and assess creatinine clearance. Either 20% increase in the serum creatinine level or 20% decrease in creatinine clearance was considered as renal dysfunction. In the off-pump group, 5, 9, and 4 patients developed renal dysfunction 6, 24, and 48 hours postoperatively, respectively in comparison with 13, 22, and 11 patients of the on-pump group at the same time. There was a significant difference between the two groups regarding renal dysfunction 6 and 24 hours postoperatively (p value=0.038 and 0.003, respectively), but no significant difference was observed at 48 hours after surgery. We found no relationship between age and weight and postoperative renal dysfunction in either of the groups. Preoperative hypertension and diabetes had no effect on postoperative renal dysfunction. Renal function was better preserved in the patients undergoing off-pump CABG than on-pump CABG. Old age was not a risk factor for renal function but it could be a matter of debate and must be studied in future experiments.

Cornelia de Lange syndrome (CdLS) is a rare multiple congenital abnormalities with dominantly inherited and developmental delay. Regarding craniofacial deformities in these patients, airway management may be challenging for anesthesiologists. In these patients, pre-anesthetic evaluation must be done with exact assessment of the airway, including physical examination and radiography, CT, or MRI of the head and neck. An anesthetist should prepare the “difficult intubation set”, including a flexible fiberscope, and may need to consult with an earnose and throat (ENT) specialist if necessary for unexpected emergency situations. In this case-report, we describe a 7-year-old boy with CdLS with prominent maxilla, mouth opening restriction, and micrognathia who underwent complete repair of ventricular septal defect and pulmonary valve stenosis surgery. Anesthetic and airway management and postoperative period were uneventful.

Aneurysm of the sinus of Valsalva is a rare congenital lesion that may be associated with other congenital lesions such as ventricular septal defect (VSD). Less common lesions can occur secondary to trauma, infective endocarditis, or syphilis. The majority of these aneurysms originate from the right coronary sinus. Patients with unruptured aneurysms usually remain asymptomatic. Rupture of the aneurysm usually causes the appearance of a continuous murmur in the left sternal border. Locations of the common ruptures include the right ventricle, the right atrium, and less commonly the left atrium. Surgical repair of the tear usually has optimal outcomes. We describe a 39-year-old man with a history of congenital VSD, subvalvular pulmonary stenosis, and rupture of the right sinus of Valsalva aneurysm complicated by infective endocarditis.