@article { author = {KHAMOUSHI, Amir Jamshid and KASHFI, F and TABATABAEI, S.M.B and HOSSEINI, SAEID and MALEKI, MAJID and , NOUHI, F}, title = {PREGNANCY OUTCOME IN WOMEN WITH BIOPROSTHETIC HEART VALVES}, journal = {Iranian Heart Journal}, volume = {3.4}, number = {2.3}, pages = {13-18}, year = {2002}, publisher = {Iranian Heart Association}, issn = {}, eissn = {}, doi = {}, abstract = {Background: To avoid the fetal and maternal risks associated with anticoagulant therapy during pregnancy, the use of bioprostheses has been advocated for young women with cardiac valve disease who may later wish to bear children. The aim of this historical cohort study was to evaluate pregnancy outcome in women with bioprosthetic heart valves.Methods: Fifteen women who became pregnant after bioprosthetic heart valve replacement were followed during 28 pregnancies. Eleven had undergone isolated mitral, 3 had aortic and 1 had tricuspid valve replacement. Their ages at the time of surgery ranged from 14 to 31 years (mean 19.85±5.54).All the women were in sinus rhythm at the time of gestation. No embolic episodes occurred either after surgery or during pregnancy, labor or the puerperium.Results: Fetal loss occurred in 7 of the 28 pregnancies (25%), and was due to abortion (N=5), pre-maturity and neonatal death (N=2). No congenital malformation was seen. The mean birth weight in 21 pregnancies was 3082c, and only 1 newborn had low birth weight (2100gr). Two cases of rapid degeneration of bioprosthetic valves leading to reoperation occurred in two patients, one in the 7th month of pregnancy and the other 4 months after delivery.Conclusion: Bioprosthetic valves can be considered the most suitable prosthetic heart valve employed in women of childbearing age because anticoagulants can be avoided, so the risk of embryopathy following the use of anticoagulant drugs is omitted.}, keywords = {Pregnancy outcome,BIOPROSTHETIC HEART VALVE}, url = {http://journal.iha.org.ir/article_83470.html}, eprint = {http://journal.iha.org.ir/article_83470_7e243f568b094846fad11247ab47d0fb.pdf} } @article { author = {MASOUMI, M.A and SALEHI, NAHID and POURMOTEABED, A.R. and ZAHEDI, ZOHREH and ABDOLI, GH.R.}, title = {ANTEGRADE-RETROGRADE COLD BLOOD CARDIOPLEGIA VERSUS ANTEGRADE CARDIOPLEGIA ON MYOCARDIAL FUNCTION AFTER CORONARY ARTERY BYPASS SURGERY}, journal = {Iranian Heart Journal}, volume = {3.4}, number = {2.3}, pages = {19-23}, year = {2002}, publisher = {Iranian Heart Association}, issn = {}, eissn = {}, doi = {}, abstract = {Objective: Antegrade and retrograde infusions of cardioplegia may provide more homogenous distribution of cardioplegia especially in cases of coronary arteries occlusion. The purpose of this study was to compare intermittent ante grade- retrograde and ante grade cardioplegia on myocardial function following CABG.Methods: One hundred ninety six patients in two groups were studied on a non randomized basis in order to compare their operational results after using the two methods. In the antegrade-retrograde method (group A), 15 ml/kg of cold blood infusion of antegrade cardioplegia was followed by 8 ml/kg of retrograde infusion. The antegrade-retrograde route of infusion was repeated every 20 minutes (IO ml/kg and 8 ml/kg respectively). In the antegrade group (group B), 15 ml/kg of cold blood cardioplegia was followed by 10 ml/kg in repeated doses every 20 minutes. Important variables of myocardial performance were compared in the two groups.Results: The two groups had similar preoperative characteristics (age, sex, body mass index, severity of coronary artery disease and ejection fraction). Postoperative ejection fraction either did not change or increased 5 to 15% in 51.1% of group A. Inotropic agent was needed in 8.2% of this group, while post operative ejection fraction reduced 5 to 20% in 76.9% of group B and inotropic agent was needed in 24.5% of this group (P<0.001 and P<0.002 respectively). The mortality rate was more in the control group, but was not statistically significant. The ventilatory support time was longer in the control group (P<0.01). Conclusion: In view of our findings, we conclude that there is a significantly better postoperative myocardial performance following antegrade-retrograde cardioplegia and we recommend it as a routine method for myocardial protection in coronary artery bypass graft.}, keywords = {HEART ARREST INDUCED METHOD,Coronary Artery Bypass,Heart Surgery}, url = {http://journal.iha.org.ir/article_83513.html}, eprint = {http://journal.iha.org.ir/article_83513_208fafa5eb8c7d347a74ec918e3d5854.pdf} } @article { author = {PARVIZI, R. and VARSHOUCHI, M and NEGARGAR, S and HASANZADEH, SOUSAN}, title = {MEDIASTINITIS FOLLOWING MEDIAN STERNOTOMY A 4-YEAR REVIEW}, journal = {Iranian Heart Journal}, volume = {3.4}, number = {2.3}, pages = {24-32}, year = {2002}, publisher = {Iranian Heart Association}, issn = {}, eissn = {}, doi = {}, abstract = {Background- Purulent mediastinitis is an unusual complication of median sternotomy. This complication often occurs shortly, usually within two weeks, after surgery. This study has been planned to clarify the situation of life-threatening infectious complications after surgical operation at our center and to better the ways of prevention as much as possible. Methods- In this study, all the patients who had undergone median sternotomy were observed over a 4-year period. The documentation of the diagnoses was completed, information about the patients including demographic characteristics, type of surgery, pre-, intra- and postoperative risk factors, clinical and laboratory findings, etiological diagnoses, responsible organisms, management methods and finally the outcome of the patients were collected and analyzed by a statistical software (SPSS- Win).Results- This review comprised 2115 patients who had undergone median sternotomy. Thirteen of them (0.61 %) suffered from post-surgical purulent mediastinitis. The type of surgery was 38% coronary artery bypass grafts (CABGs), 23% aortic valve replacement (AVR) + CABGs, and 23% valve replacement or repair. Forty-six percent of the mediastinitis patients were obese, 46% hypertensive, 38% smokers, 38% had a history of previous MI, 15% had preoperative creatinine> 1.2, and 15% needed preoperative intra aortic balloon pump. The mortality rate was 31%.Conclusion- This complication is distinguished by its clinical manifestations and positive culturing from the mediastinum. Microbial etiology is influenced by the source of contamination and must be recognized for any center separately. A combination of antimicrobial therapy and surgical intervention has better results. A better evaluation of the patients' preoperative conditions, promotion of surgical techniques and preventive measures, and an early diagnosis of mediastinitis will be effective in the reduction of this complication.}, keywords = {MEDIASTINITIS,Open Heart Surgery}, url = {http://journal.iha.org.ir/article_83514.html}, eprint = {http://journal.iha.org.ir/article_83514_d9d3a92a5337ea43b9ff52893b0af500.pdf} } @article { author = {POUR MOGHADAS, M and MONTAZERI, H.R}, title = {AN INVESTIGATION OF THE EFFECT OF VEGETARIAN DIET ON ATHEROSCLEROSIS}, journal = {Iranian Heart Journal}, volume = {3.4}, number = {2.3}, pages = {33-37}, year = {2002}, publisher = {Iranian Heart Association}, issn = {}, eissn = {}, doi = {}, abstract = {Background and Objectives: In recent years, twelve studies have indicated that a vegetarian diet could reduce the progression of atherosclerosis. Because of its applicability in our society, this study was performed to evaluate the effects of a vegetarian diet on atherosclerosis progression during a period of 12 to 31 months (average 17.2 months).Methods: The case group was a vegetarian one (15 subjects), which was compared with a control group with a normal diet (17 subjects). Coronary angiography was done before and after the study. In each group, lesion number and average maximum stenos is determined and compared in both coronary angiograms. A statistician analyzed the acquired data with T- test and Chi-square.Results: In the case (vegetarian) group, there was a 40% progression, 27% stabilization and a 33% regression, while in the control group, there was a 100% progression of atherosclerosis.Conclusion: The preventive effects of a vegetarian diet on coronary stenosis lesion progression and the regression of atherosclerotic lesion were observed. Its beneficial clinical effects on reducing angina, total cholesterol, LDL-C, and BMI were established too.}, keywords = {CORONARY ATHEROSCLEROSIS,VEGETARIAN DIET}, url = {http://journal.iha.org.ir/article_83515.html}, eprint = {http://journal.iha.org.ir/article_83515_ed1961ce71faee7a142ce5ebfe6b447b.pdf} } @article { author = {MIRMOHAMMAD SADEGHI, HASAN and SADEGHI, A.M}, title = {NEW APPROACH IN EMERGENCY OPERATION FOR REDO MITRAL VALVE REPLACEMENT: IS IT JUSTIFIED?}, journal = {Iranian Heart Journal}, volume = {3.4}, number = {2.3}, pages = {38-43}, year = {2002}, publisher = {Iranian Heart Association}, issn = {}, eissn = {}, doi = {}, abstract = {Background: With the progressive aging of western populations, cardiac surgeons is faced with treating an increasing number of critically ill and elderly patients. Controversy exists as to whether the ordinary mid-sternotomy approach to these malfunctioning mitral valves will do the job or a new right thoracotomy approach without cross clamping the aorta is better suited to take care of the problem. The potential to avoid mid-sternotomy surgery in redo patients with little chance of survival and poor quality of life postoperatively would spare unnecessary suffering, reduce operation mortality, and enhance the use of resources.Methods: We managed 52 cases of severely ill patients admitted to our department on referral from rural areas with malfunctioning prosthetic mitral valves from July 15, 2000 through June 20, 2002. Four patients were women. Preoperatively most of the patients were not moribund, but 67% had hemodynamic instability and 23% experienced cerebral ischemia. All the patients had prosthetic mitral valves. Hospital mortality and morbidity models, based on our overall experience with 52 patients operated on for malfunctioning mitral valves during the period of the study, were developed by means of multivariate logistic regression with preoperative and intraoperative variables used as independent predictors of outcome.Results: Overall hospital mortality was 14%. There was no intraoperative mortality. All the patients who survived had one or more postoperative complications. Mean hospital stay was 17 days with an average of 11 days and median of 10 days in the intensive care unit. All of the survivors (6 patients) discharged from the hospital were able to function independently and their survival at 6 months was 100%. Statistical analysis of the overall experience with this new operation for malfunction of prosthetic mitral valves confirmed that via right thoracotomy, the cross - clamping of the aorta is the most important independent patient risk factor associated with 30-day mortality and morbidity.Conclusion: Operations for critically ill patients involve increased hospital mortality and morbidity. Short-term survival is unfavorable and is associated with a poor quality of life. With additional corroborative studies to endorse the present findings, the use of right thoracotomy approach to have access to malfunctioning mitral valve without the crossclamping of the aorta remains a substantiated concept. In the context of these critically ill patients, the hypothesis that right thoracotomy approach without the cross-clamping of the aorta should be advocated for surgical intervention to save these patients and to conserve resources is supported by the presented data. }, keywords = {EMERGENCY HEART SURGERY,MITRAL VALVE MALFUNCTION,thoracotomy}, url = {http://journal.iha.org.ir/article_83516.html}, eprint = {http://journal.iha.org.ir/article_83516_ec46ec030c6a7bf99d311ce8bf8dafa6.pdf} } @article { author = {SAMADIKHAH, J and BOROUMANDAN, F and ALIZADEH ASL, A and PEYGHAMBARI M.,, M and HAKIM, S.H and AZAR FARIN, R and MOHAMMAD ALIAN, A.H}, title = {PROGNOSTIC SIGNIFICANCE OF ATRIAL FIBRILLATION AFTER THE FIRST ACUTE MYOCARDIAL INFARCTION}, journal = {Iranian Heart Journal}, volume = {3.4}, number = {2.3}, pages = {44-48}, year = {2002}, publisher = {Iranian Heart Association}, issn = {}, eissn = {}, doi = {}, abstract = {Background: Several studies have been performed to analyze the significance of atrial fibrillation (AF) following acute myocardial infarction (AMI). In this study, we evaluated the prognostic significance of AF considering timing of its occurrence after the first AMI. Methods- This investigation is a prospective multivariate study (cohort type); among 500 consecutive first infarct survivors who were admitted to our heart center over a 2-year period (1998-2000).Results: Among 500 consecutive patients (pts), 66 pts (13.2%) had AF. These pts were divided into two groups A (n=36) and B (n=30), who developed AF within and after 24 hours of onset of AMI, respectively. The infarct occurred mainly (62.8%) in the proximal right coronary artery in A group (p<0.05), left ventricular ejection fraction was more decreased in B group (p<0.05); and also mitral regurgitation was more frequent in this group (p<0.05). According to multivariate analyses; older age, female sex, hypertension, ventricular hypertrophy, ventricular tachycardia, ventricular fibrillation, pericarditis, atrioventricular block (AVB) especially complete AVB, intraventricular conduction disturbance, high admission Killip class, pulmonary congestion, heart failure in hospital and 1 year follow-up mortality were higher in both groups compared to the sinus rhythm group. AF was an independent predictor of cardiac death (in-hospital and 1 year followup) in A group (odds ratio 2.29, 95% confidence interval!'1 to 4.1, p<0.05), and B group (odds ratio 4.21, 95% confidence interval 2.1 to 7.9,p<0.05), respectively.Conclusion: The appearance of AF within or after 24 hours of first AMI is a useful parameter for evaluation of the cardiac status and prognosis of patients with AMI. We also found that emergence of AF is more common in right coronary artery lesions.}, keywords = {Atrial Fibrillation,Acute myocardial infarction,Prognosis}, url = {http://journal.iha.org.ir/article_83518.html}, eprint = {http://journal.iha.org.ir/article_83518_58de1d20da48e7dbc212c35c11ce5ec6.pdf} } @article { author = {FOROUD, A and FOROUD, AFSAR}, title = {A DOUBLE-BLIND, PLACEBO-CONTROLLED PARALLEL TRIAL OF VITAMIN C TREATMENT IN MIDDLE AGED PATIENTS (35-50 YEARS OLD) WITH MILD PRIMARY HYPERTENSION}, journal = {Iranian Heart Journal}, volume = {3.4}, number = {2.3}, pages = {49-53}, year = {2002}, publisher = {Iranian Heart Association}, issn = {}, eissn = {}, doi = {}, abstract = {Objective: An evaluation of the effect of vitamin C on blood pressure is very important because hypertension is a major risk factor for cardiovascular, cerebral and renal diseases.We studied the effect of vitamin C on the blood pressure of patients between 35-50 years old with mild primary hypertension in Kerman.Methods: We conducted a prospective one-year double-blind, placebo controlled parallel trial on 42 middle aged patients with mild primary hypertension at the hypertension clinic in Kerman University of Medical Sciences. Following a 2-week run-in phase, two age and sex matched groups of untreated hypertensive subjects received 8 weeks oral treatment with either vitamin C, 250 mg twice daily (n=21; 8 M/13F, mean age 42.7±5.3 years) or placebo one tablet twice daily (n=21; 10 M/IIF, mean age 42.7± 5.9 years). Blood pressure was measured in the sitting position on three occasions during the run-in phase, and again at 1, 2, 4 and 8 weeks after commencing treatment. Venous blood samples for the measurement of plasma ascorbic acid were measured at baseline and at 1, 2, 4, 8 weeks after treatment.Results: Plasma ascorbic acid level in vitamin C group significantly changed from 8.8±3 umol/l at baseline to 32.3±12 umolll at 8 weeks, but in placebo-treated group, it changed from 13.8±6 umolll at baseline to 9.01±4.1 umolll at 8 weeks during the study period.A more significant fall in mean blood pressure was observed in the vitamin C group than the placebo-treated group such that the mean systolic blood pressure decreased from 153.1± 5 to 144±5.3 mmHg in vitamin C group and from 154.1±4.9 to 149±4.9mmHg in the placebo group. The mean diastolic blood pressure decreased from 95.711.4 to 91.4±1.7 mmHg in the vitamin C group and from 96.2±1.6 to 94.0±1.6 mmHg in the other group.At 8 weeks, the significant difference in the reduction of systolic blood pressure (p<0.05) and diastolic blood pressure (p<0.001) between the two groups became apparent. Conclusion: Vitamin C intake has a useful effect on lowering blood pressure.}, keywords = {systolic blood pressure,DIASTOLIC BLOOD PRESSURE VITAMIN C,Antioxidant}, url = {http://journal.iha.org.ir/article_83520.html}, eprint = {http://journal.iha.org.ir/article_83520_71daec632f93f38d079708af41650de2.pdf} } @article { author = {ARABI, M.Y and MERAJI, MAHMOUD and NAKHOSTIN DAVARI, P and SHAH MOHAMMADI, A and SAMADI, M}, title = {PULMONARY ARTERY BANDING IN PATIENTS WITH VENTRICULAR SEPTAL DEFECT AND SECONDARY PULMONARY HYPERTENSION: A TEN-YEAR STUDY}, journal = {Iranian Heart Journal}, volume = {3.4}, number = {2.3}, pages = {54-58}, year = {2002}, publisher = {Iranian Heart Association}, issn = {}, eissn = {}, doi = {}, abstract = {Pulmonary artery banding (PA banding), part of a two stage- repair strategy popular in the 60s and 70s, is now largely reserved for critically ill infants with multiple ventricular septal defects (VSDs) or those with associated anomalies such as straddling atrioventricular valves. I Because of our limitations for total surgical correction in infants, we had to do PA banding in patients with VSD-pulmonary hypertension (PH) or VSD and atrial septal defect (ASD)-PH. Consequently, we decided to report our surgical experience during a ten-year period. To assess these results, we reviewed our ten-year experience with 108 patients with the diagnosis of VSD-PH or VSD - ASD-PH who had undergone PA banding in our institution. Twenty-three of these patients, however, were excluded from the study because of a lack of information and follow-up.Based on the age at which PA banding was performed, we divided patients in three groups. In the first group, there were 11(13%) patients, on whom PA-banding was performed when they were under 6 months of age. There were 38 patients (44.5%) in the second group, who had undergone PA banding when they were between 6-12 months of age. And finally, 36 (42.5%) patients made up the third group, who had had PA band performed on them when they were over one-year old. Effective PA banding was performed in 64% of Group I, 75% of Group II and 64% of Group Ill.In this study, we showed that the best time for PA banding in patients with VSD-PH or VSDASD- PH in our institution is between 6-12 months of age, and that age more than one year is not an absolute contraindication for PA banding. }, keywords = {PULMONARY ARTERY BANDING,Ventricular septal defect,PULMONARY HYPERTENTION}, url = {http://journal.iha.org.ir/article_83521.html}, eprint = {http://journal.iha.org.ir/article_83521_2fa99e8ce7f90446a17c55b6539468ae.pdf} } @article { author = {HAGHJOU, M and KHAMOUSHI, A.J and EMKANJOU, Z and BAKHSHIAN KELARIJANI, R and ARIA, ARASH and SAMIEINASAB, M.R and SADR AMELI, M.A}, title = {PERITONEAL MIGRATION OF EPICARDIALLY PLACED PACEMAKER}, journal = {Iranian Heart Journal}, volume = {3.4}, number = {2.3}, pages = {59-60}, year = {2002}, publisher = {Iranian Heart Association}, issn = {}, eissn = {}, doi = {}, abstract = {There are several reports of pacemaker migration from the site of implantation. Pacemakers can erode the skin and become exposed, migrate toward the axilla or breast and protrude from the abdominal wall into the peritoneal cavity. Intraabdominal migration of an epicardial pacemaker generator is a rare but potentially life-threatening complication. We report a case of a 53- year-old woman in whom the generator silently migrated from the sheath of the rectus abdominis muscle in the upper abdominal wall down into the peritoneal cavity.}, keywords = {EPICARDIAL PACEMAKER,migration,arrhythmia}, url = {http://journal.iha.org.ir/article_83522.html}, eprint = {http://journal.iha.org.ir/article_83522_2b34ffe23941e23b7a5439324fded1fc.pdf} } @article { author = {MALEKI, MAJID and SAFAEI, A and ROUSHANALI, F and MOSHKANI FARAHANI, M}, title = {INCIDENTAL MESOTHELIAL/MONOCYTIC CARDIAC EXCRESCENCE AND LITERATURE REVIEW}, journal = {Iranian Heart Journal}, volume = {3.4}, number = {2.3}, pages = {61-65}, year = {2002}, publisher = {Iranian Heart Association}, issn = {}, eissn = {}, doi = {}, abstract = {We present a case of the so-called mesothelial monocytic incidental cardiac excrescences (MICE) of the heart and a brief review of related literature.The patient was a 74- year- old woman. She had no history of previous cardiac instrumentation and underwent pericardial drainage and biopsy due to cardiac tamponade. A tissue sample was submitted as thrombus attached to the pericardium. Histologically, these lesions were composed of a mixture of plump histiocytoid cells, a papillary and strip arrangement of cuboidal cells, and various sized vacuoles and fibrin. The nests of cuboidal cells resembled cancer cells but showed features of mesothelial cells. Immunohistochemically, histiocytic cells were positive for CD68 but negative for cytokeratin. The cuboidal cells were positive for cytokeratin but negative for CD 68. These lesions were probably reactive because of their heterogeneous components. The significance of MICE is its possibility of being misdiagnosed as metastatic carcinoma.}, keywords = {PERICARDIAL,Mass,MESOTHELIAL,TAMPONADE,Mice}, url = {http://journal.iha.org.ir/article_83523.html}, eprint = {http://journal.iha.org.ir/article_83523_69ef2c0dec0843f67a2653a9011427b5.pdf} } @article { author = {PARVIZI, R and NEGARGAR, S and HAKIM, H and AFRASIABI, A and KOUH SOULTANI, Y and HASANZADEH SALMASI, S}, title = {COARCTATION OF AORTIC ARCH WITH ANEURYSM}, journal = {Iranian Heart Journal}, volume = {3.4}, number = {2.3}, pages = {66-68}, year = {2002}, publisher = {Iranian Heart Association}, issn = {}, eissn = {}, doi = {}, abstract = {A 28- year- old woman was admitted because of uncontrolled hypertension following delivery. Aortography showed severe coarctation of the aortic arch, and a large- sized aneurysm that was located in the aortic arch distal to the left common carotid artery. The patient was scheduled for surgery. The coarctation was removed and the aortic arch was replaced with a 28-mm Dacron tube, and the left subclavian artery was reimplanted to the Dacron tube. The patient tolerated the procedure well and was discharged from hospital 15 days later.}, keywords = {Aneurysm,Aorta,COARCTATION}, url = {http://journal.iha.org.ir/article_83524.html}, eprint = {http://journal.iha.org.ir/article_83524_e41a0e051faf62d433fba6d3cb4fb10f.pdf} } @article { author = {SABZI, F and MOULOUDI, A.A.R}, title = {REPAIR OF AN ANEURYSM OF THE PULMONARY TRUNK IN A 5-YEAR-OLD PATIENT}, journal = {Iranian Heart Journal}, volume = {3.4}, number = {2.3}, pages = {69-70}, year = {2002}, publisher = {Iranian Heart Association}, issn = {}, eissn = {}, doi = {}, abstract = {We report a case of idiopathic aneurysm of the pulmonary trunk associated with moderate insufficiency of the pulmonary valve in a 5-year-old girl. The patient was asymptomatic. The results of echocardiography and angiocardiography showed a pulmonary trunk aneurysm. The aneurysm was excised and the pulmonary valve regurgitation was repaired using cardiopulmonary bypass. The postoperative course was uneventful.}, keywords = {Cardiac Surgery,Aneurysm,PULMONARY TRUNK ANEURYSM}, url = {http://journal.iha.org.ir/article_83525.html}, eprint = {http://journal.iha.org.ir/article_83525_cd211f1a7b5b9ef387293f167661b915.pdf} }