@article { author = {Aghababaei, Mahtab and Noohi, Feridoun and Kyavar, Majid and Bakhshandeh, Hooman}, title = {Bed Management System Can Increase Hospital Revenues: Experiences of a Referral Cardiovascular Center}, journal = {Iranian Heart Journal}, volume = {22}, number = {2}, pages = {6-16}, year = {2021}, publisher = {Iranian Heart Association}, issn = {}, eissn = {}, doi = {}, abstract = {Background: Cardiovascular diseases are the leading cause of death worldwide; therefore, the importance of cardiac care hospitals is on the rise day by day. The efficient use, optimalallocation, and maximum utilization of resources are the inseparable components ofmodern management. Given the scarcity of resources, especially beds, and the complexityof the existing processes in the hospital revenue system, the establishment of systematicbed management is the right solution to this problem. The present study aimed todetermine the relationship between increased revenues and bed management.Methods: This cross-sectional study was conducted in Rajaie Cardiovascular Medical and Research Center, Tehran, Iran. Data of 613 adult patients that had undergone coronary bypass grafting and heart valve surgery were collected from the hospital medical records. Diagnosis-Related Group (DRG)-2015 was used for the standard hospital length of stay (LOS), and hospital indices were recalculated and compared with their observed values. Data were analyzed using the Spearman correlation coefficient, the Mann–Whitney test, the Wilcoxon test, and the Kruskal–Wallis test. A P value of less than 0.05 was considered significant.Results: Significant differences existed between the mean LOS and its standard values. The results showed that by the implementation of bed-management, the current LOS was halved, the bed turnover increased from 10.57 to 21.14 times, and the revenue increased by 33%.Conclusions: A potential increase in revenues was observed after considering the standards of the bed management system in our hospital. According to the results obtained, revenues can be increased with higher patient admission and shortening patient queues byestablishing systems that define a standard to control LOS, without increasing the numberof beds. (Iranian Heart Journal 2021; 22(2): 6-16)}, keywords = {financial management,Hospital,income,Diagnosis-Related Group,Length of stay,Cardiac surgical procedures}, url = {http://journal.iha.org.ir/article_128473.html}, eprint = {http://journal.iha.org.ir/article_128473_7c5a7a16a914d9309bfcc084eb2ca003.pdf} } @article { author = {ziyaeifard, mohsen and valipour, masoomeh and Kachoueian, Naser and mortazian, meysam and Heidari nia, Saeid and Gorjipour, Farhad}, title = {Evaluation of the Correlations Between Sodium Fluctuations and Clinical Outcomes in Children Undergoing Cardiopulmonary Bypass}, journal = {Iranian Heart Journal}, volume = {22}, number = {2}, pages = {27-37}, year = {2021}, publisher = {Iranian Heart Association}, issn = {}, eissn = {}, doi = {}, abstract = {Introduction: Sodium abnormalities constitute some of the most common electrolyte disorders during cardiopulmonary bypass (CPB), and they exhibit a rise for various reasons during CPB. The use of CPB for correcting congenital heart diseases in infants has profound physiological effects on most organs. The devastating effects of CPB are often more pronounced in infants. This study aimed to determine the relationship between sodium fluctuations and clinical outcomes in infants undergoing CPB.   Methods: This cross-sectional study (correlational) was conducted on 473 children who underwent CPB in 2016 according to our inclusion criteria. The samples were divided into 2 groups according to sodium fluctuations with a cutoff point of 15 mEq/L, and the clinical outcomes were compared between the 2 groups. The data were analyzed by SPSS, version 16, and presented as descriptive and inferential statistics.   Results:The incidence of cardiac (P<0.001), pulmonary (P=0.005), renal (P=0.02), neurologic (P=0.001), and hemorrhagic (P=0.02) outcomes were significantly different between the 2 groups. Gastrointestinal outcomes, infection outcomes, intubation time, intensive care unit stay, hospital stay, and mortality were not significantly different between the 2 groups.   Conclusions: Sodium fluctuations of 15 mEq/L or higher, as an independent factor, exacerbated cardiac, pulmonary, neurologic, renal, and hemorrhagic outcomes. (Iranian Heart Journal 2021; 22(2): 27-37)}, keywords = {Sodium oscillations,Pediatric cardiac surgery,Cardiopulmonary bypass,clinical outcomes}, url = {http://journal.iha.org.ir/article_128474.html}, eprint = {http://journal.iha.org.ir/article_128474_52c9fe9c1731ed2ab8287cbb1d98102e.pdf} } @article { author = {SAJJANAR, DEEPA and SAJJANAR, sanjeev}, title = {Clinico-Epidemiological and Angiographic Profiles of Patients With Premature Acute Coronary Syndrome}, journal = {Iranian Heart Journal}, volume = {22}, number = {2}, pages = {38-43}, year = {2021}, publisher = {Iranian Heart Association}, issn = {}, eissn = {}, doi = {}, abstract = {Background:Indians are more susceptible to young acute coronary syndrome (ACS), with about a fourth of the inflicted population below 40 years of age. However, the Indian population is diverse and the need for population-specific characteristics cannot be emphasized. We sought to determine the clinico-epidemiological profile of cases with young ACS among the regional population.   Methods:The present prospective observational study was carried out in a high-volume tertiary cardiac care center in north Karnataka. Patients aged below 40 years who were hospitalized with acute myocardial infarction between 2017 and 2019 to undergo invasive cardiac procedures were studied for clinico-epidemiological features. Data were analyzed using SPSS, version 23.0, and Microsoft Office 2007. All the patients’ characteristics were summarized descriptively.   Results:The mean age of the study population was 36.23±3.89 years, and men were more inflicted than women (75.9% vs 24.1%). The urban population was affected more than the rural population (60.2% vs 39.8%). Most of the study population presented with chest pain (83.5%). Angiography revealed significant single-vessel disease with the involvement of the left anterior descending artery (50.3%). The common complications noted were mitral regurgitation (29.32%) and heart failure (25.5%).   Conclusions: Young ACS is almost confined to men, and chest pain is the main presentation. Single-vessel disease is more common with the left anterior descending artery being the most involved vessel. (Iranian Heart Journal 2021; 22(2): 38-43)}, keywords = {Clinico-epidemiological profile,Young MI,Angiography,Coronary Artery Disease}, url = {http://journal.iha.org.ir/article_128478.html}, eprint = {http://journal.iha.org.ir/article_128478_07f1d4700b5288a6468a54559eb181df.pdf} } @article { author = {Alemzadeh-Ansari, Mohammad Javad and Kyavar, Majid and Khalesi, Somayeh and Dalouchi, Saeid and Noohi, Feridoun and Maleki, Majid and Peighambari, Mohammad Mehdi and Firouzi, Ata and Mohebbi, Bahram and Zadehmehr, Ali and Rashidinejad, Alireza and Shakerian, Farshad and Kiani, Reza and Khalili, Yasaman}, title = {Outcomes of Oversized Coronary Stenting in Patients Undergoing Elective Percutaneous Coronary Intervention}, journal = {Iranian Heart Journal}, volume = {22}, number = {2}, pages = {44-50}, year = {2021}, publisher = {Iranian Heart Association}, issn = {}, eissn = {}, doi = {}, abstract = {Background: The size of the coronary stent has an important role in the efficacy of stenting and its complications. The present study focused on the clinical outcomes of undersized, normal-sized, and oversized stenting.   Methods: This historical cohort study, conducted from April 2016 to March 2017 at Rajaie Cardiovascular Medical and Research Center, analyzed the results of elective percutaneous coronary intervention (PCI) and angiography on patients who met the inclusion criteria. Based on the ratio between the stent and the reference vessel, the patients were divided into 3 groups: undersized stenting (stent diameter/reference vessel diameter <0.9), normal-sized stenting (ratio=0.9–1), and oversized stenting (ratio>1). Data on demographic characteristics, procedural characteristics, underlying diseases, the hospital length of stay, major adverse cardiac events (MACE), post- PCI restenosis, stent thrombosis, and post-PCI cerebrovascular accident were extracted from the patients’ files and entered into a checklist.   Results: Oversized stenting significantly reduced the incidence of MACE 1 year after PCI compared with undersized and normal-sized stenting. The incidence of rehospitalization for acute coronary syndrome was 7.5 times lower in oversized stenting than in undersized stenting (P=0.002). The incidence of re-PCI on the involved vessel decreased significantly with an increase in the stent size (P=0.017). Additionally, there was no incidence of stent restenosis in oversized stenting (P=0.001). The other outcomes had no significant correlation with the stent size.   Conclusions: Based on the results of our study, oversized stenting could improve clinical outcomes. (Iranian Heart Journal 2021; 22(2): 44-50)}, keywords = {Stable Angina,Percutaneous Coronary Intervention,Stent,Major adverse cardiac event}, url = {http://journal.iha.org.ir/article_128479.html}, eprint = {http://journal.iha.org.ir/article_128479_d085039922d863aea006ccebd65e77a9.pdf} } @article { author = {Yellanthoor, Ramesh and Kumar, Dinesh}, title = {Electrocardiographic and Echocardiographic Findings in Asphyxiated Neonates}, journal = {Iranian Heart Journal}, volume = {22}, number = {2}, pages = {51-57}, year = {2021}, publisher = {Iranian Heart Association}, issn = {}, eissn = {}, doi = {}, abstract = {Background:The myocardium is vulnerable to ischemic injury in acute perinatal asphyxia. Asphyxial cardiomyopathy increases mortality. Clinical assessment alone is not sufficient to evaluate myocardial injury.   Methods:This study was conducted over 2 years on neonates at the gestational age of 34 weeks or more with perinatal asphyxia. Electrocardiographic (ECG) and echocardiographic changes were studied with clinical details.   Results:The study population comprised 57 neonates. Among them, 33 (57.9%) were male, 23 (40.4%) were born by cesarean section, and 3 (5.3%) were delivered via assisted vaginal delivery. Twenty-six neonates (45.6%) were intubated in the delivery room, and 15 (26.3%) required bag-and-mask ventilation at birth. The mean birth weight was 2679 g (461 g), and the mean gestation period was 38.4 weeks (1.6 wk). Central nervous system, hepatic, and renal involvement was observed in 53 (93%), 35 (61.4%), and 26 (45.6%) cases, respectively. Cardiac dysfunction was observed in 30 neonates (52.6%). Twenty cases (35.1%) required mechanical ventilation. ECG changes were observed in 44 neonates (77.1%). Grade I changes were observed in 10 cases (17.5%), Grade II in 14 (24.6%), and Grade III in 20 (35.1%). In 13 cases, ECG was normal. Twenty-six neonates (45.6%) had echocardiographic changes. Tricuspid regurgitation was observed in 8 cases (14%) and pulmonary artery hypertension with tricuspid regurgitation in 16 (28.1%). Mitral regurgitation with global hypokinesia was observed in 2 neonates, who eventually succumbed.   Conclusions:Our results demonstrated thatECG changes occurred in about three-fourths of asphyxiated neonates, and nearly half of the asphyxiated neonates had echocardiographic changes. Mitral regurgitation with global hypokinesia was associated with the worst outcome. (Iranian Heart Journal 2021; 22(2): 51-57)}, keywords = {Perinatal asphyxia,Myocardial dysfunction,ECG,echocardiography,neonate}, url = {http://journal.iha.org.ir/article_128480.html}, eprint = {http://journal.iha.org.ir/article_128480_bffa3ec2a5163375a43c5413edda162f.pdf} } @article { author = {Abouomar, Mahmoud and Hassan, Timoor and Alaarag, Ahmed}, title = {Anemia at Admission and Clinical Outcomes in Patients With Acute ST-Segment-Elevation Myocardial Infarction Undergoing Primary Percutaneous Coronary Intervention}, journal = {Iranian Heart Journal}, volume = {22}, number = {2}, pages = {58-67}, year = {2021}, publisher = {Iranian Heart Association}, issn = {}, eissn = {}, doi = {}, abstract = {Background: Anemia is common in ST-elevation myocardial infarction (STEMI) patients. The influence of anemia on the prognosis of STEMI patients remains unclear. Robust data are lacking regarding the outcome of patients with moderate-to-severe anemia who present with STEMI and who are treated via primary percutaneous coronary intervention (PCI). This study aimed to evaluate the effects of chronic anemia on major adverse cardiovascular and cerebral events (MACCE) in patients with STEMI undergoing primary PCI.   Methods: The present study recruited 330 consecutive STEMI patients who underwent primary PCI from November 2017 through October 2019 at our cardiology department. The study population was divided into 2 groups according to the hemoglobin level after primary PCI. The patients’ baseline clinical characteristics and relationships between hemoglobin levels and the incidence of MACCE during a 1-year follow-up were recorded.   Results: Patients with a hemoglobin level of less than 11 g/dL were elderly, had a lower body mass index, a higher incidence rate of diabetes, a higher Killip class at presentation, and a higher incidence rate of MACCE. Anemia at admission was an independent predictor of MACCE during hospitalization and on post-primary PCI follow-ups at 30 days, 6 months, and 1 year after PCI (P=0.034, 0.028, 0.0032, and 0.0042, respectively).   Conclusions: Age, hypertension, and diabetes in STEMI patients with moderate-to-severe anemia were associated with an increased incidence rate of MACCE. Moderate-to-severe anemia at admission was an independent predictor of MACCE during hospitalization and on post-primary PCI follow-ups at 30 days, 6 months, and 1 year.  (Iranian Heart Journal 2021; 22(2): 58-67)}, keywords = {Myocardial Infarction,Hemoglobin level,Primary PCI}, url = {http://journal.iha.org.ir/article_128481.html}, eprint = {http://journal.iha.org.ir/article_128481_25452311894d5d866c596c1768fe2a7a.pdf} } @article { author = {Sadr-Ameli, Mohammad Ali and Izadpanah, Parisa and Sadr-Ameli, Sadaf and Maghooli, Keivan and Madadi, Shabnam}, title = {Heart Rate Variability Biofeedback in Patients With Paroxysmal Atrial Fibrillation}, journal = {Iranian Heart Journal}, volume = {22}, number = {2}, pages = {68-76}, year = {2021}, publisher = {Iranian Heart Association}, issn = {}, eissn = {}, doi = {}, abstract = {Background: Heart rate variability biofeedback (HRVB) is an approach to ameliorate conditions in which HRV is relatively low. Some patients with paroxysmal atrial fibrillation (AF) show increased adrenergic tone in their paroxysms.   Methods: We conducted this study to determine the effects of HRVB on patients with paroxysmal AF. Thirty-one patients (11 women) at an average age of 58±10 years (38–79 y) with paroxysmal AF were included in the study. Of these, 19% had AF during exertion; 29% during rest; and in the remaining 52%, episodes were mixed. A 24-hour ambulatory Holter monitoring was done before and after 5 weeks of biofeedback training.   Results: The interpretation of Holter monitoring disclosed that high frequency changed significantly after HRVB. Clinically, 12 patients felt better, 4 patients felt worse, and 15 patients felt no obvious change. Low frequency and more importantly very low frequency decreased, which was due to a decrement in sympathetic tone.   Conclusions: HRVB in patients with adrenergic AF might reduce their episodes of paroxysmal AF and help them feel better. (Iranian Heart Journal 2021; 22(2): 68-76)}, keywords = {Heart rate variability Biofeedback,Paroxysmal atrial fibrillation,autonomic nervous system}, url = {http://journal.iha.org.ir/article_128482.html}, eprint = {http://journal.iha.org.ir/article_128482_fe9bf6c37a97724aacd27781530c12da.pdf} } @article { author = {Nooriasl, Samaneh and Khademzadeh, Rohangiz and Emkanjoo, Zahra}, title = {Comparison of the Response to Cardiac Resynchronization Therapy Defibrillator Implantation Between Patients With and Without Fragmented QRS in Electrocardiography}, journal = {Iranian Heart Journal}, volume = {22}, number = {2}, pages = {77-82}, year = {2021}, publisher = {Iranian Heart Association}, issn = {}, eissn = {}, doi = {}, abstract = {Background: Myocardial scars cause heterogeneous ventricular activation, which results in fragmented QRS (f-QRS) complexes and the resultant left ventricular (LV) dysfunction and dyssynchrony and thus further mortality. The accurate management of this patient population is essential to lessen mortality and improve the quality of life.   Methods: The present cross-sectional study recruited 80 patients (40 with f-QRS and 40 with non–f-QRS) who underwent cardiac resynchronization therapy defibrillator (CRT-D) implantation and followed them up for 6 months. The 2 groups were compared, before and after CRT-D implantation, concerning the New York Heart Association functional class; the quality of life; the incidence of all arrhythmias, including tachyarrhythmias; echocardiographic findings; the number of hospitalization; and mortality.   Results: The study population consisted of 80 patients at a mean age of 62.05±11.25 years: 40 cases with f-QRS and 40 with non–f-QRS. Men comprised 68.8% (n=55) of the patients. Ischemic cardiomyopathy was detected in 62.5% of the patients, nonischemic cardiomyopathy in 37.5%, and sinus rhythm in 76 cases. The mean values of the LV ejection fraction, the LV end-diastolic diameter, and the LV end-systolic diameter in both groups were 17.12±5.77, 6.44±0.81, and 5.70±0.81, respectively (P<0.05). An improvement was observed among the patients with non–f-QRS in echocardiography after CRT-D implantation, which was not related to the incidence of ischemic or nonischemic LV dysfunction. Dyspnea on exertion and mitral regurgitation improved in both groups (P>0.05).   Conclusions: The presence of f-QRS in patients with heart failure could confirm a diminished response to CRT-D implantation according to echocardiographic findings and could be considered an accurate patient selection guide. (Iranian Heart Journal 2021; 22(2): 77-82)}, keywords = {FRAGMENTED QRS,Mr,DOE,NYHA class,CRT-D}, url = {http://journal.iha.org.ir/article_128483.html}, eprint = {http://journal.iha.org.ir/article_128483_6581917cd295a8bf4ae8bd420f5eeb81.pdf} } @article { author = {Soleimani, Azam and Parsaee, Mozhgan and Haghjoo, Majid and Ghadrdoost, Behshid and Soleimani, Zahra}, title = {Is Left Atrial Strain in Non-Valvular Atrial Fibrillation a Noninvasive Predictor of the Left Atrial Appendage Spontaneous Echo Contrast?}, journal = {Iranian Heart Journal}, volume = {22}, number = {2}, pages = {83-95}, year = {2021}, publisher = {Iranian Heart Association}, issn = {}, eissn = {}, doi = {}, abstract = {Background: The left atrial appendage (LAA) spontaneous echo contrast (SEC) is a surrogate marker of thrombotic state in atrial fibrillation (AF). We investigated the correlation between LA speckle-tracking parameters and the LAA SEC or thrombosis.   Methods: This cross-sectional study evaluated 70 AF ablation candidates, irrespective of their rhythm. Complete 2D transthoracic and transesophageal echocardiographic examinations and LA speckle-tracking analyses were performed. Based on the presence of thrombosis and the severity of SEC in the LAA, the patients were divided into 3 groups.   Results: Seventy patients (mean age=54±13.6 y; 37 men) were evaluated. Sinus rhythm was reported in 41 patients and oral anticoagulant consumption in 51. The mean CHA2DS2-VASc score was 1.8±1.4, and the mean LVEF was 51.1±7.4%. The LASr in the 2- and 4-chamber views was lower in subjects with AF rhythm (P<0.0001). Patients with LAA thrombosis and moderate-to-severe SEC, all in AF rhythm, had lower LAA velocities (P<0.0001), LASr (4-chamber view=5.2±1% vs 9±2.7% vs 20.7±8.2%; P<0.0001), LAScd (P=0.003), and mean strain rates (P<0.0001) than patients with mild or no SEC. The best correlation with the LAA SEC was found for the LASr in the 4-chamber view (r= −0.58, P<0.0001). There were no differences in the time-to-peak velocities and the time delay of the opposite walls.   Conclusions: Patients in AF rhythm had remarkably lower LA strain values than those in sinus rhythm. Significantly lower LA emptying velocities and segmental and global speckle-tracking parameters were observed in patients with moderate-to-severe SEC or LAA thrombosis, and the best correlation was shown with the LASr. (Iranian Heart Journal 2021; 22(2): 83-95)}, keywords = {Atrial Fibrillation,TRANSESOPHAGEAL ECHOCARDIOGRAPHY,Left atrial strain,Speckle-tracking echocardiography}, url = {http://journal.iha.org.ir/article_128484.html}, eprint = {http://journal.iha.org.ir/article_128484_49c33fef0fcf0325045f7d68be0ce474.pdf} } @article { author = {Salimbahrami, Ahmad Reza and Yazdi, Amir Hossein and Najm Afshar, Leila and Mohammadzade-Vizhe, Zahra and Bakhshaei, Mohammad Hossein and Farhadian, Maryam}, title = {Protective Effects of N-Acetyl Cysteine on Cardiac Function in Diabetic Patients Undergoing Coronary Artery Bypass Grafting}, journal = {Iranian Heart Journal}, volume = {22}, number = {2}, pages = {96-100}, year = {2021}, publisher = {Iranian Heart Association}, issn = {}, eissn = {}, doi = {}, abstract = {Background: The preservation of cardiac function in diabetic patients undergoing coronary artery bypass grafting (CABG) would result in improved prognoses in patients. Therefore, in this study, the protective effects of N-acetyl cysteine (NAC) on cardiac function in diabetic patients undergoing CABG were determined.   Methods: This triple-blind, randomized, clinical trial study recruited 240 consecutive diabetic patients undergoing CABG in a referral tertiary health-care center, Hamadan, Iran. The patients were randomly assigned (simple random sampling) to receive either NAC or a placebo. In both groups, ischemic preconditioning was developed with a manometer cuff around the arm. The cuff was filled up to 200 mm Hg for 5 minutes before it was emptied to 0 mm Hg for 5 minutes. This technique was repeated 3 times.   Results: The mean preoperative ejection fraction (EF) and the preoperative myocardial performance index (MPI) were the same in the 2 groups (P>0.05). The postoperative EF and the MPI were not significantly different between the 2 groups (P>0.05). The trend of changes in the EF and the MPI was not different between the groups (P>0.05).   Conclusions: This study demonstrated that NAC in the ischemic preconditioning method did not create a significant effect compared with a placebo, which is in congruence with previous studies in animal models. (Iranian Heart Journal 2021; 22(2): 96-100)}, keywords = {N-acetyl cysteine,Cardiac function,Coronary Artery Bypass,Diabetic Patients,Preconditioning}, url = {http://journal.iha.org.ir/article_128485.html}, eprint = {http://journal.iha.org.ir/article_128485_671cdcc27484d82108ced152f4ceef93.pdf} } @article { author = {Peighambari, Mohammad Mehdi and Piran, Razhan and Peighambari, Shadi}, title = {Efficacy of Verapamil Injection into the Saphenous Vein Graft Before Percutaneous Coronary Intervention in Preventing Slow-Flow and No-Reflow}, journal = {Iranian Heart Journal}, volume = {22}, number = {2}, pages = {101-109}, year = {2021}, publisher = {Iranian Heart Association}, issn = {}, eissn = {}, doi = {}, abstract = {Background: Degenerative plaques in the saphenous vein graft (SVG) are prone to embolization during percutaneous coronary intervention (PCI), resulting in the slow-flow or no-reflow phenomenon and unfavorable PCI outcomes.   Methods: This prospective cohort study was conducted on 63 patients who underwent PCI on the SVG divided into 2 groups. The case group (n=32) received 200 μg of verapamil injection into the SVG before PCI, and the control group (n=31) did not receive verapamil. The primary endpoints comprised slow-flow or no-reflow, the thrombolysis in myocardial infarction (TIMI) flow grade, the TIMI frame count, and the TIMI myocardial perfusion grade after PCI. The secondary endpoints consisted of unstable angina and major adverse cardiac events, defined as a composite of total death, ST-segment or non–ST-segment elevation myocardial infarction, cerebrovascular accident, hospitalization due to heart failure, and revascularization (PCI and coronary artery bypass grafting) during hospitalization and a 3-month follow-up.   Results: The patients who received verapamil injection, compared with the control group, had significantly low rates of slow-flow and no-reflow (4.8% vs 17.5%; P=0.01) and favorable TIMI frame counts (46% vs 12%; P<0.01), TIMI flow grades (31.7% vs 14.3%; P=0.015), and TIMI myocardial perfusion grades (34.9% vs 9.5%; P=0.001). There were no differences in the secondary outcomes during both hospital stay and the 3-month follow-up.   Conclusions: Our study demonstrated that verapamil injection into the SVG before PCI significantly decreased the rate of postprocedural slow-flow and no-reflow and conferred favorable TIMI flow grades, TIMI frame counts, and TIMI myocardial perfusion grades. (Iranian Heart Journal 2021; 22(2): 101-109)}, keywords = {Percutaneous Coronary Intervention,Saphenous vein graft,Calcium-channel blocker}, url = {http://journal.iha.org.ir/article_128486.html}, eprint = {http://journal.iha.org.ir/article_128486_bb098744703cbc19e331e0c74d1250c0.pdf} } @article { author = {Jafari Fesharaki, Mehrdad and Bayat, Fariba and Dalili, Nooshin}, title = {Unusual Presentation of Acute Type A Aortic Dissection in Acute Renal Failure}, journal = {Iranian Heart Journal}, volume = {22}, number = {2}, pages = {110-114}, year = {2021}, publisher = {Iranian Heart Association}, issn = {}, eissn = {}, doi = {}, abstract = {Aortic dissection may present in different forms of unusual signs and symptoms other than chest pain. Many patients come to the emergency department for other reasons, and they are finally diagnosed with aortic dissection. Herein, we describe a patient with kidney transplantation who initially presented with acute renal failure and eventually received a diagnosis of aortic dissection. (Iranian Heart Journal 2021; 22(2): 110-114)}, keywords = {Aortic dissection,Kidney Transplantation,acute renal failure}, url = {http://journal.iha.org.ir/article_128487.html}, eprint = {http://journal.iha.org.ir/article_128487_32c2583395f1693041a7db62ed3ada26.pdf} } @article { author = {Hammami, Rania and Bahloul, Amine and Charfeddine, Selma and Abid, Leila and Gueldiche, Majdi and Kammoun, Samir}, title = {An Uncommon Complication of an Aortic Valve Replacement}, journal = {Iranian Heart Journal}, volume = {22}, number = {2}, pages = {115-118}, year = {2021}, publisher = {Iranian Heart Association}, issn = {}, eissn = {}, doi = {}, abstract = {Acute myocardial infarction after an isolated aortic valve replacement is uncommon. An iatrogenic coronary dissection during coronary cannulation should be kept in mind, and the diagnosis and management of this complication are challenging in such a setting. The patient under analgesia is usually free of symptoms, and the interpretation of troponin elevation during the postoperative period could be complex. We herein describe a male patient who showed a cardiogenic shock and an electrical storm a few hours after an isolated aortic valve surgical operation. Transthoracic and transesophageal echocardiographic examinations demonstrated a very low left ventricular systolic function, no sign of prosthesis dysfunction, and no sign of aortic dissection. Coronary angiography revealed an extensive coronary artery dissection. This dissection concerned the left main and the entire left anterior descending artery. A bailout stenting was performed successfully. We herewith discuss the technical aspects of the management of this case and explain the mechanism of this complication. (Iranian Heart Journal 2021; 22(2): 115-118)}, keywords = {Iatrogenic coronary dissection,Aortic valve replacement,ANGIOPLASTY,Cardiogenic shock,Electrical storm}, url = {http://journal.iha.org.ir/article_128488.html}, eprint = {http://journal.iha.org.ir/article_128488_f7ffd079d197057650936286ececceb4.pdf} } @article { author = {Dalili, Mohammad and Kargarfard-Jahromi, Mohammad-Reza and Kamali, Farzad}, title = {Successful Catheter Ablation in an Infant With Multiple Accessory Pathways and Incessant Arrhythmia}, journal = {Iranian Heart Journal}, volume = {22}, number = {2}, pages = {119-123}, year = {2021}, publisher = {Iranian Heart Association}, issn = {}, eissn = {}, doi = {}, abstract = {Wolff–Parkinson–White (WPW) syndrome is a common cause of supraventricular tachycardia encountered in childhood. We herein describe a 2-month-old male infant with paroxysmal supraventricular tachycardia that was refractory to multiple antiarrhythmic medications. The diagnosis of orthodromic reciprocating tachycardia over multiple accessory pathways was confirmed by meticulous mapping. One of the accessory pathways was located in the mid-septal region, and it acted as the retrograde limb in the arrhythmia circuit. The other accessory pathway was located in the right free-wall region, and it intermittently acted as the antegrade limb of the arrhythmia. Ablating the mid-septal accessory pathway eliminated the arrhythmia. (Iranian Heart Journal 2021; 22(2): 119-123)}, keywords = {Supraventricular tachycardia,Multiple accessory pathways,Infant,Ablation}, url = {http://journal.iha.org.ir/article_128489.html}, eprint = {http://journal.iha.org.ir/article_128489_6a16592eb8fd507517c5082030cbe926.pdf} } @article { author = {Ozkok, Sercin and Calıskan, Muatafa}, title = {An Adult-Onset Patient With Scimitar Syndrome: An Anatomical and Functional Evaluation by Cardiac Magnetic Resonance Imaging}, journal = {Iranian Heart Journal}, volume = {22}, number = {2}, pages = {124-129}, year = {2021}, publisher = {Iranian Heart Association}, issn = {}, eissn = {}, doi = {}, abstract = {Scimitar syndrome is a rare congenital heart disease that presents with a partial anomalous venous connection and a hypoplastic right lung. It has been reported in 0.5% to 1% of all congenital heart diseases. A partial anomalous pulmonary venous structure (scimitar syndrome) draining into the inferior vena cava was detected in a 37-year-old female patient, who presented with mild dyspnea and chest pain. The anomalous pulmonary venous drainage into the inferior vena cava (scimitar syndrome) was diagnosed by cardiac magnetic resonance imaging (CMR) and 3D contrast-enhanced magnetic resonance angiography, which demonstrated the anomalous pulmonary venous connection with a pulmonary-to-systemic flow ratio noninvasively. The patient was referred for surgery without additional interventional imaging. She had a good postoperative course. We herein present 3D magnetic resonance angiography and phase-contrast CMR findings in an adult-onset patient with scimitar syndrome. (Iranian Heart Journal 2021; 22(2): 124-129)}, keywords = {Partial anomalous pulmonary venous connection,Scimitar syndrome,Cardiac magnetic resonance imaging}, url = {http://journal.iha.org.ir/article_128490.html}, eprint = {http://journal.iha.org.ir/article_128490_2aef605fc15035a96f43b52e73efe334.pdf} } @article { author = {Khajali, Zahra and Firouzi, Ata and Ghasemi, Abdolrahim}, title = {Iliac Artery Dissection After Stenting Preductal Coarctation of the Aorta Associated With Severe Pulmonary Artery Hypertension}, journal = {Iranian Heart Journal}, volume = {22}, number = {2}, pages = {130-135}, year = {2021}, publisher = {Iranian Heart Association}, issn = {}, eissn = {}, doi = {}, abstract = {Preductal coarctation of the aorta associated with patent ductus arteriosus (PDA) during adulthood is very rare. We herein describe a 19-year-old female patient with this anomaly who presented with ascites and dyspnea (functional class III). A complete evaluation showed a large PDA, a large ventricular septal defect, severe coarctation of the aorta, severe pulmonary arterial hypertension, and severe biventricular dysfunction. Cardiac catheterization revealed evidence of a left-to-right shunt via the ventricular septal defect and vasoreactivity in the pulmonary artery. Staged interventions were, therefore, planned. The PDA was closed, and the coarctation was relieved with a Covered CP Stent. On the first postprocedural day, the patient complained of leg pain. Physical examination showed that she was pulseless. Once again, she was transferred to the catheterization laboratory, where dissection and thrombosis were detected in the iliac and femoral arteries. Balloon angioplasty and stenting of the iliac artery to the femoral artery were performed successfully. During the follow-up, the lower limb pulses were normal, biventricular function was improved, and pulmonary artery pressure was decreased significantly. (Iranian Heart Journal 2021; 22(2): 130-135)}, keywords = {COARCTATION OF AORTA,Patent ductus arteriosus,Covered stent}, url = {http://journal.iha.org.ir/article_128491.html}, eprint = {http://journal.iha.org.ir/article_128491_7329f9a6ba4536ba0d7449e583075456.pdf} }