ORIGINAL_ARTICLE
INTRAOPERATIVE MAGNESIUM SULFATE CAN REDUCE NARCOTIC REQUIREMENT AFTER CORONARY BYPASS SURGERY
Background: Narcotics are the most common drugs used after cardiac surgery and their side effects, including respiratory depression, hemodynamic instability, nausea and vomiting, and itching are dose dependent. Magnesium is both an N Methyl D Aspartate (NMDA)-receptor and a calcium-receptor antagonist and can modify the important mechanisms of nociception. The purpose of this study was to investigate the effect of magnesium sulfate on the pain score and reducing narcotic requirement in coronary artery bypass grafting surgery (CABG) patients.Methods: This randomized, double blinded, placebo-controlled trial recruited 185 patients (105 male and 80 female) undergoing elective CABG. Mean age was 58±11 years (range=24 to 79 years). The patients were divided into two groups randomly: Group 1 received magnesium sulfate as an IV infusion (80 mg/kg) during a one-hour period post induction and Group 2 received the same volume of normal saline as a placebo. During the postoperative period, the patients’ morphine requirement and pain score (visual analogue scale=scaled as 0 to 10, 0=no pain and 10=worst possible pain) at 6th, 12th, 18th, and 24th hours were recorded and documented.Results: There were no significant differences between the two groups with respect to the baseline data. In the magnesium sulfate group, only 30 (32%) patients needed morphine sulfate, whereas 75 (83%) patients in the placebo group required some doses of morphine sulfate (p value<0.001). The odds ratio showed that magnesium sulfate could strongly prevent the need for opioid analgesics for pain control.Conclusion: The intraoperative use of magnesium sulfate can reduce the need for opioids post CABG.
http://journal.iha.org.ir/article_83322_a063335fa69f659e724f55fa05947276.pdf
2011-03-01
6
11
magnesium sulfate
Coronary Artery Bypass
Narcotics
S. Mostafa
Alavi
1
Cardiac Anesthetist, Department of Anesthesia ; Rajaei Cardiovascular, Medical and Research Center, Tehran, Iran
AUTHOR
Bahador
Baharestani
2
Cardiac Surgery Department of Cardiac Surgery; Rajaei Cardiovascular, Medical and Research Center, Tehran, Iran
LEAD_AUTHOR
Bahram
Fariborz Farsad
3
Pharmacologist, Department of Pharmacology ; Rajaei Cardiovascular, Medical and Research Center, Tehran, Iran
AUTHOR
Hooman
Bakhshandeh
4
Epidemiologist; Department of Epidemiology and Biostatistics ; Tehran University of Medical Sciences and Rajaei Cardiovascular, Medical and Research Center, Tehran, Iran
AUTHOR
Touraj
Babaee
5
Cardiac Anesthetist, Department of Anesthesia ; Rajaei Cardiovascular, Medical and Research Center, Tehran, Iran
AUTHOR
Ali
Sdeghpur
6
Cardiac Surgery Department of Cardiac Surgery; Rajaei Cardiovascular, Medical and Research Center, Tehran, Iran
AUTHOR
Zahra
Faritus
7
Cardiac Anesthetist, Department of Anesthesia ; Rajaei Cardiovascular, Medical and Research Center, Tehran, Iran
AUTHOR
Reza
Golpira
8
AUTHOR
ORIGINAL_ARTICLE
EVALUATION OF 56 CASES OF LONG-SEGMENT ANASTOMOSIS OF LITA TO LAD IN RAJAEI HEART CENTER
Background: Long-segment reconstruction of the diffusely diseased left anterior descending artery (LAD) with left internal thoracic artery (LITA) is one of the methods offered in order to deal with complicated, multiple, and long-segment lesions in the LAD. In this prospective study, we analyzed the results obtained with this technique.Methods: Between Feb. 2007 and Feb. 2009, 56 patients underwent surgery via this technique. The LITA was used as a patch along the opened narrow segment of the LAD from 2 to 8 cm. Data on all the patients were collected, and all the patients were worked up for postoperative complications such as postoperative myocardial infarction, ECG changes, NIHA class, enzymatic changes, and postoperative bleeding. CT-Angiography was performed between 6 to 18 months after surgery in some cases.Results: Fifty-six cases, comprising 42 (75%) men and 14 (25%) women between 43 and 78 years of age (mean age=59.8±9.3 years) with multiple and long-segment lesions in the LAD were included in this study. Preoperative risk factors were hypertension (66.1%), diabetes (57.1%), hyperlipidemia (50%), cigarette smoking (50%), renal failure (1.8%), and positive family history (7.1%). Twenty-three (41.1%) patients had remote and 9 (16.1%) had recent myocardial infarction. Significant left main lesions were found in 7 (12.5%) patients, peripheral vascular disease in 3 (5.3%), and preoperative arrhythmias in 2 (3.6%). The mean number of grafts was 2.85±1.5. Postoperative complications were arrhythmias in 10 (17.8%) patients, postoperative myocardial infarction in 1 (1.8%), surgical bleeding in 7 (12.5%), infections in 3 (5.3%), plural effusion in 3 (5.3%), tamponade in 2 (3.6%), and pericardial effusion in 1 (1.8%), there was no mortality amongst the patients. CT-angiography, performed in 6 patients between the six and eighteenth postoperative months, revealed patent anastomoses in all the patients.Conclusion: Long segment and multiple lesions in the LAD pose a challenge for cardiac surgeons. The results of long segment LAD reconstruction using the LITA are very encouraging.
http://journal.iha.org.ir/article_83289_2fdfde6d9e30f6488d1f1326402528fa.pdf
2011-03-01
12
16
Left anterior descending artery (LAD)
LEFT INTERNAL THORACIC ARTERY (LITA)
LONG-SEGMENT ANASTOMOSIS
B
Baharestani
1
Department of cardiac surgery, Rajaei Cardiovascular, Medical and Research Center
AUTHOR
MH.
Ghaffari Nejad
2
Corresponding author, Department of Cardiac Surgery, Rajaei Cardiovascular, Medical and Research Center
LEAD_AUTHOR
HR
Vafaei
3
Department of cardiac surgery, Rajaei Cardiovascular, Medical and Research Center
AUTHOR
M
Rezaie
4
Department of cardiac surgery, Rajaei Cardiovascular, Medical and Research Center
AUTHOR
ORIGINAL_ARTICLE
PLASMA HOMOCYSTEINE LEVEL AND ITS GENOTYPES AS A RISK FACTOR FOR CORONARY ARTERY DISEASE IN PATIENTS UNDERGOING CORONARY ANGIOGRAPHY
Aims: Hyperhomocysteinemia has recently been identified as a risk for coronary artery disease (CAD). Some genetic variants such as C677T polymorphism are postulated in this regard. We studied the relation between hyperhomocysteinemia and the above genetic variant and the risk of CAD and also the number of involved vessels.Methods: In total, there were 90 patients: 45 with angiographically documented CAD and 45 with the clinical manifestations of CAD but negative angiography. The blood homocystein level was measured using the ELISA and C677T polymorphism using the PCR method.Results: The homocystein level was significantly higher in the case group (p value=0.00), but it did not show any correlation between its level and the extent of CAD. The case group was more homozygote in C677T allele but again it had no relation to the extent of CAD.Conclusion: Hyperhomocysteinemia acts as a CAD risk factor and whilst its presence increases the risk, it does not predict the extent of it.
http://journal.iha.org.ir/article_83293_ad8203581429cc3df3cab63c97462ac8.pdf
2011-03-01
17
21
HYPERHOMOCYSTEINEMIA
Genotype
risk factor
B
Naghshtabrizi
1
AUTHOR
F
Shakerian Ghahferokhi
2
SHAHEED RAJAIE CARDIOVASCULAR AND RESEARCH CENTER, TEHRAN, IRAN
LEAD_AUTHOR
F
Emami
3
AUTHOR
HR
Sanati
4
AUTHOR
ORIGINAL_ARTICLE
THE EFFECT OF PRIMARY BOLUS DOSE OF PANCURONIUM VERSUS CISATRACURIUM WITHOUT MAINTENANCE DOSE ON EXTUBATION TIME IN ADULT CORONARY ARTERY BYPASS GRAFTING
Background: Given the importance of the effect of muscle relaxants on the extubation time in coronary artery bypass grafting (CABG) patients, we sought to assess the difference in "time to extubation" and "intensive care unit (ICU) length of stay" between the primary bolus doses of Pancuronium and Cisatracurium without using the maintenance dose of them during surgery.Methods: This double blind clinical trial divided 110 patients into two equal groups receiving either Cisatracurium or Pancuronium. The patients’ surgical and cardiopulmonary bypass variables were evaluated, and the extubation time and ICU length of stay were compared between the two groups.Results: There was no difference between the two groups regarding the depth of anesthesia, train-offour (TOF) scores at the beginning of anesthesia, and the surgical and cardiopulmonary bypass variables. However, the Cisatracurium patients were extubated earlier and had a shorter ICU length of stay than the Pancuronium patients.Conclusion: An appropriate depth of anesthesia facilitates the administration of the induction dose of Cisatracurium, which confers earlier extubation and shorter ICU length of stay by comparison with Pancuronium.
http://journal.iha.org.ir/article_83299_55c98d34fb8234a32b3fc567e2dd37e6.pdf
2011-03-01
22
26
Coronary artery bypass grafting
CISATRACURIUM
PANCURONIUM
EXTUBATION
S. Zahra
Faritus
1
1Assistant Professor, Cardiac Anesthesiology Dept. Shahid Rajaei Cardiovascular, Medical and Research Center, Tehran, Iran
AUTHOR
Nahid
Aghdaei
2
1Assistant Professor, Cardiac Anesthesiology Dept. Shahid Rajaei Cardiovascular, Medical and Research Center, Tehran, Iran
AUTHOR
Bahman
Naghipour Basmanj
3
Fellowship in Cardiac Anesthesiology, Cardiac Anesthesiology Dept. Shahid Rajaei Cardiovascular, Medical and Research Center, Tehran, Iran
AUTHOR
Forouzan
Yazdanian
4
1Assistant Professor, Cardiac Anesthesiology Dept. Shahid Rajaei Cardiovascular, Medical and Research Center, Tehran, Iran
AUTHOR
Ali
Dabbagh
5
3Associate Professor, Fellowship in Cardiac Anesthesiology, Anesthesiology Research Center and Anesthesiology Dept, Shahid Beheshti University of Medical Sciences, Tehran, Iran
LEAD_AUTHOR
ORIGINAL_ARTICLE
INCIDENCE AND PREDICTORS OF CARDIAC MARKERS ELEVATION AFTER CORONARY INTERVENTION
Objectives: This study evaluated the incidence and predictors of CK-MB and troponin elevation after successful coronary intervention.Background: CK-MB and troponin elevation after coronary intervention correlate with late cardiac events and survival. 1, 2, 19, 24 We investigated the incidence and predictors of CK-MB and troponin elevation in patients who underwent percutaneous coronary intervention in Rajaie Cardiovascular, Medical and Research Center.Results: CK-MB and troponin elevation was detectable in 203 (70%) patients. Predictors of cardiac enzyme elevation were hyperlipidemia, functional class, and smoking. There were no in-hospital adverse events in the CK-MB and troponin elevation group.Conclusion: Cardiac enzyme elevation after coronary intervention was detected in 70% of all our patients and was more common in diffuse atherosclerosis hyperlipidemia, smoking, and high functional class. Enzyme elevation was observed even in the absence of discernible procedural complications, and early discharge of patients with CK-MB and troponin elevation is safe. Midterm survival of patients with CK-MB and or troponin elevation was similar to those with normal enzymes.
http://journal.iha.org.ir/article_83300_a789576ad23fc7c1d34c801045f3505b.pdf
2011-03-01
27
34
PERCUTANEOUS CORONARY INTERVENTION (PCI)
CARDIAC ENZYME (CK-MB AND TROPONIN)
CORONARY LESION TYPES
Hossein
Azarnik
1
Shaheed Rajaie Cardiovascular Medical and Research Center, Mellat Park, Tehran, 19947, Iran .
LEAD_AUTHOR
Hadi
Rezvantalab
2
AUTHOR
Hooman
Bakhshandeh
3
AUTHOR
Anooshirvan
Vakili
4
AUTHOR
Mohsen
Maadani
5
AUTHOR
ORIGINAL_ARTICLE
EFFECT OF ADDING NEOSTIGMINE IN PARAVERTEBRAL BLOCK ON POSTOPERATIVE EXTUBATION TIME IN ELECTIVE CORONARY ARTERY BYPASS GRAFT SURGERY
Introduction: Paravertebral block is a technique of regional anesthesia and is used for a number of purposes. The aim of this study was to assess the effects of adjuvant neostigmine in paravertebral block with bupivacaine for in coronary artery bypass grafting surgery (CABG).Materials and methods: In total, 68 patients were randomly assigned into two groups: bupivacaine alone (B group) and bupivacaine with neostigmine (BN group) for bilateral paravertebral thoracic block at T6 level. Postoperative times for extubation, morphine requirements, and acute pain scores were assessed.Results: The BN group patients were extubated sooner. Also, they needed less morphine in the first twenty-four hours.Discussion: The study suggests that adding neostigmine to bupivacaine in paravertebral block as an adjuvant can have beneficial postoperative effects in patients undergoing elective CABG.
http://journal.iha.org.ir/article_83303_a751f7f3e18e005a390926030c9ab1b7.pdf
2011-03-01
35
39
NEOSTIGMINE
PARAVERTEBRAL BLOCK
Coronary artery bypass grafting
Ali
Dabbagh
1
Associate Professor, Fellowship in Cardiac Anesthesiology,Anesthesiology Research Center and Anesthesiology Dept. Shahid Beheshti University of Medicine, Tehran, Iran
LEAD_AUTHOR
Reza
Alipur
2
Student of PhD Course, Immunology Dept. School of Medicine, Tehran University, Tehran, Iran
AUTHOR
Samira
Rajaei
3
Student of PhD Course, Immunology Dept. School of Medicine, Tehran University, Tehran, Iran
AUTHOR
ORIGINAL_ARTICLE
EVALUATION AND COMPARISON OF USE OF LOW-DOSE APROTININ AND TRANEXAMIC ACID IN CABG: A DOUBLE–BLIND, PROSPECTIVE, RANDOMIZED STUDY OF 150 PATIENTS
Background: Cardiovascular operations are associated with an inherent bleeding tendency that sometime leads to severe bleeding and transfusion requirement. Pharmacologic intervention to minimize post-bypass bleeding and blood product transfusions has received increasing attention for both medical and economic perspectives.Methods: In this double-blind, randomized, placebo-controlled clinical trial, three groups of patients, each comprising 50 patients undergoing on-pump coronary artery bypass grafting surgery (CABG) were blindly randomized to receive either low aprotinin, tranexamic acid, or placebo, the results were subsequently evaluated and compared between the groups.Results: The following variables were similar in the groups, and there were no statistically significant differences in these variables: age (p value=0.308), sex (p value=0.973), hyperlipidemia (p value=0.720), hypertension (p value=0.786), smoking (p value=0.72), and diabetes (p value=0.960). The amounts of drainage from chest tubes were less in the aprotinin and tranexamic acid groups compared to the placebo group, and this was statistically significant (p value<0.001). There was no statistically significant difference in need for reoperation for bleeding between the three groups (p value=0.998). Complications following surgery in the three groups were statistically the same and not significantly different (Table below). All the complications had a good course, and all the patients were discharged from hospital uneventfully. There was no mortality in any group.Conclusions: Low-dose aprotinin and tranexamic acid can significantly reduce blood loss and transfusion requirement in CABG without importantly increasing mortality and morbidity.
http://journal.iha.org.ir/article_83307_9b18fc6bb2279b0f9c7a3795ddf6383b.pdf
2011-03-01
40
44
J.
Hashemi
1
AUTHOR
MH.
Ghaffari Nejad
2
Head of Cardiovascular SurgeryWard, Shaheed Rajaiee Cardiovascular, Medical and Research Center, Tehran, Iran
LEAD_AUTHOR
B.
Baharestani
3
AUTHOR
R
. Esfandiari
4
AUTHOR
A.
Panahipoor
5
AUTHOR
ORIGINAL_ARTICLE
"VALUE "SYMPTOM-BALLOON" TIME IN ACUTE MYOCARDIAL INFARCTION WITH ST ELEVATION PATIENTS TO TREATMENT WITH PRIMARY ANGIOPLASTY WITH STENTING: RESULTS FROM REGISTRY OF PTCA IN ACUTE MYOCARDIAL INFARCTION OF REPUBLICAN RESEARCH CENTRE OF EMERGENCY MEDICINE, TASHKENT, UZBEKISTAN (CASE REPORT)
Acute cardiovascular pathology is the most common causes of death and invalidism in a modern society, among acute disturbance of coronary circulation-acute myocardial infarction (AMI) occupies the leading place. The most important in treatment of patients with ST elevation AMI (STEAMI) at which in 95% of cases is observed full thrombotic occlusion of coronary artery, is restoration of adequate blood flow in arteries and steady maintenance of its tissue perfusion. As known, restoration of an adequate blood flow in infarct-related coronary artery (IRA) by drug management or mechanical way reduces the size of myocardium necrosis, promotes conservation of functional condition of heart, reduces hospital mortality and invalidism in the remote period of observation. Carrying out of emergency PTCA and stenting in early terms of disease provides sufficient blood flow current in the IRA, it limits necrosis zone and prevents development of dilatation and dysfunction of LV. Last decade numerous researches are carried out and results of the registers comparing efficiency of thrombolytic therapy (TLT) and PTCA at STEAMI are analyzed. As a result of comparison of medicamentous and invasive methods of coronary blood flow restoration researchers have come to conclusion that it is necessary to restore coronary blood flow by any accessible way as soon as possible. From the aforesaid the exclusive role of time in successful treatment of patients STEAMI becomes clear.The aim of our work was in a study of clinical efficiency of PTCA and stenting of the IRA in various terms from the symptoms beginning by the retrospective analysis of results of treatment the patients STEAMI.
http://journal.iha.org.ir/article_83310_2d382cf0af2903b5c8d0940757e63ee8.pdf
2011-03-01
45
49
Kh.
Madjitov
1
BABAYEV ST., TASHKET, REPUBLIC OF UZBEKISTAN
LEAD_AUTHOR
ORIGINAL_ARTICLE
MALIGNANT MELANOMA IN THE HEART, WITH FOCUS ON THE HISTOPATHOLOGICAL DIAGNOSIS: REVIEW OF OUR TWO CASES IN A FIVE-YEAR PERIOD (CASE REPORTS)
Over a five-year period, we encountered two cases of malignant melanoma with metastasis to the heart and pericardium. Both patients had a relevant medical history, showing their previous involvement by this tumor. A high index of suspicion, simply provided by a precise clinical history, together with histopathological and cytological studies can be used to diagnose such patients in due course. The preliminary diagnosis is made by echocardiography, by which the tumoral masses are seen in different parts of the heart. Nevertheless, their primary or secondary origin as well as the histogenesis can only be ascertained by pathological studies. Routine staining methods are useful in the demonstration of malignant cells in the tissue or pericardial fluid samples.
http://journal.iha.org.ir/article_83311_f9bef6656e04825928854c56025da3f3.pdf
2011-03-01
50
55
Malignant Melanoma
Metastasis
Heart
PERICARDIUM
Kambiz
Mozaffari
1
SURGICAL PATHOLOGY LABORATORY, SHAHEED RAJAIE CARDIOVASCULAR, MEDICAL AND RESEARCH CENTER, MELLAT PARK, VALI ASR AVE., TEHRAN, IRAN.
LEAD_AUTHOR
Niloufar
Samiei
2
AUTHOR
Safarali
Abdolrahimi
3
AUTHOR
ORIGINAL_ARTICLE
TUMORAL HEART INVOLVEMENT IN MIDDLE-AGED WOMAN WITH DOCUMENTED STERNAL CHONDROSARCOMA
We describe the case of a 47-year-old woman with a history of sternotomy and insertion of a sternal prosthesis six months prior to admission due to sternal chondrosarcoma. The patient was admitted with dyspnea and chest discomfort, which had increased twenty days before admission. Echocardiography showed moderate pericardial effusion with moderate right ventricular enlargement and dysfunction and large gelatinous mass in the right atrium, which had protruded to the right ventricle through the inflow valve. Unfortunately, the patient died before any intervention. Final echocardiography revealed a reduction in the size of the mass, confirming that the patient’s death occurred secondary to metastatic pulmonary emboli.
http://journal.iha.org.ir/article_83314_1bf0307cbc85154ac6eb916d03f343fd.pdf
2011-03-01
53
55
Chondrosarcoma
Cardiac metastasis
M.
Parsaei
1
Dep. of Echocardiography Shaheed Rajaie Center, Tehran, Iran
AUTHOR
M.
Nikparvar
2
CARDIOVASCULAR RESEARCH CENTER, HORMOZGAN
LEAD_AUTHOR
M.
Esmaeilzadeh
3
AUTHOR
ORIGINAL_ARTICLE
DELAYED FRACTURE OF A PFM NIT-OCCLUD FLEX COIL AFTER TRANSCATHETER OCCLUSION OF PATENT DUCTUS ARTERIOSUS
We report the fracture of a 4×4 Nit-Occlud pfm coil in a child with patent ductus arteriosus (PDA), bicuspid aortic valve, and coarctation, detected three years after deployment without any adverse consequent. This report emphasizes the importance of adherence to the user guidelines of the company for the implementation of the device and also shows the significance of lateral chest X-ray in the follow-up of patients after the occlusion of the PDA, particularly in the case of using smallersized, frail pfm coils for the detection of coil fracture.
http://journal.iha.org.ir/article_83319_21f1817be0d44926fb553fa4a073229c.pdf
2011-03-01
56
59
COIL FRACTURE
Patent ductus arteriosus
COARCTATION
Elahe
Malakan Rad
1
Associate professor of pediatric Cardiology Children’s Medical Center Tehran University of Medical Sciences
LEAD_AUTHOR
M.
Meraji
2
LEAD_AUTHOR
H
. Mortezaian
3
AUTHOR
ORIGINAL_ARTICLE
GIANT CORONARY ANEURYSMS AND MASSIVE ANTEROLATERAL MYOCARDIAL INFARCTION IN A SIX-YEAR–OLD BOY WITH KAWASAKI DISEASE: A CASE REPORT
Kawasaki disease occurs across the globe, with Asians being at the highest risk. Approximately, 20% of untreated patients develop coronary artery abnormalities, including aneurysms, and severely affected patients are likely to develop coronary artery thrombosis or stenosis, myocardial infarction, aneurysm rupture, and sudden death.We herein report the case of a 6-year-old boy who developed giant coronary aneurysms, thrombosis, and massive anterolateral myocardial infarction despite appropriate treatment for Kawasaki disease, which make this patient a special case.
http://journal.iha.org.ir/article_83323_d7d0200b8f2915adc8fbb6c0cb910196.pdf
2011-03-01
60
62
Kawasaki disease
Aneurysm
Thrombosis
Yadollahi
farsani Habibollah
1
Associate professor of pediatrics, Hamedan Medical University, Besat Hospital , Iran
AUTHOR
Iraj
Sedighi
2
Associate professor of pediatrics, Hamedan Medical University, Besat Hospital , Iran
AUTHOR
Masume
Jamshidi
3
Corresponding author, Resident of pediatrics, Hamedan Medical University, Besat Hospital , Iran.
AUTHOR
Ahmad
Heidari
4
Resident of pediatrics. Besat Hospital , pediatric department , Hamedan, Iran.
AUTHOR
ORIGINAL_ARTICLE
REOPERATIVE HEMOGLOBINURIA IN A CORONARY ARTERY BYPASS GRAFT CASE WITH HEREDITARY SPHEROCYTOSIS
We present a rare case of hereditary spherocytosis (HS) with intraoperative hemolysis. A 60-yearold man with coronary artery disease, HS, and a history of splenectomy for HS and underwent coronary artery bypass graft surgery under cardiopulmonary bypass, during which he developed severe hematuria and hemolysis and his hemoglobin reached 5g/dL
http://journal.iha.org.ir/article_83324_9b9fbdd850f55d62a49741fa021377f0.pdf
2011-03-01
63
66
HEREDITARY SPHEROCYTOSIS
Hematuria
Coronary artery bypass graft surgery
Vali
Imantalab
1
Assistant professor of cardiac anesthesia, Guilan university of medical sciences HeshmatHeart hospital, Rasht, Iran.
AUTHOR
Abbas
Sedighinejad
2
Assistant professor of cardiac anesthesia, Guilan university of medical sciences HeshmatHeart hospital, Rasht, Iran.
AUTHOR
Gholamreza
Kanani
3
Cardiac surgeon. Member of European Association of Cardiothoracic Surgery and German Association of Cardiothoracic Surgery
AUTHOR
Ali Mohammad
Sadeghi Meibodi
4
Assistant professor of cardiac surgery. Guilan university of medical sciences Heshmat Heart hospital, Rasht, Iran.
AUTHOR
Ali
Mirmansori
5
Assistant professor of cardiac anesthesia, Guilan university of medical sciences HeshmatHeart hospital, Rasht, Iran.
AUTHOR
Mohammad
Haghighi
6
.Assistant professor of anesthesia,Guilan university of medical sciences.Rasht, Iran
AUTHOR