Iranian Heart AssociationIranian Heart Journal2120011201SHORT TERM RESULTS AND LONG TERM OUTCOMES OF CORONARY ANGIOPLASTY FOR CHRONIC TOTAL CORONARY OCCLUSION51183421ENM MOMTAHENS.A ABDIM MALEKIF NOUHIM. KIYAVARH.A. BASIRIM NAGHIBZADEHA.J MOMTAHENH. GHOVEH-NADOSHANJournal Article20190304<strong><em>Background-</em></strong> Angioplasty for chronic total coronary occlusion has remained a technical challenge for the interventional cardiologist, and restenosis rates remained unacceptably high. Recent trials have show that stent placement significantly redu us the rate of restenosis. We evaluated the procedural success and the immediate and long-term clinical outcome of percutaneous transluminal coronary angioplasty (PTCA) for chronic total coronary occlusion (CTO).
<strong><em>Methods and Results-</em></strong> Between November 1998 and October 2000, 147 consecutive patients were submitted to PTCA for CTO. The mean duration of total occlusion was 3.9 <span style="text-decoration: underline;">+</span> 1.4 months. The angiographic success rate was achieved in 92% of patients. There were no deaths and no emergency CABG.
Stenting was performed in 69 patients (50.7%), with stent-like results in the remaining patients (49.3%). The mean duration of clinical follow up was 25 months. The restenosis rate was 44.7% in the PTCA group versus 26% in the stent group (<em>p</em>< 0.01). During the follow-up, target lesion revascularization was performed in 25.4% of PTCA group vs. 11.6% of stent group.
<strong><em>Conclusions-</em></strong> We conclude that percutaneous transluminal coronary angioplasty for chronic total coronary occlusion is a safe procedure with a high success rate. Stent implantation after balloon angioplasty of chronic total coronary occlusion improved long-term outcome and is therefore recommended even after PTCA with stent-like results
Iranian Heart AssociationIranian Heart Journal2120011201THE NATURAL HISTORY OF ECTATIC CORONARY ARTERY DISEASE121683413ENM.A. SADR-AMELIMellat Park, Vali Asr Avenue, Tehran, IranM. SHARIFIJournal Article20190304<span style="font-size: large;">Background-</span><span style="font-size: large;"> Coronary artery ectasia (CAE) is considered an accompaniment or variant of coronary atherosclerosis. The contribution of CAE, either isolated or in association with obstructive coronary artery disease, to morbidity and mortality from ischemic heart disease is not well defined.</span>
<span style="font-size: large;">Methods and Results-</span><span style="font-size: large;"> To study the clinical and historical features and the natural history of CAE, the epidemiological, clinical, angiographic, and follow-up characteristics of three groups of patients were examined: Group A, 72 patients with CAE and coexisting coronary artery disease (CAD); group B, 45 patients with CAE only; group C, 153 patients with significant CAD but without ectasia, matched for sex, age and risk factors with group A. </span>
<span style="font-size: large;">Group A had a similar incidence of an old myocardial infarction (MI) to group C (75% vs. 77%), exercise tolerance, severity of stenotic lesions (CASS score 2.2 vs. 2.18), and similar involvement and distribution of diseased vessels. At follow up of two years, they had a similar incidence of unstable angina (6.8% vs. 4.4%) and MI plus cardiac death (5.1% vs. 6.2%). They underwent coronary bypass surgery with similar frequency (40% vs. 43%) but a lower frequency of coronary angioplasty (5.7% vs. 16.8%). Patients with pure CAE (group B) had a lower incidence of MI (25%, p<0.05) than the two other groups. The infarct was related to an ectatic coronary artery. Their exercise tolerance and ejection fraction were higher than those in groups A and C. Group B had no MI, cardiac death, surgery, or intervention at follow-up, but 5.8% of these patients developed unstable angina.</span>
<span style="font-size: large;">Conclusions-</span><span style="font-size: large;"> CAE does not confer risk in patients with coexisting stenotic CAD. In spite of a history of previous MI, patients with pure CAE have a good prognosis.</span>Iranian Heart AssociationIranian Heart Journal2120011201DYSLIPIDEMIA AND ITS MANAGEMENT IN ETHNIC IRANIANS172283414ENM MALEKIMellat Park, Vali Asr Avenue, Tehran, IranA.R. GHORBANI-SHARIFF. ADLS. OURAEIJournal Article20190304<strong><em><span style="font-size: large;">Background-</span></em></strong><span style="font-size: large;"> Coronary artery disease (CAD) is the most common cause of mortality in industrial countries. Many risk factors are recognized for predisposing of atherosclerosis in coronary arteries. An the control of risk factors are the basis of primary and secondary prevention, this study has been done for diagnosis and management of hyperlipidemia as one of major risk factors for CAD.</span>
<strong><em><span style="font-size: large;">Methods and Results-</span></em></strong><span style="font-size: large;"> Among 3000 patients who were referred to Rajai Heart Center’s risk factor clinic during 1996-1998, 528 patients were selected randomly. 485 patients (92%) had hyperlipidemia of whom nearly 79% had type II hyperlipidemia. There was no significant statistical relation between age and level of hyperlipidemia. The effect of gender on hyperlipidemia was seen in HDL (high density lipoprotein) among the 40-49 year age group. All of the patients were put on diet therapy for 2 months and if there was no response, therapy with fluvastatin, cholestyramine, gemfibrozil or a combination of two was initiated. The fluvastatin group showed a reduction of cholesterol, triglycerides (TG) and low density lipoprotein (LDL) by 17.2%, 9% and 23.7% respectively, and an increase of 7.4% in HDL level. Gemfibrozil induced a reduction of cholesterol and TG by 12% and 46.9% and cholestyramine caused a reduction of 10 % and 14.7% in cholesterol and TG and increase of 10% in HDL. The best response to</span><span style="font-size: large;"> therapy</span><span style="font-size: large;"> was seen in a combination of fluvastatin and gemfibrozil, in type IIb hyperlipidemia.</span>
<strong><em><span style="font-size: large;">Conclusions-</span></em></strong><span style="font-size: large;"> Response to diet therapy was lesser than other countries. The response to gemfibrozil was similar to other studies and response to a combination of gemfibrozil and fluvastatin were prominent</span>
Iranian Heart AssociationIranian Heart Journal2120011201RELATIONSHIP BETWEEN QTC INTERVAL AND CARDIAC AUTONOMIC NEUROPATHY IN DIABETES MELLITUS232883415ENM. POUR MOGHADASIsfahan University of Medical Sciences, Isfahan, IranM. SHOLEVARA. POURMOGHADDASJournal Article20190304<strong><em><span style="font-size: medium;">Background-</span></em></strong> <span style="font-size: medium;">Cardiovascular complications are the most common cause of mortality and morbidity in non-insulin dependent diabetes mellitus (NIDDM). Autonomic neuropathy is one of the complications of NIDDM, which may also involve the cardiovascular system. Autonomic system abnormality may increase the QTc interval. On the other hand, patients with prolonged QTc interval are prone to ventricular arrhythmia, especially unique torsade-de-points and also sudden cardiac death. This study intends to detect the prevalence of QTc prolongation in diabetic and non-diabetic patients as well as its correlation with diabetic autonomic neuropathy. </span>
<strong><em><span style="font-size: medium;">Methods and Results-</span></em></strong><span style="font-size: medium;"> This study includes 200 diabetic (case) and 200 non-diabetic patients (control group) with comparable age and gender. Evaluation of autonomic nervous system was carried out in all cases with prolonged QTc interval as well as in the control group. The results of study in the case and the control group were compared.</span>
<span style="font-size: medium;">The prevalence of prolonged QTc interval was significantly higher in the case group in comparison with the control group, 8% vs. 2%, respectively (<em>p</em> value = 0.012, OR = 4.3). Sympathetic nervous system evaluation in cases with QTc interval prolongation and negative exercise test demonstrated abnormal results in more than 50% of the case group (OR = 3). Parasympathetic nervous system evaluation test in the case group showed abnormal results in comparison to the control group (OR = 9).</span>
<span style="font-size: medium;">Abnormality of the parasympathetic nervous system was three times more common than abnormality in the sympathetic nervous system.</span>
<strong><em><span style="font-size: medium;">Conclusions- </span></em></strong><span style="font-size: medium;">With regard to the prolonged QTc interval in the case group in comparison with the control group and abnormal autonomic nervous system function in more than half of the case group, the probability of ventricular arrhythmia, torsade de points, is increased. The mentioned group is at increased risk of sudden cardiac death. Rendering approaches for decreasing the risk of sudden cardiac death in diabetic patients is seriously recommended</span>Iranian Heart AssociationIranian Heart Journal2120011201A COMPARATIVE EVALUATION OF CLINICAL USE OF CENTRIFUGAL PUMPS AND ROLLER PUMPS IN CORONARY BYPASS SURGERY293283416END JAVIDIDr. Shariati Hospital, North Kargar Ave. Tehran, IranJournal Article20190304<strong><em> Background-</em></strong> Because of simplicity of application, universal access and low cost, centrifugal pumps are commonly used for short-term mechanical cardiac assist. Indications and techniques for the application of this technology continue to evolve.
The study was undertaken to determine the advantages of the centrifugal pump over the roller pump, concerning effects on blood elements and some clinical outcomes.
<strong><em> Method and Result-</em></strong> A total of 149 patients undergoing cardiopulmonary bypass (CPB) were studied prospectively. They were divided into two groups; group A were perfused with a centrifugal pump during surgery, and group B were perfused with a roller pump. We compared blood elements (RBC, WBC, Hg and platelets) and renal function tests including BUN and creatinine, duration of cross clamp, bypass time and duration of hospital stay in these two groups.
<strong><em> Conclusion-</em></strong> The group that was perfused with a centrifugal pump had a statistically significant decrease in changes in their blood elements, and shorter duration of recovery and hospital stay.Iranian Heart AssociationIranian Heart Journal2120011201ATYPICAL FORM OF ATRIOVENTRICULAR NODAL REENTRANT TACHYCARDIA: LESS THAN EXPECTED334083417ENA YAMINI SHARIFDr. Shariati Hospital, North Kargar Ave. Tehran, IranMANSOUR MOGHADAMJournal Article20190304<strong><em> Background-</em></strong> In the typical or common form of atrioventricular nodal reentrant tachycardia (AVNRT) the anterograde limb of the reentrant circuit is a relatively slowly conducting pathway (the slow pathway) and the retrograde limb is a relatively rapidly conducting pathway (the fast pathway). In the atypical form of (AVNRT), anterograde conduction is via the fast pathway and retrograde conduction is via the slow pathway and it is associated with a long R-P interval.
<strong><em> Methods and Results-</em></strong> Among 133 Iranian patients with frequent episodes of AVNRT, which was documented by electrophysiologic study and radiofrequency (RF) catheter ablative therapy, only one patient had atypical form of AVNRT; thus the incidence was 0.75% in our patients. Slow pathway ablation was performed on our patient with atypical form of AVNRT without any complications. In 3 years of follow-up, the patient was free of arrhythmia without any anti-arrhythmic drugs.
<strong><em> Conclusions- </em></strong>This study demonstrates that the incidence of atypical AVNRT in our patients was less than proviously reported srudies.
Iranian Heart AssociationIranian Heart Journal2120011201CORRELATION OF HLA CLASS 2 WITH CORONARY ARTERY DISEASE414383418ENM MALEKIMellat Park, Vali Asr Avenue, Tehran, IranF NOUHINADER GIVTAJF BAGHERIAN NEJADJournal Article20190304Background- This study was designed to investigate whether isolated genetic factors, controlled by genes in the HLA chromosomal region, could be indicated as independent contributing influences in genesis of coronary artery disease (CAD).
Methods and Results- Twenty-four patients with fixed obstructive CAD documented by coronary angiography had no coronary risk factors with respect to age, levels of serum cholesterol, fasting TG, blood glucose, blood pressure, obesity, a history of diabetes mellitus or hypertension, cigarette smoking history, left ventricular hypertrophy, and abnormal body mass index. 4 patients also had a positive family history of CAD. HLA typing was limited to antigens of DR & DQ loci.
Control subjects (n = 12) were normal. As our sample volume was low, the analysis was not meaningful; therefore we accepted meaningful as 0.1. At DR1, DR2, DR3, DR7, DR10, DR14, DR15, DQ1, DQ2 loci, no antigens demonstrated an observed frequency significantly higher than that expected from the control population. At DR4, DR11, DQ3 loci had significantly greater frequency (45.5%, 37.5%, and 70.8%) with p values that were 0.086, 0.069, 0.02 respectively in the study group with CAD than in the control population (16.7%, 8.3%, 41.7%) with odds ratios of 4.23, 6.6, 3.4 for CAD if the patient had an antigen respectively.
Conclusions- Our data suggest a statistically significant trend between the presence of HLA - DR4, DR11 and DQ3 and CADIranian Heart AssociationIranian Heart Journal2120011201RECURRENT CANDIDA INFECTIVE ENDOCARDITIS IN MECHANICAL PROSTHETIC HEART VALVES444683419ENM.A YOUSEFNIAMellat Park, Vali Asr Avenue, Tehran, Iran.M JANATIJournal Article20190304Fungi account for about 1% of all cases of infective endocarditis. Two-thirds of cases of fungal endocarditis are due to <em> Candida</em>, and one-third are due to <em>Aspergillus</em> species.
This is a case report of a 36-year-old male, a known case of rheumatic valvular heart disease of the native aortic and mitral valves. Two years after the replacement of the aortic and mitral valves with prosthetic valves, he developed two consecutive episodes of prosthetic valve endocarditis. The results of sputum and blood cultures were negative and Elisa test was non-reactive. This patient was a healthy male without risk factors for immunodeficiency state and without a history of consumption of immunosuppressive drugs. This case emphasizes the need to regard fungal infection as a cause of prosthetic heart valve endocarditis even in healthy patients for early diagnosis and treatmentIranian Heart AssociationIranian Heart Journal2120011201SIMULTANEOUS AORTIC ROOT REPLACEMENT AND REPAIR OF SUBCLAVIAN ARTERY ANEURYSM IN PATIENT WITH MARFAN SYNDROME475183420ENA AMIR GHOFRANFaghihi Hospital, Shiraz, IranB AMINIANH. HOJATIF. SALIMIJournal Article20190304Patients with Marfan syndrome frequently develop aneurysms or dissections involving multiple segments of the aorta and major arteries and occasionally require staged replacement of different portions of the aorta. We are presenting a Marfan patient with severe sternal and vertebral deformity and simultaneous presence of a dissected aortic root aneurysm and a saccular aneurysm of the right subclavian artery. The aortic root was totally replaced including the aortic valve and the ascending aorta, and the right subclavian artery aneurysm was bypassed by an aorta-axillary graft with exclusion of the aneurysm. Post-op course was complicated by repeated attacks of ventricular fibrillation based on long Q-T intervals, which was successfully managed by mexiletine. The case is reported and general management of Marfan patients discussed