Iranian Heart AssociationIranian Heart Journal17420161201Assessment of Long- and Short-Term Complications of Percutaneous Patent Foramen Ovale Closure in Patients With Cerebrovascular Events or Peripheral Embolism Over a 12-Year Period Starting in 199861683153ENMohsenMadaniCardiovascular Intervention Research Center, Rajaie Cardiovascular, Medical, and Research Center, Iran University of Medical Sciences, Tehran, I. R. IranFaramarzAmiriRajaie Cardiovascular, Medical, and Research Center, Iran University of Medical Sciences, Tehran, I. R. IranMohammad KazemMaherCardiovascular Intervention Research Center, Rajaie Cardiovascular, Medical, and Research Center, Iran University of Medical Sciences, Tehran, I. R. Iran.Ali ZahedmehrZahedmehrCardiovascular Intervention Research Center, Rajaie Cardiovascular, Medical, and Research Center, Iran University of Medical Sciences, Tehran, I. R. Iran.BahramMohebiCardiovascular Intervention Research Center, Rajaie Cardiovascular, Medical, and Research Center, Iran University of Medical Sciences, Tehran, I. R. Iran.JamalMoosaviCardiovascular Intervention Research Center, Rajaie Cardiovascular, Medical, and Research Center, Iran University of Medical Sciences, Tehran, I. R. Iran.Journal Article20190228Background: Observational studies have favored percutaneous patent foramen ovale (PFO) closure over medical treatment for the reduction of recurrent stroke, as randomized trials have failed to demonstrate the significant superiority of percutaneous PFO closure. A few long- term studies are available on post-PFO closure outcome. This study reports long- and short- term clinical outcomes after percutaneous PFO closure. Methods: Between January 1998 and January 2015, we enrolled 51 (32 men [62.7%] and 19 [37.3%] women) consecutive eligible patients with cerebrovascular events or peripheral embolism, presumably related to PFOs, who underwent percutaneous PFO closure in our center. All the patients’ documents and clinical data were assessed. Of the entire study population, telephone contacts were applied in 47 cases. The mean follow-up time was 46.51 ± 43.43 months. The main criterion for closure was patients with at least 1 cryptogenic stroke or peripheral embolism associated with PFOs. Results: Percutaneous PFO closure was successfully performed in 51 patients. No cardiovascular or cerebrovascular deaths occurred. The mean follow-up time was 46.51 ± 43.43 months. Long-term device-related complications were cerebrovascular accidents in 3 (5.88%) patients (2, 3, and 4 y after the procedure) and open heart surgery in 1 (1.96%). The short- term complications were atrial fibrillation in 1 (1.96%) patient, air embolism in 2 (3.92%), hematoma in 2 (3.92%), and tamponade in 1 (1.96%). Conclusions: Percutaneous PFO closure was associated with a very low risk of recurrent stroke. We observed no cardiovascular or cerebrovascular mortality; however, there were a few short- and long-term device-related complications. Thus, percutaneous PFO closure is a safe treatment even in the long term. (Iranian Heart Journal 2017; 17(4): 6-16)https://journal.iha.org.ir/article_83153_6e822618c30449cfabec9b22a7de1425.pdfIranian Heart AssociationIranian Heart Journal17420161201Relationship Between the Pulmonary Artery Pressure and the Occurrence of Atrial Fibrillation After Coronary Artery Bypass Graft Surgery172083154ENSomayehBeikmohammadiRajaie Cardiovascular,Medical,and Research Center, Iran University of Medical Sciences, Tehran, IR. Iran.Hamid RezaSanatiCardiovascular Intervention Research Center, Rajaie Cardiovascular, Medical,and Research Center, Iran University of Medical Sciences, Tehran, IR. Iran.Mohammad MehdiPeighambariCardiovascular Intervention Research Center, Rajaie Cardiovascular, Medical,and Research Center, Iran University of Medical Sciences, Tehran, IR. Iran.Mohammad MostafaAnsari-RamandiRajaie Cardiovascular,Medical,and Research Center, Iran University of Medical Sciences, Tehran, IR. IranMehrdadAzimiRajaie Cardiovascular,Medical,and Research Center, Iran University of Medical Sciences, Tehran, IR. IranAliZahedmehrCardiovascular Intervention Research Center, Rajaie Cardiovascular, Medical,and Research Center, Iran University of Medical Sciences, Tehran, IR. Iran.AtaFirouziCardiovascular Intervention Research Center, Rajaie Cardiovascular, Medical,and Research Center, Iran University of Medical Sciences, Tehran, IR. Iran.EzaKianiCardiovascular Intervention Research Center, Rajaie Cardiovascular, Medical,and Research Center, Iran University of Medical Sciences, Tehran, IR. Iran.FarshadShakerianCardiovascular Intervention Research Center, Rajaie Cardiovascular, Medical,and Research Center, Iran University of Medical Sciences, Tehran, IR. Iran.OmidShafeCardiovascular Intervention Research Center, Rajaie Cardiovascular, Medical,and Research Center, Iran University of Medical Sciences, Tehran, IR. Iran.Journal Article20190228Background: Atrial fibrillation (AF) is one of the most common complications after cardiac surgeries. The incidence of postoperative AF has risen continuously over the past decades. AF is associated with lengthened hospital stays and risk of stroke. We sought to study the relationship between the pulmonary artery pressure (PAP) and the occurrence of AF after coronary artery bypass graft surgery (CABG). Methods: This prospective observational study was designed to assess the relationship between the PAP and the occurrence of post-CABG AF. Patients with chronic and paroxysmal AF before surgery were excluded. All the patients had complete evaluation via echocardiography, ECG, and laboratory testing. The patients were monitored for 3 days after surgery, and any tachycardia monitored as AF was noted. The study population was divided into 2 groups: with postoperative AF and without AF. Results: We ed 232 patients, 106 with AF and 126 with sinus rhythm. The results confirmed that the occurrence rate of AF after CABG was higher in the older patients (P ≤ 0.001). Both univariate and multivariate analyses showed a significant relationship between a higher occurrence rate of post-CABG AF and a higher PAP (mean value = 26.5 vs 20 mm Hg) in the patients (P ≤0.001 and P = 0.01, respectively). Conclusions: Although age has been the most important predictor for the occurrence of AF after CABG in the past and present studies, there are many other variables affecting its occurrence. Among the variables evaluated in this study, a higher PAP was a significant predictor for a higher occurrence rate of AF following CABG. (Iranian Heart Journal 2017; 17(4): 17-20)https://journal.iha.org.ir/article_83154_e620e32a8fb45a92d9e0cd2d018bd932.pdfIranian Heart AssociationIranian Heart Journal17420161201Effects of Primary PCI on Acute Inferior ST-Elevation MI With Complete Heart Block212583155ENVajiheDorostiRajaie Cardiovascular,Medical,and Research Center, Iran University of Medical Sciences, Tehran, I. R. Iran.AtaFirouziCardiovascular Intervention Research Center, Rajaie Cardiovascular,Medical,and Research Center, Iran University of Medical Sciences, Tehran,I. R. IranHosseinTorabi GolsefidRajaie Cardiovascular,Medical,and Research Center, Iran University of Medical Sciences, Tehran, I. R. Iran.AlirezaJebeliRajaie Cardiovascular,Medical,and Research Center, Iran University of Medical Sciences, Tehran, I. R. Iran.Journal Article20190228Background: Complete heart block is a common complication among patients with acute inferior myocardial infarction (MI) and leads to increased mortality. The aim of this study was to evaluate complete atrioventricular block after mechanical revascularization (primary percutaneous coronary intervention [PCI]) in acute inferior MI. Methods: This retrospective study enrolled 418 patients with acute inferior MI, who underwent primary PCI in Rajaie Cardiovascular, Medical, and Research Center between 2011 and 2014. Thirty-eight (9%) patients had complete heart block. Three patients expired < 14 days after PCI and were excluded the study due to lack of follow-up. The restoration of the sinus rhythm, need for permanent pacemaker (PPM) implantation, and heart-block recovery time were compared between the other 35 patients. Results: Among the 35 patients, the sinus rhythm was restored in 34 cases after a mean time of 50 hours. In 1 case, 14 days after primary PCI, PPM implantation was done due to the persistence of the heart block. Neither the restoration of the sinus rhythm and nor PPM implantation had a statistically significant correlation with primary PCI. Among the 34 patients, the heart-block recovery time was significantly longer (P < 0.05) in the diabetics and in those with QRS > 120 ms in the initial ECG. This time was significantly shorter in the patients undergoing successful stenting and the patients undergoing balloon angioplasty and was very significantly shorter in the patients with a TIMI flow of 3 after revascularization. In this study, the block recovery time was not correlated with the location of the lesions in the coronary arteries, with thrombosuction, and with IIb/IIIa inhibitor infusion. Age; gender; history of hypertension, dyslipidemia, and smoking; and very severe left ventricular dysfunction did not have any effect on this time. Conclusions: In light of the results of the current study, it can be concluded that mechanical revascularization in patients with acute inferior MI complicated with complete heart block is not effective on the restoration of the sinus rhythm and need for PPM implantation. Nonetheless, the heart-block recovery time is significantly decreased and correlated with successful stenting and balloon angioplasty. (Iranian Heart Journal 2017; 17(4): 21-25)https://journal.iha.org.ir/article_83155_e83193bbca16feb25ca7c49559317a7d.pdfIranian Heart AssociationIranian Heart Journal17420161201A Survey on Mechanical Prosthetic Pulmonary Valve Replacement in Rajaie Cardiovascular, Medical, and Research Center:7 Years’ Experience262983156ENMohammad AliSadr-AmeliCardiovascular Intervention Research Center, Rajaie Cardiovascular,Medical,and Research Center, Iran University of Medical Sciences, Tehran, I.R. Iran.TaherehZandi KermanshahiDepartment of Anesthesiology, ModaresGeneral Hospital, Shahid Beheshti University of Medical Sciences, Tehran, I.R. IranMohammad MehdiPeyghambariCardiovascular Intervention Research Center, Rajaie Cardiovascular,Medical,and Research Center, Iran University of Medical Sciences, Tehran, I.R. Iran.Mandana AmirSardariRajaie Cardiovascular,Medical,and Research Center, Iran University of Medical Sciences, Tehran, I.R. Iran.HoomanBakhshandehRajaie Cardiovascular,Medical,and Research Center, Iran University of Medical Sciences, Tehran, I.R. Iran.MaryamShojaeifardEchocardiography Research Center,Rajaie Cardiovascular,Medical,and Research Center, Iran University of Medical Sciences, Tehran, I.R. Iran.MasoomehFooladiRajaie Cardiovascular,Medical,and Research Center, Iran University of Medical Sciences, Tehran, I.R. Iran.MaryamMoradianRajaie Cardiovascular,Medical,and Research Center, Iran University of Medical Sciences, Tehran, I.R. Iran.Journal ArticleBackground: The present study aimed to assess the postoperative consequences and clinical course after mechanical prosthetic pulmonary valve replacement (PVR) in patients candidated for this procedure. Methods: In a retrospective study, by referring and reviewing surgical reports at Rajaie Cardiovascular, Medical, and Research Center, between 2006 and 2013, patients’ characteristics were assessed. Eligible patients were those who underwent PVR because of significant pulmonary insufficiency, and postoperative consequences and clinical courses were assessed retrospectively. Results: In total, 415 patients underwent PVR. The most common underlying etiology was tetralogy of Fallot, with a prevalence of 88.9%, followed by concomitant pulmonary stenosis, with a prevalence of 11.1%. Only 1.5% of the patients had malfunction in their mechanical prostheses. During the follow-up, no death was reported. Regarding the clinical course of the disease after surgery, 3.1% of the patients suffered hemorrhagic events. None of the patients developed thromboembolic events. The 1-, 2-, and 3-year hemorrhagic-free survival rates were 98.9%, 98.4%, and 97.2%, respectively. Conclusions: Regardless of the occurrence of postprocedural malfunction, PVR had an appropriate midterm outcome with rare mortality and morbidity among our study population. Our study showed that an appropriate anticoagulation support was able to confer a proper outcome vis- à-vis thromboembolic or hemorrhagic events. (Iranian Heart Journal 2017; 17(4): 26-29)https://journal.iha.org.ir/article_83156_65775a7994d1c6649114bd43b985f2c2.pdfIranian Heart AssociationIranian Heart Journal17420161201Postoperative Outcome of the Transcatheter Closure of Atrial Septal Defects Using the AMPLATZER Septal Occluder303583158ENMarziehNasiri BrojeniRajaieCardiovascular,Medical,and Research Center, Iran University of Medical Sciences, Tehran, I.R. Iran.ParisaSeilanRajaieCardiovascular,Medical,and Research Center, Iran University of Medical Sciences, Tehran, I.R. Iran.MozhganParsaeeEchocardiography Research Center, Rajaie Cardiovascular Medical,and Research Center, Iran University of Medical Sciences, Tehran, I.R. Iran.SedighehSaediRajaieCardiovascular,Medical,and Research Center, Iran University of Medical Sciences, Tehran, I.R. IranJournal Article20190228Background: The AMPLATZER Septal Occluder (ASO) has successfully replaced surgery for the repair of atrial septal defects (ASDs) within the last decade. However, the outcome and clinical consequences of this procedure have not been fully assessed. Hence, the present study aimed to determine the results of the application of the ASO in the nonsurgical transcatheter closure of ASDs. Methods: Forty-seven consecutive patients were assessed via transesophageal echocardiography to determine secundum ASDs. The study end points were the assessment of the echocardiographic consequences of ASD closure using the ASO and also the determination of the presence of postoperative complications. The patients were reassessed via transthoracic echocardiography 1 day, 1 month, and also 6 months after the intervention. Results: An assessment of the trend of the changes in right ventricular dimension and functional status showed a significant decrease in right ventricular size as well as improvement in function within 6 months after ASD closure using the ASO. The mean pulmonary artery pressure was also significantly decreased. Unsuccessful ASD closure was detected in only 3 patients, with an overall failure rate of 6.4%. Regarding postoperative complications, device displacement was found in 2.1%, interatrial septum rupture in 12.8%, small pericardial effusion in 12.8%, tamponade in 2.1%, and small residual ASDs in 12.8%, all of which were resolved procedurally within the following month. Conclusions: The clinical efficacy of the nonsurgical transcatheter closure of ASDs with the ASO was underlined in our experiment, indicating that it is a good and standard alternative to surgical repair. (Iranian Heart Journal 2017; 17(4): 30-35)https://journal.iha.org.ir/article_83158_d2d8c0f1e97017883799eeb270accbf4.pdfIranian Heart AssociationIranian Heart Journal17420161201Effects of a Nursing Supportive Program on Anxiety and Stress Levels in the Family Members of Patients After Cardiac Surgery in the ICU364183159ENTayebeRezaeiRajaie Cardiovascular,Medical,and Research center, Iran University of Medical Sciences, Tehran, I.R. Iran.RasoulAzarfarinEchocardiography Research Center, Rajaie Cardiovascular,Medical,and Research Center, Iran University of Medical Sciences, Tehran, I.R. Iran.ZiaeTotonchiRajaie Cardiovascular,Medical,and Research center, Iran University of Medical Sciences, Tehran, I.R. Iran.HoomanBakhshandehRajaie Cardiovascular,Medical,and Research center, Iran University of Medical Sciences, Tehran, I.R. Iran.AzinAlizadehaslEchocardiography Research Center, Rajaie Cardiovascular,Medical,and Research Center, Iran University of Medical Sciences, Tehran, I.R. Iran.SolmazFakhariDepartment of Anesthesiology, Faculty of Medicine, Tabriz University of Medical Sciences, Tabriz, I.R.IranJournal Article20190228Background: This research was conducted to investigate the effects of a nursing supportive program on anxiety and stress levels in the family members of patients admitted to the intensivee care unit (ICU) after cardiac surgery. Methods: This research was a quasi-experimental study. A control group and an intervention group (each = 35), both comprised of the family members of post-cardiac surgery patients admitted to the ICU, were studied. The intervention group received a nursing supportive program initially 2 hours after their patients entered the ICU (1st day) and thereafter on the 2nd and 3rd days. The control group received only the routine information. Demographic variables and an adjusted Depression Anxiety Stress Scales (DASS-21) were used to assess the anxiety and stress levels of the family members of the patients. Results: Demographic variables and the DASS scores had no statistically significant differences in stress levels between the 2 groups before the intervention. However, after the intervention, the mean score of the stress level in the intervention group dropped significantly in comparison with the control group (P = 0.0001). Anxiety levels in both groups were reduced after the intervention. However, although a statistically significant difference was observed between the 2 groups 2 hours after ICU admission and on the 2nd ICU day (P = 0.0001), there was no significant difference on the 3rd ICU day (P = 0.993). Conclusions: In light of the findings of the present study, our nursing supportive program, which was aimed at providing information, emotional and mental support, and reassurances to the family members of post-cardiac surgery patients hospitalized in the ICU, was able to decrease their stress levels and to some extent their anxiety levels. (Iranian Heart Journal 2017; 17(4): 36-41)https://journal.iha.org.ir/article_83159_bec8101e09b530094d4a9a5cb2aa8970.pdfIranian Heart AssociationIranian Heart Journal17420161201Echocardiographic Evaluation of Right Ventricular Function After Pulmonary Valve Replacement in Patients With Tetralogy of Fallot424883160ENMaryamMoradianRajaie Cardiovascular,Medical,and Research Center, Iran University of Medical Sciences, Tehran, I.R.Iran.NooraldinMomeniDepartment of Pediatric Cardiology, Baqiyatallah Hospital, BaqiyatallahUniversity of Medical Sciences,Tehran, I.R.IranBehshidGhadrdoostRajaie Cardiovascular,Medical,and Research Center, Iran University of Medical Sciences, Tehran, I.R.IranHojatMortezaeianCardiovascular Research Center, Rajaie Cardiovascular,Medical,and Research Center, Iran University of Medical Sciences, Tehran, I.R. Iran.MohamadRafi KhorgamiRajaie Cardiovascular,Medical,and Research Center, Iran University of Medical Sciences, Tehran, I.R.IranJournal Article20190228Background: Pulmonary regurgitation is a common complication after tetralogy of Fallot total correction (TFTC). Some of these patients may be candidated for pulmonary valve replacement (PVR) because right ventricular (RV) dysfunction will occur ultimately when a transannular patch has been used. The aims of this study were to evaluate echocardiographic parameters in patients who underwent PVR after TFTC and to determine their outcomes in reference to their preoperative status. Methods: Twenty-six patients with severe pulmonary regurgitation, who underwent PVR after TFTC with the transannular patch in Rajaie Cardiovascular, Medical, and Research Center, were enrolled. Some echocardiographic parameters were assessed before PVR and subsequently 1 and 3 months afterward. Results: Of the echocardiographic parameters, the RV ejection fraction was significantly improved 1 month after PVR (P <0.001), while tricuspid annular plane systolic excursion (TAPSE) was not changed significantly at 1 month postoperatively (P = 0.27). TAPSE and the RV ejection fraction were increased significantly at 3 months postoperatively (P < 0.005). The myocardial performance index (MPI) in both left and right ventricles showed a statistically significant reduction 3 months after PVR (P < 0.001). Conclusions: Our data showed that the RV ejection fraction changed early post PVR, while the changes in the MPI and TAPSE for both ventricles occurred later. Accordingly, these echocardiographic parameters should be evaluated and recorded serially in patients with TFTC. Additionally, these quantitative parameters should be assessed in the follow-up of patients after PVR. (Iranian Heart Journal 2017; 17(4): 42-48)https://journal.iha.org.ir/article_83160_2258d2991c26f9159cb37712732d2a1e.pdfIranian Heart AssociationIranian Heart Journal17420161201Development of Heart Failure Following Pace Maker Implantation in a Patient With Congenital Heart Block495283161ENKobraDoostaliDepartment of Cardiology, Shahid Beheshti, Qom University of Medical Sciences,Qom, I.R.IranSedighehSaediRajaie Cardiovascular,Medical,and Research Center, Iran University of Medical Sciences, Tehran, I.R.Iran.TaherehSaediRajaie Cardiovascular,Medical,and Research Center, Iran University of Medical Sciences, Tehran, I.R.Iran.Journal Article20190228Congenital complete heart block (CCHB) is a rare anomaly and is a potential indication for pacemaker implantation. However, pacemakers might lead to cardiomyopathy. Here we describe a young woman with CCHB presenting with heart failure early postpartum and pacemaker implantation.https://journal.iha.org.ir/article_83161_c8c09abcc0bcc60abbbedaa425d9d52d.pdfIranian Heart AssociationIranian Heart Journal17420161201Anomalous Trifurcation of the Left Main Coronary Artery: A Case Report535683162ENDaryoushSaedEchocardiography Research Center, Rajaie Cardiovascular,Medical,and Research Center, Iran University of Medical Sciences, Tehran, I.R. Iran.PeymanArastehMPH Department,Noncommunicable, Research Center, Fasa University of Medical Sciences, Fasa, I.R. IranMehranPurnazariTehran University of Medical Sciences, Tehran, I.R. Iran.Journal Article20190228Coronary artery anomalies are rare with an incidence rate < 1%. The presentation varies considerably. We present the case of an anomalous left atrial branch the left main coronary artery without independent clinical manifestations. (Iranian Heart Journal 2017; 17(4): 53-56)https://journal.iha.org.ir/article_83162_8b7d6d65a6a11b276c00df310aa23cbd.pdf