Iranian Heart Journal
Volume:18 Issue: 1, Spring 2017

All intraoperative strategies that may assist an anesthesiologist with lowering the blood transfusion rate must be considered. We assessed the efficacy of the 30° head-up position at the end of cardiopulmonary bypass (CPB) in returning CPB reservoir blood to patients, reducing the transfusion rate, and conferring hemodynamic stability after the transfer of patients to the intensive care unit (ICU).
In a single-center clinical trial, 88 adult patients undergoing elective isolated coronary artery bypass graft surgery were randomly allocated to the head-up group (n=44), in which the 30° head-up position was applied during separation CPB, and the supine group (n=44), in which weaning CPB was performed in the supine position. All the patients had left ventricular ejection fractions > 35%. The primary end point was the returned volume of filtered CPB blood to the patients. The secondary outcome measures were intraoperative and early postoperative hemodynamic parameters. Additionally, blood products transfused during surgery and in the 1st 6 hours following ICU admission were recorded.
There were no statistically significant differences in intraoperative and early postoperative hemodynamics between the 2 groups except in the returned blood volume to the patients after separation CPB (714 ± 99 mL in the head-up position group vs 285 ± 78 mL in the supine group; P = 0.0001). There were no significant differences between the 2 groups regarding the transfused blood products during surgery and the 1st 6 hours following ICU admission.
Using the 30° head-up position at the end of CPB conferred a higher return of blood to the patients but did not significantly reduce postoperative transfusion. (Iranian Heart Journal 2017; 18(1):6-15)

Pulmonary embolism is associated with high mortality rates despite improvements in its management. The aim of the present study was to analyze the outcome of 20 patients who underwent surgical pulmonary embolectomy in our institution.
The medical records of all patients undergoing pulmonary embolectomy during a 3-year period at our institution were studied for demographic and preoperative data as well as hospital mortality.
Twenty patients underwent pulmonary embolectomy. The patients were aged between 35 and 76 years old. Fourteen (70%) patients were male. The most common risk factor in these patients was a history of major surgery (55%). The hospital mortality rate was 25%.
Pulmonary embolectomy can be considered an effective approach in patients with pulmonary embolism and carries low mortality and morbidity. (Iranian Heart Journal 2017; 18(1):16-19)

Prolactin (PRL) has increasingly been recognized to play a stimulatory role in inflammatory response. Recently, studies have reported an increase in the PRL level among patients with chronic heart failure (HF); however, there are conflicting data about its role as a prognostic factor in these patients. We aimed to measure the PRL level in the acute phase of HF and the post guideline-directed medical therapy (GDMT) of HF to clarify whether PRL is an acute-phase reactant or more than an acute phase-reactant in patients with HF.
The serum PRL level was assessed in 94 patients with HF in the acute phase of HF decompensation and post-GDMT of HF. Serum N-terminal pro-brain natriuretic peptide, high-sensitive C-reactive protein, 6-minute walk test, erythrocyte sedimentation rate, CRP, blood urea nitrogen, creatinine, serum sodium, and white blood cell count were also measured. Our secondary end points were mortality, transplantation, and hospitalization due to acute HF. All the patients were followed up for 6 months.
The mean serum PRL level in the acute phase was 31.3 ng/mL, which was significantly higher than the normal reference values (4.04–15 ng/mL) (P In 57% of the patients, the mean level of PRL increased after treatment. The level remained unchanged in 3.5% of the patients and had a drop in 39.2%. Our findings suggest that PRL may be more than an acute-phase reactant alone. Larger studies are needed to further elucidate the role of PRL in patients with HF. Research regarding the treatment of patients suffering HF with high levels of PRL post-GDMT of HF with bromocriptine may have consequences like those in peripartum cardiomyopathy. (Iranian Heart Journal 2017; 18(1):20-24)

An increase in the plasma levels of catecholamines and other neurohormones after acute myocardial infarction (AMI) leads to coronary vasoconstriction and may cause the undersizing of stents during primary percutaneous coronary intervention (PCI) in ST- segment elevation myocardial infarction (STEMI). We aimed to compare the reference vessel diameter of the infarct-related artery during and after primary PCI in patients with AMI.
This prospective interventional study was performed on 43 consecutive patients with STEMI (TIMI flow grade III), who were candidated for primary PCI. The main proximal diameter of the coronary artery (reference vessel diameter) was assessed at baseline and also 3 days to 3 months after 2nd angiography. The study end point was to compare the reference vessel diameter within and after primary PCI.
Comparison between the mean diameter of the involved coronaries after PCI and the mean diameter during the procedure showed a significant increase in the real size of the right coronary artery (RCA) and a slight decrease in the size of the left circumflex artery (LCx). However, the mean sizes of the left anterior descending coronary artery remained insignificant. The decrease in the LCx diameter and inversely the increase in the RCA diameter remained significant in the study population even after adjusting cardiovascular risk factors as potential confounders.
The changes in the diameter of the reference coronary arteries, namely an increase in the RCA diameter and a decrease in the LCx diameter, are expected following primary PCI in patients with STEMI. (Iranian Heart Journal 2017; 18(1):25-29)

Pulmonary hypertension (PH) is a common consequence of mitral stenosis (MS). After treatment, PH reverses depending on the chronicity and severity of MS. The characteristic changes in the pulmonary artery (PA) secondary to an elevated pulmonary artery pressure (PAP) can be evaluated via cardiovascular magnetic resonance imaging (CMR). In this study, we aimed to evaluate if there was any correlation between PAP and hemodynamic findings measured by CMR and whether these findings could be useful in predicting the PAP response after MS relief.
Thirty-three patients with a diagnosis of severe MS, who were candidated for percutaneously transvenous mitral commissurotomy (PTMC) or mitral valve replacement (MVR), were included. CMR was performed in all of them before the procedure and PA distensibility, PA peak velocity, PA forward volume, and PA forward flow were measured. Transthoracic echocardiography was performed at baseline, immediately after the procedure, and 3 months after MS relief for the assessment systolic PAP.
Thirty-three patients with a diagnosis of MS PH (15 PTMC and 18 MVR) were enrolled in this study. The mean PAP at baseline catheterization ranged 25 to 70 mm Hg. There was a significant drop in systolic PAP immediately after the procedure and 3 months after MS relief. There was no relationship between the PA distensibility index and systolic PAP changes after MS relief. PA peak velocity was significantly higher in the patients with > 50% drops in their systolic PAP 3 months after the treatment. The multivariable analysis showed that none of the CMR findings was an independent predictor of a more systolic PAP decline.
Although we found no significant relationship between CMR findings and systolic PAP changes after MS treatment, the result of this study can be used for further investigations in this regard. (Iranian Heart Journal 2017; 18(1):30-36)

Carotid artery stenosis accounts for 10% of all ischemic strokes. Carotid endarterectomy (CEA) and carotid artery stenting (CAS) are currently the treatment for stroke prevention.
We sought to compare the efficacy and safety of each treatment in patients with carotid artery stenosis. After treatment, the patients were evaluated regarding their outcomes during the 1st and 6th postprocedural months.
Sixty-nine patients (45 male [65.2%] and 24 female [24.8%]) at a mean age of 63.85 ± 14.17 years were enrolled. In 12 (17.4%) patients, both left and right carotid arteries were stenotic. Neither CEA nor CAS had in-hospital and procedural complications. However, in longer-term follow-up, transient ischemic attack occurred in 2 (2.9%) patients in the CEA group, while significant in-stent restenosis occurred in 2 (2.9%) patients after CAS. Multivariate analysis showed no association between smoking, coronary artery disease, dyslipidemia, hypertension, diabetes mellitus, and age and stent stenosis (P = 0.9, P = 0.9, P = 0.5, P = 0.6, P = 0.8, and P = 0.1, correspondingly).
Both CEA and CAS are approved therapeutic strategies for the treatment of carotid artery stenosis. Low complications and good results can be expected if case ion is done according to the current guidelines. (Iranian Heart Journal 2017; 18(1):37-43)

Cardiovascular diseases alone account for 48% of deaths in the world. There is a high rate of coronary angiography for the early diagnosis of such diseases. Not only do patients suffer anxiety because of the invasive nature of this procedure but also they experience pain and discomfort for several hours after the procedure. We conducted this study to assess the effects of the inhalation of lavender essential oil on anxiety and pain in patients undergoing coronary angiography.
This clinical trial was performed at Rajaie Cardiovascular, Medical, and Research Center, Tehran, Iran. Eighty patients who were hospitalized for coronary angiography participated in this study. The patients were divided into 2 groups: control (n = 40) and intervention (n=40). Data collection tools included the 3 forms of demographic information, standard Spielberger questionnaire, and visual analog pain scale, which were completed by both groups before and after aromatherapy with lavender oil. The collected data were analyzed with SPSS software, version 16.0. (Armonk, NY, USA) using the χ2, McNemar, Wilcoxon, Mann–Whitney, and t tests.
The 2 groups were comparable apropos age, sex, marital status, and education level. After aromatherapy, the level of anxiety in the intervention group decreased significantly (P Smelling the scent of lavender significantly reduced anxiety and pain in our patients, before and after coronary angiography. (Iranian Heart Journal 2017; 18(1):44-50)

Percutaneous balloon pulmonary balloon valvuloplasty is the treatment of choice among patients with severe pulmonary stenosis. We describe a 56-year-old woman with severe pulmonary stenosis who presented with hemodynamic disturbances due to pulmonary thromboembolism during hospitalization. Percutaneous pulmonary balloon valvuloplasty is a safe and effective treatment for valvular pulmonary stenosis. (Iranian Heart Journal 2017; 18(1):51-55)