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Iranian Heart Journal - Volume:18 Issue: 3, Fall 2017

Iranian Heart Journal
Volume:18 Issue: 3, Fall 2017

  • تاریخ انتشار: 1396/08/03
  • تعداد عناوین: 7
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  • Amir Hossein Yazdi, Ehsan Khalilipur *, Mohammad Hossein Taghdiri, Mohammad Ali Seifrabiee, Neda Mehralizadeh Pages 6-12
    Background
    One common electrocardiographic abnormality every physician comes across frequently is left bundle branch block (LBBB), which is found usually in asymptomatic patients with some complaints of unknown significance. This study was conducted to find patterns of structural heart disease in patients with LBBB.
    Methods
    This descriptive analytic cross-sectional study was conducted in Ekbatan Hospital in Hamadan over a period of 12 months. Symptomatic patients were included and were divided into 2 groups of patients with LBBB and patients without LBBB. All the patients underwent transthoracic echocardiography and coronary angiography, and the known coronary artery disease risk factors were evaluated. A P value below 0.05 was considered meaningful.
    Results
    80 patients enrolled in our study, those with LBBB were significantly older than the ones without LBBB (mean age = 71 y vs 62 y). The known coronary artery disease risk factors were more prevalent among the LBBB group (with P values of 0.002, .006, and 0.007 for diabetes mellitus, dyslipidemia, and hypertension—respectively). Echocardiographic abnormality, defined as left ventricular systolic dysfunction, was more prevalent in the LBBB group (just 3 patients with a normal left ventricular function in the LBBB group vs 13 patients in the non-LBBB group). Valvular heart disease was seen in 57.5% of the patients in the LBBB group and 17.5% of the patients in the non-LBBB group. Obstructive coronary artery disease was reported more frequently in the patients with LBBB. (Normal coronary artery disease was reported in 2 patients in the LBBB group and in 8 patients in the non-LBBB group.)
    Conclusions
    There is a high likelihood of structural heart abnormalities in patients with LBBB, and this is a predictive finding even in asymptomatic patients. (Iranian Heart Journal 2017; 18(3):6-12)
    Keywords: Left bundle branch block, Angiography, Transthoracic echocardiography, Coronary risk factor, Structural heart disease
  • Farshad Shakerian, Hamid-Reza Sanati, Elham Sam-Nazari, Ata Firouzi, Ali Zahedmehr, Reza Kiani, Mahdyie Doaee, Akbar Nikpajouh * Pages 13-20
    Background
    An elevation in the levels of troponin I and T is more frequent than a rise in CK-MB levels after percutaneous coronary intervention (PCI). Nevertheless, the prognostic value of elevated troponin I and T levels has yet to be compared with that of elevated CK-MB levels. Given the more specific role of troponin in cardiac incidents, we sought both to investigate the factors and elevated levels of cardiac troponin in patients having undergone PCI and to examine the predictive value of elevated cardiac troponin levels in comparison with that of elevated levels of CK-MB.
    Methods
    This case-series study was conducted in Rajaie Cardiovascular, Medical, and Research Center in 2011. The inclusion criteria comprised patients with coronary artery disease and stable hemodynamic who were ively candidated for nonemergency coronary angiography in the hospital. Five hundred patients were included via convenient sampling within a year. Troponin and CK-MB levels were checked after PCI. In data analysis, the t- test, χ2 test, and Fisher exact test were used. The results were analyzed using SPSS, version 17.
    Results
    The troponin level was elevated in 26.8% of the patients following PCI. The troponin assay was negative and positive in 73.2% and 26.8% of the patients, respectively. The mean age of the patients was 56.6 ± 9.9 years (71.8% male and 28.2% female). Totally, 68.2% of the patients’ lesions were non-C patent type. There was a significant relationship between increased levels of troponin I and re-PCI (1 year after PCI) and also between gender and troponin elevation. Serum troponin was higher in the male patients after PCI.
    Conclusions
    A significant relationship was observed between elevated troponin I levels and redo- PCI a year after PCI. Increased levels of troponin I following PCI were not correlated with major cardiac events. (Iranian Heart Journal 2017; 18(3):13-20)
    Keywords: Coronary artery disease, Percutaneous coronary intervention, Troponin, Postprocedural myocardial Infarction
  • Parisa Seilani, Marzieh Nasiri-Brojeni, Sedigheh Saedi *, Majid Maleki, Tahereh Saedi Pages 21-27
    Background
    The durability of bioprosthetic valves in the pulmonary position is not well defined. In the present study, we aimed to examine the durability of bioprosthetic valves in the pulmonary position and the risk factors associated with bioprosthetic pulmonary valve dysfunction or valve failure.
    Methods
    Records of 189 patients who underwent pulmonary valve replacement (PVR) with bioprosthetic valves between 2001 and 2012 were evaluated. The outcomes of PVR were defined as transvalvular leakage, gradient increase or stenosis, hospitalization, and redo PVR. The survival time for the occurrence of the consequences after replacement was depicted as Kaplan–Meier curves.
    Results
    The most prevalent pathology leading to PVR was the tetralogy of Fallot (81.6%) either due to pulmonary insufficiency or pulmonary stenosis. The most prevalent valve used in our patients was the porcine type. During an average follow-up of 10 years, about 47% of the patients showed different degrees of valvular failure. There was at least moderate transvalvular leakage in the first 5 years in 20% of the patients.
    Conclusions
    Bioprosthetic pulmonary valves are frequently used in patients with congenital heart disease. Although they avert the need for long-term anticoagulation, they have a degeneration process starting early in the first 5 years. (Iranian Heart Journal 2017; 18(3):21-27)
    Keywords: Pulmonary valve replacement, Bioprosthetic valves, Prosthetic valve failure
  • Alireza Yaghoubi, Elham Golfeshan, Rasoul Azarfarin *, Abolfazl Nazari, Azin Alizadehasl, Amirreza Ehasni Pages 28-34
    Background
    Sleep disturbances are common following coronary artery bypass graft surgery (CABG). Nowadays, nonmedical therapies are considered along with medical therapies for sleep disturbances. The aim of this study was to evaluate the effects of acupressure on sleep quality in patients after CABG.
    Methods
    This randomized controlled trial assigned 60 patients admitted to the intensive care unit after CABG to 2 groups. Each group comprised 30 patients, with the experimental group receiving acupressure on 5 different solar points for 5 to 15 minutes during 2 consecutive postoperative days and the control group receiving only sedative drugs on request. Sleep quality was measured the day before and after CABG using the St Mary’s Hospital Sleep Questionnaire (SMHSQ) in both groups. An SMHSQ score 9 is normal and 36 is the worst sleep quality.
    Results
    According to the obtained data, before the intervention, the median (interquartile range) score for sleep quality was 15 (13–17) in the experimental group and 14 (13–14) in the control group; therefore, there was no statistically significant difference between the 2 groups (P = 0.689). However, following acupressure, the scores changed significantly: the SMHSQ score rose to 14 (13–14) in the experimental group, while it remained at 23 (23–25) in the control group—suggesting a reasonable difference in sleep quality between the 2 groups after CABG (P = 0.001). Also, the average difference in the control group’s score ( 9 points) before and after the intervention period was more than that of the acupressure group (-1 point).
    Conclusions
    Our findings showed that acupressure improved sleep quality in patients in the intensive care unit after CABG surgery. (Iranian Heart Journal 2017; 18(3):28-34)
    Keywords: Sleep quality, Coronary artery bypass surgery, Complementary therapies, Clinical trial
  • Maryam Moradian, Hamidreza Pouraliakbar, Mohammad Mahdavi *, Behshid Ghadrdoost, Zahra Faritous, Maryam Shojaei Fard Pages 35-41
    Background
    Growth retardation following malnutrition is prevalent among patients with congenital heart diseases (CHDs). This study was designed to evaluate failure to thrive (FTT) and delay in bone age in children with CHDs who were referred to our hospital and subsequently to determine their relation with cyanosis and the pulmonary artery pressure.
    Methods
    We enrolled 120 consecutive patients who were referred to Rajaie Cardiovascular, Medical, and Research Center for cardiac catheterization or surgical correction. Growth parameters, comprising height (cm), weight (kg), and head circumference (cm), were measured by an experienced nurse. Bone age was evaluated by taking an anteroposterior wrist X-ray and reported by a radiologist, who was not aware of the exact cardiac diagnosis. The pulmonary artery pressure was measured during cardiac catheterization or surgical correction.
    Results
    Bone growth retardation, FTT, short stature, and microcephaly were seen in 46.6%, 43.7%, 29.4%, and 5.1% of the patients, correspondingly. There was a significant relationship between the presence of cyanosis and delayed bone age, particularly when O2 saturation was less than 75% (P
    Conclusions
    According to our results, delayed bone age and growth retardation are common findings in children with CHDs. The presence of cyanosis and/or pulmonary hypertension may further deteriorate these conditions and should be promptly managed. (Iranian Heart Journal 2017; 18(3):35-41)
    Keywords: Congenital heart disease, Cyanosis, Failure to thrive, Pulmonary hypertension, Bone age
  • Avisa Tabib, Ramin Baghaie-Tehrani, Afshin Javdan *, Mohammad Mahdavi, Ziae Totonchi Pages 42-51
    Background
    Complete transposition of the great arteries (TGA) is the second most common cyanotic congenital heart disease (CHD). Arterial switch operation (ASO) is now the standard surgical procedure for complete TGA. The present study is an analytical overview of the results of ASO.
    Methods
    In this retrospective study, all cases of ASO at our tertiary care center between June 2010 and June 2013 were included. Demographic, anatomic, and intraoperative data were extracted medical files and mortality and morbidity rates were calculated.
    Results
    One hundred consecutive patients (67% male, mean age = 3.5 mon) were included. The most common subtype of CHD was TGA VSD PDA in 52%, and the most common position of the coronary artery was seen in 1L; 2RCx (17%). The global mortality rate was 20%, with the respective highest rates in the Taussig-Bing subtype (50%), in the patients with a history of balloon septostomy (48%), and in the cases with preoperative prostaglandin E1 therapy (49%) (P > 0.05). Prolonged mean preoperative CCU stay, prolonged mean postoperative intubation period, and prevalence of severe postoperative mitral regurgitation were significantly higher in the expired group (P
    Conclusions
    This study showed a relatively high mortality rate in the patients undergoing ASO, in comparison to similar evidence, while the morbidity rate in the surviving patients was acceptable. Proper parallel circulations, timing of the surgery, and adequate skills among surgeons are essential for the success of ASO. (Iranian Heart Journal 2017; 18(3):42-51)
    Keywords: Transposition of the great arteries, Arterial switch, Surgery, Congenital heart disease, VSD, dTGA
  • Atoosa Mostafavi, Haniye Hajiali, S. A. Hussein Tabatabaei * Pages 52-57
    Background
    In this study, pulmonary artery longitudinal deformation indices were evaluated in patients with pulmonary venous hypertension and compared to those in normal subjects to delineate the effects of a high pulmonary pressure on vessel wall characteristics.
    Methods
    Fifteen patients with a diagnosis of pulmonary venous hypertension and 15 healthy individual were evaluated. In the parasternal short-axis view at the level of the aortic valve, the longitudinal axis of the pulmonary artery was obtained and velocity, strain, and strain rate at different levels of the vessel wall were measured by color-coded Doppler myocardial imaging.
    Results
    The systolic strain was positive in most segments of both normal and pulmonary hypertension groups. Negative strain was observed only in some parts of the proximal segments in the normal group, but was defined in the other parts of the vessel wall in the pulmonary hypertension group. Velocity, strain, and strain rate were significantly lower in the pulmonary hypertension group, mostly in the medial wall.
    Conclusions
    This study evaluated the deformation indices of the pulmonary artery in patients with pulmonary venous hypertension and compared them to those in normal subjects. This was the first study by color-coded Doppler myocardial imaging and found a significant reduction in velocity, strain, and strain rate in the pulmonary hypertension group. Our findings can be a basis for future investigations in other types of pulmonary hypertension. (Iranian Heart Journal 2017; 18(3):52-57)
    Keywords: Pulmonary artery, Pulmonary artery hypertension, Strain, Strain rate, Doppler echocardiography