فهرست مطالب
Iranian Heart Journal
Volume:19 Issue: 3, Fall 2018
- تاریخ انتشار: 1397/07/25
- تعداد عناوین: 12
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Pages 6-14BackgroundIschemic mitral regurgitation is a major source of morbidity and mortality of myocardial infarction. Surgical intervention for significant ischemic mitral regurgitation at the time of coronary artery bypass grafting (CABG) is controversial and has always presented a great challenge. The purpose of this study was to describe the current surgical options for ischemic mitral incompetency and to discuss when mitral valve repair via the Kay method may be favored over mitral valve replacement.MethodsTwelve patients candidated for the Kay mitral valve repair plus CABG were recruited. The efficacy of mitral valve repair was echocardiographically recorded at follow-up. To validate the diagnosis of ischemic mitral regurgitation, we conducted a detailed chart review— which included all preoperative cardiac imaging tests at the first, sixth, and 12th postoperative months, as well as the operative records and pathology reports.ResultsTwelve patients (5 male and 7 female) underwent CABG plus the Kay mitral valve repair. All the patients had significant mitral valve incompetency, which was resolved in all of them (P<0.05). There was no preoperative or postoperative mortality. No further postoperative mortality was reported at 1 year’s follow-up. The Kay technique for mitral valve repair had a desirable result insofar as 8 (72.7%) patients had only mild mitral regurgitation and 4 (33.3%) had mild-to-moderate mitral regurgitation.ConclusionsIn the current era and in Iran, mitral valve repair—especially via the Kay method—has been proven to confer improved short and long-term survival, decreased valve-related morbidity, and enhanced left ventricular function. Future randomized prospective clinical trials are needed to compare this cost-effective surgical technique with its counterparts.Keywords: Mitral regurgitation, Coronary artery bypass graft (CABG), Mitral valve repair, Kay method
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Pages 15-19BackgroundPulmonary morbidity is a common complication of cardiac surgery, and the most common type of morbidity is atelectasis. The risk factors related to pulmonary morbidities and atelectasis have been previously explored in coronary artery bypass graft and valvular surgery. In this study, we sought to determine the risk factors related to atelectasis after adult congenital heart disease surgery (ACHDS).MethodsThis cross-sectional study was conducted on 43 patients (mean=36.3 and SD=16.37) who underwent ACHDS. The risk factors related to atelectasis were identified using a questionnaire which contained demographic factors, types of CHD, underlying diseases, and the length of postoperative stay in bed. The collected data were subsequently analyzed with SPSS.ResultsOf the 43 patients, only 3 (7%) had atelectasis after ACHDS. The tetralogy of Fallot surgery and delayed postoperative ambulation (>24 h) had a P value of 0.027 and 0.000, respectively. The other factors had P values higher than 0.05 and were, thus, not related to atelectasis.ConclusionsThe tetralogy of Fallot surgery and delayed postoperative ambulation (>24 h) were associated with the rate of atelectasis after ACHDS.Keywords: Pulmonary atelectasis, Congenital heart defect, Cardiac surgical procedures, Thoracic surgery
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Pages 20-29BackgroundMyocardial infarction (MI) is a major cause of death worldwide. Several acute-phase inflammatory proteins such as interleukin-6 (IL-6) and C-reactive protein (CRP) have been examined as the potential indicators of atherosclerosis and the risk of coronary artery disease (CAD). This study aimed to examine whether inflammation could explain the relationship between depression and CAD.MethodsIn this repeated-measure cross-sectional study, we measured CRP and IL-6 in 162 patients with acute MI at the time of admission and on the fifth day. The patients were categorized into depressed and non-depressed groups based on the Beck Depression Inventory questionnaire. Additionally, on the fifth day of hospitalization, a checklist of acute MI complications was completed for each patient.ResultsThe depressed patients had a significantly higher mean value of IL-6 and CRP than the non- depressed group (for IL-6, F=17.06 and P<0.001; for CRP, F=8.92 and P=0.002). Moreover, the depressed patients experienced more post-MI brady- and tachyarrhythmias.ConclusionsThe depressed patients with acute MI had a higher level of inflammatory factors and more complications such as arrhythmias in their hospitalization period, which might have affected their prognosis. Therefore, it is imperative that more attention be paid to CAD patients with depressed mood in terms of the management and assessment of their prognosis.Keywords: Myocardial infarction, Inflammatory factors, Depression, Interleukin-6, C-reactive protein
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Pages 30-37BackgroundThe cannulation of the internal jugular vein is done to access the central vein for hemodynamic monitoring and other purposes. A safe internal cannulation of the jugular vein is performed using anatomical landmarks on the surface of the skin or using the ultrasound-guided method. In this study, we compared the ultrasound-guided technique and the anatomical landmark method for the internal ion of the jugular vein catheter by anesthesia residents on adult patients in terms of the rates of their success rate and complications.MethodsIn this study, 90 patients were divided into 2 equal groups. The anatomical landmark technique was used in the first group and ultrasound guidance in the second group to cannulate the internal jugular vein. In both methods, the number of attempts, the rate of failure, the rate of carotid rupture, and the rate of complications such as pneumothorax, hematoma, and arrhythmias were documented.ResultsThere was no statistically significant difference between the 2 groups vis-à-vis the number of the attempts to catheterize each patient (P=0.352). Cannulation failure was reported in only 1 patient in each group, and there was no significant difference between the 2 groups (P=0.062). The results demonstrated no significant difference between the groups (P=0.750) concerning the rate of complications of the internal jugular vein catheterization.ConclusionsNeither of the methods of ultrasound guidance and anatomical landmarks had a significant superiority in terms of the success rate and the complications of the ion of the internal jugular vein catheter. The reason for the absence of a significant difference between the 2 groups in the above parameters was the anesthesia residents’ insufficient personal skills in performing ultrasound.Keywords: Ultrasound, Anatomical criteria, Central vein catheterization
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Pages 38-45Backgroundcoronary artery occlusion is the main reason for cardiovascular disease-related deaths the world over. Hence, identifying its main determinants is essential for the proper prevention of coronary artery disease and its-related mortality and morbidity. The present study investigated the association between cardiovascular risk factors and the occlusion of coronary arteries in patients.MethodsIn this cross-sectional study, the medical records of 2046 consecutive patients with suspected cardiovascular disorders who were referred to the Angiography Center at Imam Hossein Hospital in the Iranian province of Ilam between January 2010 and January 2012 were reviewed via census sampling. Based on the angiography findings, the patients were classified as normal or involved coronary artery groups. The risk factors for cardiovascular disorders were also recorded. Binary and multivariable logistic regression models were used to determine the adjusted odds ratio (OR) for each risk factor.ResultsIn the final multivariable regression modeling, the variables of gender (OR=3.44 and 95% CI: 1.02 to 5.58), age (OR=1.10 and 95% CI: 1.05 to 1.15), a family history of coronary disease (OR=1.12 and 95% CI: 1.30 to 1.94), current smoking (OR=1.50 and 95% CI: 1.02 to 1.98), systolic blood pressure (OR=1.16 and 95% CI: 1.05 to 1.28), diastolic blood pressure (OR=1.04 and 95% CI: 1.00 to 1.09), and high-density lipoprotein cholesterol (HDL-C) (OR=1.04 and 95% CI: 1.00 to 1.08) significantly increased the risk for coronary artery occlusion.ConclusionsAmong the different non-modifiable variables, gender, age, and a family history of CAD and among the modifiable variables, smoking, hypertension, and a reduced HDL-C level increased the risk for coronary involvement. Further cohort studies and meta-analyses are required to clarify the causative association between these risk factors and coronary occlusion.Keywords: Cardiovascular disease, Risk factor, Angiography
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Pages 46-50BackgroundDiabetes mellitus (DM) is a chronic disease which increases the risk of coronary artery disease (CAD). We sought to determine the relationship between the serum HbA1c level and the severity of CAD in diabetic patients.MethodsThis cross-sectional study enrolled 138 patients with DM who were candidated for ive coronary angiography. HbA1C was measured in all the patients. The study population’s demographic information was collected through questionnaires. The data were analyzed with the SPSS software, version 16, and the descriptive statistical method was used to present the results.Resultsive coronary angiography was normal in 4.3% of the patients, while 26.1% had single- vessel disease, 47.8% had double-vessel disease, and 21.7% had triple-vessel disease. The serum HbA1c was less than 7% in 23.9%, between 7% and 9% in 39.1%, and more than 9% in 36.9% of the patients. A serum HbA1c level of more than 9% was reported in 42.1% of the patients with triple-vessel disease.ConclusionsOur results indicated a relationship between the serum HbA1c level and the severity of CAD.Keywords: Coronary artery disease, Diabetes mellitus, HbA1c, Coronary angiography
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Pages 51-59BackgroundThere are 2 different methods of suctioning the airway: the open tracheal suction system (OTSS) and the closed tracheal suction system (CTSS). The aim of this study was to compare the efficacy of the OTSS and the CTSS in maintaining the stability of hemodynamic and oxygen parameters in patients after cardiac surgery.MethodsThis randomized controlled clinical trial was conducted on 60 patients who were under mechanical ventilation after cardiac surgery. The study population was randomly divided into the OTSS and CTSS groups. All the patients were at least 18 years old and hemodynamically stable. Hemodynamic parameters such as systolic and diastolic blood pressures were measured. Oxygen parameters such as the saturation percentage of arterial blood oxygen (SpO2) and the oxygen pressure of arterial blood (PaO2) were measured before, immediately, and also 3 and 5 minutes after suction. All the parameters were compared between the 2 groups.ResultsThe mean heart rate, the mean systolic blood pressure, and the mean arterial blood pressure showed a higher increase in the OTSS group (P<0.05), as the mean PaO2 and SpO2 were higher in the CTSS group (P<0.05).ConclusionsThe CTSS caused fewer disturbances in the hemodynamic and oxygen parameters in comparison with the OTSS in our study population. Therefore, disturbances in the aforementioned parameters can be avoided by using the CTSS in patients undergoing cardiac surgery.Keywords: Airway management, Suction, Cardiac surgical procedures, Hemodynamics
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Pages 60-63BackgroundCoronary artery disease is the leading cause of death in most societies today. One of the most important diagnostic and therapeutic methods used in this field is cardiac catheterization. This procedure is, however, invasive and can lead to cardiac complications, vascular complications, and even death.MethodsIn this study, we reviewed the characteristics of adolescent patients who needed emergent surgery due to catheterization complications between 2005 and 2015 at Rajaie Cardiovascular, Medical, and Research Center, Tehran, Iran. This study was done descriptively. Of 1028 patients transferred to the operating room in the first 24 hours after catheterization, a total of 36 patients needed emergent surgery due to catheterization complications. The data of these patients were extracted the archives and analyzed using the SPSS software.ResultsAcute mitral valve regurgitation post percutaneous transmitral commissurotomy occurred in 8 (22%) patients, vascular rupture and retroperitoneal hematoma in 8 (22%), rupture of the cardiac chambers and tamponade in 5 (14%), coronary artery dissection in 4 (11%), vascular access thrombosis in 3 (8%), vascular access dissection in 3 (8%), embolization and malposition of the Amplatzer device in 2 (6%), clot formation on the Amplatzer device in 1 (3%), cardiac arrest in 1 (3%), and vascular sheath fracture in 1 (3%). Of the 36 patients, 6 died.ConclusionsA comparison of the incidence rates of post-cardiac catheterization complications leading to emergent surgery between our center and other similar centers shows no significant difference.Keywords: Cardiac catheterization, Complication, Emergent surgery
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Emergency Surgical Treatment for the Total Occlusion of the Left Main Coronary Artery: A Case ReportPages 64-67BackgroundThe acute occlusion of the left main coronary artery (LMCA) in the absence of the collateral circulation is extremely rare, but it remains a catastrophic and mostly fatal entity due to myocardial infarction with severe cardiogenic shock and arrhythmias.MethodsWe evaluated 2 patients with an acute or acutely evolving occlusion of the LMCA undergoing coronary artery bypass grafting (CABG).ResultsThe in-hospital mortality rate was 50%. Revascularization was achieved with on-pump CABG in both patients.ConclusionsThe total occlusion of the LMCA represents a unique clinical condition. The LMCA occlusion with shock is regarded as a class IA indication for acute surgical revascularization. Nonetheless, emergent percutaneous coronary intervention (PCI) may be an effective method to acutely revascularize these patients. Additionally, aggressive post-PCI care—including intra- aortic balloon pumps, extracorporeal membrane oxygenation, CABG, and ventricular support devices—may be required to improve patient survival.Keywords: Left main coronary artery obstruction, Myocardial infarction, Cardiogenic shock, Early revascularization, Coronary artery bypass surgery
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Pages 68-70The manifestation of cardiac masses varies considerably depending on their location. Among the primary cardiac tumors, sarcomas are the most common. Sarcomas spread mostly to lungs, but metastasis to other sites such as the liver has also been reported. Here, we report a case of a large primary cardiac sarcoma with metastasis to the liver. The patient was a 76-year-old woman who presented with dyspnea. Echocardiography revealed a thickened involved right ventricular free wall and a large multi-lobulated mass featuring multiple cavitations and necrotic foci with attachment to the right atrial free wall and extension to the atrioventricular groove. The abdominal and pelvic sonographic examination illustrated multiple heterogeneous non–well-defined masses in the liver parenchyma. The biopsy result was a cardiac sarcoma. The patient refused any therapeutic intervention.Keywords: Primary cardiac sarcoma, Metastatic cardiac mass, Transthoracic echocardiography, Cardio-oncology
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Pages 71-73BackgroundCongenital ventricular diverticula, defined as a protrusion of the free wall of the ventricle including the endocardium, the myocardium, and the pericardium, behave similarly to an accessory ventricular chamber which contracts synchronously with the normal ventricles.Case PresentationA 42-year-old man presented with functional class II exertional dyspnea, fatigue, and flushing. Transthoracic echocardiography showed deep recesses with the outpouching of the basal-to-mid free wall and septal hyperkinesia. All the echocardiographic data were highly suggestive of isolated right ventricular (RV) noncompaction. Magnetic resonance imaging revealed multiple large outpouchings in the RV free wall, the RV outflow tract, and the basal anterior left ventricular wall, which had a wide neck and a normal contractility. The left ventricular myocardium was hypertrabeculated but did not fulfill the noncompaction criteria of cardiac magnetic resonance imaging.ConclusionsA muscular type of diverticula with prominent trabeculation and normal contractility, but without abnormalities, on both perfusion and gadolinium enhancement images was reported here. Such cases should not be mistaken for noncompaction or pseudoaneurysms.Keywords: Congenital ventricular diverticula, Cardiac magnetic resonance, Transthoracic echocardiography
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Pages 74-76The congenital atresia of the left main coronary artery is a very rare form of coronary anomalies with poor clinical outcomes if left untreated. Patients require surgical correction with coronary artery bypass grafting after the diagnosis. Here, we report a case of the congenital left main atresia in a 36-year-old woman who had a previous heart surgery with this anomaly having gone undetected.Keywords: Congenital heart disease, Left main atresia, Coronary abnormality