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Iranian Heart Journal - Volume:17 Issue: 2, Summer 2016

Iranian Heart Journal
Volume:17 Issue: 2, Summer 2016

  • تاریخ انتشار: 1395/06/22
  • تعداد عناوین: 8
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  • Majid Kyavar, Reyhaneh Shabani, Hooman Bakhshandeh Abkenar, Peyman Keyhanvar, Shabnam Madadi* Pages 6-11
    Background
    Pulmonary regurgitation is a common finding in patients after tetralogy of Fallot total correction (TFTC). Right ventricular enlargement and dysfunction have been ascribed to pulmonary insufficiency (PI), which is an important issue in the follow-up of patients with TFTC. We sought to compare PI measured by echocardiography with data provided by cardiac magnetic resonance imaging (CMR).
    Methods
    We studied 155 ed patients (91 male; median age = 25.65 y, range = 15–55 y) after TFTC. To quantify the pulmonary regurgitant fraction (PRF) by CMR, we performed flow velocity mapping. On Doppler echocardiography, the length, width, and localization of the regurgitant flow, no-flow time, and pressure half-time were measured. The severity of PI on echocardiography was categorized as nonsignificant and significant and was thereafter compared to the data obtained by CMR.
    Results
    In all 155 patients, the measurement of the flow and volume was possible by CMR, and the measurement of PI was possible by Doppler echocardiography. The mean PRF, as determined by CMR, was 33% ± 16.4%. Pulmonary regurgitation has been reported to be a causative factor in right ventricular volume enlargement. A PRF > 20% was considered significant and was compared with echocardiographic parameters and also right ventricular size and function and other indices resulted CMR. The regression analysis showed a significant correlation between PI severity on CMR and right ventricular enlargement on MRI at end diastole (r = 0.746; P
    Conclusions
    There was no significant correlation between right ventricular ejection fraction and PI severity on CMR (r=0.553; P=0.45). On echocardiography, the semiquantitative estimation of pulmonary regurgitation showed that there were 26 patients with mild-to- moderate PI and 99 patients with severe PI. A right ventricular end-diastolic volume index (RVEDVI) of 121 mL/m² was 87% sensitive and 54% specific for severe PI, and an RVEDVI of 180 mL/m² was 90% specific for severe PI.
    Keywords: Pulmonary regurgitation, Cardiac MRI, Echocardiography
  • Mona Kia, Seyed Abdolhussein Tabatabaei, Ata Allah Bagherzadeh*, Farahnaz Nikdoust Pages 12-17
    Background
    Despite the clear beneficial effects of atrioventricular nodal ablation (AVNA) in atrial fibrillation (AF), the differences in these effects between the 2 technical methods of AVNA—retrograde and antegrade approaches—remain unclear. The present study aimed to compare the outcome of these 2 AVNA approaches in AF.
    Methods
    This clinical trial was performed on 109 consecutive patients candidated for cardiac resynchronization therapy (CRT) due to the presence of simultaneous heart failure and AF. The eligible patients were randomly scheduled for CRT via left AVNA or CRT via right AVNA or medical treatment approaches.
    Results
    No statistically significant differences were observed between the right (3.12–1.88) and left (3.12–1.78) approaches of AVNA regarding a decrease in New York Heart Association score as well as an increase in left ventricular ejection fraction (18.0%–23.75% in the right approach and 18.46%–25.77% in the left approach). Although the severity of mitral regurgitation significantly decreased following both CRT via the left AVNA approach and CRT via the right AVNA approach, the reduction in the severity of mitral regurgitation was more prominent in those treated by CRT via the right AVNA approach.
    Conclusions
    In reducing the severity of mitral regurgitation as well as femoral complications, right AVNA was superior to left AVNA, while left AVNA was preferable to right AVNA concerning the escape rate, procedure time, and radiofrequency rate.
    Keywords: Atrial fibrillation, Atrioventricular junctional ablation, Cardiac resynchronization therapy
  • Farahnaz Nikdoust, Reza Zangeneh, Seyed Abdolhussein Tabatabaei* Pages 18-24
    Background
    As the cardiac function in patients with rheumatoid arthritis (RA) has not been well studied via echocardiography yet, we aimed to determine cardiac involvement and echocardiographic features in patients with RA of at least 5 years’ duration who referred to our hospital between 2012 and 2014.
    Methods
    In this cross-sectional study, patients with RA were compared to healthy controls in terms of the cardiac function via Doppler echocardiography. After collecting the clinical and demographic data in both groups, we performed Doppler echocardiography for both groups to evaluate ventricular function and dimensions as well as valvular function.
    Results
    Forty-six patients with RA (mean age = 51.3 y) were compared to 48 healthy controls (mean age = 50.2 y). The body mass index was significantly higher in the patients with RA (P = 0.01). Left ventricular ejection fraction was significantly lower in the case group (P
    Conclusions
    In this study, we observed disturbed echocardiographic characteristic features in the patients with RA as compared with the controls.
    Keywords: Echocardiography, Rheumatoid arthritis, Left ventricular ejection fraction
  • Hossein Azarnik, Majid Kyavar, Shabnam Madadi*, Nasim Naderi, Farzad Kamali, Amir Khosropour, Javad Robat Sarpoushi, Armin Marashizadeh Pages 25-29
    Background
    In recent years, noninvasive methods have replaced angiography in the diagnosis of aortic dissection and concomitant coronary artery disease (CAD). Computed tomography (CT) angiography allows the assessment of CAD in this setting.
    Methods
    In this retrospective study, we investigated the incidence of CAD in patients presenting with type A or B aortic dissection between 2011 and 2014 as assessed by CT angiography and the influence of concomitant CAD and coronary artery bypass grafting (CABG) on the in-hospital outcomes of these patients.
    Results
    Ninety-one patients (67% male) were included in this study. Thirty-five (38.5%) patients had concomitant CAD on their CT angiography, and coronary artery ectasia was observed in 17 (18.7%) patients. Sixty-seven (73.6%) patients underwent surgery for their aortic dissection. Concurrent CABG was performed in 22 (62.8%) patients, who had significant coronary stenosis on coronary CT angiography. Mortality was significantly higher in the patients who had concomitant CAD. (Sixty-seven percent of the patients with CAD died; P
    Conclusions
    Nowadays, invasive coronary angiography is infrequently performed in acute type A aortic dissection due to delay in surgery and increase in the risk of rupture. Multi-slice coronary CT angiography is a good alternative modality for the diagnosis of aortic dissection and CAD simultaneously with acceptable accuracy.
    Keywords: Aortic dissection, Coronary artery disease, 256, slice coronary CT angiography
  • Ata Firouzi, Sakineh Ahmadzadeh, Mohammadreza Bayanati, Parham Sadeghipour, Reza Kiani, Hamid Reza Sanati*, Negar Salehi, Farshad Shakerian, Ali Zahedmehr, Leila Shokrian Pages 30-37
    Background
    The preferred treatment for isolated pulmonary valve stenosis is percutaneous balloon pulmonary valvuloplasty. The aim of our study was to evaluate the efficacy and short-term results of this procedure in pediatric and adult patients with pulmonary valve stenosis.
    Methods
    In this retrospective case series, we reviewed the hospital records of pediatric and adult patients with a diagnosis of pulmonary valve stenosis subjected to balloon pulmonary valvuloplasty over a period of 10 years. Data regarding the immediate postprocedural findings as well as echocardiographic transvalvular pressure gradients after 6 months were recorded and analyzed.
    Results
    Between 2003 and 2013, a total of 248 patients underwent balloon pulmonary valvuloplasty in our institution. Seventy-nine (31.8%) patients were
    Conclusions
    In our case series, we demonstrated that balloon pulmonary valvuloplasty was an effective and safe method for the treatment of pulmonary valve stenosis in both pediatric and adult populations. However, there was a tendency toward a higher postprocedural pressure gradient in the older patients, which made the obstruction more difficult to regress.
    Keywords: Congenital heart diseases, Pulmonary valve stenosis, Balloon valvuloplasty
  • Sepideh Jafari Naeini, Mozhgan Parsaee *, Shabnam Madadi, Zahra Hosseini Pages 38-43
    Background
    Although echocardiography has constituted the primary method of evaluating cardiac disease for many years now, using another method to complete the examination—especially in dubious situations such as calcified valvular diseases or poor echocardiography window—seems necessary. In studies in different countries, cardiac magnetic resonance imaging (CMR) has been introduced as an acceptable noninvasive complementary method for the evaluation of the severity of aortic stenosis (AS) with good reproducibility and reliable results in comparison with echocardiography.
    Methods
    In a cross-sectional survey in Rajaie Cardiovascular, Medical, and Research Center’s CMR Department between 2009 and 2014, all patients with a diagnosis of AS were evaluated for the severity of AS in terms of peak velocity and peak gradients via both echocardiography and CMR (velocity-encoded method), and the results were analyzed by SPSS using the t-test and ANOVA.
    Results
    After the exclusion of patients with insufficient data, 26 patients were included and evaluated. There were no significant differences between the 2 groups (CMR vs. echocardiography) or between the subgroups (considering cardiovascular risk factors, ejection fraction, and valvular features).
    Conclusions
    CMR was comparable with echocardiography in evaluating AS severity in our study and was not inferior to echocardiography, although more studies are recommended for a more in-depth evaluation.
    Keywords: Aortic stenosis, CMR, Echocardiography, Velocity, encoded method
  • Seyed Kianoosh Hosseini, Masoud Fakhraei, Siamak Khavandi, Soheila Khavandi* Pages 44-47
    A double left anterior descending coronary artery originating the left and right coronary arteries is a rare congenital coronary artery anomaly. In the present report, we describe a patient with a double left anterior descending coronary artery arising the left and right coronary arteries. To our knowledge, only a limited number of such cases have been reported in the literature so far.
    Keywords: Coronary artery anomaly, Double left anterior descending artery, Coronary artery angiography
  • Ahmad Mirdamadi, Mojgan Gharipour*, Seied Mahfar Arasteh Pages 48-52
    Although a patent foramen ovale (PFO) has been suggested as a risk factor for recurrent strokes, many stroke patients with PFOs have another source of emboli that remains unidentified if the PFO is considered the only embolic source. We report a case of stroke due to emboli an aortic aneurysm with a concomitant PFO.
    Keywords: Patent foramen ovale, Stroke