The Journal of Tehran University Heart Center
Volume:1 Issue: 1, Jan 2006

Sudden, unexpected death may occur in apparently healthy individuals. Its occurrence in psychiatric patients has raised the concern that the use of psychotropics, especially antipsychotics, may be associated with an increased risk of sudden death. This concern is maintained even though not all psychiatric patients who have succumbed to sudden death have been on psychotropics. Early reports presented the concern that the use of chlorpromazine and thioridazine were associated with sudden death. More recently, the focus shifted to the more potent agents. Indeed, the FDA Advisory Committee discussed the possibility of a connection between sudden death and haloperidol. No decision could be reached by the FDA Committee because of the enormous complexity of the problem. Nonetheless, since sudden death continues to catastrophically complicate the course of some patients, the scope of this review is to further investigate the relationship between antipsychotic agents and sudden death.

A good animal model for coronary surgery experiments has been difficult to establish. An ideal model should have the closest morphological resemblance to human beings. The objective of this study is to establish sheep as a model for these experiments. The anatomical aspects of left anterior descending coronary artery (LAD) and right internal thoracic artery (RITA) in the sheep are studied. Coronary artery bypass grafting between the RITA and LAD coronary artery was performed. Patency of the anastomosis was evaluated by follow-up angiography. On a beating heart, the RITA was anastomosed to the LAD in adult sheep. A left anterior thoracotomy in the fifth intercostals space gave good access to both vessels. Ventricular fibrillation (VF) was a major intra-operative problem. Its incidence and relation to ischemic time was studied. The anastomosis patency was tested immediately and at follow-up by a modified technique of angiography. The morphological anatomy of both LAD and RITA was studied in detail and analysed. Surviving sheep were studied for 6 months or more. RITA was easy to harvest. The most common anatomy for the LAD was presence of two diagonal branches and absence of an overlying vein. The incidence of ventricular fibrillation (VF) during LAD snaring was 10.8% (mean ischemic time before VF occurrence was 4 minutes). The modified angiography technique produced good quality angiograms. Wound infection was initially a problem but controlled with prophylactic antibiotics. Favorability of RITA and LAD anatomy prove sheep as a good animal model for coronary artery surgery experiments. VF incidence is acceptable. Wound infection is controlled. Good quality follow-up is feasible.

In cases of moderate(2 or 3+ on a scale of 0 to 4+) nonorganic mitral regurgitation (MR) and coronary artery disease, operative strategy continues to be debated between coronary artery bypass grafting alone (CABG) or concomitant valve repair. To clarify the optimal management of these patients, we evaluated the mid-term results of isolated CABG in the study group. From March 2002 to February 2005, 40 consecutive patients (57.5% male, mean age: 62.45±8.7 years, mean ejection fraction: 44.15±12.6%, mean New York Heart Association class 2.5±0.78) with coronary artery disease and moderate MR without organic mitral valve disease (prolapse, rheumatism, etc.) underwent CABG alone. Thirty one (77.5%) patients had either postoperative or follow-up transthoracic echocardiography with mean follow up time of 10.82±8.12 months. Patient''s pre and postoperative data were compared to evaluate the results of isolated CABG on moderate MR. MR was ischemic (with persistent wall motion abnormality) in 25(62.5%) patients and functional (without persistent wall motion abnormality) in 15(31.5%). Considering postoperative and follow up transthoracic echocardiography, 54.8% had no or mild MR (29% MR 1+, 25.8% no MR) and 45.2% had moderate MR (16.1% MR 3+, 29% MR 2+). Resolution of MR was significant (p<0.001), but it had no correlation with ischemic MR (p=0.46), preoperative ejection fraction (p=0.09), LV systolic (p=0.70) and diastolic dimensions (p=0.80). Seven patients died, 2 in hospital and 5 later. Although for coronary artery disease accompanying moderate nonorganic MR, CABG alone reduces severity of MR significantly, many patients are left with moderate MR. Preoperative diagnosis of moderate nonorganic MR may warrant concomitant mitral repair.

We applied a modified Cox III Maze procedure using radiofrequency ablation in the treatment of atrial fibrillation associated with rheumatic heart valve disease and evaluated the outcome of 20 patients of atrial fibrillation associated rheumatic valve disease who underwent radiofrequency ablation Maze III procedure plus heart valve surgery. Demographic, echocardiographic, Electrocardiographic and Doppler study data were calculated before surgery, six month and one year after surgery.. No perioperative deaths occurred in the study group. Duration of additional time for doing radiofrequency ablation was about 22 minutes. Freedom from atrial fibrillation was 85% and 75% at six months and one year follow-up respectively... The addition of the radiofrequency ablation Maze procedure to heart valve surgery is safe and effective in the treatment of atrial fibrillation associated with rheumatic heart valve disease..

The incidence of stroke is 2.1-5.2% in bypass surgery patients with a mortality of 0-38%. This study was designed to evaluate the incidence of significant carotid artery stenosis and its related risk factors in candidates for coronary artery bypass graft (CABG) surgery. 1045 consecutive candidates for CABG underwent carotid artery Doppler examination in a prospective study. The relation of age, sex, smoking and diabetes as well as lipid profile and carotid stenosis was evaluated.. In 1045 CABG candidates with the mean age of 60 years, the prevalence of significant carotid stenosis (>60%) was 6.9%. In the patients who aged 65 years and older, significant stenosis was12.5%. Age of 50 years and above, female gender, hypercholesterolemia and diabetes mellitus are independent risk factors for significant carotid stenosis. Significant carotid stenosis has an earlier beginning in our study. Cost effectiveness studies are recommended for revising the previous screening protocols.

It has been well documented that left ventricular hypertrophy (LVH) is an independent factor for cardiac death in children. The epidemiologic information reveals that there is a very high prevalence of LVH in children with chronic renal failure (CRF). The purpose of this study was to evaluate the existence of left ventricular hypertrophy, its severity and other cardiac abnormalities in children and young adults with chronic renal failure (CRF), end stage renal disease (ESRD) on hemodialysis (HD) or post renal transplantation (RTx). Sixty-three patients including 31 females and 32 males aged 1 to 18-year- old with defined causes for renal damage were enrolled in the study. Study patients were distributed in three groups: HD (n=45), CRF (9) and RTx (9). LVH and degree of hypertension were compared with an age and sex-matched control group (63 normal individuals). Left ventricular mass indexed for height (LVM/Ht and LVM/Ht2.7) and body surface area (LVM/BSA), and other related parameters were determined by echocardiography in both groups. Laboratory investigations were carried out at a reference laboratory for the study group. The index of LVM/BSA in CRF group was more (r=0.765) than the control group. The HD patients had significantly higher LV systolic and diastolic dimensions. Analysis of variance (ANOVA) showed the influence of groups on subject score on the LVM. A significant effect of groups on the mean score on the LVM was noted. An important finding of this study was the correlation between serum creatinine and LVM in the HD and RTx subjects by both linear and multiple regression analyses. There was also significant difference amongst groups with respect to blood parameters, which is discussed. This study demonstrates that left ventricular hypertrophy and cardiac abnormalities are frequent findings in children with renal impairment or ESRD. The degree of hypertrophy is often severe, particularly following transplantation. Further studies to clarify the relationship between biochemical disturbances and ventricular abnormalities are suggested.

The effects of opium dependence on prognosis and short term outcome of patients with acute myocardial infarction (AMI) are not clear yet. From March 2004 to August 2004 all male patients admitted with diagnosis of AMI were enrolled. Patients who fulfilled DSM- IV-TR criteria were chosen as opium dependent patients (ODP). Demographic data, risk factors, peak enzyme levels, location of MI, mortality and ejection fraction were collected and analyzed. We studied the mortality, readmission, functional class, performed revascularizations and coronary angiogram results in a short term follow-up (184 ± 37 days). A total number of 160 patients were enrolled, of which 45 (28.1%) were opium dependent. In 137 patients 6 months follow up was completed. Duration of admission was higher in O.D.P (11.3 days versus 8.7, P= 0.03) There was no significant difference in age, EF, location of MI, peak enzymes levels, angiographic findings, risk factors (except for cigarette smoking and triglyceride level), in-hospital mortality, need for readmission, 6 months mortality, functional class, and the need for revascularization. In an unselected cohort of patients admitted with AMI, there was no significant difference in specifications, short term outcome and prognosis of AMI between ODP and nondependents except for duration of hospitalization. Keywords: Opium dependence, Acute myocardial infarction, Mortality, Angiographic findings

Cardiac hydatid cyst (CHC) is a rare disease that was endemic in some regions especially in sheep-raising areas. The most commonly accepted theory for the routes of heart involvement in hydatid cyst was infestation by the hexacanthus embryo through coronary arteries. Here, we describe a case with the primitive cardiac hydatid cyst located around the pulmonary valve (PV) and main pulmonary artery (mPA) extended to right and left pulmonary arteries and metastasized to both lungs. Could it be possible for the embryo to adhere PV and mPA directly?

A 56-year-old man with a two year history of chronic stable angina underwent elective coronary artery bypass grafting (CABG) due to angiographic report of three vessel disease and tight stenosis at proximal part of left anterior descending artery (LAD). While harvesting of radial artery (RA), the distal half of radial artery was found to bifurcate to two parallel branches with equal size. We used this as a single conduit to bypass the first and second obtuse marginal (OM) branches. The patient had a smooth post-operative course and uneventful recovery.