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Cardiovascular and Thoracic Research - Volume:7 Issue: 1, Mar 2015

Journal of Cardiovascular and Thoracic Research
Volume:7 Issue: 1, Mar 2015

  • تاریخ انتشار: 1394/01/23
  • تعداد عناوین: 9
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  • Vahideh Zarea Gavgani *, Faranak Kazemi Majd, Shirin Nosratnejad, Ali Golmohammadi, Homayoun Sadeghi Bazargani Pages 1-5
    Objective
    To assess the efficacy of written information versus non written information intervention in reducing hospital readmission cost, if prescribed or presented to the patients with HF.
    Methods
    The study was a systematic review and meta-analysis. We searched Medline (Ovid)and Cochrane library during the past 20 years from 1993 to 2013. We also conducted a manual search through Google Scholar and a direct search in the group of related journals in Black Welland Science Direct trough their websites. Two reviewers appraised the identified studies, and meta-analysis was done to estimate the mean saving cost of patient readmission. All the included studies must have been done by randomization to be eligible for study.
    Result
    We assessed the full-texts 3 out of 65 studies with 754 patients and average age of 74.33.The mean of estimated saving readmission cost in intervention group versus control group was US $2751 (95% CI: 2708 – 2794) and the mean of total saving cost in intervention group versus control group was US $2047 (base year 2010) with (95% CI: 2004 – 2089). No publication bias was found by testing the heterogeneity of studies.
    Conclusion
    One of the effective factors in minimizing the healthcare cost and preventing from hospital re-admission is providing the patients with information prescription in a written format.It is suggested that hospital management, Medicare organizations, policy makers and individual physicians consider the prescription of appropriate medical information as the indispensable part of patient’s care process.
    Keywords: Heart Failure, Patient Admission, Meta, Analysis
  • Mehwish Hussain *, Nazeer Khan, Mudassir Uddin, Mansour M. Al-Nozha Pages 6-12
    Introduction
    Coronary artery disease (CAD) is a persistent public health problem worldwide.Chest pain is one of the perceptible symptoms of the same disease. Literature has found acute chest pain as plausible risk factors for CAD. Nevertheless, none of the study has estimated duration from chronic chest pain to the diagnosis of CAD. The objective of the study was to estimate duration from chronic chest pain to CAD and to assess impact of risk factors on same duration.
    Methods
    Data were obtained from community based study on 17,232 Saudi adults. History of patients about onset of chest pain and other risk factors were inquired. Descriptive measures were obtained by Kaplan-Meier curve. Effect of demographic and clinical factors was assessed by Cox regression models.
    Results
    Out of 24% patients with chest pain, 21% diagnosed with CAD. The average duration was5 years. About 12% of patients with chest pain diagnosed with CAD after one year. Advancing age, female gender, no exercise and reduced high density lipoprotein (HDL) were significantly hazardous predictors throughout duration from chest pain to diagnosis of CAD.
    Conclusion
    The duration from chest pain to CAD was 5 years. Age, gender, exercise and HDL can be variables of concern to deteriorate hazards of CAD for patients with chest pain.
    Keywords: Chronic Chest Pain, Coronary Artery Disease, Duration Analysis, Diagnosis, Predictors
  • Seyed Kazem Shakuri, Yaghoub Salekzamani, Ali Taghizadieh, Hamed Sabbagh-Jadid *, Jamal Soleymani, Leyla Sahebi, Roya Sahebi Pages 13-17
    Introduction
    Prevention of pulmonary complications after coronary artery bypass graft is attended as a very important issue. The aim of this study was to evaluate the role of pulmonary rehabilitation before surgery for reducing the risk of pulmonary complications after surgery.
    Methods
    In a randomized clinical trial, 60 patients undergoing heart surgery were randomly divided into two groups A and B. Chest physiotherapy was performed before and after surgery on group A patients however it was done on group B’s, only after surgery. Effects of preoperative pulmonary rehabilitation were compared between two groups, using spirometry and arterial blood gas (ABG).
    Results
    Thirty nine males (65%) and 21 females (35%) with mean age of 8.10 ± 9.56 were analyzed.The mean differences were statistically significant for predicted forced vital capacity (FVC) (CI95%:1.3 to 8.7) and Predicted Peak Flow indices (PEF) (CI 95%: 1.9 to 9.4) of spirometry indicator,PCO2 index (of ABG parameter) (CI 95%: 1.4 to 8.9) and mean oxygen saturation (mean Spo2) (CI 95%: 0.6 to 1.7) of ABG index in two groups.
    Conclusion
    The performance of pulmonary rehabilitation program before surgery is recommended, as it may result in the reduction of complications of heart surgery.
    Keywords: Coronary Artery Bypass, Respiratory Rehabilitation, Arterial Blood Gas, Spirometry
  • Feridoun Sabzi, Reza Faraji * Pages 18-23
    Introduction
    Pathological involvement of pericardium by any disease that resulting in effusion may require decompression and pericardiectomy. The current article describes rare patients with effusion who after pericadiectomy and transient hemodynamic improvement rapidly developed progressive heart failure and subsequent multi organ failure.
    Methods
    During periods of five years, 423 patients in our hospital underwent pericardiotomy for decompression of effusion. The clinical characteristics of those patient with postoperative low cardiac output (B group) (14 cases) recorded and compared with other patients without this postoperative complication (A group) by test and X2. Significant variables in invariables (P≤0.1) entered in logistic regression analysis and odd ratio of these significant variables obtained.
    Results
    Idiopathic pericardial effusion, malignancy, renal failure, connective tissue disease, viral pericarditis was found in 125 patients (27%), 105 patients (25.4%), 65 patients (15.6%), 50 (17.1%) and 10 (2.4%) of patients subsequently. The factors that predict post-operative death in logistic regression analysis were malignancy, radiotherapy, constrictive pericarditis inotropic drug using IABP using, pre-operative EF and pericardial calcification.
    Conclusion
    Certain preoperative variables such as malignancy, radiotherapy, low EF, calcified pericardium and connective tissue disease are associated with POLCOS and post-operative risk of death. This paradoxical response to pericardial decompression may be more frequent than currently appreciated. Its cause may relate to the sudden removal of the chronic external ventricular support from the effusion or thicken pericardium resulting in ventricular dilatation and failure or intra operative myocardial injury due to pericardiectomy of calcified pericardium, radiation and cardiomyopathy.
    Keywords: Disease, Pericardium, Low Cardiac Output Syndrome
  • Masoud Nazemiyeh, Akbar Sharifi *, Farhad Amiran, Leili Pourafkari, Mohammadreza Taban Sadeghi, Hossein Namdar, Mohsen Abbasnezhad Pages 24-27
    Introduction
    Congestive heart failure (CHF) is a common disease and its prevalence is increasingin industrialized countries. NT-proBNP measurement is an established diagnostic test fordiagnosis of CHF in patients who present to emergency room with acute dyspnea. The primaryobject of this study was to determine the relationship between levels of brain natriuretic peptideprecursor and severity of lung function impairment in patients with chronic CHF.
    Methods
    This cross-sectional and analytical study that performed in Tuberculosis andLung Disease Research Center of Tabriz University of Medical Sciences on 95 patients withchronic heart failure, and relation between NT-proBNP levels and pulmonary functionparameters were examined.
    Results
    Sixty-four patients were male and 31 were female. The average age of male and femaleswas 62.90 ± 11.54 and 61.61 ± 11.98 years, respectively. A significant inverse linear correlationwas found between NT-proBNP and FEV1 (P<0.001, r = -0.367), FVC (P<0.001, r = -0.444),TLC (P=0.022, r = -0.238), maximal midexpiratory flow (MMEF) (P=0.047, r = -0.207) andleft ventricular ejection fraction (LVEF) (P<0.001, r = -0.461). A significant positive linearcorrelation was found between NT-proBNP and FEV1/FVC (P =0.013, r = 0.257), RV/TLC (P =0.003, r=0.303) and 5 Hz Raw (r = 0.231, P = 0.024).
    Conclusion
    This study showed that, both restrictive and obstructive ventilator impairments canoccur in chronic CHF and as NT-proBNP increases appropriate to hemodynamic deterioration,pulmonary dysfunction increases.
    Keywords: Congestive Heart Failure, NT, proBNP, Respiratory Function Tests, Oscillometry
  • Nemat Bilan, Azar Dastranji *, Afshin Ghalehgolab Behbahani Pages 28-31
    Introduction
    Diagnostic criteria for acute lung injury (ALI) and Acute RespiratoryDistress syndrome (ARDS) includes acute onset of disease, chest radiographdemonstrating bilateral pulmonary infiltrates, lack of significant left ventriculardysfunction and Pao2/Fio2 (PF) ratio ≤300 for ALI or ≤200 for ARDS. Recent criteriarequire invasive arterial sampling. The pulse oximetric saturation Spo2/Fio2 (SF) ratiomay be a reliable non-invasive alternative to the PF ratio.
    Methods
    In this cross-sectional study, we enrolled 70 patients with ALI or ARDSwho were admitted in Tabriz children’s hospital pediatrics intensive care unit (PICU).Spo2, Fio2, Pao2, charted within 5 minutes of each other and calculated SF and PFwere recorded to determine the relationship between SF and PF ratio. SF values wereexamined as a substitute of PF ratio for diagnosis ARDS and ALI.
    Results
    The relationship between SF and PF ratio was described by the followingregression equation: SF=57+0.61 PF (P<0.001). SF ratios of 181 and 235 correspondedof PF ratio 300 and 200. The SF cutoff of 235 had 57% sensitivity and 100% specificityfor diagnosis of ALI. The SF cutoff of 181 had 71% sensitivity and 82% specificity fordiagnosis of ARDS.
    Conclusion
    SF ratio is a reliable noninvasive surrogate for PF ratio to identify childrenwith ALI or ARDS with the advantage of replacing invasive arterial blood sampling bynon-invasive pulse oximetry.
    Keywords: ARDS, ALI, Pao2, Fio2, Pulse Oximetry
  • Naser Aslanabadi, Iraj Jafaripour, Mehrnoush Toufan, Bahram Sohrabi, Ahmad Separham, Reza Madadi, Hossien Feazpour, Yosef Asgharzadeh, Mostafa Ahmadi, Abdolrasol Safaiyan, Samad Ghafari * Pages 32-37
    Introduction
    Mitral stenosis (MS) causes structural and functional abnormalitiesof the left atrium (LA) and left atrial appendage (LAA), and studies show that LAA performance improves within a short time after percutaneous transvenous mitral commissurotomy (PTMC). This study aimed to investigate the effects of PTMC on leftatrial function by transesophageal echocardiography (TEE).
    Methods
    We enrolled 56 patients with severe mitral stenosis (valve area less than1.5 CM2). All participants underwent mitral valvuloplasty; they also underwenttransesophageal echocardiography before and at least one month after PTMC.
    Results
    Underlying heart rhythm was sinus rhythm (SR) in 28 patients and atrialfibrillation (AF) in remainder 28 cases. There was no significant change in the leftventricular ejection fraction (LVEF), left ventricular end diastolic dimension (LVEDD),or the left ventricular end systolic dimension (LVESD) before and after PTMC in bothgroups. However, both groups showed a significant decrease in the left atrial volumeindex (LAVI) following PTMC (P=0.032 in SR and P=0.015 in AF group). LAA ejectionfraction (LAAEF) and the LAA emptying velocity (LAAEV) were improved significantlyafter PTMC in both groups with SR and AF (P<0.001 for both).
    Conclusion
    Percutaneous transvenous mitral commissurotomy improves left atrial appendage function in patients with mitral stenosis irrespective of the underlying heart rhythm.
    Keywords: Balloon Valvuloplasty, Atrial Appendage, Atrial Function
  • Domenico Attina*, Francesco Buia, Vincenzo Russo, Emanuele Pilato, Luigi Lovato, Roberto Di Bartolomeo, Maurizio Zompatori Pages 38-40
    Traumatic thoracic aortic rupture is a life-threatening condition; aortic isthmus is the most common site of rupture, but in rare cases traumatic injury can localize elsewhere, such as at aortic arch or at the level of the diaphragm. In the past few years, endovascular treatment of traumatic aortic injury became a safe procedure, with lower mortality and complication, if compared with open surgery. We report a case of a 40-year-old-man admitted to emergency department after a violent car crash in which an aortic traumatic double rupture was successfully treated with two endovascular stent-grafts coverage.
    Keywords: Trauma, Thoracic Aorta, Aortic Rupture, Endovascular Stent Graft, Endovascular Procedure, Emergency
  • Michel Francklyn Mitsomoy *, Valerica Alexoiu, Matthias Kirsch Pages 41-42
    We present the case of a 64 years old male patient who had recently suffered an infective aortic valve endocarditis (Streptococcus agalactiae) complicated by embolic arthritis of the right hip. Initial echocardiography revealed moderate aortic insufficiency developed on a tricuspidaortic valve with a small vegetation (5 mm × 4 mm) on the left coronary cusp. Furthermore, ananeurysmal dilatation of the ascending aorta (maximal diameter, 54 mm) was noted. Other heartvalves and left ventricular function were considered normal. The patient completed a 4 weekscourse of antibiotherapy, and the right hip arthritis was treated by drainage and synovectomy.The patient was subsequently referred to surgery on an outpatient basis for the aneurysm of theascending aorta. Preoperative computed tomography showed localized aortic dissection of thetubular ascending aorta characterized by an intimal tear without medial hematoma but excentricbulging of the aortic wall. This lesion was initially considered a penetrating ulcer of the aortic wallThe operative specimen allowed to make differential diagnosis with a penetrating aortic ulcer byshowing that the lesion did not develop within an atherosclerotic plaque. However, downstreamextension of the dissection was probably limited by the presence of transmural calcifications on itsdistal side. The patient underwent successful complete aortic root replacement using a stentlessFreestyle bioprosthesis with Dacron graft extension as reported previously.
    Keywords: Aortic Dissection, Svenson Classification, Aortic Ulcer