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Multidisciplinary Cardiovascular Annals - Volume:7 Issue: 1, Oct 2016

Multidisciplinary Cardiovascular Annals
Volume:7 Issue: 1, Oct 2016

  • تاریخ انتشار: 1395/08/28
  • تعداد عناوین: 6
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  • Selim Isbir * Page 1
  • Bahram Ghasemzadeh, Shayan Naghshbandi, Yousef Rezaei *, Masoud Shafiei, Bahareh Kazemborji, Majid Haghjoo, Tooraj Babaei, Majid Maleki, Saeid Hosseini Page 2
    Introduction
    The cox-maze procedure (CMP) is considered the gold standard surgical therapy for atrial fibrillation (AF), however, cryosurgical ablations are changing daily practice. The aim of this study was to assess the safety and efficacy of the cryosurgical ablation in rheumatic mitral valve (MV) patients with chronic AF undergoing MV surgery with or without concomitant cardiac surgeries and to compare cryoablative CMP with surgical cryoablative pulmonary vein isolation (cryo-PVI).
    Methods
    In a prospective observational study, a total of 65 patients with long-standing persistent AF who had MV surgeries as the main procedure and underwent either biatrial cryoablative CMP-IV or surgical cryo-PVI were evaluated.
    Results
    The patients’ mean age was 49.6 ± 10.6 years, and they were followed for a median of 16 months (ranging from 3 to 60 months). The rates of sinus rhythm were 60.9% in the CMP-IV and 74.3% in the surgical cryo-PVI groups at follow-up period. The preoperative LA size of > 4.5 cm discriminated late AF with a sensitivity of 89% and a specificity of 45% (area under receiver operating characteristics curve = 0.733, 95% confidence interval [CI] = 0.602 - 0.863). No in-hospital mortality and permanent pace-maker implantation were developed. In Cox regression analysis, the preoperative LA size (Hazard ratio [HR] 1.962, 95% CI 1.175 - 3.276, P = 0.010) and AF duration (HR 1.028, 95% CI 1.002 - 1.054, P = 0.032) predicted late AF.
    Conclusions
    Cryoablative CMP-IV or surgical cryo-PVI for long-standing persistent AF are safe, efficacious, and cost-effective at restoring sinus rhythm in the setting of rheumatic MV surgery combined with or without other cardiac surgeries.
    Keywords: Atrial Fibrillation, Mitral Valve Surgery, Cox Maze Procedure, Pulmonary Vein Isolation, Left Atrial Size
  • Ahmad Amin *, Hossein Navid, Mitra Chitsazan, Bahar Ghaleshi, Sepideh Taghavi, Nasim Naderi Page 4
    Background
    Acute pulmonary vasoreactivity testing (APVT) is performed during right heart catheterization (RHC) in patients with pulmonary arterial hypertension (PAH) to identify those who may benefit from long-term calcium channel blocker (CCB) therapy. Inhaled nitric oxide (iNO) is the most commonly used agent. However, a few other agents such as intravenous (i.v.) epoprostenol or i.v. adenosine can also be used. At present, intravenous prostaglandins and iNO are expensive and not-easily available in most Iranian medical facilities. Indeed intravenous adenosine is less expensive and available in all hospital settings.
    Objectives
    We aimed to investigate the safety profile of adenosine in a group of Iranian PAH patients undergoing APVT.
    Methods
    In this prospective study, a total of 57 consecutive patients with PAH who were scheduled to undergo RHC were enrolled. Acute reactivity testing was performed in 56 patients.
    Results
    Twenty (36%) patients had positive APVT. In all cases, adenosine administration was limited by the occurrence of drug-induced minor side effects including chest pressure or tightness, flushing and dyspnea. The maximal tolerated dose of adenosine was 225 ± 25 µg/kh/min (range 200 - 300 µg/kh/min) in the study population. Only 2 patients developed atrioventricular block at doses of 100 µg/kh/min and 150 µg/kh/min, respectively. Both patients spontaneously converted to sinus rhythm within one minute of discontinuation of adenosine infusion.
    Conclusions
    Intravenous adenosine can be safely used for APVT in Iran.
    Keywords: Adenosine, Adverse Effects, Pulmonary Hypertension, Safety
  • Anita Sadeghpour, Azin Alizadehasl *, Zahra Azizi, Alireza Alizadeh Ghavidel Page 5
    Background
    The management of the medical and surgical treatment of tricuspid regurgitation (TR) is still controversial because of the contradictory outcomes of relevant studies. The present study sought to compare these 2 management modalities in terms of survival rates and predictors of clinical outcomes.
    Methods
    The present 7-year retrospective cohort study, conducted in 2014 at a tertiary center, recruited 806 consecutive patients with TR. The study population was divided into surgically and medically treated patients. After matching the 2 groups, we analyzed 686 patients (399 [58.2%] patients in the surgical treatment group), consisting of 216 (31.5%) male and 470 (68.5%) female patients at a mean age of 53.0 ± 13.4 years. There were 319 (49.5%) patients with severe TR (216 [67.7%] patients in the surgical treatment group).
    Results
    In the patients with severe TR in the New York heart association (NYHA) functional classes (FCs) of III and IV, the 5-year survival rate was 78.6% in the surgical treatment group and 60.6% in the medical treatment group. The Cox regression analysis showed that age, preoperative NYHA FC, inferior vena cava (IVC) size, length of admission, ICU stay days, and postoperative complications in the surgical treatment group and symptoms (chest pain, ascites, and peripheral edema), number of rehospitalization and IVC size in the medical treatment group were the significant independent risk factors of mortality.
    Conclusions
    Overall mortality in the patients with severe TR had a significant correlation with the patients’ NYHA FC symptoms (ascites, peripheral edema, and chest pain), and IVC size. The survival rates of the patients with severe TR in the NYHA FCs of III and IV were higher in the surgery group and were affected by several preoperative and operative factors.
    Keywords: Tricuspid Regurgitation, Surgery, Medical Management, Ascites, Peripheral Edema
  • Maziar Khorsandi *, Scott Dougherty, Kasra Shaikhrezai, Dena Khorsandi, Edward Thomas Brackenbury Page 6
    Background
    Conventional aortic valve replacement (AVR) surgery has been performed using cardioplegic cardio-respiratory arrest method. However this technique is often challenged when the surgeon is faced with a patient who has undergone previous coronary artery bypass grafting surgery (CABG), poor residual cardiac reserve and multiple comorbidities. Here the surgeon’s technical ability is challenged in performing careful dissection in order to preserve the integrity of the coronary artery grafts and to ensure myocardial protection from ischaemic damage.
    Case and Operative Strategy: We present a case of a 76-year-old man with a past history of previous CABG surgery and severe peripheral vascular disease who presented with acute heart failure secondary to severe aortic stenosis requiring urgent AVR. Our safety surgical strategy included preoperative, prophylactic insertion of intra-aortic balloon pump and performing beating heart AVR in the setting of good bilateral arterial conduits and absence of the native coronary circulation. We also performed bi-caval cannulation to allow for potential fallback position of delivering retrograde cardioplegia into the coronary sinus under direct vision in case significant myocardial ischemia was encountered during cross clamping. The patient had an uneventful beating heart AVR surgery and remained asymptomatic on follow-up.
    Conclusions
    Beating heart AVR can be performed safely in the setting of good bilateral arterial conduits. Careful forward planning by prophylactic insertion of intra-aortic balloon pump and bi-caval cannulation allowing the option of delivering cardioplegia directly into the coronary sinus in case myocardial ischaemia was encountered during cross-clamping, would allow for beating heart AVR to be performed safely.
    Keywords: High risk, Aortic Valve Replacement, Beating Heart
  • Ata Firouzi *, Abolfazl Dohaei, Mona Heidarali, Hojat Mortazavian Page 7
    Introduction
    Renal arteriovenous fistula is a rare clinical entity which may have a serious effect on the hemodynamics.
    Case Presentation
    We report a case of renal arteriovenous fistula with undetermined diagnosis at her first presentation. Finally after 9 years her problem was diagnosed and managed successfully with coil embolization.
    Conclusions
    We should consider renal arteriovenous fistula as a differential diagnosis for hematuria. The gold standard modality for evaluation is DSA. Endovascular management is the best treatment.
    Keywords: Kidney, Arteriovenous Fistula, Embolization