anita sadeghpour

Infective endocarditis (IE) is associated with several morbidities and high rate of mortality. Predicting these morbidities can be helpful in managing patients and can prevent possible complications, result from IE. In this study, we aimed to evaluate the association between C-reactive protein (CRP), N-terminal pro brain natriuretic peptide (BNP), monocyte to high density lipoprotein (HDL) ratio Charlson comorbidity index, and European System for Cardiac Operative Risk Evaluation (Euro SCORE) in complicated cases of IE.

This prospective study was conducted on a referral center from January 2017 to December 2020. Patients with definite or possible diagnosis of IE based on the modified Duke criteria were included in this study. Demographic information and serum levels of N-terminal pro BNP, D-Dimer, CRP were evaluated in patients. In addition, we used Charlson comorbidity index and The Euro SCORE for subjective assessment.

One hundred and four patients(64 males, median age: 58) included in the final analysis. Intracardiac involvement, central nervous system (CNS) complications and systemic complications were observed in nine patients(9.7%), 16 patients(15.4%), and eight patients (7.7%) respectively. The mortality rate was 14.4%. D-dimer (P = 0.008), pro-BNP (P = 0.008), and Charlson criteria (P = 0.012) were higher in patients with systematic complications. In addition, NT pro‑BNP was significantly associated with CNS complications (P = 0.04) and D‑Dimer level was significantly associated with in‑hospital mortality (P = 0.008).

Serum biomarkers such as pro‑BNP and D‑dimer, and comorbidity indices can be used for risk stratification of patients with IE. The level of pro‑BNP is significantly associated with CNS complications and the level of D‑dimer is significantly with mortality in patients with IE.

The shape of the left ventricle (LV) is an important index to explore cardiac pathophysiology. A comparison was provided to estimate circumferential, longitudinal, and radial wall stress in LV based on the thick?walled ellipsoidal modelsof Mirsky and Ghista?Sandler for discriminating significant coronary artery disease (CAD) patients from no CAD patients.

According to the angiography findings, 82 patients with CAD were divided into two groups: 25 patients without significant CAD and 57 patients with significant CAD of single vessel and multivessel. An ellipsoidal LV geometry was used to calculate end?systolic passive stress as the mechanical behavior of LV. Echocardiographic views?based measurements of LV diameters used to estimate the end?systolic wall stress.

Circumferential wall stress between the control group and significant CAD groups was significantly elevated for the Ghista model (P = 0.008); also, radial and longitudinal stress of the multi?vessel CAD group was significantly higher than the control group (P = 0.01 and P = 0.005, respectively). All stress parameters of the multi?vessel CAD group were statistically significant compared to the control group for the Mirsky model. Receiver operating characteristics curve analysis was shown the circumferential stress of multi?vessel CAD with an area under the curve (AUC) of 0.736 for the Ghista model and an AUC of 0.742 for the Mirsky model.

These results indicated that Ghista and Mirsky model estimates ofcircumferential passive stress were the potential biomechanical markers to predict patients with multi?vessel CAD. It could be a noninvasive and helpful tool to quantify the contractility of LV.

Thyroid hormones play an important role in cardiac tissue function. Therefore, it is important to understand the relationship between thyroid hormone levels and cardiac disorders.

The present study aimed to assess the relationship between normal serum level of thyroid hormones and left ventricular systolic and diastolic dysfunction.

In this cross sectional descriptive retrospective study, 391 patients were selected. They were referred to the Rajaie Cardiovascular Research Center, Tehran, Iran from 2019 to 2021. After extracting echocardiographic and laboratory data from the clinical records, the parameters affecting the left ventricular systolic and diastolic dysfunction were analyzed using statistical software.

The mean age of patients was 41 ± 12.8 years. Among them 58.1% of all patients were female. Tricuspid regurgitation (TR) severity had a significant relationship with thyroid stimulating hormone (TSH) level (P = 0.02). End diastolic interventricular septum thickness (IVSD) was inversely associated with thyroxin4 (T4) level (P = 0.04). Mitral valve inflow deceleration time (MVDT) was inversely correlated with thyroxin3 (T3) (P = 0.04). Left ventricular ejection fraction (LVEF) was inversely related to TSH level and end diastolic right ventricular internal diameter (RVIDd) was directly related to TSH (P = 0.05).

Thyroid hormone levels in the normal range can be associated with the tricuspid regurgitation severity, end diastolic right ventricular internal diameter (RVIDd), mitral valve inflow deceleration time (MVDT), and. end diastolic interventricular septum thickness (IVSD). Due to the high prevalence of heart disorders, information on thyroid hormone levels can be helpful in the identification and timely treatment of these disorders.

Infective Endocarditis (IE) is a life-threatening disease. Regardless of improved healthcare, the incidence of IE has increased over time. A variety of microorganisms have been found to be associated with IE.

This study aimed to determine the incidence of various microorganisms in patients admitted with IE and to assess their relationships with in-hospital complications.

This prospective cross-sectional study was conducted on patients with definite or possible IE based on the Duke criteria at a tertiary referral center between 2016 and 2021. Blood cultures were performed for all the patients to document the positive or negative blood cultures as well as the types of microorganism. Statistical analyses were performed using the SPSS 18 software.

The study population consisted of 286 patients (181 males (63.3%) and 105 females (36.7%)) with the mean age of 49.67 ± 17.11 years. The most common cardiac predisposing factor was the prosthetic valve (n = 110, 38.5%) followed by a history of congenital heart disease (n = 68, 23.8%), while the most frequent non-cardiac predisposing factors were a history of chronic kidney disease (n = 75, 26.2%) and diabetes mellitus (n = 53, 18.5%). The most frequent causative microorganisms were coagulase-negative Staphylococcus (n = 37, 12.9%), Staphylococcus aureus (n = 31, 10.4%), Enterococcus (n = 29, 10.1%), and Streptococcus viridans (n = 14, 4.9%). The most common complications were acute renal failure (26.6%), heart failure (17.5%), and pulmonary involvement (8.4%).

The frequencies of microorganisms related to IE, especially culturenegative IE, vary in different countries, precluding the practical use of a specific guideline around the world. Further research is, therefore, required to determine the epidemiology and microbiology of IE in different countries with a view to eventually devising an individualized guideline appropriate to the epidemiology and microbiology of IE in every country.

The goal of the study was to identify earlier pathology of the Left Ventricle (LV) using Speckle Tracking Echocardiography (STE) without angiography results for detecting Coronary Artery Disease (CAD) patients who have need invasive coronary reperfusion.

A total of seventy-five referral patients to angiography (mean age 57±9 years) with chest pain, underwent Two-Dimensional Echocardiography (2D-ECG). Conventional echocardiographic parameters were calculated for the assessment of LV function. End systole and early diastole longitudinal strain, strain rate, and velocity with 2D-STE were estimated to evaluate myocardial function. Discriminated analysis was performed to detect CAD patients from the healthy group.

According to the angiography results, patients were divided into CAD group (n=55) and healthy group (n=20). There was a significant decrease in longitudinal strain, strain rate, and velocity in patients with CAD compared to the healthy group (systolic longitudinal strain for CAD group -15.9±2.2% vs. -19.6±2.2% for healthy group and early diastolic longitudinal strain for CAD patients -9.5±1.2% vs. -12.0±1.3% for the healthy group) (P-value<0.05). Discriminate analysis of end-systolic and early diastolic longitudinal strain with 81.8% and 89.1% indicated the highest sensitivity, respectively.

End systolic and early diastolic longitudinal strain parameters derived with the STE method are superior predictors for detecting CAD patients referred to angiography for revascularization.

Enterococci are responsible for 5% to 18% of infective endocarditis (IE) cases. We aimed to determine demographic data, predisposing factors, clinical presentations, complications and echocardiographic findings concerning enterococcal endocarditis.

Since 2006, all adult patients with a possible or definite diagnosis of IE based on the modified Duke criteria have been enrolled in the Iranian Registry of Infective Endocarditis. In this study, patients with IE of enterococcal origin were detected and their demographic characteristics, predisposing factors, complications, laboratory data and echocardiographic findings were assessed.

Out of 731 patients diagnosed with endocarditis. Enterococci were found in 60 patients: 32 men (53.3%) and 28 women (46.7%) at a mean age of 55.21 ± 17.9 years. Definite IE was diagnosed in 57 (95%) patients, and possible IE was suspected in 3 patients (5%). The most frequent predisposing factor was the prosthetic valve (n=28, 46.7%), followed by a history of previous endocarditis (n=12, 20%). An acute course (<6 wk) was reported in 38 patients (63.3%). Fever (n=58, 95%) and loss of appetite (n=17, 28.3%) were the most frequent symptoms. The most frequent location of involvement was the aortic valve (n=22, 36.7%), followed by the mitral valve (n=20,33.3%). Vegetation was detected in 53 patients (88.3%), abscess formation in 8 (13%). Fifteen patients (25%) had heart failure, and 11 (18%) had central nervoussystem complications. The mortality rate was 20%.

Given the serious complications and the high mortality rate in the patients with IE of enterococcal origin, which may be due to these organisms’ intrinsic resistance to many antibiotics, we suggest further studies to determine more effective antibiotic regimens and even individualized antibiotic therapies for enterococcal endocarditis.

Several surgical procedures such as excision or exclusion are recommended for the closure of the left atrial appendage (LAA). This study was conducted with the aim to evaluate the success rate of different surgical techniques for LAA closure, their respective complications, and the rate of post-surgical cerebrovascular accident (CVA). This retrospective study included 150 consecutive patients who underwent LAA closure most commonly after mitral valve surgery within 3 to 6 months after surgery. An expert echocardiographic fellow collected the data on patients’ surgical LAA closure methods and history of CVA, types of prosthetic valves, mortality, and bleeding. The failure rate for complete LAA closure was 36.7% (55 patients) in our study. The greatest success rate of complete LAA closure was seen in purse-string method (75.5%), followed by resection method (71.4%), while the lowest success rate (≈ 33.3%) was observed in ligation method. A significant relationship was observed between clots on the surface of metallic valve and postoperative CVA (P = 0.001; likelihood ratio: 32).  In multivariate analysis, there was also no statistically significant relationship between partial LAA closure and the incidence of post-surgical CVA (P > 0.050). We observed the highest success rate of complete LAA closure in purse-string method followed by resection method. Interestingly, our results showed that despite the higher rate of residual LAA clot in cases of partial LAA closure, the occurrence of post-surgical CVA was mostly related to the presence of clots on the surface of metallic mitral prostheses rather than the presence of partial LAA closure.

The early diagnosis of heart failure in patients with hypertrophic cardiomyopathy (HCM) remains a challenge. In this study, we sought to evaluate cardiac mechanics in patients with HCM.

Sixty patients (60% men, mean age = 45.8 ± 17 y) with documented HCM were identified from an ongoing clinical registry.

The values of maximal left ventricular (LV) wall thickness, the ejection fraction (EF), global the longitudinal strain (GLS), and the global circumferential strain (GCS) were 2.2 ± 0.5 cm, 54.1 ± 6.5%, −15.3 ± 4.5%, and −26.9 ± 7.5, consecutively. Cardiovascular magnetic resonance imaging (CMR) data on 34 patients were included in the analysis. Nearly half of the patients had obstructive HCM; and in comparison with nonobstructive HCM, there were no significant differences in terms of GLS, GCS, EF, and the New York Heart Association Functional Class (NYHA FC). EF was similar between the 2 NYHA FC groups (I and II vs III and IV). GLS had a meaningful difference between the NYHA FC groups. In patients with a late gadolinium enhancement (LGE) value of equal to or greater than 15%, EF, GLS, and GCS were correlated and reduced.  Additionally, in those with an LGE value of between 5% and 15%, EF was preserved with a reduced GLS. GLS was worse in patients with an E/average E′ ratio of equal to or greater than 14.

Our study showed that an increased LV wall thickness and/or a reduced LV end-diastolic volume, with better GCS, maintained a normal EF despite a reduced GLS. GLS had a better correlation with NYHA FC and LGE in CMR than EF alone. (Iranian Heart Journal 2020; 21(4): 43-59)

 Pericardial mesothelioma cyst occurs rarely, and is often found incidentally. The coexistence between large pericardial mesothelial cyst and hypertrophic obstructive cardiomyopathy (HOCM) can make difficulties in medical management.

Our case was a 33-year-old man presented with dizziness and pallor while standing since four years before, and recent syncope. On admission, transthoracic echocardiography reveled presence of hypertrophic cardiomyopathy in association with relatively small right ventricular and atrium due to compression effect by a large echo-free space at the right side of heart suggestive of pericardial cyst. Cardiac computed tomography confirmed presence of HOCM and large pericardial cyst. Patient underwent surgical septal myectomy and large mesothelial pericardial cyst excision because of persistent symptoms and compression effect of cyst on the right chambers despite beta-blocker therapy.

 To best of our knowledge, the coexistence of the large pericardial mesothelial cyst and HOCM has not been reported before.

Congenital absence of the pericardium is a rare condition. Diagnosis and management of this condition remain a dilemma for clinicians. Here, we report a case of 15-year-old boy who had complaint of palpitation. Considering the echocardiographic features, pericardial agenesis associated with atrial septal defect (ASD) was suspected and multimodality imaging was performed for subsequent confirmation. Mal-aligned septum leads to failure in ASD device closure; therefore, the defect was repaired surgically by using a Dacron patch. Physicians need to be aware of this disorder and its associated congenital abnormalities, to enable them to make a correct diagnosis and treatment plan.

Acute kidney injury (AKI) due to antibiotic nephrotoxicity is a complication that can be avoided or managed properly if diagnosed early.

We aimed to determine the incidence and risk factors of AKI and to assess the possible effects of nephrotoxic antibiotic therapy on its development in a large group of patients with infective endocarditis (IE).

Patients with definite or possible IE diagnosed based on the Duke criteria were included in this retrospective cohort study at a tertiary referral center from 2007 to 2017. Data were derived from the single-center Iranian Registry of Infective Endocarditis (IRIE). Baseline risk factors for AKI were assessed via repeated serum creatinine measurements. Patients (n = 22) with end-stage renal failure undergoing dialysis were excluded. AKI was defined and staged in accordance with the Kidney Disease: Improving Global Outcomes (KDIGO) classification.

Totally, 498 patients at a mean age of 45 ± 16 years were studied. The baseline creatinine level was 1.26 ± 0.72 mg/dL. AKI occurred in 126 (26.3%) patients 1 week after the initiation of antibiotic therapy. There was a significant relationship between AKI and the use of gentamicin (P = 0.01) and gentamicin and vancomycin concomitantly (P = 0.01). At the end of the treatment, after dose adjustment and additional treatments, the incidence of AKI decreased to 22.7%, whereas this improvement was less remarkable in the patients with prior renal failure. Some independent variables, including age (P = 0.04), diabetes (P < 0.0001), prior renal failure (creatinine > 2 mg/dL), anemia (P = 0.003), left-sided IE (P = 0.04), and positive blood cultures with Staphylococcus aureus (P = 0.04) had a statistically significant association with AKI.

Close monitoring of the renal function is essential in IE patients receiving treatment with nephrotoxic antibiotics, especially patients with advanced age, diabetes, chronic renal failure, anemia, and left-sided IE.

By estimating the total coronary plaque burden, the Coronary Artery Calcium (CAC) score determines the risk of Coronary Artery Disease (CAD). The presence of a zero CAC score may be highly predictive of very low risk patients for Major Cardiac Adverse Events (MACEs) due to its close relation with the severity of CAD.

The present study aimed to evaluate the value of a zero CAC score for predicting MACEs in patients older than 60 years suspected of CAD.

Between April 2011 and March 2012, 128 patients aged > 60 years with a zero CAC score on admission without a previous history of CAD were consecutively included in this study with a mean follow-up period of 45.7 months. The continuous variables were compared using t-test or Mann–Whitney U test and the categorical ones were compared using chi-square test. The statistical analyses were done using the SPSS statistical software, version 23.0.

This study was conducted on 128 patients (35 males and 93 females). The incidence of MACEs was 2.3% in a mean follow-up period of 45.7 months and 0.6 per 100 patient-years. Additionally, the MACE-free survival rates were 99.1%, 99.1%, and 87.7% in one, three, and five years, respectively. The negative predictive value of a zero CAC score for predicting long-term MACEs was 100% in the patients older than 70 years and 96.8% in those aged between 60 and 70 years. No cardiac-related death was recorded within the follow-up period.

A zero CAC score had a high negative predictive value for predicting long-term MACEs in elderly patients with mild to moderate pretest probability of CAD, which reached 100% among the patients older than 70 years

Slow coronary flow (SCF) is a condition defined as the delayed passage of the contrast agent in the absence of angiographic coronary artery stenosis. Left ventricular (LV) systolic and diastolic dysfunction has been reported in patients with SCF, which can influence their functional capacity. This study compared myocardial deformation between cases with normal coronary arteries and patients with SCF. This cross-sectional comparative study included 32 patients with SCF and 32 controls with normal epicardial coronary arteries (NECA). After coronary angiography, echocardiography was done for all the participants and the results were compared between the groups. A total of 64 patients were studied. The mean global longitudinal peak systolic strain (GLPS.Avg) was 16.85. SCF was significantly more frequent in the men than in the women (P < 0.05). Diabetes mellitus, systemic hypertension, a history of past or current smoking, and a family history of coronary artery disease (CAD) in the patients with SCF and dyslipidemia in the NECA group were more frequent, although these differences were not statistically significant. GLPS.Avg and global longitudinal peak systolic stress in the apical 4-chamber view (GLPS.A4C) in the patients with SCF were significantly lower than those in the NECA group. Global strain in the apical 2- and 3-chamber views (GLPS.A2C and GLPS.LAX), septal E, septal A, lateral E, lateral A, and right ventricular Sm (peak myocardial systolic velocity) were also nonsignificantly lower in the patients with SCF. Strain imaging using 2D echocardiography was abnormal in our patients with SCF, in comparison with the NECA group. These abnormalities may represent subtle systolic and/or diastolic dysfunction in patients suffering from SCF.

Although the TAVI technique has been widespread in Europe and America, concerns have emerged regarding the associated complications, mainly paravalvular leakage, vascular complications, stroke, post-operative pacemaker implantation due to complete AV block, optimal access sites, long-term valve durability, and economic sustainability, therefore controversy remains about the ideal treatment of high-risk operable patients. Sutureless tissue valves like Perceval S may be a good option for these high risk operable patients. We will present the clinical outcomes of first cases of Perceval S in Iranian patients. From July 2015 to August 2016, 11 patients (8 male, 3 female) with severe aortic stenosis who were candidates for aortic valve replacement were included in this study. The mean age of patients was 73 ± 8 ranged from 65 to 86 years. The most common presenting symptom was dyspnea and three of the patients had coronary artery disease in need for concomitant revascularization. Preoperative peak gradient across the aortic valve ranged from 72 to 135 mmHg (mean = 97 ± 25). All patients were followed up from 3 to 20 months with a median of 13 months. Dramatic reduction of trans-aortic peak gradients was seen in all patient (mean postoperative gradient = 29 ± 8 mmHg). Small degrees of transvalvular and paravalvular leakage were seen in intraoperative echocardiographies but only one patient had small asymptomatic paravalvular leakage during midterm follow up. Two patients need for transient pace maker; however we had no case of complete heart block. Mean post-operative mediastinal bleeding was 480 ± 150 mL and no patient needed re-exploration for bleeding or tamponade management. ICU stay time was 3 ± 1.54 days, and there was no in-hospital mortality. All patients were discharged in good status and there was no mortality during follow-up period. Preliminary clinical results of the first experience was encouraging; however we need to continue the study with more study volume, more follow up period and more high risk or complicated patients.

Hypertrophic cardiomyopathy (HCM) is clinically characterized by the presence of left ventricular hypertrophy in the absence of hypertension and valvular heart disease. Diastolic dysfunction is an important pathology in patients with HCM, and it is characterized by abnormal relaxation, increased left ventricular filling pressure, pulmonary congestion, and ultimately cardiac symptoms. The present study aimed to assess the isovolumic relaxation time (IVRT) in patients with HCM as an important indicator of diastolic dysfunction.
Nineteen control subjects and 35 patients with HCM were included in the present study. Diagnosis was based on the confirmation of unexplained myocardial hypertrophy in the left ventricle by conventional echocardiography. The peak velocity of early (E) and late (A) filling, E-wave deceleration time (DT), and the E/A ratio were assessed using pulsed-wave Doppler (PWD) echocardiography at the tip of the mitral valve leaflets in the apical 4-chamber view. The IVRT was measured in the 4-chamber view via the PWD method. To that end, the filtering gain of the images was adjusted and the IVRT was estimated.
The mean age of the patients was 31±16 years. The IVRT more significantly increased in the patients with HCM than in the control group (P The diastolic function was impaired in our patients with HCM. Moreover, the IVRT as a noninvasive index of the diastolic function was prolonged in those with HCM.

The presence of pericardial effusion (PE) in the setting of infective endocarditis (IE) may be a sign of more severe IE. In this study, we aimed to determine the prevalence and prognostic significance of PE in patients with native valve IE.
The Iranian Registry of Infective Endocarditis (IRIE) is a single-center observational hospital-based study of patients with IE. Between 2002 and 2015, all patients with a diagnosis of IE who had been enrolled in the IRIE were evaluated.
A total of 445 patients (68.3% male) were enrolled in this registry, and 221 (49.7%) patients had PE. PE was more prevalent in the patients with native valve IE and those with right-heart involvement (65% in right-heart IE vs 50% in left-heart IE; P=0.002). The rate of in-hospital mortality was 20% and 19.2% in the patients with and without PE, respectively, and the presence of PE was not a predictor of in-hospital death in our multivariate analyses. Additionally, there was no relationship between the rates of IE-related complications and the severity of PE. However, the prevalence of PE was higher in the patients with right-sided IE as well as in those with aortic root abscess and systemic emboli at presentation.
The prevalence of PE in the setting of IE was relatively high in the present study. Most cases of PE had mild effusion, and there was no relationship between the severity of PE and IE- related complications as well as in-hospital mortality.

Mitral stenosis is a common and important type of valvular heart disease. This study was performed to determine and compare the hemodynamic, echocardiographic and clinical data before and after percutaneous transvenous mitral commissurotomy (PTMC). In this prospective cohort, the data for 171 consecutive patients with PTMC at a university referral heart hospital have been collected and analyzed from March 2015 till September 2016. Due to the missing data reported on the medical charts, 20 cases were further dismissed. Therefore, clinical studyonhemodynamicmonitoring and echocardiography have been observed and compared on the remaining 151 consecutive cases. In this study, demographic data, clinical symptoms and medication before the procedure and systolic pulmonary arterial pressure (SPAP), pulmonary capillary wedge pressure (PCWP), trans mitral valve gradient and mitral valve area (MVA) before and after PTMC have been measured. The results showed that according to Wilcoxon test there was a significant increase in PCWP, significant decrease in mean gradient of mitral valve and significant reduction in SPAP after PTMC (P = 0.0001). In this study, post-procedure mitral regurgitation (MR) values after echocardiography and angiography have been compared and it was stated that about 90.4% (138 cases) are diagnosed with mild MR (no MR and mild MR) in angiography while 10.6% (16 cases) have trivial and mild MR in echocardiography (P < 0.0001). Totally it may be concluded that there is significant difference between the hemodynamic and echocardiographic data after PTMC. Echocardiography estimates the MR complications after PTMC to be higher than angiography.

We evaluated chest pain alongside other midterm subjective and objective complications of the transcatheter closure of atrial septal defects (ASDs) and patent foramen ovales (PFOs) with various closure devices.
This cross-sectional study, performed from March 2010 to October 2015 in Rajaie Cardiovascular, Medical, and Research Center, evaluated 313 patients (mean age = 29.12 ± 10 years, 32.9% male) for probable complications associated with the transcatheter occlusion of secundum ASDs (n = 289, mean age = 30.5 ± 11.4 years, 28% male) or PFOs (n = 24, mean age = 42.8 ± 10.2 years). ASD closure was performed under sedation and transesophageal echocardiography (TEE) guidance. Duration of follow-up was 12 ± 3 months (mean follow-up = 11.52 months).
Among the subjective complications, chest pain was the most frequent complaint during the follow-up period and although it was common (7.3%), a clear cardiac etiology was rare. Thirteen (4.2%) patients reported palpitation during the follow-up period, and 4 had documented arrhythmias—including atrial flutter, atrial fibrillation, and 2:1 atrioventricular block. Migraine with or without aura occurred in 1.6% of the patients. Objective complications comprising tamponade, device embolization, and thrombus formation occurred in 6 (1.9%) patients. There was no procedure-related mortality in our patients.
Transcatheter closure of PFOs and secundum-type ASDs in our adult patients using ASD septal occluders was associated with a high degree of success, minimal procedural subjective and objective complication rates, and excellent short- and midterm results. Although chest pain was common after the first month following ASD closure, there was no cardiac death or aortic erosion in 11.52 months follow up.

Anomalous origin of the left coronary artery from the pulmonary artery (ALCAPA) is a rare congenital cardiac malformation. We report three cases of ALCAPA who survived to adulthood. The first case was a 51-year-old woman who complained of typical chest pain that was diagnosed with ALCAPA using cardiac catheterization and coronary computed tomographic angiography (CTA). The second case was a 30-year-old woman with a history of surgery for atrial septal defect at 10 years old who presented with progressive exertional dyspnea. Cardiac catheterization confirmed the diagnosis of ALCAPA. The third case was a 19-year-old man who was brought to our clinic due to aborted sudden cardiac death on the previous day. Cardiac catheterization and coronary CTA confirmed the diagnosis. They underwent the closure of orifice of the anomalous left coronary artery and grafting the left anterior descending artery concomitantly with mitral valve repair. All patients were followed up during a mean of 8.7 months and they were asymptomatic.

Coronary-cameral fistulas (CCFs) constitute a rare anomaly that can be incidentally detected during angiography. CCFs are solitary, large or small assemblies that originate from coronary arteries and enter one of the cardiac chambers. We describe a 29-year-old woman, whoreferred to our clinic with the chief complaints of palpitation, atypical chest pain, and dyspnea on exertion (functional class II). Multimodality imaging confirmed the diagnosis of a CCF from the left main with extension to the right atrium and drainage therein. The CCF was closed percutaneously with a patent ductus arteriosus occluder successfully.

A 30-year-old woman was referred to our department for a cardiology visit. She had a medical history of ophthalmologic disorders. Her chief complaints were dyspnea, lightheadedness, and fainting after the Valsalva maneuver. Physical examination showed systolic murmurs at the left upper sternal border as well as corneal thinning and bulging in the 2 eyes. Transthoracic echocardiography revealed local significant hypertrophy in the base of the interventricular septum with significant left ventricular outflow obstruction and severe mitral regurgitation.

Pain is a symptom of discomfort or tissue injury experienced by patients. Among patients in intensive care unit (ICU), pain is a common phenomenon..
The purpose of this study was to evaluate the effect of preferred music listening on behavioral measures of pain, as an indicator of pain assessment, in patients undergoing coronary artery bypass graft surgery (CABG)..
Patients and This blinded clinical trial was performed on 60 patients admitted to ICU following CABG. Patients intubated and those under mechanical ventilation were unable to report their pain. The study population was randomly divided into two groups of control and music intervention groups (preferred music listening). In the intervention group, preferred music (including classical, instrumental and traditional music as well as Quran recitation) was played via a headphone for 30 minutes. In the control group, patients were in bed at the same time and only mute headphones were used. The pain levels of patients were assessed at three time intervals; a) during rest, b) 10 minutes prior to receiving music, following a painful procedure (e.g., change of position for dressing change) and c) in the final 3 minutes of music following a painful procedure using the method of “critical care pain observation tools” (CPOT)..
The mean pain behavior scale score 10 minutes prior to receiving music, following a painful procedure, was 2.77 ± 1.04 in the music intervention group and 2.33 ± 1.12 in the control group. The score increased after a painful procedure compared to that before the procedure in the control group and reached 2.67 ± 1.124; this increase (0.34 unit) in the control group was statistically significant (P = 0.008). In contrast, the score in the music intervention group dropped to 2.20 ± 1.06 and statistical tests showed a significantly reduced pain behavior scale score in the music intervention group (P The results of this study showed beneficial effect of preferred music listening on reducing pain sensation during painful procedures in intubated patients after CABG..

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.
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).
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.
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.

Myxomas are the most common primary cardiac tumors. They are mostly located in the left atrium, but 15% to 20% of them arise from the right atrium (RA). We herein describe a 22-year-old man with a giant RA mass and simultaneous pulmonary embolism. The mass was detected accidentally on transthoracic echocardiography in preoperative workup for an elective noncardiac surgery and was confirmed with multimodality imaging. The patient underwent surgical removal of the mass and concomitant pulmonary artery embolectomy. Histopathological examination confirmed the diagnosis of an RA myxoma. He had an uneventful recovery and was asymptomatic after 24 months of follow-up. This case is a villous RA myxoma, which is a very rare subtype with a high tendency to pulmonary embolism. We report this case as an unusual location of a very large myxoma and emphasize the role of multimodality imaging in the preoperative management of this patient as cardiac computed tomography angiography confirmed the associated pulmonary embolism..