فهرست مطالب mohaddeseh behjati

Prosthetic valve malfunction is a hazardous clinical entity that needs early diagnosis and management. Hereby, we present a case of tricuspid valve (TV) malfunction due to interaction of central venous pressure (CVP) catheter with TV leaflets. Our case was a 38-year-old male who referred to our center with the diagnosis of TV malfunction. Confirming the diagnosis of TV malfunction, intravenous Heparin was initiated. Anticoagulation therapy was discontinued early due to the development of significant headache in the setting of subarachnoid hemorrhage. Due to contraindication of anticoagulation therapy, he underwent redo TV. On the 4th post-operative day, echocardiography examination illustrated significant increase in gradients of TV prosthesis. At this time, fluoroscopy depicted interaction of CVP catheter with TV leaflets due to its cardiac advancement resulted in fixed TV leaflets in semi-open position. By extraction of CVP catheter the TV gradients improved immediately. Malposition of CVP catheter or large CVP catheter could be considered as one of the rare causes of TV malfunction. Repositioning of CVP catheter brings dramatic improvement in this case.

Transesophageal echocardiography probe intubation or extubation: which side is generating more aerosols associated with spreading COVID-19 contamination?

Bardet-Biedl syndrome (BBS) (MIM 209900) is a genetic disorder with a wide spectrum of clinical manifestations including retinal dystrophy, hypogenitalism, polydactyly, obesity, renal abnormalities and mental retardation. We describe a 13-year-old girl, a known case of Bardet-Biedl syndrome, who was going to undergo hysterectomy due to hydrometrocolpous. She was homozygous autosomal recessive for gene BS57. She was obese and had impaired vision, renal abnormality, borderline intelligence, recurrent urinary tract infection, menstrual problems, normal secondary sex chrematistics and corrected polydactylies. She had also big nose, thin upper lip, slightly everted lower lip, small mouth and retrognathia. Her electrocardiography showed incomplete right bundle branch block. We identified atrioventricular septal defect (AVSD). In conclusion, physicians who deal with cases who suffered from Bardet-Biedl syndrome, should be vigilant about seeking for identification of cardiac anomalies such as partial AVSD. This leads to earlier identification of the existing cardiovascular disease which facilitates appliance of curative measures.

Context: 

Cardiogoniometry (CGM) is a noninvasive technique for quantitative three‑dimensional vectorial analysis of myocardial depolarization and repolarization. We describe a method of surface electrophysiological cardiac assessment using CGM performed at rest to detect variables helpful in identifying coronary artery disease (CAD) and interplaying factors in patients who underwent coronary artery bypass graft (CABG).

In this study, all patients with CAD undergoing CABG were enrolled. Echocardiography, CGM, and electrocardiography (ECG) were obtained before surgery and a month later. The ECG and CGM alterations were compared before and after CABG and the accuracy of those two methods was evaluated.

In this study, 50 patients were enrolled, of which 33 (66%) were male versus 17 (44%) female, with a mean age of 39.12 ± 60 years. The mean ejection fraction before and after surgery was 44.3 ± 7.9% (range: 20–55) and 40.9 ± 12.5% (20–50), respectively. Before surgery, all patients had sinus rhythm, five cases had left bundle‑branch block (LBBB), and one case was with right bundle‑branch block (RBBB). Subsequently, after surgery, five cases had LBBB, and two cases were found to have RBBB. The rate of postoperation bleeding was 20%. There was no significant change in echocardiographic characteristics before and after operation (P = 0.81); likewise, no significant change was seen in ECG criteria before and after operation (P = 0.96). A significant correlation was seen regarding CGM characteristics before and after CABG (P = 0.003).

A significant association was seen regarding CGM characteristics before and after undergoing an operation. In addition, the specificity and sensitivity of the CGM and ECG before and after operation improved well.

Arrhythmogenic left ventricular cardiomyopathy (ALVC) is a rare inherited cardiomyopathy characterized by the progressive fibrofatty replacement of the left ventricular (LV) myocardium in combination with arrhythmias of LV origin. Herein, we present a case of the coincidence of ALVC and left ventricular non-compaction (LVNC) in a 34-year-old woman presenting with the chief complaint of palpitation. The patient had a history of an episode of severe common cold the previous year. Her mother was diagnosed with typical hypertrophic cardiomyopathy. The patient’s preliminary echocardiography demonstrated evidence of LVNC. Subsequent evaluation using cardiac magnetic resonance (CMR) imaging showed a mildly enlarged LV without hypertrophy, along with noticeable myocardial trabeculation (Fig. 1) and a mildly decreased systolic function. Late gadolinium enhancement illustrated a fibrotic layer in the mid-anterior LV segment (Fig. 2). There was an elongated, thick stripe of subepicardial fat deposition at the base-to-mid–anteroseptal, anterior, and anterolateral LV segments (Fig. 3 & Fig. 4). Right ventricular apical trabeculation was prominent, with a regular ventricular function. The CMR tissue characterization criteria indicated the coincidence of ALVC and LVNC. Advances in noninvasive imaging modalities have significantly improved the delineation of the morphologic appearance of ventricles in different cardiomyopathies, facilitating identification and diagnosis. (Iranian Heart Journal 2024; 25(2): 92-95)

 Congenital malformation of mitral valve could encounter in isolation or with other congenital heart diseases.

 Here, we report a case of congenital hypoplastic anterior mitral valve leaflet (AMVL).

 A 30-year-old male with a history of diabetes mellitus was referred with pleuritic chest pain since the previous day. He was admitted with impression of pericarditis. Trans thoracic echocardiography showed no pericardial effusion with incidental finding of lipomatous change of mitral valve annulus and hypoplastic AMVL with mild to moderate mitral regurgitation.

 Cardiac magnetic resonance imaging showed thickening and fibrosis replacement of intervalvular fibrosa which extended to AMVL and resulted in restricted mitral valve annulus (12.4 mm) with subsequent restricted MV opening without significant mitral stenosis or regurgitation. These data were in favor of congenital hypoplastic MV annulus.

 Hypoplastic AMVL with restricted mitral valve annulus is a rare cause of mitral valve malformation and could be well tolerated since adulthood with good prognosis.

 Endourologic or percutaneous interventional treatments in genitourinary (GU) is a growing field of science with the advent of improved imaging techniques and smaller catheters. Hereby, we report case series of endovascular GU angioembolization procedures performed in our center.

 In this study, we report cases who underwent successful angioembolization. A total of 76 cases of bladder transitionary cell carcinoma cells, 8 cases of bladder and renal arteriovenous malformation (AVMs), 33 cases with hematuria after percutaneous nephrolithotomy (PCNL), 29 cases of renal angio-myolipoma, 3 benign prostatic hyperplasia (BPH) cases high risk for surgery and 5 cases of hematuria in the setting of acute renal trauma had undergone GU endovascular treatment.

 The success rate for angioembolization of bladder transitionary carcinoma cell was 100% but in 2 cases hematuria continued due to another GU source. Coil embolization of bladder and renal AVMs and renal angio-myolipoma were successful in all cases. Cessation of hematuria after PCNL was successful in all cases except one. Coli embolization of BPH and hematuria due to renal trauma were ceased in all cases. Complications included easily controllable hematoma in 3 cases. Contrast induced nephropathy and fever occurred in 12% and 20%, respectively. Pain duration was within 4 - 10 days after embolization of AVM or tumor. Embolization could be done in high output priapism and varicocel but we did not perform these procedures because of no referral.

 Coil embolization of GU system is quite safe and approved method and could be used with high success rate and low failure rate.

Despite the important role of coronary computed tomography angiography (CCTA) in determining the features of coronary atherosclerotic plaques, very few studies have investigated the role of plaque dimensions in the process of coronary artery obstruction. Therefore, this study aimed to assess the relationship between the characteristics and dimensions of calcified plaques and coronary artery stenosis using CCTA.

This study aimed to evaluate the relationship between calcified plaque dimensions and coronary artery stenosis in patients undergoing CCTA. Patients and

This cross-sectional study was conducted on 211 plaques of candidate patients for prospective and retrospective electrocardiography (ECG)-gated CCTA, using spiral scanning at 120 kV. The length, width, thickness, and luminal areas of calcified plaques were assessed in all coronary arteries.

The mean rate of stenosis was estimated to be 56.1 ± 24.4%. The number of patients with stenosis < 50% was 100 (47.3%). Stenosishada significant relationship with the plaque luminal areaandthe luminal dimeter of thenormalcoronary artery proximal and distal to the plaque (P < 0.05). However, there was no significant correlation between stenosis and normal luminal area (P > 0.05). Meanwhile, a significant relationship was found between stenosis and the width and length of plaques (P < 0.05).

The present results indicated a significant association between stenosis and the width, length, and luminal area of plaques. It can be concluded that plaque dimensions are a predictive factor for stenosis.

Cardioplegia is used to protect the heart from ischemic injury during cardiovascular bypass. We randomly selected candidates for coronary artery bypass surgery undergoing either microplegia or del Nido cardioplegia.

We performed a controlled randomized double-blind study to evaluate 60 patients undergoing coronary artery bypass surgery in Rajaie Cardiovascular Medical and Research Center during a 3-month period. During surgery, the case group received microplegia, and the control group received del Nido cardioplegia. Preoperative, intraoperative, and postoperative personal information was collected from the patients’ records, and the data were analyzed using the SPSS software, version 22, using appropriate statistical tests.

Out of 60 patients under study, 28 patients underwent microplegia, and 32 patients received del Nido cardioplegia. The patients, randomly assigned to the groups, did not significantly differ concerning height, weight, and body surface area. No significant differences existed between the 2 groups. The levels of postoperative decreases in hemoglobin and hematocrit were significant in the microplegia group and led to an increase in the number of blood transfusions in the intensive care unit. A significant increase in CK-MB was observed in the del Nido group 24 hours after surgery.

Microplegia, compared with del Nido cardioplegia, conferred proper myocardial protection. However, the use of the microplegia technique was associated with more significant decreases in hemoglobin and hematocrit postoperatively, and the beneficial effects of microplegia in reducing hemodilution were not well-reflected. 

The occurrence of obstructive sleep apnea (OSA) and its health-related issues, especially cardiovascular diseases (CVD), are increasing in developing countries. With a 3-year follow-up study, the present study aimed to determine the incidence of cardiovascular events in patients with OSA in an Iranian population.

In this prospective cohort study, 415 adults (300 patients with OSA and 115 patients without OSA) with a history of snoring and/or witnessed apneas or other suspected sleep breathing disorders were consecutively enrolled and followed up for three successive years to evaluate the development of cardiovascular events including acute coronary syndrome, cerebrovascular accidents (including ischemic or hemorrhagic strokes or transient ischemic attacks), death due to cardiac causes and all-cause mortality. 

415 patients were studied with a mean age of 56.2 ±15.7 years, 211 (50.8) of whom were male. Cardiovascular events developed in 15 participants (5%) of the OSA group, and 3 participants (2.6 %) of the OSA negative group. No significant differences were observed between the two groups in terms of the incidence of any of these events (P-value> 0.05). Using multiple logistic regression model (with P-value <0.2 as the significance level), age, OSA, and history of CVD remained as significant predictors for the development of cardiac composite events (incidence of CVD, CVA, death due to cardiac causes, and all-cause mortality) with the odds ratios of (95% confidence interval) 1.03 (1.01, 1.06), 2.41 (1.02, 5.76), and 7.40 (2.91, 18.67), respectively.

The present study showed that OSA is associated with a more than twofold increased risk of cardiovascular events. Thus, obstructive sleep apnea should be considered an independent cardiovascular risk factor.

Flow-mediated dilation (FMD) is considered a marker of endothelial cell dysfunction (ECD) and has been mostly evaluated in coronary artery disease. The role of ECD in the pathogenesis of pulmonary hypertension (PH) is not well-known. This study sought to evaluate the relationship between FMD and PH.
In this cross-sectional study, the FMD of the brachial artery was measured in 40 confirmed PH patients. Meanwhile, echocardiographic findings, the 6-minute walk test (6MWT), and serum pro-brain natriuretic peptide (pro-BNP) level were evaluated. Overall, 20 patients accomplished all evaluations, and their data were analyzed using SPSS software (version 23).
There was an inverse relationship between pro-BNP and 6MWT (r<0, P<0.05). A significant direct relationship was observed between left ventricular ejection fraction and FMD (P=0.031). Right ventricular (RV) dilation was significantly correlated with pro-BNP (P=0.046). There was a significant direct correlation between RV function and FMD and a significant inverse relationship between pro-BNP and FMD (P=0.05). The independent t-test showed no relationship between FMD and syncope (P=0.75).
Endothelial cell function, which can be evaluated by FMD, was involved in patients with PH. The FMD and 6MWT were helpful as objective prognostic markers in PH. Furthermore, pro-BNP was a noninvasive indicator in the diagnosis of RV systolic dysfunction.

Coronary Atherosclerosis is the leading cause of death and disability worldwide. Atherosclerosis could be detected noninvasively by coronary calcification, measured by calcium score in CT angiography. Dietary factors are influential in the evolution of coronary plaques, and one of the most prevalent drinks is black tea. We aimed to evaluate the effects of black tea on coronary calcium scores.

This cross-sectional analytical descriptive study was conducted on 200 candidates for CT angiography referred by their physician because their symptoms were suggestive of ischemia. A questionnaire was filled out for every participant, and the habit of tea drinking was asked and marked as none drinker, 1-3 cups per day and >3 cups per day.

89.5% of the participants consumed tea. The mean calcium score in patients who did not drink tea was 674.9±154.74 in those patients who drank 1-3 glasses per day, 269.5±46.9 and in those who drank more than three glasses of tea and was 261.1±45.2. There was a significant statistical relationship between calcium scores and tea intake, independent to other traditional risk factors (P= 0.001). Significant coronary artery plaques were also less prevalent in those who drank tea (36% and 41% in 1-3 and >3 cups, respectively) than non-drinkers (67%). Still, the number of involved vessels was not significantly different.

Regular black tea consumption could have protective effects on coronary artery calcification.

Our case was a 70-year-old male with a past history of coronary artery bypass graft surgery and true aneurysmectomy seven years ago who presented with chest pain and dyspnea. Echocardiography demonstrated scarred and aneurysmal apex (6.15 cm ×2.19 cm) with a small rupture just at most protruding part of it, to and from flow across this rupture site resulted in slow oozing of blood into pericardial sac with mobile clot in apex, clot formation in pericardial sac extended into both apical parts and distorted apical and apicoseptal geometry without communication with right ventricular cavity. Cardiac MRI (CMR) showed the following data: large apical pseudoaneurysm at the site of ruptured patch (depth: 46mm, width: 60mm), narrow orifice (5mm), septated left ventricular apical outpouching surrounded by apical layers and included clots in different sizes and ages. He underwent a successful surgical operation. In this case, CMR provides excellent images essential for patient management.

Despite the availability of iron chelators, toxicity due to increased iron load is the leading cause of death in thalassemia major patients, especially in Iran. This study was performed to determine the association between cardiovascular magnetic resonance using T2?weighted sequences (CMR T2*) and diagnostic value of echocardiographic arterial elasticity in major beta?thalassemia patients without cardiac symptoms in Isfahan, Iran, in 2019 and 2021.

This cross?sectional study assessed the association between CMR T2*, advanced echocardiographic arterial elasticity criteria, and serum ferritin in 67 patients with major beta?thalassemia patients without cardiac symptoms at Chamran Cardiovascular, Medical, and Research Center in Isfahan, Iran, in 2019–2021. Data analysis was performed among the 67 patients using SPSS, version 24.0 (StatisticalProcedures for Social Sciences, Chicago, Illinois, USA). Spearman’s rank test was used to assess the correlation between T2*CMR, echocardiographic arterial elasticity criteria, and ferritin. All parameters are presented as mean ± standard deviation. The results were considered statistically significant at P < 0.05.

There was a positive correlation between CMR T2* and arterial elastance index (P = 0.035, r = 0.258), according to the Spearman test. In addition, CMR T2* was not correlated with the  erum ferritin (P = 0.158, r = 0.201).

Totally, according to the obtained results, it may be concluded that the arterial elastance index from echocardiography and the CMR T2* may be indicators of myocardial iron overload in patients with major beta?thalassemia patients without cardiac symptoms.

Garlic may have anti-oxidanmayti-hypertensive and anti-hyperlipidemic properties. However, the effects of its administration on cardiac function in heart failure (HF) patients impact require further investigation. We aimed to evaluate garlic prescription effects on cardiac outcomes and quality of life scores in Iranian HF patients.

From August to December 2020, a randomized, double-blind clinical trial was conducted. Individuals with heart failure (New York heart association (NYHA) functional class of II and III) referred to private clinics in Isfahan, Iran, were randomly assigned to intervention (n=80) and control (n=80) groups. They have received 500 mg of odorless garlic tablets or the same shape and dosage of placebo twice daily for three months. Laboratory data, cardiac outcomes (end-diastolic diameter, ventricular septal thickness, NYHA functional class, left ventricular ejection fraction), quality of life score (Minnesota living with HF questionnaire), and the Modified Borg Scale (MBS) were all evaluated at the baseline and the end of the trial.

The population’s mean age was 58.1±13.5 years (55% males). Patients who consumed garlic had remarkably improved functional class compared to placebo takers and their baseline (NYHA practical class of II, 79.4% vs. 50.6%, P<0.001 and 79.4% vs. 54%, P=0.006, respectively). MBS levels were significantly lower among garlic consumers (baseline: 2.52±0.5, after three months: 2.2±1.06, P= 0.040).

Garlic administration may improve cardiac function and breathe in HF patients. Complementary research is necessary to confirm our findings.

Endovascular aortic repair (EVAR) of abdominal aortic aneurysms (AAAs) has been marked as standard practice during the past decades. We aimed to investigate the shortand long-term outcomes of EVAR in patients with AAAs in Isfahan, Iran. .

This retrospective study conducted on 50 patients with AAAs who have undergone EVAR procedure consequently in four different hospitals (Chamran hospital, Asgarieh hospital, Sepahan hospital and Saadi hospital) in Isfahan, Iran, between 2017 to 2020. We followed patients for one year and recorded short-term and one-year outcome include Endoleak, Aorta-iliac expansion, and mortality in hospital records during one year and telephone follow up. Data was entered in SPSS (ver.25) and analyzed with Univariate Linear Regression and Chi-Square Test.

The mean age of participants was 66.6±11.7 years old, in which 88%(n=44) of them were male. Elective EVAR was performed in 88% of patients. Regarding the complications one year after EVAR, endoleak and CIN (contrast-induced nephropathy) were occurred in 6%(n=3) and 6%(n=3) of patients, respectively. We also reported the rate of in-hospital mortality and one-year mortality as 2%(n=1) and 8%(n=4), respectively. Univariate regression analysis revealed no significant difference regarding one-year mortality in patients who underwent EVAR. In patients who underwent spinal anesthesia in comparison with general and regional anesthesia before EVAR, there were lower rate of vascular complications [0% (n=0) versus 23.5% (n=4) and 20.0% (n=2), P=0.053], level of blood urea nitrogen (BUN) [9.8 ± 13.9 versus 17.0 ± 13.1 and 14 ± 6.2, P=0.031] and creatinine (Cr) [0.6±1.1 versus 1.1±0.6 and 1.3±0.5, P=0.005], respectively.

Desirable short- and long-term outcomes as expected, combined with a reduction in hospital length of stay and mortality and one-year mortality allowed EVAR to become the favorable therapeutic strategy for AAAs in Iran especially in high-risk patients. Lower rate of vascular complications, ICU length of stay and lower level of BUN and Cr were observed using spinal anesthesia in patients who underwent EVAR in our centers.

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.

Our case was a 45-year-old woman who presented with a chief complaint of intermittent typical chest pain. In electrocardiography, ST-elevation in the lateral leads was observed. Echocardiography showed mild left ventricular systolic dysfunction with hypokinesia in the anteroapical segment. Coronary angiography was normal, and chest computed tomography showed a large mediastinal mass without any compression on the coronary arteries. Cardiac magnetic resonance imaging demonstrated a nonhomogeneous encapsulated mass close to the right ventricle and adjacent to the ascending aorta, the pulmonary artery trunk, and the superior vena cava, with compression effects on the coronary artery. There was transmural gadolinium enhancement in the mid-to-apical anterior and inferior walls with akinesia in these segments, in favor of myocardial infarction with nonobstructive coronary arteries. The patient underwent surgical mass resection, and the pathological investigation confirmed the diagnosis of a type B1 thymoma. (Iranian Heart Journal 2022; 23(1): 214-219)

Fontan operation is a reliable palliative surgery for patients with single ventricle physiology. Still, the development of complication is common; one of these complications that need to interventional approach is veno-venous collaterals between systemic and pulmonary veins. A 16-yearoldgirl with a history of modified Fontan operation at 9 years ago was referred with progressive cyanosis and dyspnea on exertion. In contrast trans-thoracic echocardiography (TTE), no fenestration was seen in Fontan circulation. Cardiac magnetic resonance revealed partial anomalous pulmonary vein connection (PAPVC) from left upper pulmonary vein to vertical vein and then into the in nominate vein and SVC with the reverse flow from superior vena cava (SVC) to left upper pulmonary vein(LUPV). This anomalous vein became severe engorged and tortuous. Possibly, LUPV and the verticalvein was dilated gradually as a result of increased pressure in the Fontan circuit. Finally, she underwent successful coil embolization in the midpart of the vertical vein. The oxygen saturation increased from80% to 93%.

Cardiac Calcified Amorphous Tumors (CATs) are rare non-neoplastic heart intracavitary mass lesions. Cardiac CATs may arise in any heart chamber and are characterized histopathologically by diffuse calcium infiltration. The recommended treatment of choice is complete resection of the mass through surgery. Herein, three cases with thalassemia were presented with significant CATs that remained asymptomatic during close observation without any surgical interventions.

The three patients suffered from thalassemia. One of them had a calcified mass (3.8 × 0.74 cm) in the right ventricle in the vicinity of ventricular trabeculations, which prolapsed into the tricuspid valve orifice that resulted in moderate to severe tricuspid regurgitation without the development of any stenosis. Another case had an irregular calcified mass (2.3 × 0.75 cm) in the roof of the left atrium. The third case had a large calcified mass with a mobile component in right ventricular trabeculation. Surgical resection of the mass was recommended in all the cases, but they were closely monitored without surgical intervention. During the five-year follow-up, they remained totally asymptomatic and had no cardiovascular or cerebral events.

Immobile CATs in patients with thalassemia can be asymptomatic. Hence, they can be closely monitored and surgical intervention can be delayed for many years.

There are various ways to improve the quality of life of social groups. Evaluation of these strategies and improvement of the quality of life of nursing staff should be prioritized by the healthcare administration.

This study aimed to measure the quality of life and related factors in the nursing staff of three selected hospitals.

This periodic descriptive study was conducted on 200 nurses working in three hospitals of Tehran, Iran. The quality of life data were collected using the World Health Organization Quality of Life (WHOQOL-BREF) questionnaire, and the demographic data were collected and analyzed in SPSS for Windows, version 16 (released in 2007, SPSS Inc., Chicago, USA).

The average scores of physical, mental, social, and environmental health were measured in this study. Mental health showed the highest score, whereas environmental health had the lowest score. No significant correlation was found between the nurses’ income level and quality of life.

The environmental and social health scores were significantly higher in married women as compared to men. Also, the score of social health was higher in married nurses, regardless of gender. Therefore, improvement of nurses’ quality of life should be prioritized by health managers in healthcare plans in the light of various factors described in this study.

Cardiac Hydatidosis is a rare and ominous complication of hydatid disease. Cardiac echinococcosis may be asymptomatic for several years but could be discovered after the development of lethal complications.

A 31-year-old-male referred with possible diagnosis of acute pericarditis. Abdominal and pelvic spiral CT scan showed focal and heterogeneous increased thickness of lateral left ventricular (LV) wall with protrusion into LV and bulging into pericardial space without central enhancement. His condition deteriorated suddenly due to cardiac tamponade with round cystic lesions suspected to hydatid cyst. Cardiac magnetic resonance imaging showed some round particles within effusion suggestive of possible scolex around the LV. There was round, and inhomogeneous cystic mass originated from sub-epicardial layer of mid-lateral LV that protruded into pericardial space. Diagnosis of hydatic cyst was confirmed by surgical specimen.

We suggest that patients with pericarditis should be probed with echocardiography for the presence of hydatid cysts.

A 65-year-old male was introduced with a history of percutaneous coronary intervention 2 years ago who received Aspirin and Plavix. He was referred for coronary angiography after receiving thrombolytic therapy for ST-elevation myocardial infarction in precordial leads. On admission, he had dyspnea with low oxygen saturation, leukocytosis, lymphopenia, elevated C‑reactive protein, and cardiac troponin levels. Transthoracic echocardiography demonstrated left ventricular ejection fraction (LVEF) of 25% and pulmonary artery pressure of 45 mmHg. Asmall thrombus at the site of the previously deployed stent was noticeable at coronary angiography. The chest computed tomography depicted significant involvement of the lungs manifested by peripheral ground‑glass opacifications. A positive polymerase chain reaction confirmed coronavirus infection. He was oxygen dependent for 1 week. Gradually, his respiratory distress improved and his LVEF reached to 30% after discharge.

Wilson’s disease is a disorder of copper metabolism that results in the accumulation of copper in various body tissues. The most common organs involved in this disease are the liver and the brain, with most of the clinical symptoms being related to these 2 organs. Albeit less affected, the cardiovascular system is also involved. In this paper, we aim to report a very rare cardiac complication of Wilson’s disease. 1 (Iranian Heart Journal 2021; 22(3): 123-127)