rezayat parvizi

 Atherosclerotic cardiovascular disease (ASCVD) is considered a worldwide health problem associated with high morbidity, mortality, and cost of care. In the present study, we examined risk-enhancing factors for ASCVD in healthcare workers of the AZAR cohort population.

 Data from a total of 500 participants were used for this cross-sectional study. Demographic characteristics, anthropometric indices, biochemical factors, and blood pressure were assessed. To evaluate the associations of ASCVD with the parameters mentioned above, univariate and multivariate logistic regression analyses were conducted.

 The total frequency of subjects with severe (≥7.5) and low (<7.5) ASCVD was 7.6% (95% CI: 5.4-10.3), and 90.6% (95% CI: 87.7-93.0), respectively. The top strongest links were found between ASCVD and atherogenic index of plasma (AIP) (odds ratio [OR]: 12.8, 95% CI: 3.2-49.9), diabetes (OR: 7.6, 95% CI: 2.8-25), and daily smoking (OR: 7.0, 95% CI: 2.8-20). Based on a multivariate logistic regression model, low-density lipoprotein cholesterol (LDL-C)/apolipoprotein B (Apo b), diabetes, hematocrit, age, Triglycerides (TG)/high-density lipoprotein cholesterol (HDL-C), systolic blood pressure, HDL-C, apolipoprotein A-I (Apo A-I), hemoglobin, and Apo B/Apo A-I have significant associations with ASCVD severity.

 In conclusion, the present study showed significant associations between the severity of ASCVD with some parameters among healthcare workers of AZAR cohort study.

Aortic valve replacement (AVR) may complicate conduction abnormalities and require permanent pacemaker (PPM) implantation. New techniques that lessen this challenge may lead to the development of new approaches. Our objective was to evaluate the contemporary incidence of early postoperative PPM implantation in patients undergoing isolated AVR and root disease with the standard AVR surgical technique compared with the novel suture AVR technique.

The clinical data of 354 patients (250 male, 104 female) who underwent surgery for isolated AVR and root disease in different referral cardiology departments in Tabriz, Iran, over 4 years were analyzed. Patients with preoperative significant conduction abnormalities were excluded from the study. The patients were evaluated for in-hospital mortality, postoperative PPM implantation, and their stay in the ICU after surgery.

The mean age of the patients was 52.46±16.13 years. Totally, 183 patients (51.7%) were operated on with the new suture AVR technique. In-hospital mortality was lower in this group than in the group that underwent the “classic” surgical technique (2.5% vs 3.7%). PPM implantation was required in 3 patients (0.8%) after the novel suture AVR technique, whereas it was needed in 12 patients (3.4%) in the other group (P=0.024). The mortality rate was 9 patients (2.5%) in group 1 and 13 patients (3.7%) in group 2, which was not statistically significant (P=0.296). According to the logistic regression, the survival rate in the group operated on with the classical surgical method was 0.27 times higher than that in the patients operated on with the new method.

Permanent complete AV block is a critical complication after AVR surgery. A lower PPM requirement and higher survival in patients operated on with the new method was the main finding of this study. New techniques with lower PPM requirements may be suitable for cardiac surgery.

Bacteria, especially staphylococcal groups, cause aortic graft infection. Infection stems from synthetic materials that repair aneurysms or artery blockages. Aortic stent infection and vegetation formation are rare, and heterogeneous presentations and ambiguous findings in routine diagnostic modalities render the diagnosis challenging. A 25-year-old man with a history of catheter-based aortic stenting for hypertension associated with severe aortic coarctation was referred to our tertiary care hospital. Five months before the presentation, the patient had been infected with COVID-19, but he recovered after mild symptoms. Nevertheless, 3 months later, he developed erythematous lesions, progressive anorexia, epigastric pain, fever, and weakness. The results of blood tests, blood cultures, transthoracic echocardiography, plain chest radiography, computed tomography angiography, and electrocardiography were unremarkable. We found severe infectious aortitis, crescent thickness surrounding the aorta, pseudoaneurysm development, and a mass with dimensions of 17 mm×8 mm within the aortic stent on transesophageal echocardiography (TEE). Broad-spectrum antibiotic therapy was initiated, and the patient was transferred to the operating room, where the infected stent and adhesive vegetation were removed. The patient recovered remarkably after the surgery and was discharged. At 6 months’ follow-up, he was in good condition. Our findings highlight the significance of maintaining vigilance and a high level of clinical suspicion for the possibility of vegetation formation and aortitis as the possible sequelae of COVID-19, particularly in patients with an implanted stent. Furthermore, we strongly suggest TEE in patients with implanted stents to detect vegetation and aortitis.

The aim of this study was to evaluate the effectiveness of behavioral activation therapy on cognitive flexibility and depression in patients with a history of Cardiac surgery.

The quasi-experimental study was a pretest-posttest or control group. The statistical population included all Cardiac patients operated on in Tabriz heart hospitals. Based on this, about 60 people in two groups of 30 people including the experimental group (N=30) and the control group (N=30) were selected by Convenience Sampling. Beck, Steer and Brown (1996) standard depression questionnaires and Dennis and Wonder Wall (2010) cognitive flexibility questionnaire were used to collect data. Multivariate covariance was used to analyze the data.

The results of multivariate analysis of covariance of behavioral activation therapy on depression (P>0.05) and cognitive flexibility (P>0.01) and its components including alternatives (P>0.05), control (P>0.01), alternatives to human behaviors (P>0.05), are effective. Therefore, the use of behavioral activation therapy has a significant effect on depression and cognitive flexibility and its components, including alternatives, controls and alternatives to human behaviors in the experimental group.

Behavioral activation treatment reduces depression and increases cognitive flexibility and its components, including alternatives, controls and alternatives to its human behaviors in patients undergoing Cardiac surgery.

The effects of recent Covid-19 pandemic on this planet must be viewed with a wise eye and we should learn that human beings are interconnected chains, and that ignoring the laws of existence will undoubtedly continue with reflections similar to the way we are today. Although the community of heart surgeons is not at the forefront of the treatment of this epidemic, they are ready to rush to the aid of other colleagues if necessary. The aim of preparing this protocol is to prioritize cardiac surgery procedures, maintain blood and blood product reserves and provide the appropriate care for patients while taking precautions for the safety of medical staff. The general recommendation in this first version of protocol is to postpone all elective cardiac surgeries and perform emergent and urgent cases according to suggested personal protection strategies for Covid-19.

Redo mitral valve replacement (MVR) is an important therapeutic approach in patients with the malfunction of the prosthetic mitral valve, especially in patients with severe dyspnea or a large thrombus burden. Redo replacement (MVR) and thrombectomy are different surgical approaches in these patients. This study evaluated the outcome of the second mitral valve surgery including mechanical MVR (M-MVR), biologic MVR (B-MVR), and surgical thrombectomy.

To this end, 71 patients were included in this study, who underwent second mitral valve surgery following the malfunction of the prosthetic mitral valve in the last 10 years. These patients were divided into M-MVR, B-MVR, and surgical thrombectomy groups and their demographic, clinical, echocardiographic, and laboratory findings were gathered as well. Then, the patients were evaluated for their third MV surgery if it was performed, followed by evaluating the pump time and cross-clamp time

Fifty-seven, 8, and 6 patients underwent M-MVR, B-MVR, and thrombectomy, respectively. Based on the results, the mortality rate was not significantly different between the 3 groups (P = 0.059). In addition, 12 patients underwent the third surgery with the highest (100%) and lowest (0%) rates at thrombectomy and B-MVR groups, respectively. Higher pump time and cross-clamp time were significantly associated with an increased mortality rate (P = 0.014 and P = 0.026, respectively).

In the malfunction of the prosthetic mitral valve, mortality rate failed to significantly differ between the patients undergoing M-MVR, B-MVR, and thrombectomy but third surgery is often needed after thrombectomy. It seems that the replacement of previous prosthetic valve with a new mechanical or biological valve yields better results in the case of prosthetic valve malfunction

Primary cardiac tumors are rare (0.001 to 0.03%). Malignant tumors account for 25%, of which 75% are cardiac sarcomas.
Case Persentation: Here, we report a case of a 57-year-old male with palpitation and history of left atrial (LA) myxoma resection presented to cardiology clinic for postsurgical follow up and transthoracic echocardiography revealed a large non-homogenous mass in LA with right atrium invasion, which was confirmed by trans-esophageal echocardiography. The patient underwent surgical resection of tumor and the pathological diagnosis was malignant fibrous histiocytoma (MFH). MFH could be asymptomatic and the diagnosis be established as a surgical or complementary examination. In patients with history of myxoma resection and cardiac masses, further evaluation is recommended.

Cardiovascular gene therapy is a sophisticated approach, thanks to the safety of vectors, stable transgene expression, delivery method, and different layers of the heart. To date, numerous expression vectors have been introduced in biotechnology and biopharmacy industries in relation to genetic manipulation. Despite the rapid growth of these modalities, they must be intelligently designed, addressing the cardiac-specific transgene expression and less side effects. Herein, we conducted a pilot project aiming to design a cardiac-specific hypoxia-inducible expression cassette.
We explored a new approach to design an expression cassette containing cardiac specific enhancer, hypoxia response elements (HRE), cardiac specific promoter, internal ribosome entry site (IRES), and beta globin poly A sequence to elicit specific and inducible expression of the gene of interest. Enhanced green fluorescent protein (eGFP) was sub-cloned by BglII and NotI into the cassette. The specificity and inducible expression of the cassette was determined in both mouse myoblast C2C12 and mammary glandular tumor 4T1 as ‘twin’ cells. eGFP expression was evaluated by immunofluorescence microscope and flow cytometry at 520 nm emission peak.
Our data revealed that the designed expression cassette provided tissue specific and hypoxia inducible (O2 It is suggested that cardiac-specific enhancer combined with cardiac-specific promoter are efficient for myoblast specific gene expression. As well, this is for the first time that HRE are derived from three well known hypoxia-regulated promoters. Therefore, there is no longer need to overlap PCR process for one repeated sequence just in one promoter.

Anomalous origin of the left coronary artery from pulmonary artery (ALCAPA) is not a common anomaly in adulthood. Its early diagnosis requires physician suspicion and the early treatment of disease can prevent its serious side effects. In this article, we presented a young female with pansystolic murmur and heart failure with final diagnosis of ALCAPA syndrome.

Lipid oxidation and generation of free radicals are important factors contributing to the formation of atherosclerotic plaque. Bilirubin is supposed to play a protective role against atherosclerosis, coronary artery diseases (CAD) and inflammation for its strong antioxidant property. Thus, this study aims at investigating the relationship of bilirubin level with the severity and type of coronary artery stenosis (CAS) in different patient groups. In this cross-sectional study 200 consecutive patients, who underwent elective angiography in Madani Heart hospital, Tabriz, Iran, were selected and their blood samples were measured for total, direct, and indirect bilirubin level, with Diazo method using colorimetric technique. Following angiography, comparisons were made between the severity and location of CAS and therapeutic follow-up plan with total, direct, and indirect bilirubin level. Of 200 studied patients, 129 (64.5%) and 71 (35.5%) subjects were male and female, respectively. The cases were classified into 5 subgroups based on angiography results as follows: 59 (29.5%) cases with normal angiography, 11 cases (5.5%) with minimal CAD, 56 cases (28%) with single vessel involvement, 35 (17.5%) cases with two vessel involvement and 39 cases (19.5%) with three vessel involvement. The mean total bilirubin level was 1.47 ± 0.8 mg/dl, 1.27 ± 0.12 mg/dl, 1.27 ± 0.06 mg/dl, 1.6 ± 0.04 mg/dl and 0.98 ± 0.05 mg/dl, respectively for the cases with above order. The mean difference in serum total bilirubin between normal angiography group and three-vessel involvement group was 0.49 mg/dl (P <. 0001). There was a significant inverse relation between bilirubin level (total, direct and indirect) and number of involved vessels and involvement intensity increased as serum bilirubin level decreased. Severity of coronary arteries stenosis as well as the number of involved vessels increased as serum bilirubin level decreased. According to results, there was a significant inverse relation between serum bilirubin level and coronary involvement (type and intensity). Higher bilirubin serum levels played a protective role against CAD, even in the presence of other risk factors. Therefore, bilirubin level can be used as a predictor of CAD in the future.

Although aberrant right subclavian artery (ARSA) is a rare abnormality but it is the most common anomaly of aortic arch. Compressive effects of the artery are responsible for the patients’ symptoms. Association of this disorder with other anomalies and necessity of treatment in symptomatic patients are the important aspects of this condition. Here we describe a 12 years old girl with dysphagia and ultimate diagnosis of ARSA. The ligation procedure of the artery was successful without any complications. Dysphagia could be the main symptom of the ARSA in children as same as old adults.

Primary echinococcosis of the heart is exceptionally uncommon and is reported 0.5% to 2% of all hydatid cyst sites in comparison with liver (70%) or lung (20%) involvement. Hydatid disease of the heart is caused by the cestode tapeworm echinococcosis granulosis or alveolaris. We present a 29-year-old female with hydatid disease of the liver and heart. She only complained of abdominal pain and palpitation. Echocardiography and multi-slice computed tomography (MSCT) showed a 120×101 mm cyst in the liver and 64 mm in the right ventricular free wall. Both cysts were excised within one procedure successfully.

Atrial fibrillation (AF) is the most common sustained cardiac arrhythmia in patients with mitral valve disease affecting 50% of patients undergoing mitral valve surgery, contributing to increased risks of systemic embolization, anticoagulant- related hemorrhage and mortality. The maze procedure is an effective way to treat AF. Over the last several years, cryoablation was substituted for atrial incision in many reports to simplify the maze procedure. However, few studies have been carried out to evaluate the results of cryoablation surgery. In the present study we evaluated the results of this procedure. In this cross sectional study, 47 AF patients were treated with Cryo-Maze surgery method. Rhythm assessment using electrocardiographic and echocardiographic survey was performed in all patients before surgery, during the patients’ hospital stay, on discharge and after six months. Survival rate of the studied patients at six months was 93.6%. Sinus rhythm restoration rate in Cryo-Maze patients was 72.1% on discharge and 76.7% six months after their operation. The present study revealed that Cryo-Maze procedure is an effective and safe therapeutic modality in AF while normal sinus rhythm can be achieved in patients following this intervention.

In tolerance to oral anticoagulant drugs may arise as an inborn genetic defect resulting in insensitive hepatic receptor sites to oral anticoagulants or it may be due to one of several acquired causes such as noningestion or malabsorption of the drugs, simultaneous ingestion of barbiturates or the inadvertent consumption of foods with a high vitamin K content. It is an uncommon phenomenon and the genetic defect is usually not recognized until the need for oral anticoagulation arises. We report here a case of resistance to Warfarin in the hope that an awareness of this phenomenon may turn up similar case of study.

Surgical treatment of active infective endocarditis (IE) requires not only homodynamic repair, but also, special emphasis on the eradiation of the infection to prevent recurrence. This study was undertaken to examine the outcome of surgery for active infective endocarditis in a cohort of patients.Patients and One hundred and sixty-four consecutive patients underwent valve surgery for active IE in Madani heart centre (Tabriz, Iran) from 1996 to 2006. The patients with diagnosis of IE (according to Duke Criteria) were eligible for the study. The mean age of patients was 36.3 ± 16 years, with 34.6±17.5 yrs for native valve endocarditis and 38.6±15.2 yrs for prosthetic valve endocarditis (p= 0.169). Ninety-one (55.5%) of patients were males. The infected valve was native in 112 (68.3%) of patients and prosthetic in 52 (31.7%). There was no predisposing heart disease in 61 (37%) of patients. The aortic valve was infected in 78(47.6%), the mitral valve in 69 (42.1%), and multiple valves in 17 (10.3%) of patients. Active culture-positive endocarditis was present in 81 (49.4%) whereas 83(50.6%) patients had culture-negative endocarditis. Staphylococcus aureus was the most common isolated microorganism. Ninety patients (54.8%) were in NYHA classes III and IV. Mechanical valves were implanted in 69 patients (42.1%) and bioprostheses in 95 (57.9%), including homograft in 19 (11.5%) cases. There were 16 (9%) operation-related deaths, but only 1 death in patients undergoing aortic homograft replacement. Reoperation was required in 18 (10.9%) cases.Based on multivariate logistic regression analysis, Staphylococcus aureus infection (p= 0.008), prosthetic valve endocarditis (p=0.01), paravalvular abscess (p=0.001) and left ventricular ejection fraction less than 40% (p=0.04) were independent predictors of hospital mortality. Surgery for infective endocarditis continues to be challenging and associated with high operation-related mortality and morbidity. Prosthetic valve endocarditis, impaired ventricular function, paravalvular abscess and Staphylococcus aureus infection associated with hospital mortality. Also we found that aortic valve replacement with an aortic homograft could be performed with acceptable hospital mortality and provided satisfactory results.

The present study was undertaken to compare the in hospital results of coronary artery bypass graft (CABG) with (on pump) or without (off pump) cardiopulmonary bypass (CPB). Data were collected on all first-time isolated CABGs with saphenous vein and/or artery grafts at Shahid Madani Hospital in Tabriz-Iran، between 2006 and 2009. Age and clinical profile were marched between on pump and off pump group patients. Patients with concomitant cardiac operations or beating pump technique were excluded from the study. The study included 994 patients; CABG with CPB (ONCABG) was done in 578 (58%) and CABG without CPB (OPCABG) in 416 (42%). For pump and off pump group respectively، mortality rate was 2/3%، and 0. 2%، the number of grafts was2/92 ± 0. 82 and 2/12 ±o. 73 and the use of intra aortic balloon-pump (IABP) was1. 5% and5. 4%. Post operative ejection fraction (EF) was improved in off pump group (47. 9±0. 6) versus on pump group (44. 53±1. 5) and the latter group had more post operative atrial fibrillation، Stroke، acute renal failure، bleeding rate and blood products transfusion، prolonged intubation time but was not statistically significance. Meanwhile Hospitalization time and use of inotrops was less in comparison with former patients group. Off pump CABG was a safe method in our series. Patients with comparable risk profiles have similar prevalence''s of selected complications after ONCABG and OPCABG، though some clinical and hemodynamic results are better with off pump technique.

Splenomegaly-induced thrombocytopenia is fully described in hematological and surgical literature, but its association with severe aortic stenosis is rare. We present a case of severe aortic valve stenosis with severe splenomegaly-induced thrombocytopenia in which aortic valve replacement was done with a number 23 homograft and splenectomy was performed after the end of cardiopulmonary bypass. Platelet count turned to normal value post-operatively, and the patient spent an ordinary convalescence period and was discharged from the hospital without any complications.

Many studies have reported on the association between human coronary artery disease (CAD) and certain persistent bacterial and viral infections. The aim of the present analysis was to investigate the possible association between HAV infection and angiography proven CAD. Blood from 200 patients undergoing coronary angiography was tested for antibodies to HAV by enzyme immunosorbent assay at Madani Heart Hospital, Tabriz University of Medical Sciences, Iran. CAD prevalence was 90% in HAV seropositive and 84.4% in HAV seronegative patients (Pv= 0.2). This analysis demonstrated that HAV seropositivity is not a risk factor for CAD.

It is estimated that cardiopulmonary disorders eslkjpecially coronary artery disease are the leading causes of mortality in world and Iran. The arteriosclerotic process in the coronary arteries, as in other blood vessels, consists of focal intimal accumulation of lipids, complex carbohydrates, blood and blood products, fibrous tissue, and calcium deposits associated with changes in the media, that causes unstable angina and myocardial infarction. Treatment of these patients is medical therapy and coronary artery bypass grafts surgery (CABGs) with or without cardiopulmonary by pass (CPB). The aim of this research is studying One Years Clinical Out come after Coronary Artery Bypass. This research is cross sectional and case control trial study. It was performed in Shahid Madani hospital in Tabriz – iran during the year 2006-2007. The patients who had CABGs with or without CPB were studied. The information was collected by filling a questionnaire and was analyzed by the t-test and chi-square program. In this study 196 patients had CABG without CPB (group I) and 133 with CPB (group II). Number of grafts in group I 2.49 ± 0.04 and 2.73 ± 0.04 in group II. The rate of complications in 2 groups was not significant, EF is improved in group I, and use of Inotrops and IABP was less than in group II. In group I hospitalization (ICU, hospital) was less than in comparison with group II. According to results CABG without CPB is a safe method. According to results out comes of this study is comparable with other studies in world.

Nowadays coronary artery bypass graft (CABG) surgery is a common operation and postoperative complications are inevitable. Among the important complications are neurologic and cognitive ones. These problems have a significant role in the disability and the mortality of patients. The present study was designed to detect the frequency of postoperative cognitive complications, and the correlation of it with different risk factors such as age, sex, history of cerebrovascular disease, preoperative cerebrovascular hemodynamic state, intraoperative variables and neurologic complications. Methods & materials: In this descriptive, analytic, and prospective study, 201 elective patients, with normal sinus rhythm, ejection fraction of more than 30%, and isolated CABG, during a period of about one year were included. Neurologic examination, cognitive evaluation (by mini-mental state examination or MMSE), intracranial arteries study (by transcranial Doppler or TCD) and carotid duplex were performed preoperatively. Intraoperative and postoperative complications were followed up to discharge time. About one month later neurologic examination and MMSE were repeated. Two hundred and one patients (158 male, 43 female) with the average age of 57.29±9.67 were studied. The history of cerebrovascular disease in 4.5% was detected. Out of them, 131 patients had three-coronary- vessel disease, 64 had two-vessel-disease, 5 one-vessel-disease, and 1 patient had diffuse coronary disease. TCD was performed in 183 patients and showed abnormal state in 23 and normal in 160 cases. The total number of involved arteries was 36, among which basilar artery was the most common (12 numbers). In 154 patients carotid duplex was performed, 102 had plaque, inducing <50% stenosis in 99, 50-74% stenosis in 1, and 75-90% stenosis in 2 cases. Abnormal intima media thickness (>0.7 mm) reported in 86 patients. Postoperative neurologic complication occurred as follows: 4 stroke, 7 deliriums, and 3 amnesia. One of the operated patients died. Postoperative MMSE can be performed in 154 patients, among them 45 showed decrement of MMSE (mean: 2.29). There were no significant correlations between MMSE decrement and age, sex, previous cerebrovascular disease, preoperative hemodynamic state. Difference of MMSE changes in CABG patients with neurologic complication (0.078) and the patients without complication (0.863) was noticeable, but was not statistically significant. This study shows that post operative cognitive complications in elective, normal sinus rhythm, ejection fraction of more than 30% and isolated CABG patients appears to be due to CNS structural lesions, but further study with larger sample is needed.

We describe 6 cases of chronic thromboembolic pulmonary hypertension, who underwent pulmanry thromboendarterectomy in our center. Transthoracic and transesophageal echocardiography provided valuable data on surgical accessibility of thrombus, its extension, chronicity and hemodynamic consequences on right ventricular function. transesophageal echocardiography as a rapid, bedside and easily available method has been a useful guide for diagnosis and guiding the treatment for these patients

High sensitive C-reactive protein (HS-CRP) has prognostic utility in patients with acute coronary syndromes and is a strong independent predictor of future coronary events in apparently healthy subjects. In this study, the prognostic value of the HS-CRP was evaluated in detection of coronary artery events when combined with serum LDL–C/HDL–C ratio. Three hundred male patients who suffered from the symptoms of coronary artery diseases were divided into three subgroups according to the number of diseased vessels (66 with one diseased vessel, 87 with two diseased vessels, and 0 with three diseased vessels). Control group consisted of 7 males who seemed to be healthy individuals (without diseased vessesl). Serum levels of HS-CRP were measured by ELISA method and those of lipid parameters by standard methods using Cobas Mira autoanalizor. The relationships between the measured variables were analyzed by Pearson tests. Comparing with the control group significant elevation were noticed in serum levels of HS-CRP in patients with coronary artery diseases in all cases (P<0.05). Also there was a significant correlation between the serum levels of HS-CRP, LDL-C, HDL-C and LDL-C/HDL-C ratio (P<0.05). A significant correlation between the number of diseased vessels and the elevated level of HS-CRP was also found (p<0.00). The direct correlation between serum levels of HS-CRP and LDL–C/HDL-C ratio and number of diseased vessels suggests that predictive value of HS-CRP in men is considerably increased when it is combined with serum LDL–C/HDL–C ratio.

It is well documented that coronary artery bypass grafting (CABG) with cardiopulmonary bypass (CPB) causes ischemia and oxidative stress of the whole body. To compare the effect of on – pump and off –pump CABG on the induction of the oxidative stress and the metabolism of homocysteine which is involved in the synthesis of glutathione was investigated in the CABG patients during the early postoperative period. Plasma homocysteine, folate total antioxidant capacity (TAC) and malonedialdehyde (MDA) were determined by standard methods on blood samples obtained from 40 patients undergoing CABG, preoperatively and at 0,12,48,120 hours and 6 months after surgery, The patients were divided into two matched groups. One of the groups underwent off - pump and the other on – pump CABG. A marked reduction of homocysteine, folate and significant elevation of MDA were noticed at 0, 12, 48 hours after operation in the both groups (P<0.05). A negative and marked correlation between homocysteine and TAC but a positive and significant correlation between homocysteine and MDA were observed (P<0.05 in the both groups). In CABG operation because of oxidative stress and consumption of GSH (Reduced Glutathione) immediate reduction in the plasma levels of homocyteine occurs in the both techniques. However using off pump CABG induction of oxidative stress and changes in plasma levels of homocysteine are not as high as on- pump CABG. The on-pump technique was correlated with a faster decrease in the homocysteine level during the first 12 hours and with a faster and higher elevation of the homocysteine concentration 12-48 hours postoperatively.

Postoperative atrial fibrillation (AF) is a common complication of coronary artery bypass graft surgery (CABG) and is associated with an increased incidence of other complications and an increased hospital length of stay. Prevention of AF is a reasonable clinical goal. The aim of this study is to determine the predictive value of multiple clinical, hemodynamic and operative variables for the occurrence of postoperative AF.
Methods:This research is a descriptive study. Patients scheduled for elective CABG between 1997 and 1999 were recruited. The patients underwent holter monitoring for 3 consecutive days. Information was collected by a questionnaire. Statistical analysis was based on the SPSS software and was done through the descriptive statistical method.
200 patients underwent isolated CABG between 2001 and 2003. The patients with a mean age of 55±8 years old underwent holter monitoring for 3 days. AF occurred in 20% of the patients, postoperatively. 30% of the patients converted to sinus rhythm spontaneously, 60% converted with amiodarone and 10% of the patients required electric shock.
Beta blockers are the first line of medication for the prevention of postoperative AF. The incidence of AF during the first postoperative week after CABG varies between 5-40%; prolonged mechanical ventilation after CABG significantly increases the incidence of postoperative AF