فهرست مطالب

Iranian Heart Journal - Volume:22 Issue: 4, Fall 2021

Iranian Heart Journal
Volume:22 Issue: 4, Fall 2021

  • تاریخ انتشار: 1400/07/19
  • تعداد عناوین: 19
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  • Mohsen Ziyaeifard, Hojatallah Assadzade, Gholamreza Makhmalbaf, Ziya Totonchi, Zahra Faritous * Pages 6-14
    Background

    Mechanical ventilation is an important risk factor for acute kidney injury (AKI) in cardiac surgery patients. The Weaning protocol can speed weaning after open-heart surgery and might reduce the AKI risk in these patients. We explore the influence of the weaning protocol on the intubation time in cardiac surgery patients who developed AKI.

    Methods

    In a randomized clinical trial, 100 patients with AKI after open-heart surgery were enrolled. After surgery, the patients were randomized to the weaning protocol group (the intervention group) and the conventional weaning group (the control group). Arterial blood gas, hemodynamic variables, the serum blood urea nitrogen level, the creatinine level, and the intubation time were recorded and compared between the 2 groups.

    Results

    The weaning protocol group displayed a statistically significant shorter intubation time than the conventional weaning group (8.89±1.74 h vs 9.93±1.56 h; P=0.002). The postoperative serum urea level (r=0.240, P<0.016) and creatinine level (r=0.245, P<0.014) were positively correlated with the intubation time and the weaning protocol compared with conventional weaning. The weaning protocol decreased the urea and creatinine levels in cardiac surgery patients (P<0.04).

    Conclusions

    The use of the weaning protocol in cardiac surgery patients with AKI conferred shorter intubation times and lower blood urea nitrogen and creatinine levels than the use of conventional weaning. (Iranian Heart Journal 2021; 22(4): 6-14)

    Keywords: randomized controlled trial, Mechanical Ventilation, Weaning protocol, Acute kidney injury
  • Hakimeh Saadatifar, Hediyeh Mohaghegh, Maryam Ahmadi, Mayam Moshkani Farahani * Pages 15-24
    Background

    Thalassemia is a hematologic and genetic disorder prevalent both in Iran and the world. As these patients receive frequent transfusions, they are exposed to iron overload in different tissues such as the liver and the heart. Vitamin D and magnesium deficiencies have been known as important risk factors for cardiovascular diseases. We studied the association between the plasma levels of vitamin D and magnesium and different levels of heart involvement in thalassemia major patients.

    Methods

    Sampling was performed by the convenience method based on the inclusion/exclusion criteria of the study. Patients’ data, including age, sex, vitamin D plasma levels, magnesium plasma levels, cardiac iron overload based on MRI T2*, echocardiographic information, and electrocardiographic (ECG) information, were collected.

    Results

    In this study, 43 patients, composed of 20 men (46.5%) and 23 women (53.5%) at a mean age of 31.35±7.03 years were examined. In total, 39.5% and 27/9% of them had abnormal echocardiography and ECG. Maximum cardiac abnormalities observed in echocardiography were related to left ventricular diastolic dysfunction (23.3%), right ventricular enlargement (9%), reduced left ventricular ejection fractions (9%), and more-than-mild tricuspid valve regurgitation (9%). Moreover, a reduction in the magnesium plasma level was associated with an increase in the number of cardiac abnormalities in echocardiography significantly (P<0.05). There was a significant relationship between echocardiography and ECG results.

    Conclusions

    Considering the inverse relationship between the plasma levels of vitamin D and magnesium and cardiac iron overload, we recommend that the plasma level of vitamin D and magnesium be checked periodically in these patients. (Iranian Heart Journal 2021; 22(4): 15-24)

    Keywords: Iron, Thalassemia, Vitamin D, Magnesium, heart disease
  • Muzakkir Amir, Randy Rabby *, Peter Kabo, Robertus Setiadji Pages 25-33
    Background

    The management of low-burden premature ventricular complexes (PVCs) (<10%) is currently a matter of debate among clinicians. Several small studies have shown an increased risk for left ventricular dysfunction in a lower PVC burden. Radiofrequency ablation is known to have favorable effects on PVC frequencies and left ventricular dysfunction. However, data are scarce regarding ablation in patients with low-burden PVCs, especially its benefits on symptom burden and the quality of life. This study aimed to compare symptom burden and the quality of life before and 6 months after ablation.

    Methods

    Thirty-one patients with low-burden PVCs who underwent radiofrequency ablation were assessed. The ASTA (Arrhythmia-Specific questionnaire in Tachycardia and Arrhythmia) was used to assess symptom burden and the quality of life in the patients. The score was calculated before and 6 months after ablation.

    Results

    Significant differences existed in the mean scores before and 6 months after ablation concerning the ASTA burden scale symptom score (38.83 vs 4.45; P<0.05), the ASTA health-related quality of life (HRQoL) physical subscale (30.30 vs 1.91; P<0.05), the ASTA HRQoL mental subscale (32.41 vs 4.51; P<0.05), and the ASTA HRQoL total scale (32.09 vs 2.90; P<0.05).

    Conclusions

    Radiofrequency ablation was associated with a favorable outcome in terms of symptom burden and the quality of life in our patients with low-burden PVCs in the short term. (Iranian Heart Journal 2021; 22(4): 25-33)

    Keywords: Premature ventricular complexes, Low burden, radiofrequency ablation
  • Majid Moini, MohammadReza Zafarghandi, Javad Salimi, Sina Zarrintan, Peyman Bakhshaei, Mohammad Hassani * Pages 34-44
    Background

    We report the angioplasty results of patients suffering from chronic lower extremity ischemia with the involvement of femoropopliteal arteries.

    Methods

    Sixty-five patients were studied. All patients with lower extremity chronic ischemia resulting from femoropopliteal arterial lesions at Sina Hospital, Tehran University of Medical Sciences, Tehran, Iran, from September 22, 2013, through March 21, 2015, were included in the study. The success of angioplasty and stenting was defined as the diminishing of the stenosis to less than 30%. A follow-up Doppler ultrasound was conducted to evaluate restenosis and reocclusion. Additionally, healing of ulcers and recovery of claudication were assessed at follow-up visits.

    Results

    The mean age of the study participants was 64.5±9.7 years. Forty-four patients (67.7%) were male, and 21 patients (32.3%) were female. In follow-up Doppler ultrasounds, 7 patients (10.8%) had stenosis, while 9 patients (13.8%) had occlusion, and 49 patients (75.4%) had a normal patent arterial flow. On follow-up, 53 patients (81.5%) did not report claudication. The success rate of the procedures was 98.46%. The presence of preprocedural tissue gangrene was a potential predictor of restenosis and reocclusion (P<0.05).

    Conclusions

    It seems that endovascular management is a feasible and effective technique in lower extremity arterial ischemia due to lesions in femoropopliteal arteries, even in subtypes TASC  C and D. (Iranian Heart Journal 2021; 22(4): 34-44)

    Keywords: Femoropopliteal, ANGIOPLASTY, Chronic limb ischemia
  • Mohammad Asadpour Piranfar, Mehrdad Jafari Fesharaki, Reyhaneh Taati * Pages 45-53
    Background

    Standard treatment in patients with ST‐elevation myocardial infarction (STEMI) is the reperfusion therapy of coronary arteries with the most appropriate therapeutic method. The purpose of the present study was to compare the 3-month outcome between primary percutaneous coronary intervention (P-PCI) and thrombolytic therapy regarding the ejection fraction (EF) of patients with STEMI who were referred to 2 hospitals in Tehran with the same door-to-balloon and door-to-needle times (≈90 min).

    Methods

    This cohort study enrolled 43 patients referred to Taleghani Hospital and Labbafinejad Hospital, affiliated with Shahid Beheshti University of Medical Sciences, in Tehran, Iran. Based on a researcher-made questionnaire, the initial and the 3-month EFs in the P-PCI group (n=19) and the thrombolytic therapy group (n=24) were determined and compared.

    Results

    No significant differences were found in demographic variables between the 2 therapeutic methods. Most participants were aged 60 years or older and male. The outcome of P-PCI and thrombolytic therapy in terms of the EF showed no significant differences at baseline (41% vs 42.6%) and 3 months’ follow-up (50.2% vs 50.3%) (P>0.05). Additionally, the mortality and rehospitalization rates were the same in both groups (P>0.05).

    Conclusions

    No significant differences were observed in the 3-month outcome between P-PCI and thrombolytic therapy at 90-minute treatment intervals concerning the EF of patients with STEMI. Thus, either one may be used based on access to the Cath Lab and the patient’s situation. (Iranian Heart Journal 2021; 22(4): 45-53)

    Keywords: Primary PCI, THROMBOLYTIC THERAPY, STEMI
  • Mostafa Abdelmonaem *, Ahmed Khashaba, Ahmed Onsy Pages 54-65
    Background

    Epicardial adipose tissue is defined as the adipose tissue located between the outer wall of the myocardium and the visceral layer of the pericardium. Epicardial adipose tissue can be measured by echocardiography and more precisely by computed tomography (CT). The present study aimed to investigate the relationship between epicardial fat volume (EFV) assessed by multi-detector CT and the severity of coronary artery disease (CAD).

    Methods

    This cross-sectional study was conducted on 140 patients with a low-to-intermediate pretest probability of CAD referred for multi-detector CT coronary angiography. EFV was quantified during the non-contrast phase of the imaging protocol, and the severity of CAD was assessed in terms of segment involvement and segment stenosis scores during the contrast phase.

    Results

    The study population included 105 men (75%) at a mean age of 56±10.27 years. Risk factors of atherosclerosis were analyzed among the patients. Body mass index ranged between 24 kg/m2 and 30.9 kg/m2, hypertension was detected in 77.5%, diabetes mellitus was reported in 55%, and 67.5% were smokers. While 17.5% of the studied patients had normal coronaries, 37.5% had single-vessel disease and 45% had multi-vessel disease. A significant relationship existed between EFV and the coronary artery calcium score (P=0.011). Highly significant relationships were also detected between EFV and both segment involvement and segment stenosis scores (P=0.001 and P=0.003, respectively). Patients with normal coronary arteries had a lower EFV than those with coronary lesions (a highly significant relationship, P=0.004), whether with single-vessel or with multi-vessel disease.

    Conclusions

    EFV increased in patients with either significant coronary artery stenosis or coronary calcification. Risk factors of atherosclerosis showed direct relationships with EFV. (Iranian Heart Journal 2021; 22(4): 54-65)

    Keywords: EFV, CAD, SIS score, SSS score
  • Zahra Khajali, Fateme Jorfi *, Niloufar Samiei, Majid Maleki, Sedighe Saedi, Behshid Ghadrdoost, Maryam Keshavarz Hedayati Pages 66-70
    Background

    Pulmonary valve replacement (PVR) is frequently performed during the correction of various congenital heart disease. Pulmonary valve substitutes include bioprostheses, homografts, and mechanical valves. Among these, bioprosthetic valves are probably the most widely used because they are readily available and they do not need lifelong anticoagulation therapy. However, most of these bioprostheses will fail and require replacement mainly due to structural valve degeneration.

    Methods

    We retrospectively identified all patients who had undergone PVR at Rajaie Cardiovascular Medical and Research Center between 2010 and 2017. Medical records were reviewed for demographic and clinical information and follow-up imaging results.

    Results

    A total of 435 patients were eligible, and they had regular follow-ups after PVR based on their medical records. Mechanical valves were used for 66% of the patients (n=288) at first PVR and bioprosthetic valves for 34% of the patients. Forty-five patients with mechanical pulmonary valves (15%) received at least 1 thrombolytic therapy due to prosthetic valve thrombosis. Seventeen patients needed redo PVR, and 28 patients (62%) had successful thrombolytic therapy. There was no significant association between redo PVR and the prosthetic valve size (P=0.7) or the valve type (P=0.07), although the percentage of patients with first bioprosthetic valves who needed redo PVR was almost twice that of patients with first mechanical valves (13.4% vs 5.9%).

    Conclusions

    A mechanical valve can be a promising option for PVR in selected patients. (Iranian Heart Journal 2021; 22(4): 66-70)

    Keywords: Congenital heart disease, Mechanical valve, Pulmonary valve
  • Shabnam Madadi, Pegah Salehi *, Soudeh Roudbari, Masoud Roudbari Pages 71-79
    Background

    Several algorithms have been designed for the localization of pre-ablation accessory pathways (APs) in Wolff–Parkinson–White (WPW) syndrome based on QRS or delta-wave polarity in different (electrocardiographic) ECG leads. Due to the difficulty of catheter placement in the tricuspid ring, leading to increased likelihoods of ablation failure and recurrence in right-sided APs, it is essential to design an algorithm to correctly predict the location of these APs before ablation.

    Methods

    In this retrospective study, 294 known WPW patients with right-sided APs who had clear pre-excitation in the 12-lead ECG were divided into 8 anatomic zones and were then studied using ECG and electrophysiological characteristics.

    Results

    An algorithm was designed based on the sum of QRS and delta-wave polarity in the V1 and inferior leads. The sensitivity and specificity of the proposed algorithm for predicting free-wall APs, including posterolateral and posterior APs, were 95% and 25%, respectively. Sensitivity and specificity were 72.7% and 95.8% for anterolateral and anterior APs, respectively, and 100% and 60% for lateral APs, respectively. In septal APs, the respective rates of sensitivity and specificity of the algorithm were 60% and 80% for the posteroseptal AP, 61% and 98% for the anteroseptal AP, and 31% and 90% for the midseptal AP. 

    Conclusions

    The proposed algorithm provides a precise and simple way to differentiate between right-sided APs before performing ablation, thereby reducing ablation failure and recurrence. (Iranian Heart Journal 2021; 22(4): 71-79)

    Keywords: Right-sided accessory pathway, Wolff–Parkinson–White syndrome, Electrocardiography, Electrophysiology, radiofrequency ablation
  • Mohamed Naseem *, Sameh Samir Pages 80-89
    Background

    The relationship between metabolic syndrome (MS) and the MS score and the angiographic outcome of primary percutaneous coronary intervention (PPCI) for ST-segment-elevation myocardial infarction (STEMI) is still unclear. We aimed to examine the association between angiographic outcomes including angiographic no-reflow and MS.

    Methods

    We prospectively included 100 patients with STEMI treated with PPCI. Angiographic no-reflow was defined as a thrombolysis in myocardial infarction (TIMI) risk score of below 3 or a TIMI risk score of 3 with a myocardial blushing grade (MBG) of 0 to 1 in the absence of mechanical complications. MS was defined based on the National Cholesterol Education Program criteria. The MS score was defined as the number of MS components present.

    Results

    Totally, 26 patients (26%) developed no-reflow. The patients with no-reflow had a higher prevalence of MS, a higher level of triglycerides, a lower level of high-density lipoprotein, and a higher fasting blood glucose level. The fasting blood glucose level and the time from symptom onset to wire crossing were independent predictors of the no-reflow phenomenon (OR, 1.225; 95% CI, 1.105 to 2.854; P<0.001) and (OR, 1.049; 95% CI, 1.026 to 1.073; P<0.001).
    There were significant negative correlations between the MS score and both the post-intervention TIMI flow grade and MBG (P<0.001 for both).

    Conclusions

    MS plays an important role in the development of no-reflow in STEMI patients treated with PPCI with significant negative correlations between the MS score and both the post-intervention TIMI flow grade and MBG. (Iranian Heart Journal 2021; 22(4): 80-89)

    Keywords: Metabolic syndrome score, No-reflow, Myocardial Infarction
  • Fereidoon Rastgou, Mahkameh Torabian, Ahmad Bitarafan Rajabi, Ata Firouzi, Hadi Malek, Nahid Yaghoobi, Hassan Firoozabadi * Pages 90-100
    Background

    We sought to evaluate the relationship between left ventricular (LV) perfusion and function assessed by ECG-gated single-photon emission computerized tomography (SPECT) myocardial perfusion imaging (MPI) and serum high-sensitivity C-reactive protein (hs-CRP).

    Methods

    The images of 86 patients were reviewed for perfusion/functional defects by visual (subjective) interpretation. Quantitative (objective) LV measurements, including summed stress score (SSS), were calculated with the quantitative gated SPECT/quantitative perfusion SPECT (QGS/QPS) software. Via the quantitative method, the patients were categorized into an SSS<4 group (normal LV perfusion) and an SSS≥4 group (abnormal LV perfusion).

    Results

    There was no significant difference regarding the mean (±SD) hs-CRP level between normal (1.54±1.6 mg/L) and abnormal (1.88±2.61 mg/L) LV perfusions assessed by visual interpretation (P=0.493). However, by the quantitative (objective) method, the mean (±SD) hs-CRP level was significantly higher in the SSS≥ 4 group than in the SSS< 4 group (1.36±2.08 vs 2.37±2.37; P=0.04). Receiver operating characteristic curve analysis (cutoff value =1 mg/L) distinguished patients with an SSS of 4 or greater with a sensitivity of 69% and specificity of 70% (area under the curve =0.71; P=0.001).

    Conclusions

    The hs-CRP level had acceptable sensitivity and specificity to determine LV perfusion defects by the objective method but not by the subjective assessment (visual method) of LV perfusion defects. (Iranian Heart Journal 2021; 22(4): 90-100)

    Keywords: Single-photon emission computed tomography (SPECT), Myocardial perfusion imaging, Coronary Artery Disease, C-reactive protein
  • Atoosa Hosseinzadeh *, Sima Lakdizaji, Vahid Zamanzadeh, Mohammad Zia Totonchi Pages 101-111
    Background

    Acute pain management has been a challenge for health professionals. We designed the present study to evaluate the effectiveness of pain control between intravenous patient-controlled analgesia (IV PCA) and conventional nurse-controlled analgesia (NCA) after coronary artery bypass graft (CABG) surgery concerning patient satisfaction during the postoperative period in the intensive care unit (ICU). 

    Methods

    In this randomized clinical trial, 80 patients who underwent first-time elective CABG were enrolled by the convenience sampling method and were randomly allocated to 2 groups: PCA and NCA. PCA plus a continuous infusion of morphine was started immediately after the transfer of the patients to the ICU. NCA was based on the IV injections of morphine on demand. The level of pain was assessed using a numeric rating scale, and patient satisfaction was assessed using the pain treatment satisfaction scale. Further, sedation levels, morphine consumption, and side effects were evaluated from extubation until 48 hours after surgery. Additionally, nurses’ opinions regarding the PCA method were obtained.

    Results

    Numeric rating scale scores were higher in the NCA group than in the PCA group. Morphine consumption in the PCA group was significantly higher than that in the NCA group. Patient satisfaction was higher in the PCA group than in the NCA group (P<0.001). PCA was safe, and there were no differences in the incidence of serious adverse effects such as nausea and vomiting or respiratory depression.

    Conclusions

    In our patients, PCA with a background infusion of morphine increased morphine consumption and improved pain relief, without increasing side effects. It appears that NCA can be recommended for patients after CABG. (Iranian Heart Journal 2021; 22(4): 101-111)

    Keywords: Patient-controlled analgesia, Coronary artery bypass surgery, Verbal rating scale, Morphine
  • Dina Ezzeldin *, Yousef Amin, Amr Mansour Pages 112-126
    Background

    Local vascular complications in pediatrics undergoing congenital cardiac catheterization are consistently reported to be the commonest regardless of the access type and side.

    Methods

    This is a retrospective study with data collection of multidetector computed tomography studies performed between 2016 and 2019 from 3 large cardiac centers in our country.

    Results

    Totally, 190 patients who required both arterial and venous access sites were randomization into Group I or the planned ipsilateral group (the planned insertion of both arterial and venous sheaths in the same limb), Group II or the planned contralateral group (the planned insertion of arterial and venous sheaths in different limbs), and Group III or the unplanned group (unplanned vascular access sidedness after the failure of initial randomization). The incidence and types of local vascular complications during the hospital stay were recorded.Patients with the unplanned vascular access site had a higher incidence of local vascular complications, longer hospital stays, with higher needs for heparin and thrombolytic therapy than patients with the planned vascular access site. Patients with a systematically planned contralateral access site showed a lower incidence of arterial thrombosis, delayed capillary refilling time, and arteriovenous fistula, as well as lower needs for heparin and thrombolytic administration than patients with the planned ipsilateral vascular access site.

    Conclusions

    Systematic planned contralateral vascular access in patients who undergo congenital heart disease catheterization requiring both arterial and venous sheaths is associated with a lower incidence of vascular complications, especially in patients weighing less than 10 kg. (Iranian Heart Journal 2021; 22(4): 112-126)

    Keywords: Vascular Complications, Pediatric cardiac catheterization, Lost pulsation, Congenital cardiac catheterization, Vascular Access
  • Seyedeh Zoha Tabatabaei, Elahe Motevaseli *, Zeinab Samiee Zafarghandi, Seyed Abdolhossein Tabatabaei Pages 127-134
    Background

    Coronary artery disease (CAD) is a multifactorial disorder and one of the major causes of death all over the world. Both genetics and the environment are responsible for CAD occurrence. Recent studies have shown the considerable role of epigenetics in various diseases. HOTAIR is a circulating long noncoding RNA (lncRNA) in the blood with an epigenetic regulation role in transcriptional pathways in different diseases. Recent investigations have shown that HOTAIR could be a potential biomarker for diagnosis and therapeutic targets in CAD.

    Methods

    In the present study, we sought to evaluate the expression of HOTAIR lncRNAs in the blood samples of 30 patients with a family history of CAD and 30 sporadic CAD samples with coronary angiography-confirmed CAD. The expression level was examined using the semiquantitative reverse transcriptase-polymerase chain reaction technique. For the epigenetic validation of HOTAIR function, the expression level of the HOXD10 gene as the main target of HOTAIR lncRNAs in expression modulation was evaluated.

    Results

    The expression level of HOTAIR was higher in patients with familial CAD than in sporadic CAD patients, whereas the expression level of HOXD10 in the familial CAD group was lower than that in the sporadic group. Notably, the average age of the familial CAD group was lower than that of the sporadic group.

    Conclusions

    The high expression level of HOTAIR in patients with a family history of CAD in comparison with sporadic CAD patients shows the role of genetics and epigenetics in the expression level of HOTAIR. High expression levels of HOTAIR increase susceptibility to CAD and have a positive correlation with age at CAD onset. (Iranian Heart Journal 2021; 22(4): 127-134)

    Keywords: Coronary Artery Disease, Epigenetics, HOTAIR long noncoding RNA, HOXD10
  • Majid Maleki, Maryam Aliramezany * Pages 135-139

    Pulmonary agenesis is a very rare congenital disorder with a chromosome recessive inheritance. Half of the cases with pulmonary agenesis suffer from other congenital disorders such as cardiovascular, skeletal, and gastrointestinal defects. Clinical manifestations vary from respiratory problems to recurrent chest infections, which occur in different stages of life including infancy, childhood, and adolescence. The mortality rate of pulmonary agenesis is about 50% among neonates, especially if it is associated with other disorders like cardiac anomalies. In this paper, we report a case of left-sided lung agenesis in a 32-year-old woman. (Iranian Heart Journal 2021; 22(4): 135-139)

    Keywords: Congenital heart defect, Pulmonary agenesis, Respiratory infections
  • Iswandy Turu’ Allo *, Badai Tiksnadi, Chaerul Achmad, Mira Rahmawati Pages 140-144

    Torsade de pointes (TdP) is an infrequent, yet fatal ventricular arrhythmia as it may degenerate into sudden cardiac death. Given its lethality, it is important to understand its triggering factors and management. We report a rare case of TdP during an exercise stress test. A 64-year-old woman with controlled hypertension underwent an exercise stress test due to her atypical chest pain. She had no family history of sudden cardiac death. A baseline electrocardiogram showed an insignificant prolongation in her corrected QT (QTc) value (479 ms). During the second stage, she developed a transient TdP and was managed in the intensive care unit. A further examination showed moderate hypokalemia, and coronary angiography showed 90% to 95% stenosis in her right coronary artery. A follow-up exercise stress test after electrolyte replacement therapy and coronary revascularization showed a negative ischemic response without arrhythmia. TdP in this patient might have been related to 3 conditions: ischemic burden, hypokalemia, and exercise. Further examinations are needed to inform further management and preventive measures. (Iranian Heart Journal 2021; 22(4): 140-144)

    Keywords: Arrhythmias, Exercise test, Hypokalemia, Ischemia, Torsade de pointes
  • Mahdi Kahrom, Masoomeh Tabari, Saleheh Asghari * Pages 145-147

    High take-off right coronary artery (RCA) is a rare coronary variation with an incidence rate of 0.019% to 0.17% that can make disturbances during cardiac surgery. This abnormality may be silent clinically and diagnosed during the surgical repair of coexisting anomalies such as aortic valve abnormalities and ventricular or atrial septal defects or at autopsy evaluation of an athlete with sudden cardiac death. We herein describe a middle-aged man who suffered from exertional dyspnea. The patient had no history of concurrent diseases. Echocardiography revealed a left ventricular ejection fraction of 50% and severe stenosis in the aortic valve (gradient =70 mm Hg). He was scheduled for aortic valve replacement. However, during preoperative angiographic assessments, attempts to cannulate the right coronary ostium were unsuccessful. During surgery, a high take-off RCA was incidentally found with a long intramural course. The artery was saved and internally fenestrated into the right sinus after a modified aortotomy along with aortic valve replacement. (Iranian Heart Journal 2021; 22(4): 145-147)

    Keywords: Anomalous origin, Open-heart surgery, High take-off, Right coronary artery
  • Harsha Sagar, Ashwal Jayaram *, Vyshak Surendra, Krishnanand Nayak, Sudhakar Rao Pages 148-155

    Lung cancers can extend along or grow through the pulmonary veins to invade the left atrium. A 51-year-old man, previously healthy, presented with left-sided chest pain, dry cough, and dyspnea of 2 months’ duration. The patient also had a history of weight loss and decreased appetite. On physical examination, he had tachycardia and tachypnea. Cardiac examination revealed normal heart sounds and no murmurs. Auscultation of the chest revealed diminished breath sounds in the left hemithorax. Chest radiography showed a left-sided massive pleural effusion. A computed tomography scan confirmed the radiographic findings with a mass extending along the pulmonary vein into the left atrium, suggestive of tumor thrombosis. Transthoracic and transesophageal echocardiographic examinations revealed a mass within the left atrium, measuring about 1.9×1.6 cm at its largest diameter. This case report has 2 primary justifications, considering the rarity and the poor outcome. (Iranian Heart Journal 2021; 22(4): 148-155)

    Keywords: Lung cancer, PULMONARY VEIN, Tumor thrombosis, Left atrial metastasis
  • Azin Alizadehasl, Tahereh Saedi *, Sedigheh Saedi Pages 156-158

    Renal cell carcinoma (RCC) is a malignant tumor, a known sequel of which is metastasis to the heart via intraluminal venous extension (the inferior vena cava). However, tumor metastasis without inferior vena cava involvement is rare. Cardiac metastasis might necessitate surgical excision even in the very advanced stages of the disease. Here we describe a patient with RCC extension to the heart without evidence of a mass in the venous system. (Iranian Heart Journal 2021; 22(4): 156-158)

    Keywords: renal cell carcinoma, CARDIAC THROMBUS, Metastasis
  • Jijin Satheesh, M .Sudhakar Rao *, Vishal Chandra Sharma, Kanhai Lalani, Padmakumar Ramachandran, Arvind Prabhu Pages 159-163

    Carotid artery stenting (CAS) has become a promising alternative to carotid endarterectomy in the management of atherosclerotic carotid artery disease. A 68-year-old woman with diabetes and hypertension presented with an ischemic infarct in the right precentral gyrus. The patient was diagnosed with carotid stenosis, and she underwent CAS. Severe postoperative complications in the form of decreased visual acuity and visual field defect arose, and she was eventually diagnosed with central retinal artery occlusion, resulting in a near-total loss of unilateral vision. CAS reduces carotid plaques; however, it can lead to significant shedding of carotid plaques, followed by retinal artery embolism and ultimately serious loss of vision. This complication is of paramount importance, and it requires ample consideration from the interventionist before CAS. Ophthalmic evaluation is vital following CAS, and it is imperative that patients be informed of the risk of permanent vision loss. We herewith emphasize preoperative visual assessment in patients undergoing carotid revascularization who have risk factors for ocular sequelae. (Iranian Heart Journal 2021; 22(4): 159-163)

    Keywords: Retinal artery, Vision loss, Carotid stenting, Cherry-red spot