Evaluation of Patients with Severe Aortic Stenosis after TAVI with Self-Expandable vs. Balloon-Expandable Devices

Background: The introduction of transcatheter aortic valve implantation (TAVI) for the treatment of severe aortic stenosis (SAS) has expanded the therapeutic possibilities for successfully managing SAS in cases with intermediate and high surgical risks. However, the complications and outcomes of new devices have not been studied enough. Hence, the purpose of this study is to evaluate the midterm results of the Core Valve and Evolute R self-expandable (SE) devices versus the Edwards SAPIEN balloon-expandable (BE) devices. Methods and Material: This was a quasi-experimental study conducted in Tehran, Iran, from May 2012 to June 2017. SAS patients who were not ideal candidates for surgery were randomly assigned to either SE or BE groups. For each patient, a questionnaire, including four sections comprised of Basic characteristics, echocardiographic, angiographic, and Computed Tomography (CT) scan data was filled. TAVI was followed by echocardiography a week later and after three months they were reevaluated by another questionnaire. Results: The total number of patients was 60. The mean ages of patients undergoing the procedure with SE or BE devices were 81.2 ± 8 and 79.8 ± 7, respectively. Mortality occurred in 20% of the patients (5 cases in the SE group and 7 cases in the BE);mortality causes were 66.6 % cardiac and 33% non-cardiac. Moderate to severe Paravalvular leakage in both groups did not differ significantly. The mortality rate was 5 (41.6%) in the SE group versus 7 (58.3%) in the BE group (P > 0.05). Conclusion: In conclusion, the BE group did not experience fewer paravalvular leaks in comparison with the SE. Morbidity and mortality between the BE and the SE groups did not differ significantly.

Is Any Correlation between Platelet Indices with Extent of Coronary Artery Involvement in Ischemic Heart Diseases?

Ischemic heart disease (IHD) is the most common cause of death around the world. Nowadays Platelet counts (PC) and volumetric platelet indices are available routinely in most laboratories and reflect the level of mobility and production of platelets. It seems that the excessive flexibility and size of the platelets and their local activation have correlation with extent of ischemic heart disease. So our objective is the study of platelet indices in ischemic heart disease. This non-randomized prospective study was performed on 245 patients with ischemic heart disease, who underwent the coronary angiography. The patients were divided into four groups: stable angina, unstable angina, acute myocardial infarction and control group;and then platelet indices, including the platelet counts (PC), the average platelet volume (MPV), the Platelet Distribution Width (PDW) and plateletcrit (PCT) in each group with the extent of coronary disease were compared based on an Syntax Score system and observational methods. The average ages of the patients were 57 years and 65% of them were male and the rest were female. A significant difference is exists between indices in all three groups compared to the control that this difference was related to gender and the type of the coronary artery involvement. However, only in infarction group, PDW in different disease intensities was significantly different. In this study, unlike many of the previous studies no relationship was found between the MPV with the extent of coronary disease.

Study the Effect of High Dialysate Potassium Solution in Comparison to Low Potassium Dialysate Solution in End Stage Renal Disease Patients

Background: Nowadays cardiovascular diseases remain as the single most common cause of death in chronic dialysis patients;the aim of this study was to evaluate the effects of two different regimens of dialysis potassium removal in patients with a tendency to develop arrhythmias during haemodialysis (HD). Methods and Materials: There were 88 (36 men and 52 women) end stage renal disease (ESRD) patients recruited for the study. They received regular haemodialysis three times per week at the haemodialysis units of a university medical centre (Golestan hospital) during year 2011. We compared the arrhythmogenic effects of two dialysis techniques. Results: There was a tendency in the HD solution with constant (3 mEq/l) K for premature ventricular complex (PVC) appearance in to be reduced as compared with constant (2 mEq/l) K in the time of dialysis period, although this reduction was not statistically significant(P = 0.09). There was a significant reduction in SVC in the HD solution with constant (3 mEq/l) K as compared with constant (2 mEq/l) K. Discussion: In conclusion, the use of a model of intra-HD potassium that is more close to potassium serum concentration of ESRD patients can reduce the arrhythmogenic effect of HD in patients on regular HD treatment.

The effect of aerobic training on endothelium-dependent vasodilatation in patients with coronary artery disease who were revascularized and young men

Aim: The aim of this study was to determine the effect of training on endothelium-dependent vasodilatation in patients with coronary artery disease (CAD) after revascularization and healthy young men. Background: Impaired endothelial function has been observed in patients with CAD and those with CAD risk factors. Studies have shown that exercise can enhance endothelial function. Methods: This experimental cross-sectional study was conducted on patients with CAD (3 months after CABG and PCI) and students of medical school in 2011. Endothelium dependent dilation of the brachial artery was determined by using high-resolution vascular ultrasonography through flow-mediated vasodilatation (FMD) after induction of ischemia, and the data were analyzed using SPSS, dependent t-test and ANCOVA. Findings: The findings showed that at baseline, FMD was reduced in revascularized patients, when compared with healthy young men, after 8 weeks, and exercise training significantly improved FMD in patients underwent training group [from 4.31 ± 1.45 (SD)% to 6.15 ± 0.773 (SD)%, p p ed unchanged, and even after aerobic training, it did not significantly modify the brachial artery diameter in these groups. Conclusion: Our study demonstrates that endothelial dysfunction persisting in CAD patients after revascularization and aerobic training can improve endothelial function in different vascular beds in CAD patients and healthy young men. This may contribute to the benefit of regular exercise in preventing and restricting cardiovascular disease.

Study the effect of exercise on systolic pulmonary artery pressure in healthy subjects

Introduction: As no data is available concerning the cut-off value defining abnormal pulmonary artery systolic pressure (PASP) response in subjects of various ages, the aim of this study is to assess physiological PASP response to exercise in healthy individuals of various ages. Material and methods: One hundred and twenty three healthy volunteers, aged 30 to 70 years, underwent Doppler echocardiographic measurements at rest and after treadmill exercise test. Pulmonary artery systolic pressure was estimated at rest, and immediately after peak exercise using Bernoulli formula (four times tricuspid valve regurgitation velocity squared adding an estimated right atrial pressure). Results: Lower and upper limits of PASP during rest was 7 and 28 mmHg and after peak exercise was 14 and 48 mmHg respectively. After exercise, PASP increased from rest (14 ± 4 mmHg) to peak (25 ± 7 mmHg). Pulmonary artery systolic pressure during rest and peak exercise, increased with age, but has no correlation with body mass index or gender. Conclusion: Pulmonary artery systolic pressure at peak exercise can frequently reach values ≥ 30 mmHg in healthy individuals with good exercise capacity, especially in elderly individuals, which goes beyond pathologic definitions of pulmonary hypertension.

Study the Effect of Spironolactone in Airway Resistance with Impulse Oscillometry in Patients with Congestive Heart Failure

Background: CHF (Congestive Heart Failure) is one of the most important causes of mortality and morbidity in the world. Diuretics such as spironolactone can decrease pulmonary congestion and reduce the amount of fibrosis in CHF patients. The goal was to assess whether spironolactone can decrease air way resistance and can we follow up the effect of diuretic therapy in patients of heart failure quantitatively by means of impulse oscillometry. Methods: It was clinical trial which performed in Ahvaz teaching hospital. 24 patients with congestive heart failure (CHF) which was classified as functional class II-IV and had EF Result: The age of patient was 61 ± 10 and the age of control was 57 ± 7 years old. The data of oscillometry before and after spironolactone were X5 (−0.14 ± 0.05 vs −0.14 ± 0.05, P: 0.93), R5 (0.39 ± 0.21 vs 0.39 ± 0.15, P: 0.35), X20 (−0.04 ± 0.06 vs −0.06 ± 0.06, P: 0.37), R20 (0.04 ± 0.03 vs 0.06 ± 0.06, P: 0.37), Zrs (0.39 ± 0.21 vs 0.39 ± 0.15, P: 0.35). Conclusion: There was a trend toward reduction of peripheral airway resistances in CHF patients than controls with use of 1 month of spironolactone. Although there was not significant change in the number of X5, R5, X20, R20 occurred the trend toward reduction of number triggers the point that oscillometry can be used for quantitative follow up of CHF patients.

Transradial angiography procedure approach in with and without radial artery anomalies

Introduction: The transradial coronary angiography has several benefits such as the reducetion in access site complications especially in fully anticoagulated patients. The presence of arterial anomalies in upper limb arteries has an important role in procedural success. Methods: retrograde transarterial sheath injection was done in patients with transradial coronary angiography. Arterial anomalies in the upper limb evaluated. Cannulation time, the time of catheter passage to ascending aorta, and Angiographic time, were also meseared. Results: in 2011, 165 consecutive patients were studied, 116 (70.3%) male, age 56.7 ± 11.1 years. With 96.6% success rate in procedure, totally 59 anomolies were observed in 44 patients (26.7%). Radial artery by itself had ?25 anomalies (15.1%). The most frequent anomaly was abnormal origin of radial artery in 14 patients (8.5%) followed by tortuosities in 10 ulnar (6%). 9 brachial (5.4%), 7 radial (4/2%), 5 subclavian (3%) and 3 brachiocephalic arteries (1.8%). There also were 4 loops in ulnar artery (2.4%) and one in radial and brachinl arteries (each 0.6%). Other anomalies include 4 patients (2.4%), except cannulation time (p = 0.97), there were associations between anomalies and each of other times (p = 0.001) and contrast volume (p = 0.009). Anomalies didn’t have any effect on procedural success rate and just in one patient with sulclavian loop procedure changed to femoral approach (p = 0.19).

Distributions of ischemic heart disease risk factors in patients who were admitted for angioplasty in Iran

The aim of this study was to study the prevalence of different risk factors of coronary artery disease (CAD) in Patients who were admitted for angioplasty. Methods: A cross-sectional study was conducted on 333 patients who were admitted with diagnosis as a CAD and candidates for angioplasty in Imam Khomeini hospital, Ahvaz city, Iran 2011. The prevalence of different risk factors was determined using descriptive statistics. Results: The prevalence of CAD risk factors in overall subjects were: 1) 45.3% hypertension (considering >140/90 mmHg);2) 34.5% high cholesterol (>240 mg/dl);3) 27.6% diabetic mellitus (>126 mg/dL);4) family history of heart disease: 20.7%;5) smokers: 19.9%. Conclusion: This data have shown the prevalence of IHD (Ischemic Heart Disease) risk factors specially about hypertension in patients with IHD was high, so could require urgent decision making to national control program of non-communicable diseases in Iran.

Optimization of Liver Iron Load Assessment by Pixel-Based T2* MRI in Thalassemic Patients

Purpose: To improve liver iron load assessment by investigating the precision of different approaches of T2* Measurement. Background: Iron overload is a major problem in the treatment of thalassemic patients. Liver iron concentration (LIC) is an important index toward the management of body iron load. The accuracy of iron load estimation may suffer from the methodology of T2* measurement and there is no complete agreement upon the best approach of T2* calculation. Methods: 32 β-thallasemic patients (18 male) with the mean age of 20.0 ± 6.5 years were involved in this study. A multi-echo fast gradient-echo technique on a 1.5 T MRI system was used to measure liver iron overload and the T2* map of liver was reconstructed on a pixel-by-pixel basis. The T2* map and MRI images were utilized to deter- mine accurate location of ROI (region of interest). The mean of T2* were computed from the ROIs. The reproducibility of calculated T2* values in two methods were obtained. Moreover, the mean of the pixel’s T2* was calculated in the entire liver parenchyma of one slice. The T2* value of the entire slice was compared with the ROI approach. Results: In the ROI based method, the CoV for the intra-observer reproducibility was 8.5% and for the inter-observer was 9.78%. In the pixel based method, the CoVs for intra-observer and inter-observer reproducibility were 2.79% and 3.91%. There was an acceptable correlation (r = 0.96) between the T2* values calculated by the ROI and the entire slice. Conclusions: The pixel-based approach is more precise to determine the appropriate placement of the ROI. The assessment of T2* in the entire slice reduces the user-based errors significantly.

Right Atrial Giant Myxoma Occupying the Right Ventricular Cavity

Introduction: Atrial myxomas are the most common primary heart tumors. Because of nonspecific symptoms, early diagnosis may be a challenge [1] [2]. Left atrial myxoma may or may not produce characteristic findings on auscultation. Two-dimensional echocardiography is the diagnostic procedure of choice. Most atrial myxomas are benign and can be removed by surgical resection. Cardiac myxoma is located mostly in left atrium [3]. This was amazing huge mass of cardiac myxoma in unusual part of the heart with the patient showed significant response to anticoagulation after presumed recurrence of tumor. Case Presentation: A case of giant right atrial myxoma mimicking the right ventricular tumor is described. Surgery was performed in 41 years old female and the fist like tumor with its stalk was excised. Surprisingly it recurred after 2 month as the smaller tumor was completely resolved with anticoagulation therapy. In addition because of previous normal echocardiography that was done for another reasons, we estimated the speed of tumor’s growth (3 millimeter/month). Conclusion: To sum up a very large myxoma in right ventricle may only present with occasional dyspnea and we can diagnose it with precise evaluation and with performing on time echocardiography.