Tehran University of Medical Sciences The Research in Heart Yield and Translational Medicine (RHYTHM) 3115-7270 3 4 2008 10 25 187 190 Shaukat Ali Jawaid Managing Editor, Pakistan Journal of Medical Sciences, Karachi, Pakistan 2015 10 03 https://jthc.tums.ac.ir/index.php/jthc/article/view/102 https://jthc.tums.ac.ir/index.php/jthc/article/download/102/100

Tehran University of Medical Sciences The Research in Heart Yield and Translational Medicine (RHYTHM) 3115-7270 3 4 2008 10 25 191 196 Kyomars Abbasi Tehran Heart Center, Tehran University of Medical Sciences, Tehran, Iran. Iman Abbasi Tehran Heart Center, Tehran University of Medical Sciences, Tehran, Iran. Naghmeh Moshtaghi Tehran Heart Center, Tehran University of Medical Sciences, Tehran, Iran. 2015 10 03 Atrial fibrillation is the most prevalent permanent arrhythmia. It may be associated with other cardiac pathologies which need surgical treatment. Various types of surgery including the traditional cut-sew operations and operations using different energy sources are currently in use. In comparison with medical treatment, surgery is safe, effective, and has reliable results. https://jthc.tums.ac.ir/index.php/jthc/article/view/103 https://jthc.tums.ac.ir/index.php/jthc/article/download/103/101

Tehran University of Medical Sciences The Research in Heart Yield and Translational Medicine (RHYTHM) 3115-7270 3 4 2008 10 25 197 204 Reza Forough Bellevue College, Science Division, Bellevue, Washington, USA. Matthew W. Miller College of Veterinary Medicine, The Texas A&M University, USA. Mildred Mattox College of Veterinary Medicine, The Texas A&M University, USA. Wayne Dunlap College of Medicine, The Texas A&M University, USA. Andy Ambrus College of Veterinary Medicine, The Texas A&M University, USA. Rola Barhoumi College of Veterinary Medicine, The Texas A&M University, USA. Cristine L. Heaps College of Veterinary Medicine, The Texas A&M University, USA. Janet L. Parker College of Medicine, The Texas A&M University, USA. 2015 10 03 Background: Angiogenesis gene therapy has long been sought as a novel alternative treatment for restoring the blood flow and improving the contractile function of the ischemic heart in selected clinical settings. Angiogenic fibroblast growth factor-1 (FGF-1) is a promising candidate for developing a promising gene therapy protocol due to its multipotent ability to stimulate endothelial cell (EC) growth, migration, and tube formation. Despite these advantages, however, FGF gene therapy has suffered setbacks mainly due to the inefficient delivery rate of the growth factor in vivo. Given the potent angiogenic effect of FGF-1, we reasoned that constitutively synthesized minute quantities of this polypeptide hormone, when empowered with the ability to escape the cellular constraint, could freely act in a paracrine/autocrine fashion on nearby existing capillary plexuses and lead to neovascularization and restoration of the blood flow to ischemic tissues for reparative purpose. Methods: We report the direct gene transfer of a retroviral-based mammalian expression vector encoding a secreted form of FGF-1 (sp-FGF-1) for the purpose of therapeutic angiogenesis into the porcine myocardium subjected to the surgical placement of an ameroid occluder to induce the chronic coronary occlusion of the left circumflex coronary artery (LCx) and regional myocardial ischemia. Coronary angiography, performed 3 weeks after surgery, confirmed the interruption of the blood flow in the LCx distal to the site of ameroid placement. Results: Immunohistochemical analysis using antibody specific to von Willebrand factor (vWF), an endothelial marker, showed a significant increase (p<0.05) in myocardial vascularity in the sp-FGF-1 hearts compared to the control (vector alone). Importantly, an assessment of the cardiac function by echocardiography, performed 3 weeks after surgery, demonstrated improved cardiac contractility due to increased left ventricular free wall contraction in the sp-FGF-1-treated animals only.  Conclusion: These results suggest that the intramyocardial delivery of our chimeric secretory FGF-1 gene can enhance vascularity and improve cardiac contractility in a chronic ischemic heart. This protocol may serve useful for developing reparative angiogenesis strategies aimed at improving the pumping function of the ischemic hearts in human patients.  https://jthc.tums.ac.ir/index.php/jthc/article/view/104 https://jthc.tums.ac.ir/index.php/jthc/article/download/104/102

Tehran University of Medical Sciences The Research in Heart Yield and Translational Medicine (RHYTHM) 3115-7270 3 4 2008 10 25 205 208 Abbas Salehi Omran Tehran Heart Center, Tehran University of Medical Sciences, Tehran, Iran. Abbasali Karimi Tehran Heart Center, Tehran University of Medical Sciences, Tehran, Iran. Setareh Davoodi Imam Khomeini Hospital, Tehran University of Medical Sciences, Tehran, Iran. Hossein Ahmadi Tehran Heart Center, Tehran University of Medical Sciences, Tehran, Iran. Namvar Movahedi Tehran Heart Center, Tehran University of Medical Sciences, Tehran, Iran. Mehrab Marzban Tehran Heart Center, Tehran University of Medical Sciences, Tehran, Iran. Banafsheh Alinejad Tehran Heart Center, Tehran University of Medical Sciences, Tehran, Iran. Neda Ghaffari Marandi Tehran Heart Center, Tehran University of Medical Sciences, Tehran, Iran. 2015 10 03 Background: Prosthetic valve endocarditis (PVE) is an important cause of morbidity and mortality associated with heart valve replacement surgery. The aim of the present study was to describe the early outcome of treatment in patients with PVE in a single center. Methods: The data of all the episodes of PVE registered at our institution between 2002 and 2007 were collected and analyzed retrospectively. The patients were assessed using clinical criteria defined by Durack and colleagues (Duke criteria). The analysis included a detailed study of hospital records. The continuous variables were expressed as mean ± standard deviation, and the discrete variables were presented as percentages. Results: Thirteen patients with PVE were diagnosed and treated at our center during the study period. In all the cases, mechanical prostheses were utilized. The patients' mean age was 46.9±12.8 years. Women made up 53.8% of all the cases.  Early PVE was detected in 6 (46.2%) patients, and late PVE occurred in 7 (53.8 %). Eleven (84.6%) patients were treated with intravenous antimicrobial therapy, and the other two (15.4%) required surgical removal and replacement of the infected prosthesis in addition to antibiotic therapy. Blood cultures became positive in 46.2% of the patients. Mortality rate was 15.4% (2 patients). Conclusion: It seems that in selected cases with PVE, i.e. in those who remain clinically stable and respond well to antimicrobial therapy, a cure could be achieved by antimicrobial treatment alone with acceptable morbidity and mortality risk. https://jthc.tums.ac.ir/index.php/jthc/article/view/105 https://jthc.tums.ac.ir/index.php/jthc/article/download/105/103

Tehran University of Medical Sciences The Research in Heart Yield and Translational Medicine (RHYTHM) 3115-7270 3 4 2008 10 25 209 214 Hassan Moladoust Department of Medical Physics, Tarbiat Modares University, Tehran, Iran. Manijhe Mokhtari-Dizaji Department of Medical Physics, Tarbiat Modares University, Tehran, Iran. Zahra Ojaghi-Haghighi Shaheed Rajaie Heart Center, Iran University of Medical Sciences, Tehran, Iran. 2015 10 03 Background: The recent developments in tissue Doppler imaging (TDI) now more than ever permit the quantification of the myocardial function. In the current systems, tissue tracking or displacement curves are generated from color tissue Doppler data through the instantaneous temporal integral of velocity-time curves. Methods: The purpose of the present study was to assess regional myocardial displacement via spectral TDI. Maximum myocardial velocities were extracted from spectral pulsed tissue Doppler images using a developed computer program and were integrated throughout the cardiac cycle. Spectral tissue Doppler echocardiography was performed to evaluate longitudinal and radial functions in 20 healthy men, and the calculated end-systolic displacements were subsequently compared with the displacements measured from the same areas via color tissue tracking. Results: According to the Bland-Altman analysis between spectral tissue tracking and color tissue tracking, the significant arithmetic mean was 7.34 mm with SD mean differences of ±2.24 mm in all of the evaluated segments. Despite significant differences (p<0.001), there was a good significant correlation between the two methods (r=0.79, p<0.001). Conclusion: A verification study showed that the proposed approach had the ability to assess regional myocardial displacement using spectral TDI, which can be used in a wider range of equipment than is currently possible. https://jthc.tums.ac.ir/index.php/jthc/article/view/106 https://jthc.tums.ac.ir/index.php/jthc/article/download/106/104

Tehran University of Medical Sciences The Research in Heart Yield and Translational Medicine (RHYTHM) 3115-7270 3 4 2008 10 25 215 218 Hassan Radmehr Imam Khomeini Medical Center, Tehran University of Medical Sciences, Tehran, Iran. Alireza Bakhshandeh Imam Khomeini Medical Center, Tehran University of Medical Sciences, Tehran, Iran. Mehrdad Salehi Imam Khomeini Medical Center, Tehran University of Medical Sciences, Tehran, Iran. Iraj Ghorbandaeipour Imam Khomeini Medical Center, Tehran University of Medical Sciences, Tehran, Iran. Amir Hossein Sadeghpoor Tabai Imam Khomeini Medical Center, Tehran University of Medical Sciences, Tehran, Iran. Mehdi Sanatkarfar Imam Khomeini Medical Center, Tehran University of Medical Sciences, Tehran, Iran. Ahmad Reza Nasr Imam Khomeini Medical Center, Tehran University of Medical Sciences, Tehran, Iran. 2015 10 03 Background: Elderly patients (>75 years) have constituted the fastest growing portion of the coronary artery bypass grafting (CABG) patient population over the last two decades. Of the goals that surgical care for the elderly pursues, cure may be an unfeasible one; nevertheless, palliation and comfort warrant sufficient importance. The present study sought to examine the postoperative course and events in elderly patients undergoing CABG with or without other procedures and to compare the results with those in younger patients. Methods: Demographic, mortality, morbidity, and resource utilization data were collected from the records of the patients undergoing CABG between January 2005 and July 2007 in Imam Khomeini Medical Center, Tehran, Iran. Results: The mean time to extubation was 9.3 and 6.3 hours in the elderly and non-elderly patients, respectively (p<0.01). Blood transfusion was required in 87.8% of the elderly compared to 58.5% of the non-elderly subjects (p<0.01). The mean Intensive Care Unit stay was 2.1 days for the elderly and 1.4 days for the non-elderly patients (p<0.001). In-hospital mortality was 9% for the elderly patients vs. 2.8% for the younger group (p<0.001). Conclusion: The elderly patients undergoing CABG had a significantly higher morbidity rate, with an increased incidence of postoperative renal failure, neurological complications, and in-hospital mortality. https://jthc.tums.ac.ir/index.php/jthc/article/view/107 https://jthc.tums.ac.ir/index.php/jthc/article/download/107/105

Tehran University of Medical Sciences The Research in Heart Yield and Translational Medicine (RHYTHM) 3115-7270 3 4 2008 10 25 219 224 Hakimeh Sadeghian Tehran Heart Center, Tehran University of Medical Sciences, Tehran, Iran. Abbasali Karimi Tehran Heart Center, Tehran University of Medical Sciences, Tehran, Iran. Seyed Hosein Ahmadi Tehran Heart Center, Tehran University of Medical Sciences, Tehran, Iran. Masoumeh Lotfi-Tokaldany Tehran Heart Center, Tehran University of Medical Sciences, Tehran, Iran. Nader Fallah Tehran Heart Center, Tehran University of Medical Sciences, Tehran, Iran. Reihaneh Zavar Tehran Heart Center, Tehran University of Medical Sciences, Tehran, Iran. Seyed Hesameddin Abbasi Tehran Heart Center, Tehran University of Medical Sciences, Tehran, Iran. 2015 10 03 Background: Discrete subaortic stenosis (DSS) is a progressive condition. Controversy still rumbles on as to whether the subaortic membrane causes aortic regurgitation (AR) and whether membrane resection reduces AR severity. We investigated the association between the left ventricular outflow tract peak gradient (LVOT-PG) and AR severity preoperatively and changes in AR severity and obstruction recurrence after surgery in DSS patients. Methods: Twenty patients were evaluated before and after surgery for DSS (mean follow-up time: 13.60±9.61 months). The patients were evaluated via transthoracic echocardiography and transesophageal echocardiography, if necessary. The cut-off point for surgery was LVOT-PG ≥50 mmHg or the presence of progressive AR. Results: The mean age of the patients was 28.55±15.23 years, and 35% of them were male. LVOT-PG decreased from a mean of 80.83±42.72 mmHg preoperatively to 19.14±14.03 mmHg postoperatively and to 25.47±16.10 at follow-up. AR was identified in 15 (75%) patients preoperatively: mild in 8 (40%) and moderate in 7 (35%). The postoperative change in AR severity was insignificant. The correlation between preoperative LVOT-PG and the incidence and severity of preoperative AR was not significant. AR severity had no correlation with age. Membrane recurrence occurred in 25% of the patients. Conclusion: Our results indicated no relationship between AR severity and LVOT-PG and the patient’s age. Patient selection for surgery can, therefore, be carried out on the basis of LVOT-PG or AR severity separately. Subaortic resection may reduce AR severity in some patients, but th Background: The incidence of stroke after coronary artery bypass grafting (CABG) is between 0.9% and 6.7%, which significantly increases in-hospital and out-hospital costs. This study was designed to evaluate the prevalence of significant carotid stenosis and its risk factors in CABG. Methods: In total, 2044 consecutive patients undergoing elective CABG were investigated through a pre-operative duplex scanning of the carotid arteries. The relation of age, sex, smoking, hypertension, diabetes, dyslipidemia, and coronary disease with carotid stenosis was evaluated. Results: The prevalence of carotid stenosis was 7.6%. The multivariate analysis showed that age over 55 and left main coronary disease were significant independent risk factors for carotid stenosis. Female gender, smoking, hypertension, and diabetes were the risk factors in the univariate logistic regression model. Conclusion: Carotid stenosis is prevalent in CABG candidates. It seems that age ≥55 years and left main coronary disease are the independent risk factors for carotid stenosis in CABG patients. https://jthc.tums.ac.ir/index.php/jthc/article/view/139 https://jthc.tums.ac.ir/index.php/jthc/article/download/139/137

Tehran University of Medical Sciences The Research in Heart Yield and Translational Medicine (RHYTHM) 3115-7270 4 3 2009 07 21 185 188 Afsoon Fazlinezhad Ghaem Hospital, Mashhad University of Medical Sciences, Mashhad, Iran. Sara Azimi Ghaem Hospital, Mashhad University of Medical Sciences, Mashhad, Iran. Mahmoodreza Azarpazhooh Ghaem Hospital, Mashhad University of Medical Sciences, Mashhad, Iran. Mohammad Khajedaluee Ghaem Hospital, Mashhad University of Medical Sciences, Mashhad, Iran. Mohsen Mahdinezhad Kashani Islamic Azad University, Mashhad Branch, Mashhad, Iran. 2015 10 03 Background: Stroke, one of the most important causes of morbidity and mortality in the world, is of great importance in young adults (15-45 years), amongst whom the causes of stroke and transient ischemic attack (TIA) are different from those in older ages and a significant portion of them have no known etiology. Patent foramen ovale (PFO) is considered a probable cause in this group. Methods: Patients between 15 and 45 years of age with TIA or stroke were examined and evaluated for causes of cerebrovascular accidents. Patients with no definite cause for stroke or TIA, except for PFO, despite our extensive evaluations were categorized as cryptogenic. The controls were comprised of those between 15 and 45 years old who underwent transesophageal echocardiography (TEE) for reasons other than stroke. The frequency of PFO and its characteristics were compared between the two groups. Results: The case group comprised 48 patients with cryptogenic stroke (n=31) and TIA (n=17), and the control group consisted of 57 patients. The age distribution of the groups was normal, and there was no significant difference between the age and gender of the two groups. The frequency of PFO in the case and control groups was 52% and 25%, respectively (p value=0.003, odds ratio=3.33, confidence interval=1.46-7.63). The exaggerated motion of the interatrial septum (IAS) in the case and control groups was 18.8% and 0%, respectively. Right-to-left shunt at rest in the case and control groups was 78% and 28%, respectively (significant differences). The differences in terms of PFO size, number of bubbles, and atrial septal aneurysm were not significant between the two groups. Conclusion: PFO had a relation with stroke and TIA in the young adults, and right-to-left shunt at rest and exaggerated motion of the IAS could increase the possibility of paradoxical emboli. It seems that the presence of atrial septal aneurysm, number of bubbles, and PFO size did not increase the risk of cerebrovascular accidents. https://jthc.tums.ac.ir/index.php/jthc/article/view/140 https://jthc.tums.ac.ir/index.php/jthc/article/download/140/138

Tehran University of Medical Sciences The Research in Heart Yield and Translational Medicine (RHYTHM) 3115-7270 4 3 2009 07 21 189 192 Hossein Ahmadi Tehran Heart Center, Tehran University of Medical Sciences, Tehran, Iran. Mohammad Ali Boroumand Tehran Heart Center, Tehran University of Medical Sciences, Tehran, Iran. Maryam Sotoudeh Anvari Tehran Heart Center, Tehran University of Medical Sciences, Tehran, Iran. Abbasali Karimi Tehran Heart Center, Tehran University of Medical Sciences, Tehran, Iran. Naghmeh Moshtaghi Tehran Heart Center, Tehran University of Medical Sciences, Tehran, Iran. 2015 10 03 Acinetobacter lwoffii, an important nosocomial pathogen, is a gram-negative aerobic bacillus that is a component of the normal flora on the skin, oropharynx, and perineum of about 20-25% of healthy individuals. We herein present a case of a 66-year-old man with combined mitral and aortic valve endocarditis associated with multi-drug resistance acinetobacter lowffii bacteremia. https://jthc.tums.ac.ir/index.php/jthc/article/view/141 https://jthc.tums.ac.ir/index.php/jthc/article/download/141/139

Tehran University of Medical Sciences The Research in Heart Yield and Translational Medicine (RHYTHM) 3115-7270 4 3 2009 07 21 193 196 Ahmadreza Afshar Shahid Motahhari Hospital, Urmia University of Medical Sciences, Iran. Babak Nasiri Shahid Madani Hospital, Tabriz University of Medical Sciences, Iran. 2015 10 03 This report presents a case of left radial artery pseudoaneurysm developing at the previous site of invasive monitoring. The patient had prosthetic mitral valve replacement one month earlier, and anti-coag