Tehran University of Medical Sciences The Research in Heart Yield and Translational Medicine (RHYTHM) 3115-7270 8 2 2015 10 13 65 69 EN Maryam Esmaeilzadeh Echocardiography Research Center, Rajaie Cardiovascular, Medical and Research Center, Iran University of Medical Sciences, Tehran, Iran. MohammadTaghi Salehi-Omran Roohani Hospital, Babol University of Medical Sciences, Babol, Iran. Majid Maleki Echocardiography Research Center, Rajaie Cardiovascular, Medical and Research Center, Iran University of Medical Sciences, Tehran, Iran. Majid Haghjoo Echocardiography Research Center, Rajaie Cardiovascular, Medical and Research Center, Iran University of Medical Sciences, Tehran, Iran. Feridoun Noohi Echocardiography Research Center, Rajaie Cardiovascular, Medical and Research Center, Iran University of Medical Sciences, Tehran, Iran. Zahra Ojaghi-Haghighi Echocardiography Research Center, Rajaie Cardiovascular, Medical and Research Center, Iran University of Medical Sciences, Tehran, Iran. Anita Sadeghpour Echocardiography Research Center, Rajaie Cardiovascular, Medical and Research Center, Iran University of Medical Sciences, Tehran, Iran. Paridokht Nakhostin-Davari Echocardiography Research Center, Rajaie Cardiovascular, Medical and Research Center, Iran University of Medical Sciences, Tehran, Iran. Hooman Bakhshandeh-Abkenar Echocardiography Research Center, Rajaie Cardiovascular, Medical and Research Center, Iran University of Medical Sciences, Tehran, Iran. 2015 10 11 2015 10 11 Background: Noninvasive techniques for the localization of the accessory pathways (APs) might help guide mapping procedures and ablation techniques. We sought to examine the diagnostic accuracy of strain imaging for the localization of the APs in Wolff-Parkinson-White syndrome. Methods: We prospectively studied 25 patients (mean age = 32 ± 17 years, 58.3% men) with evidence of pre-excitation on electrocardiography (ECG). Electromechanical interval was defined as the time difference between the onset of delta wave and the onset of regional myocardial contraction. Time differences between the onset of delta wave (δ) and the onset of regional myocardial contraction (δ-So), peak systolic motion (δ-Sm), regional strain (δ-ε), peak strain (δ-εp), and peak strain rate (δ-SRp) were measured. Results: There was a significant difference between time to onset of delta wave to onset of peak systolic motion (mean ± SD) in the AP location (A) and normal segments (B) versus that in the normal volunteers (C) [A: (57.08 ± 23.88 msec) vs. B: (75.20 ± 14.75)  vs. C: (72.9 0 ± 11.16); p value (A vs. B) = 0.004 and p value (A vs. C) = 0.18] and [A: (49.17 ± 35.79) vs. B: (67.60 ± 14.51) vs. C: (67.40 ± 6.06 msec); p value ( A vs. B) < 0.001 and  p value (A vs. C) = 0.12, respectively]. Conclusion: Our study showed that strain imaging parameters [(δ-So) and (δ-Strain)] are superior to the ECG in the localization of the APs (84% vs. 76%). https://jthc.tums.ac.ir/index.php/jthc/article/view/285 https://jthc.tums.ac.ir/index.php/jthc/article/download/285/278

Tehran University of Medical Sciences The Research in Heart Yield and Translational Medicine (RHYTHM) 3115-7270 8 2 2015 10 13 106 110 EN Hassan Teimouri Shahid Madani Hospital, Lorestan University of Medical Sciences, Lorestan, Iran. Feridoun Sabzi Imam Ali Hospital, Kermanshah University of Medical Sciences, Kermanshah, Iran. Babak Nasiri Shahid Madani Hospital, Lorestan University of Medical Sciences, Lorestan, Iran. 2015 10 11 2015 10 11 Right ventricular failure due to right coronary artery disease, right ventricular hypertrophy, stunning, abnormal septal motion, myocardial infarction, or non-homogeneous distribution of cardioplegia is an uncommon but serious complication of open heart surgery. We report a patient with severe right ventricular hypertrophy secondary to severe mitral valve stenosis and another patient with detachment of the right coronary artery due to the dissection of the ascending aorta. The patients developed right ventricular failure, which persisted after surgery and rendered weaning from cardiopulmonary bypass unsuccessful. Through a hemi-Fontan, or bidirectional cavopulmonary shunt, and an intra-aortic balloon pump, the patients were successfully weaned from cardiopulmonary bypass. This shunt may be an alternative to a right ventricular assist device in some patients with right ventricular failure. The long-term outcome and the indication of bi-directional cavopulmonary shunt has not been confirmed, although it is believed to be effective for saving the life of patients with low cardiac output and acute right ventricular failure. In our cases, six months following the operation, there was some degree of recovery of the right ventricular function. In long-term follow-up, however, it would be interesting for the authors to know if the improved right ventricular function, with better antegrade pulsatile flow in the pulmonary artery, in any way interferes with the functioning of the bidirectional cavopulmonary shunt. https://jthc.tums.ac.ir/index.php/jthc/article/view/291 https://jthc.tums.ac.ir/index.php/jthc/article/download/291/284

Tehran University of Medical Sciences The Research in Heart Yield and Translational Medicine (RHYTHM) 3115-7270 8 2 2015 10 13 119 120 EN Mohammad Hossein Mandegar Processor of Cardiac Surgery, Tehran University of Medical Sciences, Shariati General Hospital,Kargar Street, Tehran,Iran. Farideh Roshanali Shariati General Hospital, Kargar Street, Tehran, Iran. 2015 10 11 2015 10 11 No Abstract https://jthc.tums.ac.ir/index.php/jthc/article/view/294 https://jthc.tums.ac.ir/index.php/jthc/article/download/294/287

Tehran University of Medical Sciences The Research in Heart Yield and Translational Medicine (RHYTHM) 3115-7270 8 2 2015 10 13 70 75 EN Fardin Yousefshahi Tehran Heart Center, Tehran University of Medical Sciences, Tehran, Iran. Khashayar Azimpour Shariati Hospital, Tehran University of Medical Sciences, Tehran, Iran. Mohammad Ali Boroumand Tehran Heart Center, Tehran University of Medical Sciences, Tehran, Iran. Mahdi Najafi Tehran Heart Center, Tehran University of Medical Sciences, Tehran, Iran. Khosro Barkhordari Tehran Heart Center, Tehran University of Medical Sciences, Tehran, Iran. Mitra Vaezi Shariati Hospital, Tehran University of Medical Sciences, Tehran, Iran Nahid Rouhipour Moayeri Hospital, Social Security Organization, Tehran, Iran. 2015 10 11 2015 10 11 Background: Central venous (CV) catheters play an essential role in the management of critically ill patients in the Intensive Care Unit (ICU). CV lines are, however, allied to catheter-associated blood stream infections. Bacterial colonization of CV lines is deemed the main cause of catheter-associated infection. The purpose of our study was to compare bacterial colony counts in the catheter site before CV line insertion in two groups of post-cardiac surgery patients: a group receiving Sanosil (an antiseptic agent composed of H2 O2 and silver) and a control group. Methods: This interventional prospective double-blinded clinical trial recruited the patients in three post-cardiac surgeryICUs of a heart center. The participants were divided into interventional (113 patients) and control (136 patients) groups. Sanosil was added to the routine preparation procedure (Chlorhexidine bath one day before and scrub with Povidone-Iodine just before the CV line insertion). After the removal of the CV lines, the catheters tips were sent for culture and evaluation of colony counts. Results: Catheter colonization occurred in 55 (22.1%) patients: 26 (23%) patients in the Sanosil group and 29 (21.3%) in the control group; there was no significant statistical difference between the two groups (p value = 0.75, RR = 1.05, 95%CI:0.76-1.45). The most common organism having colonized in the cultures of the catheter tips was staphylococcus epidermis:20 cases in the control group and 16 cases in the intervention group. Conclusion: Catheter colonization frequently occurs in post-cardiac surgery patients. However, our results did not indicate the effectiveness of adding Sanosil to the routine preparation procedure with respect to reducing catheter bacterial colonization. https://jthc.tums.ac.ir/index.php/jthc/article/view/286 https://jthc.tums.ac.ir/index.php/jthc/article/download/286/279

Tehran University of Medical Sciences The Research in Heart Yield and Translational Medicine (RHYTHM) 3115-7270 8 2 2015 10 13 111 115 EN Mohammad Dalili Rajaie Cardiovascular, Medical and Research Center, Iran University of Medical Sciences, Tehran, Iran. Jayakeerthi YRao Heart Rhythm Management Center, Universitair Ziekenhuis Brussels – Vrije Universiteit Brussel, Brussels, Belgium. Pedro Brugada Heart Rhythm Management Center, Universitair Ziekenhuis Brussels – Vrije Universiteit Brussel, Brussels, Belgium. 2015 10 11 2015 10 11 Catheter ablation is an accepted, highly effective modality of treatment for cardiac arrhythmias in children. The success rate depends on the operator’s experience, especially in cases involving complex anatomies. We hereby report our recent experience of successful ablation of accessory pathways in three children with complex congenital heart diseases. The first case was a 7-year-old girl with tricuspid atresia and a previous Glenn shunt, in whom a sub-epicardial overt accessory pathway was successfully ablated via the coronary sinus. The second case, a 9-year-old girl, received accessory pathway ablation via the fenestration of an extracardiac Fontan pathway. The third case was a 14-year-old boy with dextrocardia, common atrium, common ventricle, and a previous extracardiac Fontan operation, in whom ablation of a concealed accessory pathway was carried out retrogradely from the aorta. All the ablations were done in Rajaie Cardiovascular, Medical and Research Center, Tehran, and all the patients were discharged from the hospital without any complication. https://jthc.tums.ac.ir/index.php/jthc/article/view/292 https://jthc.tums.ac.ir/index.php/jthc/article/download/292/285

Tehran University of Medical Sciences The Research in Heart Yield and Translational Medicine (RHYTHM) 3115-7270 8 2 2015 10 13 76 88 EN Feridoun Sabzi Imam Ali Hospital, Kermanshah University of Medical Sciences, Kermanshah, Iran. Hashem Kazerani Imam Ali Hospital, Kermanshah University of Medical Sciences, Kermanshah, Iran. Arash Jalali Tehran Heart Center, Tehran University of Medical Sciences, Tehran, Iran. Mojgan Samadi Imam Ali Hospital, Kermanshah University of Medical Sciences, Kermanshah, Iran. Fahime Ghasemi Imam Ali Hospital, Kermanshah University of Medical Sciences, Kermanshah, Iran. 2015 10 11 2015 10 11 Background: The incidence of coronary artery bypass grafting surgery (CABG) in elderly patients has been increasing. There are contradictory reports on the early outcome of elderly coronary artery patients as compared with their young counterparts. We designed this retrospective study to address this issue. Methods: We retrospectively analyzed the results of 1489 on–pump CABG cases performed at our hospital during a 4.5-year period. Perioperative data such as demographic, medical, clinical, operative, and postoperative variables were collected and compared between patients 70 years old or younger (Group A, n = 1164) and patients above 70 years of age (Group B, n = 325). Statistical analysis was performed using the t-test for the continuous and the X2 tests for the categorical variables. Significant variables according to the univariate analysis (X2 and t-test) were further analyzed using multivariate logistic regression analysis. Results: The variables of weight (P value < 0.001), preoperative Po2(P value = 0.005), ejection fraction > 30% (Pvalue = 0.001), body surface area (P value = 0.003), and hypercholesterolemia (P value = 0.007) were higher in Group A, whereas preoperative myocardial infarction (P value < 0.001), postoperative low cardiac output syndrome (P value = 0.019), emergent surgery (P value = 0.003), inotropic drug use (P value < 0.001), preoperative heparin use (P value < 0.001), re-exploration for bleeding (P value = 0.015), hospital stay (P value < 0.001),  low ejection fraction (≤ 30%) (P value = 0.001), preoperative creatinine > 1.5 mg/dl (P value < 0.001), chronic obstructive pulmonary disease (P value < 0.001), intra-aortic balloon pump use (P value < 0.001), infection (P value < 0.001), pulmonary complications (P value < 0.001), atrial fibrillation (P value < 0.001), postoperative renal complications (P value < 0.001), and death (P value = 0.012) were more frequent in Group B. Conclusion: CABG in the elderly patients had certain surgical risks such as chronic obstructive pulmonary disease, preoperative myocardial infarction, emergent surgery, and death. Also, postoperative complications such as pulmonary complications, inotropic drug use, intra-aortic balloon pump use, and infection were more frequent in the elderly than in the younger patients.   https://jthc.tums.ac.ir/index.php/jthc/article/view/287 https://jthc.tums.ac.ir/index.php/jthc/article/download/287/280

Tehran University of Medical Sciences The Research in Heart Yield and Translational Medicine (RHYTHM) 3115-7270 8 2 2015 10 13 116 118 EN Seyed Ebrahim Kassaian Tehran Heart Center, Tehran University of Medical Sciences, Tehran, Iran. Kyomars Abbasi Tehran Heart Center, Tehran University of Medical Sciences, Tehran, Iran. Ayman Atmaz Al-Sibaie Rashid Hospital, Dubai, United Arab Emirates. 2015 10 11 2015 10 11 42 47 EN Forouzan Yazdanian Shaheed Rajaie Cardiovascular Medical and Research Center, Tehran University of Medical Sciences, Tehran, Iran. Rasoul Azarfarin Cardiovascular Research Center, Tabriz University of Medical Sciences, Tabriz, Iran. Nahid Aghdaii Shaheed Rajaie Cardiovascular Medical and Research Center, Tehran University of Medical Sciences, Tehran, Iran. Seyedeh Zahra Faritous Shaheed Rajaie Cardiovascular Medical and Research Center, Tehran University of Medical Sciences, Tehran, Iran. Soudabeh Djalali-Motlagh Shaheed Rajaie Cardiovascular Medical and Research Center, Tehran University of Medical Sciences, Tehran, Iran. Abdollah Panahipour Shaheed Rajaie Cardiovascular Medical and Research Center, Tehran University of Medical Sciences, Tehran, Iran. 2015 10 11 2015 10 11 Background: Reintubation in patients after cardiac surgery is associated with undesirable consequences. The purpose of the present study was to identify variables that could predict reintubation necessity in this group of patients. Methods: We performed a prospective study in 1000 consecutive adult patients undergoing cardiac surgery with cardiopulmonary bypass. The patients who required reintubation after extubation were compared with patients not requiring reintubation regarding demographic and preoperative clinical variables, including postoperative complications and in- hospital mortality. Results: Postoperatively, 26 (2.6%) of the 1000 patients studied required reintubation due to respiratory, cardiac, or neurological reasons. Advanced age and mainly cardiac variables were determined as univariate intra- and postoperative predictors of reintubation (all p values < 0.05). Multiple logistic regression analysis revealed lower preoperative (p = 0.014; OR = 3.00, 95%CI: 1.25 - 7.21), and postoperative ejection fraction (p = 0.001; OR = 11.10, 95%CI: 3.88 - 31.79), valvular disease (p = 0.043; OR = 1.84, 95%CI: 1.05 - 3.96), arrhythmia (p = 0.006; OR = 3.84, 95%CI: 1.47 - 10.03), and postoperative intra-aortic balloon pump requirement (p = 0.019; OR = 4.20, 95%CI: 1.26 - 14.00) as the independent predictors of reintubation. Conclusion: These findings reveal that cardiac variables are more common and significant predictors of reintubation after cardiac surgery in adult patients than are respiratory variables. The incidence of this complication, reintubation, is low, although it could result in significant postoperative morbidity and mortality. https://jthc.tums.ac.ir/index.php/jthc/article/view/280 https://jthc.tums.ac.ir/index.php/jthc/article/download/280/273

Tehran University of Medical Sciences The Research in Heart Yield and Translational Medicine (RHYTHM) 3115-7270 8 1 2015 10 11 48 53 EN Alireza Alizadeh-Ghavidel Heart Valve Disease Research Center, Rajaie Cardiovascular, Medical and Research Center, Tehran University of Medical Sciences, Tehran, Iran. Eskandar Noorizadeh Alinasab Hospital, Tabriz University of Medical Sciences, Tabriz, Iran. Hamidreza Pouraliakbar Heart Valve Disease Research Center, Rajaie Cardiovascular, Medical and Research Center, Tehran University of Medical Sciences, Tehran, Iran. Yalda Mirmesdagh Heart Valve Disease Research Center, Rajaie Cardiovascular, Medical and Research Center, Tehran University of Medical Sciences, Tehran, Iran. Saeid Hosseini Heart Valve Disease Research Center, Rajaie Cardiovascular, Medical and Research Center, Tehran University of Medical Sciences, Tehran, Iran. Behnam Asgari Heart Valve Disease Research Center, Rajaie Cardiovascular, Medical and Research Center, Tehran Mahyar Gholamour-Dehaki Amir Kabir Research Institute, Tehran, Iran. 2015 10 11 2015 10 11 Background: Pleurotomy during coronary artery bypass grafting (CABG) may cause post-operative events, mostly pulmonary complications. In this study, we evaluated the influence of pleurotomy during CABG on the clinical outcome following left internal mammary artery (LIMA) harvesting. Methods: Between March and August 2009, 102 patients who underwent cardiac surgery were enrolled in this study and divided into two groups: group A (n = 48, 36 male and 12 female patients at a mean age of 56.5 ± 11.2 years) underwent routine CABG and pleurotomy and group B (n = 54, 46 male and 8 female patients at a mean age of 55.4 ± 10.3 years) had CABG with intact pleura. The patients were compared regarding their demographic data, surgical data, and postoperative events. Results: The incidence of postoperative pericardial effusion was similar between the groups, but the incidence of postoperative pulmonary complications such as pleural effusion (except for mild pleural effusion) on the second (no: 10.4%, mild: 41.7%, moderate: 45.8% and severe: 2.1% in group A versus no: 42.6%, mild: 44.4%, moderate: 13%, and severe: 0 in group B) and fifth postoperative days (no: 27.1%, mild: 33.3%, moderate: 35.4%, and severe: 4.2% in group A versus no:42.6%, mild: 44.4%, moderate: 13%, and severe: 0 in group B) was significantly lower in group B (p value < 0.001 and  pvalue = 0.007, respectively). Also, the incidence of atelectasis (except for mild atelectasis) on the second (no: 2.1%, mild:22.9%, moderate: 72.9%, and severe: 2.1% in group A versus no: 9.2%,mild: 59.3%, moderate: 31.5%, and severe: 0 in group B) and fifth postoperative days (no: 22.9%, mild: 39.6%, moderate: 35.4%, and severe: 2.1% in group A versus no:39.6%, mild: 49.1%, moderate: 11.3%, and severe: 0 in group B) was significantly higher in group A (p value < 0.001 and p value = 0.004, respectively). Postoperative partial oxygen pressure and O2 saturation were similar between the groups, but partial carbon dioxide pressure was significantly lower in group A (p value = 0.017). Amount of bleeding (p value = 0.008) and duration of hospitalization (p value =0.002) were significantly higher in group A than those in group B. Conclusion: Our results indicate that keeping the pleura intact has beneficial effects on the respiratory function, without increasing the incidence of postoperative pericardial effusion.         https://jthc.tums.ac.ir/index.php/jthc/article/view/281 https://jthc.tums.ac.ir/index.php/jthc/article/download/281/274

Tehran University of Medical Sciences The Research in Heart Yield and Translational Medicine (RHYTHM) 3115-7270 8 1 2015 10 11 54 57 EN Seyed Hossein Ahmadi Tehran Heart Center, Tehran University of Medical Sciences, Tehran, Iran. Seyed Hesameddin Abbasi Tehran Heart Center, Tehran University of Medical Sciences, Tehran, Iran AND Family Health Research Center, Iranian Petroleum Industry Health Research Institute, Tehran, Iran. Murat Ugurlucan Duzce AtaturkStateHospital,Cardiovascular Surgery Clinic, Duzce, Turkey. Payvand Bina Tehran Heart Center, Tehran University of Medical Sciences, Tehran, Iran. 2015 10 11 2015 10 11 Although coronary artery disease (CAD) is not common among individuals younger than 40-45 years of age, a small percentage of this age group needs to undergo surgical revascularization because of CAD. Why some people are at higher risk of developing premature CAD is not clearly known. Increased number of traditional risk factors or genetic predisposition may play significant roles in this regard. A 22-year-old man with a negative history for all traditional risk factors except for a family history of premature CAD referred to our center due to an episode of myocardial infarction of one month’s duration. He had no congenital heart disease and no hypercoagulable state, and there was a negative history of drug abuse. His coronary angiography showed extensive CAD. He underwent coronary artery bypass grafting and he left the hospital in good healthy condition. One year after surgery, his follow-up showed that he was symptom free and he still had no new traditional risk factor. It seems that a positive family history of premature CAD is an important and independent risk factor for developing premature CAD and individuals with this type of history should be treated more cautiously. https://jthc.tums.ac.ir/index.php/jthc/article/view/282 https://jthc.tums.ac.ir/index.php/jthc/article/download/282/275

Tehran University of Medical Sciences The Research in Heart Yield and Translational Medicine (RHYTHM) 3115-7270 8 1 2015 10 11 58 60 EN Hojjat Mortezaeian Rajaie Cardiovascular, Medical and Research Center, Tehran University of Medical Sciences, Tehran, Iran.