Tehran University of Medical Sciences The Research in Heart Yield and Translational Medicine (RHYTHM) 3115-7270 9 2 2015 10 11 54 58 EN Kourosh Soleimannejad Shahid Mostafa Hospital, Ilam University of Medical Sciences, Ilam, Iran. Younos Nouzari Tehran Heart Center, Tehran University of Medical Sciences, Tehran, Iran. Alireza Ahsani Imam Khomeini Hospital, Tehran University of Medical Sciences, Tehran, Iran. Mostafa Nejatian Tehran Heart Center, Tehran University of Medical Sciences, Tehran, Iran. Kourosh Sayehmiri Psychosocial Injuries Research Center, Ilam University of Medical Sciences, Ilam, Iran. 2015 10 11 2015 10 11 Background: Exercise and rehabilitation are important methods for decreasing the risk factors of coronary artery disease (CAD). We aimed to evaluate the effect of the cardiac rehabilitation (CR) exercise program on the cardiac structure and physiology in patients undergoing percutaneous coronary intervention (PCI). Methods: In this randomized controlled study, 146 patients with CAD were divided equally into two groups: case group (undertaking CR after PCI) and control group (without rehabilitation after PCI). All the patients in the case group underwent echocardiography (before and after CR), and echocardiography was performed for the control group simultaneously. The CR exercise program encompassed 24 sessions, twice or three times a week, with each session lasting between 15 and 45 minutes, depending on the individual patient’s tolerance. Left ventricular (LV) ejection fraction, LV diastolic function, LV end-systolic and diastolic diameter, and right ventricular (RV) end-diastolic diameter were measured in the CR group before and after rehabilitation and compared to those in the control group at the same times. Results: In this study, 146 patients (46 female and 100 male) were evaluated: 73 in the rehabilitation group and 73 in the control group. The mean age of the patients in the CR and control groups was 58.05 ± 10.27 and 56.76 ± 10.07 years, respectively. The CR exercise program had useful effects on LV diastolic function after PCI. The distribution of LV diastolic dysfunction after the CR exercise program was changed significantly only in the CR group (p value = 0.043). In the CR group, normal, grade I, grade II, and grade III LV diastolic dysfunction were observed in 20.5%, 69.8%, 6.8%, and 2.7%, respectively. This distribution was changed respectively to 30.1%, 61.6%, 5.4%, and 2.7% following CR, which showed a significant improvement due to CR in LV diastolic function, most prominently in the patients with grade I diastolic dysfunction (p value = 0.390). There was no significant change in LV and RV diameter before and after rehabilitation, while the ejection fraction increased significantly (p value < 0.05) in both groups. Conclusion: The RC exercise program can be effective in the augmentation of LV diastolic dysfunction after PCI, withoutsignificant changes in LV diameters. https://jthc.tums.ac.ir/index.php/jthc/article/view/326 https://jthc.tums.ac.ir/index.php/jthc/article/download/326/319

Tehran University of Medical Sciences The Research in Heart Yield and Translational Medicine (RHYTHM) 3115-7270 9 2 2015 10 11 82 84 EN Seyfollah Abdi Rajaei Cardiovascular, Medical and Research Center, Iran University of Medical Sciences, Tehran, Iran. Hoseinali Basiri Rajaei Cardiovascular, Medical and Research Center, Iran University of Medical Sciences, Tehran, Iran. Negar Salehi Rajaei Cardiovascular, Medical and Research Center, Iran University of Medical Sciences, Tehran, Iran. Hamid Reza Pouraliakbar Rajaei Cardiovascular, Medical and Research Center, Iran University of Medical Sciences, Tehran, Iran. Anoushiravan Vakili-Zarch Rajaei Cardiovascular, Medical and Research Center, Iran University of Medical Sciences, Tehran, Iran. 2015 10 11 2015 10 11 The coarctation of the aorta (CoA) is rare in adulthood. Diagnosis is made by clinical suspicion and physical findings such as blood pressure difference between the upper and lower extremities, pulse delay in the femoral artery, and systolic murmur over the thoracic spine.The CoA in adulthood and in patients with associated aneurysm is challenging and different complications even with proper treatment can occur. Covered stents are indicated in concomitant aneurysm, older age, and tight coarctation. A 26-year-old male with resistant hypertension due to a CoA diagnosed by computed tomography angiography referred to our center for an attempted stent implantation. Cardiac catheterization and aortography revealed a long CoA after the origin of the left subclavian artery with a 60 mmHg gradient. Moreover, there was a large aneurysm in the site of the coarctation. Under general anesthesia and fluoroscopic guidance, two balloon-expandable covered Cheatham-Platinum stents (size 18 in 44 millimeters and size 18 in 50 millimeters) were successfully implanted across the CoA with no residual gradient. On 2 years' follow-up, the patient had no symptoms except for mild hypertension. In this patient, the use of a covered stent within the aneurysm was safe and effective https://jthc.tums.ac.ir/index.php/jthc/article/view/331 https://jthc.tums.ac.ir/index.php/jthc/article/download/331/324

Tehran University of Medical Sciences The Research in Heart Yield and Translational Medicine (RHYTHM) 3115-7270 9 2 2015 10 11 97 98 EN Arash Gholoobi Assistant Professor of Cardiology, Atherosclerosis Prevention Research Center, Imam Reza Hospital, EbneSina Ave., Mashhad, Iran. 2015 10 11 2015 10 11 No Abstract https://jthc.tums.ac.ir/index.php/jthc/article/view/335 https://jthc.tums.ac.ir/index.php/jthc/article/download/335/328

Tehran University of Medical Sciences The Research in Heart Yield and Translational Medicine (RHYTHM) 3115-7270 9 2 2015 10 11 59 63 EN Parvin Akbari-Asbagh Breastfeeding Research Center, Tehran University of Medical Sciences, Tehran, Iran. Mohammad Ali Navabi-Shirazi Breastfeeding Research Center, Tehran University of Medical Sciences, Tehran, Iran. Aliakbar Soleimani Breastfeeding Research Center, Tehran University of Medical Sciences, Tehran, Iran. Maryam Razzaz Breastfeeding Research Center, Tehran University of Medical Sciences, Tehran, Iran. Naseradine Akbari-Asbagh Baharloo Hospital, Tehran University of Medical Sciences, Tehran, Iran. Hussein Rayatzadeh Breastfeeding Research Center, Tehran University of Medical Sciences, Tehran, Iran. Mamak Shariat Maternal Fetal and Neonatal Research Center, Tehran University of Medical Sciences, Tehran, Iran. 2015 10 11 2015 10 11 Background: Chylothorax is a rare but serious postoperative condition with a high rate of morbidity and may lead to the mortality of children undergoing congenital heart disease (CHD) surgery. This study evaluated the specific surgical procedures associated with the higher risk of postoperative chylothorax. Methods: We assessed 435 cases undergoing CHD surgery between April 2003 and May 2006. We detected postoperative chylothorax in 6 patients. The diagnosis of chylothorax was established based on the presence of an odorless fluid with the characteristic milky appearance of the fluid (except when the patients were fasting in the immediate postoperative period), a triglyceride level greater than 110 mg/dL or between 50 and 110 mg/dL with a pleural fluid white cell count greater than 1000, and more than 80% lymphocytes on differential when the pleural fluid was not chylous. Results: Over a 37-month period, 435 (mean age = 51.6 months; 232 males) patients underwent various types of surgical procedures for CHD; 6 patients developed chylothorax after the Fontan operation; one patient died due to severe chylothorax;3 patients were managed by nutritional modifications, diuretics, and thoracocentesis; and  2 patients required thoracic duct ligation. The Fisher exact test analysis showed a significant association between the Fontan operation and postoperative chylothorax (p value < 0.0001). Conclusion: Our study showed a significant association between the Fontan surgery and chylothorax. https://jthc.tums.ac.ir/index.php/jthc/article/view/327 https://jthc.tums.ac.ir/index.php/jthc/article/download/327/320

Tehran University of Medical Sciences The Research in Heart Yield and Translational Medicine (RHYTHM) 3115-7270 9 2 2015 10 11 85 89 EN Gholamreza Moradi Imam Ali Cardiovascular Surgery Center, Kermanshah University of Medical Sciences, Kermanshah, Iran. Fereydoun Sabzi Imam Ali Cardiovascular Surgery Center, Kermanshah University of Medical Sciences, Kermanshah, Iran. Abdolhamid Zokaei Imam Ali Cardiovascular Surgery Center, Kermanshah University of Medical Sciences, Kermanshah, Iran. Naser Hemati Imam Ali Cardiovascular Surgery Center, Kermanshah University of Medical Sciences, Kermanshah, Iran. 2015 10 11 2015 10 11 Aortic dissection begins with the formation of a tear in the aortic intima, and it directly exposes an underlying diseased medial layer to the driving force of the intraluminal blood. This blood penetrates the diseased medial layer and cleaves the media longitudinally, thereby dissecting the aortic wall. Herein, we report the case of a 38-year-old woman, who presented with chest pain and dyspnea. After physical examination, laboratory evaluation, echocardiography, and CT–angiography, extensive aortic dissection was diagnosed involving the innominate and left common carotid arteries. Accordingly, the debranching of the aortic arch arteries was performed. During the procedure, the patient was monitored with bilateral regional cerebral tissue oximetry. The patient did not show any signs of complications either in the postoperative period or at postoperative three-month weekly follow-up or at subsequent monthly follow-up for the past year. https://jthc.tums.ac.ir/index.php/jthc/article/view/332 https://jthc.tums.ac.ir/index.php/jthc/article/download/332/325

Tehran University of Medical Sciences The Research in Heart Yield and Translational Medicine (RHYTHM) 3115-7270 9 2 2015 10 11 64 69 EN Younes Nozari Tehran Heart Center, Tehran University of Medical Sciences, Tehran, Iran. Mostafa Bahrehmand Imam Ali Heart Center, Kermanshah University of Medical Sciences, Kermanshah, Iran. Seyed Kianoosh Hosseini Tehran Heart Center, Tehran University of Medical Sciences, Tehran, Iran. Mehran Mahmoodian Tehran Heart Center, Tehran University of Medical Sciences, Tehran, Iran. Ahmad Sharafi Tehran Heart Center, Tehran University of Medical Sciences, Tehran, Iran. 2015 10 11 2015 10 11 Background: Mean platelet volume (MPV) correlates with platelet activity. The relation between MPV and long-term outcome in patients undergoing percutaneous coronary intervention (PCI) has been investigated in several studies. The aim of the present study was to investigate the utility of MPV in prognosticating the long-term outcome after elective PCI. Methods: The study cohort included 2627 patients undergoing elective PCI between September 2008 and June 2010, whose baseline MPV measurements before PCI were available. The patients were divided into three groups of MPV < 9.1 fL, MPV = 9.1 to 10 fL, and MPV > 10 fL, and they were assessed for developing major adverse cardiac events (MACE), comprising death, myocardial infarction (MI), target vessel revascularization (TVR), and target lesion revascularization (TLR) over a one-year follow-up. Results: Of 2539 patients, major adverse cardiac events (MACE) at one year occurred in 77 (3.0%) patients, including mortality in 26 (1.0%). The patients in the highest tertile (MPV > 10 fL) had no increased frequency of MACE compared to those in the mid (9.1 to 10 fL) and lowest ( < 9.1 fL) tertiles (3.3%, 2.2%, and 3.8%, respectively; p value = 0.14).No significant differences were found for each of the primary endpoints among the MPV tertiles. In multivariate logistic regression, we investigated the association between high MPV and total MACE (OR = 1.10, 95%CI: 0.69-1.77; p value = 0.68), death (OR = 1.14, 95%CI: 0.51-2.54; p value = 0.74), and non-fatal MI (OR = 1.85, 95%CI: 0.73-4.67; p value = 0.19) at one year's follow-up but MPV did not remain in the model in any of the cases.In the diabetic patients, the one-way analysis of variance demonstrated that mortality was 1.6% (4 patients) in the highest tertile, 0.8% (2 patients) in the mid tertile, and 0.5% (one patient) in the lowest tertile. Conclusion: There was no direct correlation between pre-procedural MPV and MACE in elective PCI. MPV can only be considered as an appropriate factor for predicting mortality in diabetic patients undergoing elective PCI. https://jthc.tums.ac.ir/index.php/jthc/article/view/328 https://jthc.tums.ac.ir/index.php/jthc/article/download/328/321

Tehran University of Medical Sciences The Research in Heart Yield and Translational Medicine (RHYTHM) 3115-7270 9 2 2015 10 11 90 92 EN Alireza Rostamzadeh Seyyed-al-Shohada Heart Center, Urmia University of Medical Sciences, Urmia, Iran. Kamal Khademvatani Seyyed-al-Shohada Heart Center, Urmia University of Medical Sciences, Urmia, Iran. Yousef Rezaei Seyyed-al-Shohada Heart Center, Urmia University of Medical Sciences, Urmia, Iran. Nariman Sepehrvand National Institute of Health Research, Tehran University of Medical Sciences, Tehran, Iran. 2015 10 11 2015 10 11 Right-sided heart thrombus is a life-threatening condition that necessitates immediate therapy. Detection of right-sided heart thrombus is usually via transthoracic echocardiography. Generally, thrombolysis is considered a treatment of choice, but there is currently no consensus about the optimal therapeutic choice. We present a case of multiple right atrial thrombi with concurrent mobile and broad-based in situ thrombi in a patient with a history of chronic obstructive pulmonary disease, which was completely resolved by thrombolysis following a failed Heparin infusion. The patient was sent home in good clinical condition and was stable at 3 months' follow-up. https://jthc.tums.ac.ir/index.php/jthc/article/view/333 https://jthc.tums.ac.ir/index.php/jthc/article/download/333/326

Tehran University of Medical Sciences The Research in Heart Yield and Translational Medicine (RHYTHM) 3115-7270 9 2 2015 10 11 70 75 EN Babak Baharvand-Ahmadi Department of Cardiology, Lorestan University of Medical Sciences, Lorestan, Iran. Mehrdad Namdari Department of Cardiology, Lorestan University of Medical Sciences, Lorestan, Iran. Hirbod Mobarakeh Farzan Clinical Research Institute, Tehran, Iran. 2015 10 11 2015 10 11 Background: Diagnosis of coronary artery disease (CAD) in early stages is vital in decreasing mortality by reducing the risk factors. The aim of this study was to investigate the association between erectile dysfunction (ED) and CAD. Methods: A total of 200 patients were divided into four groups according to their angiography results: Group 1 (G1, n = 59): patients with one-vessel disease (1-VD); Group 2 (G2, n = 40): patients with two-vessel disease (2-VD); Group 3 (G3, n = 50): patients with three-vessel disease (3-VD); and controls (C, n = 51) without any coronary disease. The International Index of Erectile Function (IIEF) was completed for all the patients to assess their sexual function and ED in the last 6 months. Results: Mean age of the participants was 57.69 ± 12.466 years. The prevalence of ED in the CAD patients was significantly higher than that of the controls (75.16% vs. 60.8%; p value = 0.041). There was a significant direct correlation between the number of involved vessels in the CAD patients and ED severity (r: 0.183; p value = 0.010), and the ED rate increased with age. Conclusion: In conclusion, ED severity correlated with the number of involved vessels documented by coronary https://jthc.tums.ac.ir/index.php/jthc/article/view/329 https://jthc.tums.ac.ir/index.php/jthc/article/download/329/322

Tehran University of Medical Sciences The Research in Heart Yield and Translational Medicine (RHYTHM) 3115-7270 9 2 2015 10 11 93 96 EN Feridoun Sabzi Kermanshah University of Medical Sciences, Imam Ali Hospital, Kermanshah, Iran. Samsam Dabiri Kermanshah University of Medical Sciences, Imam Ali Hospital, Kermanshah, Iran. Alireza Poormotaabed Kermanshah University of Medical Sciences, Imam Ali Hospital, Kermanshah, Iran. 2015 10 11 2015 10 11 Chylothorax in adult occurs most commonly in the wake of cardiac and thoracic procedures. Injuries to the  common thoracic duct in the thorax or its branches in the mediastinum, injuries to the thymus tissues, dissection of the superior vena cava or ascending aorta, dissection of the aortic arch, disruption of the accessory lymphatics in the left or right thorax, and increased pressure in the systemic vein exceeding that of the thoracic duct (usually in the superior vena cava thrombosis, Glenn Shunt, and hemi-Fontan) have been proposed as the possible causes of chylothorax after surgery for congenital heart disease. However, pulmonary hypertension is an exceedingly rare cause of chylothorax in adults. We present a case of chylothorax after atrial septal defect surgery in a 30-year-old female patient with pulmonary hypertension. The postoperative period was complicated by chylothorax, which was confirmed by the high lipid content of chylous effusion. The patient was treated conservatively with diet therapy, and the effusion was abolished completely after two weeks. No recurrence of chylothorax was detected at 3 months' follow-up. https://jthc.tums.ac.ir/index.php/jthc/article/view/334 https://jthc.tums.ac.ir/index.php/jthc/article/download/334/327

Tehran University of Medical Sciences The Research in Heart Yield and Translational Medicine (RHYTHM) 3115-7270 9 2 2015 10 11 76 81 EN Zahra Ojaghi-Haghighi Echocardiography Research Center, Rajaei Cardiovascular, Medical and Research Center, Iran University of Medical Sciences, Tehran, Iran. Atoosa Mostafavi Echocardiography Research Center, Shariati Medical and Research Center, Tehran University of Medical Sciences, Tehran, Iran. Hassan Moladoust Cardiovascular Research Center, Guilan University of Medical Sciences, Rasht, Iran. Feridoun Noohi Echocardiography Research Center, Rajaei Cardiovascular, Medical and Research Center, Iran University of Medical Sciences, Tehran, Iran. Majid Maleki Echocardiography Research Center, Rajaei Cardiovascular, Medical and Research Center, Iran University of Medical Sciences, Tehran, Iran. Maryam Esmaeilzadeh Echocardiography Research Center, Rajaei Cardiovascular, Medical and Research Center, Iran University of Medical Sciences, Tehran, Iran. Niloofar Samiei Echocardiography Research Center, Rajaei Cardiovascular, Medical and Research Center, Iran University of Medical Sciences, Tehran, Iran. 2015 10 11 2015 10 11 Background: Left ventricular (LV) twist is due to oppositely directed apical and basal rotation and has been proposed as a sensitive marker of LV function. We sought to assess the impact of chronic pure mitral regurgitation (MR) on the torsional mechanics of the left human ventricle using tissue Doppler imaging. Methods: Nineteen severe MR patients with a normal LV ejection fraction and 16 non-MR controls underwent conventional echocardiography and apical and basal short-axis color Doppler myocardial imaging (CDMI). LV rotation at the apical and basal short-axis levels was calculated from the averaged tangential velocities of the septal and lateral regions, corrected for the LV radius over time. LV twist was defined as the difference in LV rotation between the two levels, and the LV twist and twisting/untwisting rate profiles were analyzed throughout the cardiac cycle. Results: LV twist and LV torsion were significantly lower in the MR group than in the non-MR group (10.38˚ ± 4.04˚ vs.13.95˚ ± 4.27˚; p value = 0.020; and 1.29 ± 0.54 ˚/cm vs. 1.76 ± 0.56 ˚/cm; p value = 0.021, respectively), both suggesting incipient LV dysfunction in the MR group. Similarly, the untwisting rate was lower in the MR group (-79.74 ± 35.97 ˚/s vs.-110.96 ± 34.65 ˚/s; p value = 0.020), but there was statistically no significant difference in the LV twist rate. Conclusion: The evaluation of LV torsional parameters in MR patients with a normal LV ejection fraction suggests the potential role of these sensitive variables in assessing the early signs of ventricular dysfunction in asymptomatic patients https://jthc.tums.ac.ir/index.php/jthc/article/view/330 https://jthc.tums.ac.ir/index.php/jthc/article/download/330/323