Tehran University of Medical Sciences The Research in Heart Yield and Translational Medicine (RHYTHM) 3115-7270 10 3 2015 12 17 117 121 EN Anil Ozen Türkiye Yüksek Ihtisas Hospital, Cardiovascular Surgery Department, Ankara, Turkey. Muhammet Onur Hanedan Türkiye Yüksek Ihtisas Hospital, Cardiovascular Surgery Department, Ankara, Turkey. Çetin Murat Songur Türkiye Yüksek Ihtisas Hospital, Cardiovascular Surgery Department, Ankara, Turkey. Emre Boysan Türkiye Yüksek Ihtisas Hospital, Cardiovascular Surgery Department, Ankara, Turkey. Ertekin Utku Unal Türkiye Yüksek Ihtisas Hospital, Cardiovascular Surgery Department, Ankara, Turkey. Serkan Mola Türkiye Yüksek Ihtisas Hospital, Cardiovascular Surgery Department, Ankara, Turkey. Halil Ibrahim Erkengel Türkiye Yüksek Ihtisas Hospital, Cardiovascular Surgery Department, Ankara, Turkey. Emre Kubat Türkiye Yüksek Ihtisas Hospital, Cardiovascular Surgery Department, Ankara, Turkey. Zafer Iscan Türkiye Yüksek Ihtisas Hospital, Cardiovascular Surgery Department, Ankara, Turkey. Ufuk Tutun Türkiye Yüksek Ihtisas Hospital, Cardiovascular Surgery Department, Ankara, Turkey. Ahmet Sarıtas Türkiye Yüksek Ihtisas Hospital, Cardiovascular Surgery Department, Ankara, Turkey. Cemal Levent Birincioglu Türkiye Yüksek Ihtisas Hospital, Cardiovascular Surgery Department, Ankara, Turkey. 2015 12 17 2015 12 17 Background: Surgical treatment of a ruptured abdominal aorta aneurysm (RAAA) continues to present a significant challenge to surgeons. There are some patient factors such as age and gender that cannot be changed, and comorbid conditions can be optimized but not eliminated.  The purpose of this study was to identify the risk factors affecting high mortality after the surgical repair of an RAAA. Methods: Data on 121 patients who underwent surgical repair for RAAAs between January 1997 and June 2011 in our institution were collected retrospectively. All the patients had been diagnosed by computed tomography (CT) scans, and intraoperative extra-luminal blood was visualized intraoperatively. Variables studied comprised demographic data; preoperative, operative, and postoperative data; and the causes of mortality. Multivariate regression analysis was used to determine the predictors of mortality. Results: One hundred eight (89.2%) patients were male and 13 (10.7%) were female at an average age of 68.9 ± 10.5 years. Totally, 121 patients underwent surgery for RAAAs. Fifty-four patients had aortic tube grafts, 32 aortobiiliac grafts, 20 aortobifemoral grafts, 1 aortoiliac graft, and 1 aortofemoral graft for the replacement of the RAAAs. Seven patients had only surgical exploration. Operative mortality was 41.3% (50 patients). The factors associated with mortality were preoperative shock, free blood, positive inotropic agent, hematocrit value, and need for blood and plasma. In the multivariate analysis, preoperative shock and positive inotropic agents were found to be significant as the predictors of death (OR: 19.8, 95%CI: 3.2-122.8 and OR: 8.6, 95% CI: 2.9-26.3, respectively). Conclusion: This study revealed that the preoperative clinical findings affected the mortality associated with RAAAs. https://jthc.tums.ac.ir/index.php/jthc/article/view/424 https://jthc.tums.ac.ir/index.php/jthc/article/download/424/374

Tehran University of Medical Sciences The Research in Heart Yield and Translational Medicine (RHYTHM) 3115-7270 10 3 2015 12 17 163 164 EN Khosro Barkhordari Tehran Heart Center, Tehran University of Medical Sciences, Tehran, Iran. Akbar Shafiee Tehran Heart Center, Tehran University of Medical Sciences, Tehran, Iran. 2015 12 17 2015 12 17 - https://jthc.tums.ac.ir/index.php/jthc/article/view/438 https://jthc.tums.ac.ir/index.php/jthc/article/download/438/388

Tehran University of Medical Sciences The Research in Heart Yield and Translational Medicine (RHYTHM) 3115-7270 10 3 2015 12 17 122 128 EN Mehrnoush Dianatkhah Department of Pharmacotherapy, Faculty of Pharmacy, Tehran University of Medical Sciences, Tehran, Iran. Padideh Ghaeli Department of Pharmacotherapy, Faculty of Pharmacy, Tehran University of Medical Sciences, Tehran, Iran. Azita Hajhossein Talasaz Department of Pharmacotherapy, Faculty of Pharmacy, Tehran University of Medical Sciences, Tehran, Iran. AND Tehran Heart Centre, Tehran University of Medical Sciences, Tehran, Iran. Abbasali Karimi Tehran Heart Centre, Tehran University of Medical Sciences, Tehran, Iran. Abbas Salehiomran Tehran Heart Centre, Tehran University of Medical Sciences, Tehran, Iran. Peyvand Bina Tehran Heart Centre, Tehran University of Medical Sciences, Tehran, Iran. Arash Jalali Tehran Heart Centre, Tehran University of Medical Sciences, Tehran, Iran. Saba Ghaffary Department of Pharmacotherapy, Faculty of Pharmacy, Tehran University of Medical Sciences, Tehran, Iran. Nazila Shahmansouri Tehran Heart Centre, Tehran University of Medical Sciences, Tehran, Iran. Shaghayegh Vejdani Department of Pharmacotherapy, Faculty of Pharmacy, Tehran University of Medical Sciences, Tehran, Iran. 2015 12 17 2015 12 17 Background: Postoperative neurological injuries, including cognitive dysfunction, sleep disorder, delirium, and anxiety, are the important consequences of coronary artery bypass graft surgery (CABG). Evidence has shown that postoperative sleep disturbance is partly due to disturbed melatonin secretion in the perioperative period. The aim of this study was to evaluate the effect of melatonin on postoperative sleep disorder in patients undergoing CABG. Method: One hundred forty-five elective CABG patients participated in a randomized double-blind study during the preoperative period. The patients were randomized to receive either 3 mg of melatonin or 10 mg of Oxazepam one hour before sleep time. Each group received the medication from 3 days before surgery until the time of discharge. Sleep quality was evaluated using the Groningen Sleep Quality Score (GSQS), and the incidence of delirium was evaluated by nursing records. Sleep quality and anxiety scores were compared before and after surgery through the Wilcoxon signed-rank test. The analysis of covariance (ANCOVA) and independent t-test were used to compare the sleep and anxiety scores between the groups. P values ≤ 0.05 were considered statistically significant. Results: Totally, 137 patients at a mean age of 60 years completed the study (76% male). The analysis of the data showed that sleep was significantly disturbed after surgery in both groups. The patients in the Oxazepam group demonstrated significantly higher disturbance in their mean postoperative GSQS score than did their counterparts in the melatonin group (p value < 0.001). A smaller proportion of the participants experienced delirium in the melatonin group (0.06%) than in the Oxazepam group (0.12%); however, this difference was not statistically significant. Conclusion: The result of the present study revealed that melatonin improved sleep in post-cardiac surgery patients more than what was observed with Oxazepam. Therefore, melatonin may be considered an effective alternative for Benzodiazepines in the management of postoperative sleep disorder. https://jthc.tums.ac.ir/index.php/jthc/article/view/425 https://jthc.tums.ac.ir/index.php/jthc/article/download/425/375

Tehran University of Medical Sciences The Research in Heart Yield and Translational Medicine (RHYTHM) 3115-7270 10 3 2015 12 17 165 166 EN Ali Hosseinsabet Tehran Heart Center, Tehran University of Medical Sciences, Tehran, Iran. 2015 12 17 2015 12 17 - https://jthc.tums.ac.ir/index.php/jthc/article/view/439 https://jthc.tums.ac.ir/index.php/jthc/article/download/439/389

Tehran University of Medical Sciences The Research in Heart Yield and Translational Medicine (RHYTHM) 3115-7270 10 3 2015 12 17 129 133 EN Nooredin Mohammadi Department of Critical Care Nursing, School of Nursing and Midwifery, Iran University of Medical Sciences, Center for Nursing Care Research, Tehran, Iran. Mohammad Abbasi International Campus, Iran University of Medical Sciences, Tehran, Iran. Alireza Nikbakht Nasrabadi Tehran University of Medical Sciences, Tehran, Iran. Abbas Salehiomran Tehran University of Medical Sciences, Tehran, Iran. Saeid Davaran Tehran University of Medical Sciences, Tehran, Iran. Reza Norouzadeh Shahed University, Nursing and Midwifery Faculty, Tehran, Iran. 2015 12 17 2015 12 17 Background: Coronary artery bypass graft surgery (CABG) improves the quality of life, increases survival, and influences the patient's mental and emotional aspects. Little information is available on the lived experience of Iranian patients after this surgery. Understanding the lived experiences of patients will help health professionals with better provision of high quality care. Methods: This hermeneutic phenomenological study aimed to understand the lived experience of patients after CABG.  Van Manen's method was used to conduct the study. A semi-structured, face-to-face interview technique was employed to explore the experiences of the patients following surgery. Seven men and 4 women between 49 and 80 years old were interviewed. Results: Passion for life was the main theme extracted from the participants’ interviews. This theme comprised the three sub-themes of receiving attention from family, being hopeful, and being spiritually oriented. Conclusion:  The results showed that the participants experienced passion for life after their surgery. This finding reveals that patients tend to find a new perspective on life and their health after surgery. https://jthc.tums.ac.ir/index.php/jthc/article/view/440 https://jthc.tums.ac.ir/index.php/jthc/article/download/440/390

Tehran University of Medical Sciences The Research in Heart Yield and Translational Medicine (RHYTHM) 3115-7270 10 3 2015 12 17 134 139 EN Parvin Akbariasbagh Imam Khomeini Complex, Tehran University of Medical Sciences, Tehran, Iran. Mohammad Reza Mirzaghayan Imam Khomeini Complex, Tehran University of Medical Sciences, Tehran, Iran. Naseredin Akbariasbagh Baharlo Hospital, Tehran University of Medical Sciences, Tehran, Iran. Mamak Shariat Maternal-Fetal and Neonatal Research Center, Tehran University of Medical Sciences, Tehran, Iran. Bita Ebrahim Valiasr Hospital, Breastfeeding Research Center, Tehran, Iran 2015 12 17 2015 12 17 Background: Injured phrenic nerve secondary to cardiac surgeries is the most common cause of diaphragmatic paralysis (DP) in infants. The aim of this study was to determine the risk factors for DP caused by congenital heart defect corrective surgeries in pediatrics. Methods: This cross-sectional study, conducted in a 2-year period (2006–2008), included 451 children with congenital heart diseases admitted to the Pediatric Cardiac Surgery Ward of Imam Khomeini Hospital. The diaphragmatic function was examined via fluoroscopy, and the frequency of DP and its relevant parameters were evaluated. Results: Of the 451 patients, comprising 268 males and 183 females at an age range of 3 days to 204 months (28.2 ± 33.4 months), 25 (5.5%) infants (60% male and 40% female, age range = 15 days to 132 months, 41.2 ± 28.1 months) had DP as follows: 48% unilateral right-sided and 36% unilateral left-sided. Additionally, 68% had cyanotic congenital heart disease and 84% had DP following total correction surgery.  The highest prevalence rates of DP resulting in phrenic hemiparesis were observed after arterial switch operation, Fontan procedure, and Blalock–Taussig shunt surgery, respectively. Thirteen (52%) of the 25 DP patients underwent surgical diaphragmatic plication because of severe respiratory distress and dependency on mechanical ventilation, and most of the cases of plication underwent arterial switch operation. The rate of mortality was 24% (6 patients). Conclusion: DP with a prevalence of 5.5% was one of the most common complications secondary to cardiac surgeries in the infants included in the present study. Effective factors were age, weight, cyanotic congenital heart defects, and previous cardiac surgery. Diaphragmatic plication improved prognosis in severe cases. https://jthc.tums.ac.ir/index.php/jthc/article/view/427 https://jthc.tums.ac.ir/index.php/jthc/article/download/427/377

Tehran University of Medical Sciences The Research in Heart Yield and Translational Medicine (RHYTHM) 3115-7270 10 3 2015 12 17 140 148 EN Somayeh Nejati Behavioral Sciences Research Center, Shahid Beheshti University of Medical Sciences, Tehran, Iran. Alireza Zahiroddin Behavioral Sciences Research Center, Shahid Beheshti University of Medical Sciences, Tehran, Iran. Gita Afrookhteh Azad University of Sciences and Research, Tehran, Iran. Soheila Rahmani https://jthc.tums.ac.ir/index.php/jthc/article/view/360 https://jthc.tums.ac.ir/index.php/jthc/article/download/360/353

Tehran University of Medical Sciences The Research in Heart Yield and Translational Medicine (RHYTHM) 3115-7270 10 1 2015 10 13 50 52 EN Burak Acar Turkey Yuksek Ihtisas Hospital, Ankara, Turkey. Muhammed Suleymanoglu Turkey Yuksek Ihtisas Hospital, Ankara, Turkey. Cengiz Burak Turkey Yuksek Ihtisas Hospital, Ankara, Turkey. Burcu Mecit-Demirkan Turkey Yuksek Ihtisas Hospital, Ankara, Turkey. Yesim Guray Turkey Yuksek Ihtisas Hospital, Ankara, Turkey. Omac Tufekcioglu Turkey Yuksek Ihtisas Hospital, Ankara, Turkey. Sinan Aydogdu Turkey Yuksek Ihtisas Hospital, Ankara, Turkey. 2015 10 13 2015 10 13 Blunt chest traumas mostly occur due to car accidents and can cause many cardiac complications such as septal rupture, free-wall rupture, coronary artery dissection or thrombosis, heart failure, arrhythmias, and chordae and papillary muscle rupture. One of the most serious complication is tricuspid regurgitation (TR), which can be simply diagnosed by physical examination and confirmed by echocardiography. We describe a 48-year-old female patient, diagnosed with severe TR 13 years after a blunt chest trauma due to a car accident. TR was diagnosed with transthoracic echocardiography and three dimensional transthoracic echocardiography had defined the exact pathology of the tricuspid valve. The patient underwent successful surgery with bioprosthetic valve implantation and was discharged at 6th postoperative day without any complication. The patient had no problem according to the follow-up one month and six months after operation https://jthc.tums.ac.ir/index.php/jthc/article/view/365 https://jthc.tums.ac.ir/index.php/jthc/article/download/365/358

Tehran University of Medical Sciences The Research in Heart Yield and Translational Medicine (RHYTHM) 3115-7270 10 1 2015 10 13 24 33 EN Shervin Assari Department of Psychiatry, University of Michigan School of Medicine, Ann Arbor, MI, USA AND Center for Research on Ethnicity, Culture and Health, School of Public Health, University of Michigan, Ann Arbor, MI, USA. 2015 10 13 2015 10 13 Background: Patients with heart disease experience limited activities of daily living (ADL). This is a cross-country comparison of the additive effects of Socioeconomics, health behaviors, and the number of medical comorbidities on disability among patients with heart disease. Methods: The current study used a cross-sectional design. Data came from the Research on Early Life and Aging Trends and Effects (RELATE). The current analysis utilized data on elderly individuals (age ≥ 60 y) from 13 countries. The outcome was any ADL limitation (i.e. bathing, dressing, using toilet, transferring, lifting heavy things, shopping, and eating meals). Socioeconomics (i.e. age, gender, education, and income), health behaviors (i.e. exercise, smoking, and drinking), and number of chronic medical conditions (i.e. hypertension, respiratory, arthritis, stroke, and diabetes) were entered into country-specific logistic regressions, considering at least one limitation in ADL as the main outcome. Results: Number of comorbid medical conditions and age were positively associated with disability in 85% of the countries. Physical activity and drinking were linked to disability in 54% and 31% of countries, respectively. Higher education and income were associated with lower disability in 31% and 23% of the countries, respectively. Female gender was associated with higher disability only in 15% of the countries. Smoking was not associated with disability, while the effects of socioeconomics, drinking, exercise, and medical comorbidities were controlled. Conclusion: Determinants of disability depend on the country; accordingly, locally designed health promotion interventions may be superior to the universal interventions for patients with heart disease. Medical comorbidities, however, should be universally diagnosed and treated. https://jthc.tums.ac.ir/index.php/jthc/article/view/361 https://jthc.tums.ac.ir/index.php/jthc/article/download/361/354

Tehran University of Medical Sciences The Research in Heart Yield and Translational Medicine (RHYTHM) 3115-7270 10 1 2015 10 13 53 57 EN Feridoun Sabzi Imam Ali Hospital, Kermanshah University of Medical Sciences, Kermanshah, Iran. 2015 10 13 2015 10 13 Giant left atria are defined as those measuring larger than 8 cm and are typically found in patients who have rheumatic mitral valve disease with severe regurgitation. Enlargement of the left atrium may create compression of the surrounding structures such as the esophagus, pulmonary veins, respiratory tract, lung, inferior vena cava, recurrent laryngeal nerve, and thoracic vertebrae and lead to dysphagia, respiratory dysfunction, peripheral edema, hoarse voice, or back pain. However, a huge left atrium is usually associated with rheumatic mitral valve disease but is very rare in a normally functioning prosthetic mitral valve, as was the case in our patient. A 46-year-old woman with a past medical history of mitral valve replacement and chronic atrial fibrillation was admitted to our hospital with a chief complaint of cough and shortness of breath, worsened in the last month. Physical examination showed elevated jugular venous pressure, respiratory distress, cardiac cachexia, heart failure, hepatomegaly, and severe edema in the legs. Chest radiography revealed an inconceivably huge cardiac sell-out. Transthoracic echocardiography demonstrated a huge left atrium, associated with thrombosis, and normal function of the prosthetic mitral valve. Cardiac surgery with left atrial exploration for the extraction of the huge thrombosis and De Vega annuloplasty for tricuspid regurgitation were carried out. The postoperative course was eventful due to right ventricular failure and low cardiac output syndrome; and after two days, the patient expired with multiple organ failure. Thorough literature review showed that our case was the largest left atrium (20 × 22 cm) reported thus far in adults with a normal prosthetic mitral valve function. https://jthc.tums.ac.ir/index.php/jthc/article/view/366 https://jthc.tums.ac.ir/index.php/jthc/article/download/366/359

Tehran University of Medical Sciences The Research in Heart Yield and Translational Medicine (RHYTHM) 3115-7270 10 1 2015 10 13 34 42 EN Seyed Hesameddin Abbasi Tehran Heart Center, Tehran University of Medical Sciences, Tehran, Iran. Seyed Ebrahim Kassaian Tehran Heart Center, Tehran University of Medical Sciences, Tehran, Iran. Saeed Sadeghian Tehran Heart Center, Tehran University of Medical Sciences, Tehran, Iran. Abbasali Karimi Tehran Heart Center, Tehran University of Medical Sciences, Tehran, Iran. Soheil Saadat Sina Trauma Research Center, Tehran University of Medical Sciences, Tehran. Iran. Flora Peyvandi Fondazione IRCCS Ca’ Granda Ospedale Maggiore Policlinico Milano, Angelo Bianchi Bonomi Hemophilia and Thrombosis Centre, Milan, Italy AND Department of Pathophysiology and Transplantation, Università degli Studi di Milano, Milan, Italy. Arash Jalali Tehran Heart Center, Tehran University of Medical Sciences, Tehran, Iran. Tahereh Davarpasand Tehran Heart Center, Tehran University of Medical Sciences, Tehran, Iran. Nazila Shahmansouri Tehran Heart Center, Tehran University of Medical Sciences, Tehran, Iran. Masoumeh Lotfi-Tokaldany Tehran Heart Center, Tehran University of Medical Sciences, Tehran, Iran. Maryam Amiri-Abchouyeh Tehran Heart Center, Tehran University of Medical Sciences, Tehran, Iran. Farah Ayatollahzade-Isfahani Tehran Heart Center, Tehran University of Medical Sciences, Tehran, Iran. Frits Rosendaal Department of Clinical Epidemiology and Department of Thrombosis and Haemostasis, Leiden University Medical Center, Leiden, The Netherlands. 2015 10 13 2015 10 13 Background: Data on premature coronary artery disease (CAD) are scarce. The Tehran Heart Center's Prematur