Tehran University of Medical Sciences The Research in Heart Yield and Translational Medicine (RHYTHM) 3115-7270 12 3 2017 06 19 101 106 EN Mohsen Mohammadi Department of Medical Radiation Science, School of Paramedicine, Shahid Beheshti University of Medical Sciences, Tehran, Iran. Leili Danaee Department of Medical Physics, Faculty of Medicine, Tabriz University of Medical Sciences, Tabriz, Iran. Effat Alizadeh Department of Medical Biotechnology, Faculty of Advanced Medical Sciences, Tabriz University of Medical Sciences, Tabriz, Iran. 2016 03 27 2016 12 13 Radiation risk allied to invasive cardiology is relatively high, and protecting both patients and cardiologists is necessary. The aim of this review is to discuss how to better protect patients and cardiologists against radiation exposure. We performed a global search on PubMed, Science Direct, and Scopus databases via keywords of “interventional cardiologist”, “patient”, “radiation”, and “exposure” and then performed an overview of the main strategies for risk reduction among interventional cardiologists and exposed patients. The 1st line for protection is awareness of both radiation risk factors and exposure doses and how to manage and minimize exposure levels. In conclusion, radiation-attenuating techniques can effectively reduce occupational/treatment radiation exposure to both operators and patients in cardiology interventions. https://jthc.tums.ac.ir/index.php/jthc/article/view/520 https://jthc.tums.ac.ir/index.php/jthc/article/download/520/575

Tehran University of Medical Sciences The Research in Heart Yield and Translational Medicine (RHYTHM) 3115-7270 12 3 2017 06 19 107 113 EN Samira Taravatmanesh Department of Epidemiology, School of Health, Shahid Beheshti University of Medical Sciences, Tehran, Iran. Davood Khalili Prevention of Metabolic Disorders Research Center, Research Institute for Endocrine Sciences, Shahid Beheshti University of Medical Sciences, Tehran, Iran. Soheila Khodakarim Department of Epidemiology, School of Health, Shahid Beheshti University of Medical Sciences, Tehran, Iran. Samaneh Asgari Prevention of Metabolic Disorders Research Center, Research Institute for Endocrine Sciences, Shahid Beheshti University of Medical Sciences, Tehran, Iran. Farzad Hadaegh Prevention of Metabolic Disorders Research Center, Research Institute for Endocrine Sciences, Shahid Beheshti University of Medical Sciences, Tehran, Iran. Fereidon Azizi Endocrine Research Center, Research Institute for Endocrine Sciences, Shahid Beheshti University of Medical Sciences, Tehran, Iran. Siamak Sabour Safety Promotions and Injuries Prevention Research Centre, Shahid Beheshti University of Medical Sciences, Tehran, Iran. 2016 04 03 2016 12 24 Background: Several studies have emphasized the importance of cardiovascular disease (CVD) prevention. However, there is a dearth of data on the prevention of cardiovascular disease recurrence. The present study was the 1st in Iran to evaluate factors associated with CVD recurrence.   Methods: This prospective cohort study was conducted on 483 subjects (> 30 years old) with a history of CVD who participated in the Tehran Lipid and Glucose Study and were followed up for 12 years (1999–2012). The relationships between the most important established risk factors for CVD and CVD recurrence were evaluated. Results: Totally, 258 (53.4%) men and 225(46.5%) women at a mean age of 59.2 ± 10.7 years were recruited in the study. Our results showed that over the 12-year follow-up, the incidence of a recurrent event (per 100 person-years) was 48.5. Further, after controlling the possible confounding factors, the following variables had a significant relationship with CVD recurrence: age (HR = 1.02; p value = 0. 001), male sex (HR = 1.4; p value = 0.012), smoking (HR = 1.7; p value = 0.004), and increased fasting blood sugar (HR = 2.1; p value = 0.001). Conclusion: We found that the established variables in the development of CVD (i.e., age, sex, and smoking) played an important role in the risk of CVD recurrence.  https://jthc.tums.ac.ir/index.php/jthc/article/view/528 https://jthc.tums.ac.ir/index.php/jthc/article/download/528/597

Tehran University of Medical Sciences The Research in Heart Yield and Translational Medicine (RHYTHM) 3115-7270 12 3 2017 06 08 114 118 EN Seyed Ahmad Aleyasin National Institute of Genetic Engineering and Biotechnology, Tehran, Iran. Tayebe Navidi National Institute of Genetic Engineering and Biotechnology, Tehran, Iran. Saeed Davoudi Tehran Heart Center, Tehran University of Medical Sciences, Tehran, Iran. 2016 04 24 2017 01 02 Background: There are only a few reports concerning the genetic risk factors for coronary artery disease (CAD). However, 2 polymorphisms of rs10757274 and rs2383206 on chromosome 9p21.3 have been shown recently to be associated with CAD in certain populations. This is the 1st study to investigate their validity and association with CAD in a sample of the Iranian population. Methods: Genomic DNA was extracted from the peripheral blood of all participants, consisting of 111 cases with CAD and 100 normal controls with normal coronary angiographies.  Genotyping of rs10757274 and rs2383206 was performed in the cases and controls using designed mismatch primers via the polymerase chain reaction-restriction fragment length polymorphism (PCR-RFLP) method.  Results: Statistical analysis presented a significant association between the rs10757274 GG (p value = 0.029, χ2 = 7.078) and rs2383206 GG (p value = 0.036, χ2 =6.658) genotypes and CAD among the cases as compared with the normal controls. Haplotype analysis of rs10757274 and rs2383206 polymorphisms showed 43% GG/GG haplotype with a significant association with CAD (p value = 0.014, χ² = 6.058). Conclusion: The results of this study provide an insight into the underlying molecular mechanism of CAD pathogenesis and pave the way for future functional studies on these variants. https://jthc.tums.ac.ir/index.php/jthc/article/view/540 https://jthc.tums.ac.ir/index.php/jthc/article/download/540/595

Tehran University of Medical Sciences The Research in Heart Yield and Translational Medicine (RHYTHM) 3115-7270 12 3 2017 06 19 119 127 EN Hamidreza Goodarzynejad Tehran Heart Center, Tehran University of Medical Sciences, Tehran, Iran. Mohammadali Boroumand Tehran Heart Center, Tehran University of Medical Sciences, Tehran, Iran. Mehrdad Behmanesh School of Biological Sciences, Tarbiat Modares University, Tehran, Iran. Shayan Ziaee Tehran Heart Center, Tehran University of Medical Sciences, Tehran, Iran. Arash Jalali Tehran Heart Center, Tehran University of Medical Sciences, Tehran, Iran. Leyla Pourgholi Tehran Heart Center, Tehran University of Medical Sciences, Tehran, Iran. 2016 06 15 2017 05 24 Background: Hepatic lipase (HL) plays a crucial role in lipid metabolism, but there is debate about whether HL acts in a more pro- or more anti-atherogenic fashion. We aimed to examine the relationship between the -514 C/T polymorphism within the HL gene (LIPC) and the risk of angiographically determined premature coronary artery disease (CAD). Methods: Four hundred seventy-one patients with newly diagnosed angiographically documented (≥ 50% luminal stenosis of any coronary vessel) premature CAD were compared to 503 controls (subjects with no luminal stenosis in coronary arteries). A real-time polymerase chain reaction and high-resolution melting analysis was used to distinguish between the genotypes. Results: There was no significant difference in the distribution of -514 C/T genotypes between the 2 groups in the whole population or in the men, but the examined polymorphism was found to be associated with the presence of CAD in the women (p value = 0.029). After the application of a multiple logistic regression model, the minor T allele of the LIPC gene was not found to be independently associated with the presence of CAD either in the total population (adjusted OR = 0.97, 95% CI = 0.75-1.25; p value = 0.807) or in the women (adjusted OR = 0.91, 95% CI = 0.59-1.40; p value = 0.650) and in the men (adjusted OR = 1.15, 95% CI = 0.81-1.64; p value = 0.437) separately. Conclusion: Our findings suggest that there is no relationship between the LIPC -514 C/T and the risk of premature CAD or its severity in patients undergoing coronary angiography. https://jthc.tums.ac.ir/index.php/jthc/article/view/568 https://jthc.tums.ac.ir/index.php/jthc/article/download/568/596

Tehran University of Medical Sciences The Research in Heart Yield and Translational Medicine (RHYTHM) 3115-7270 12 3 2017 06 19 128 130 EN Reza Jafarzadeh Esfehani Department of Medical Genetics, Mashhad University of Medical Sciences, Mashhad, Iran. AND Medical Genetics Research Center, Mashhad University of Medical Sciences, Mashhad, Iran. Sara Hosseini Imam Reza Hospital, Mashhad University of Medical Sciences, Mashhad, Iran. Mahmood Ebrahimi Imam Reza Hospital, Mashhad University of Medical Sciences, Mashhad, Iran. Majid Jalalyazdi Imam Reza Hospital, Mashhad University of Medical Sciences, Mashhad, Iran. Azadeh Mahmoudi Gharaee Imam Reza Hospital, Mashhad University of Medical Sciences, Mashhad, Iran. 2017 06 18 2017 06 18 The anomalous origin of the left coronary artery from the pulmonary artery (ALCAPA) is a rare congenital anomaly. The usual clinical course is severe left-sided heart failure and mitral valve insufficiency presenting during the first months of life. However, in some cases, the collateral blood supply from the right coronary artery is sufficient and symptoms may be subtle or even absent. We describe a 49-year-old woman presenting with atypical chest pain during physical exertion. The exercise tolerance test and then coronary angiography by indication revealed an anomalous origin of the left coronary artery. The patient underwent surgical treatment, whereby a pulmonary artery tube graft from the aorta to the left coronary artery was created and the main pulmonary artery was reconstructed with a bovine pericardial patch. The patient was discharged from the hospital without any chest pain and dyspnea and was symptom free during a follow-up period of 18 months. Clinicians should consider ALCAPA as a differential diagnosis in adults with presentations similar to exercise-related asthma. https://jthc.tums.ac.ir/index.php/jthc/article/view/735 https://jthc.tums.ac.ir/index.php/jthc/article/download/735/579

Tehran University of Medical Sciences The Research in Heart Yield and Translational Medicine (RHYTHM) 3115-7270 12 3 2017 06 19 131 133 EN Yazdan Ghandi Amir Kabir Hospital, Arak University of Medical Sciences, Arak, Iran Akbar Shafiee Tehran Heart Center, Tehran University of Medical Sciences, Tehran, Iran. Mehrazad Sharifi Amir Almomenin Hospital, Arak University of Medical Sciences, Arak, Iran. Najmeh Sadat Bolandnazar Mafi Military Hospital, Shush, Khuzestan, Iran 2017 06 19 2017 06 19 The VACTERL association, co-occurrence of vertebral, anorectal, cardiac, tracheoesophageal, genitourinary, and limb malformations, is a rare congenital anomaly. Several cardiac anomalies have been reported as a part of the VACTERL association, particularly ventricular and atrial septal defects. Pulmonary artery sling is a rare congenital abnormality in which the left pulmonary artery arises from the right pulmonary artery. This anomaly is not frequently observed in the VACTERL association and has been rarely reported.  A 20-month-old girl was admitted to our hospital due to pneumonia in the right lung, which had pulmonary artery sling as a part of the VACTERL association. Barium meal X-ray showed pressure effects on the esophagus, and computed tomography angiography revealed pulmonary artery sling. Pneumonia management was done. However, the parents of our patient refused to give consent for the surgical correction of this vascular anomaly. Three months after discharge from the hospital, the patient was visited, at which time the parents again refused surgery and treatment for their daughter despite our recommendations. https://jthc.tums.ac.ir/index.php/jthc/article/view/737 https://jthc.tums.ac.ir/index.php/jthc/article/download/737/600

Tehran University of Medical Sciences The Research in Heart Yield and Translational Medicine (RHYTHM) 3115-7270 12 3 2017 06 19 134 137 EN Seyed Ebrahim Kassaian Tehran Heart Center, Tehran University of Medical Sciences, Tehran, Iran. Seyed Khalil Forouzannia Tehran Heart Center, Tehran University of Medical Sciences, Tehran, Iran. Ali Hosseinsabet Tehran Heart Center, Tehran University of Medical Sciences, Tehran, Iran. Tahereh Davarpasand Tehran Heart Center, Tehran University of Medical Sciences, Tehran, Iran. 2017 06 19 2017 06 19 The pseudoaneurysm of the aorta is rarely due to trauma and infection but usually is a late complication of previous surgical procedures like coronary artery bypass graft surgery. We describe a 65-year-old woman with the pseudoaneurysm of the ascending aorta due to coronary artery bypass graft surgery. It was revealed in coronary artery angiography after nonspecific symptoms. It was confirmed by multidetector computed tomographic angiography. The patient refused open cardiac surgery, so we decided to use an atrial septal defect occluder device in off-label way to seal the pseudoaneurysm orifice. In a hybrid operating room setting, the procedure was done successfully and patient’s hospitalization course was eventless. In multidetector computed tomographDepartment of Cardiovascular Surgery, Gulhane School of Medicine, Ankara, Turkey. 2015 10 13 2015 10 13 The bicuspid aortic valve is known to be the most common congenital cardiac malformation, with an approximate incidence rate of 1-2% in the general population. Most patients are unaware of the disease until the onset of infective endocarditis, which is a life-threatening complication that may affect a heart valve or other cardiac structures at the site of endothelial damage. A 22-year-old man presented to our internal medicine clinic with a complaint of acute onset dyspnea and fatigue. His body temperature was 38 °C. A diastolic murmur was detected at the right sternal border. Two-dimensional transthoracic echocardiography revealed severe aortic insufficiency, and two-dimensional transesophageal echocardiography showed that the aortic valve was bicuspid. There was also a flail lesion extending the left ventricular outflow tract, resulting in pathological coaptation and severe aortic insufficiency. The patient was referred to our cardiovascular department for surgery. We herein present this case of a bicuspid aortic valve complicated by infective endocarditis due to the underlying disease of chronic otitis media related to a rare pathogen: Alloiococcus otitidis. The patient underwent a successful aortic valve replacement surgery due to aortic insufficiency following infective endocarditis. He was discharged on the 16th postoperative day in good condition. https://jthc.tums.ac.ir/index.php/jthc/article/view/374 https://jthc.tums.ac.ir/index.php/jthc/article/download/374/367

Tehran University of Medical Sciences The Research in Heart Yield and Translational Medicine (RHYTHM) 3115-7270 10 2 2015 10 13 101 105 EN Seyed Reza Aghili Department of Medical Mycology and Parasitology, and Invasive Fungi Research Center (IFRC), Faculty of Medicine, Mazandaran University of Medical Sciences, Sari, Iran. Tahereh Shokohi Department of Medical Mycology and Parasitology, and Invasive Fungi Research Center (IFRC), Faculty of Medicine, Mazandaran University of Medical Sciences, Sari, Iran. Mohammad-Ali Boroumand Tehran Heart Center, Tehran University of Medical Sciences, Tehran, Iran. Shirinsadat Hashemi-Fesharaki Student Research Committee, Faculty of Medicine, Mazandaran University of Medical Sciences, Sari, Iran. Bahar Salmanian Department of Sciences, Seddigheh Tahereh Branch, Farhangian University, Sari, Iran. 2015 10 13 2015 10 13 The incidence of candidemia due to the uncommon non-albicans Candida species appears to be increasing, and certain species such as Candida (C.) membranaefaciens have been reported in some clinical researches. Vascular catheters are considered the likely culprit for the sudden emergence of hospital-acquired candidemia. The identification of C. membranaefaciens can be problematic in clinical practice owing to its phenotypic resemblance to C. guilliermondii. We report the first case of C. membranaefaciens in Iran, which occurred in a 70-year-old woman, who had coronary artery bypass grafting (CABG). We isolated germ-tube negative yeast from both blood culture and central venous catheter (CVC) tip culture on brain-heart infusion agar, Sabouraud dextrose agar plates, and biphasic brain-heart infusion media bottle; it developed smooth, pink colonies on CHROMagar Candida. By using the polymerase chain reaction and sequencing of theinternal transcribed spacer region of rDNA, we identified C. membranaefaciens. After the removal of the CVC and initiation of Fluconazole treatment, the patient's condition gradually improved and she was discharged from the hospital. The early detection of organisms in the catheter, removal of the catheter, and treatment with anti-fungal antibiotics have an important role in controlling disease and preventing septicemia after CABG. As C. membranaefaciens is an opportunistic Candida species, both clinicians and microbiologists should be aware of the factors that confer fast diagnosis and appropriate treatment. https://jthc.tums.ac.ir/index.php/jthc/article/view/375 https://jthc.tums.ac.ir/index.php/jthc/article/download/375/368

Tehran University of Medical Sciences The Research in Heart Yield and Translational Medicine (RHYTHM) 3115-7270 10 2 2015 10 13 106 108 EN Vasileios Patris Heart and Chest Hospital, Liverpool, UK. Orestis Argiriou Medical School, University of Ioannina, Ioannina, Greece. Niki Lama Heart and Chest Hospital, Liverpool, UK. Haris Georgiou Evangelismos General Hospital, Athens, Greece. Constantine Halkias North Middlesex University Hospital, London, UK. Christos Charitos Evangelismos General Hospital, Athens, Greece. 2015 10 13 2015 10 13 Cutaneous complications caused by a pacemaker or defibrillator are widely documented, but the development of a bronchocutaneous fistula has never been described before. We report the case of a 79-year-old man who was admitted to our hospital because of a seemingly superficial cutaneous infection, externalized defibrillator leads, and hemoptysis. Bronchoscopical investigation proved the existence of the fistula, which connected the epicardium, the left main bronchus, and the aforementioned site of skin infection. The patient refused an operation for the complete removal of the epicardial defibrillator and was treated conservatively. This case demonstrated that the long-term presence of foreign bodies in the epicardium may cause serious complications https://jthc.tums.ac.ir/index.php/jthc/article/view/376 https://jthc.tums.ac.ir/index.php/jthc/article/download/376/369

Tehran University of Medical Sciences The Research in Heart Yield and Translational Medicine (RHYTHM) 3115-7270 10 2 2015 10 13 109 112 EN Naser Hemati Imam Ali Hospital, Kermanshah University of Medical Sciences, Kermanshah, Iran. Alireza Poormotaabed Imam Ali Hospital, Kermanshah University of Medical Sciences, Kermanshah, Iran. Samsam Dabiri Imam Ali Hospital, Kermanshah University of Medical Sciences, Kermanshah, Iran. Feridoun Sabzi Imam Ali Hospital, Kermanshah U