Tehran University of Medical Sciences The Research in Heart Yield and Translational Medicine (RHYTHM) 3115-7270 12 4 2018 02 24 149 154 EN Lukman Amin Department of Internal Medicine, Faculty of Medicine, Universitas Indonesia, Jakarta, Indonesia. Hilman Amin Department of Internal Medicine, Faculty of Medicine, Universitas Indonesia, Jakarta, Indonesia. Sally Nasution Department of Internal Medicine, Faculty of Medicine, Universitas Indonesia, Jakarta, Indonesia. Marulam Panggabean Department of Internal Medicine, Faculty of Medicine, Universitas Indonesia, Jakarta, Indonesia. Hamzah Shatri Department of Internal Medicine, Faculty of Medicine, Universitas Indonesia, Jakarta, Indonesia. 2015 11 27 2016 07 25 Background: Mortality and major adverse cardiac events (MACE) frequently occur after percutaneous coronary intervention (PCI). Therefore, the ability to predict such events through an established risk stratification method is of great importance. The present study was aimed at determining the risk stratification of mortality and MACE in post-PCI patients at the intensive cardiac care unit of Cipto Mangunkusumo Hospital (CMH) using 7 variables of the New Mayo Clinic Risk Score (NMCRS). Method: This cross-sectional study drew upon secondary data gathered from the medical records of 313 patients that underwent PCI at the intensive cardiac care unit (ICCU) of CMH between August 1st, 2013, and August 31st, 2014. The primary end point was all-cause mortality and MACE. Seven variables in the NMCRS, namely age, left ventricular ejection fraction, serum creatinine, preprocedural cardiogenic shock, myocardial infarction, and peripheral arterial disease, were evaluated. Results: The mortality and MACE incidence rates in the post-PCI patients were 3.8% (95%CI: 2.6-5.0) and 8.3% (95% CI: 6.6-10.0), respectively. Regarding the NMCRS stratification, elderly patients with lower left ventricular ejection fraction, increased serum creatinine, preprocedural cardiogenic shock, myocardial infarction, and peripheral arterial disease had higher mortality and MACE incidence rates among the post-PCI patients. The mortality and MACE incidence rates significantly increased in the post-PCI patients with a higher NMCRS. Conclusion: Patients with a higher NMCRS had a tendency toward higher mortality and MACE incidence rates following PCI. https://jthc.tums.ac.ir/index.php/jthc/article/view/406 https://jthc.tums.ac.ir/index.php/jthc/article/download/406/642

Tehran University of Medical Sciences The Research in Heart Yield and Translational Medicine (RHYTHM) 3115-7270 12 4 2018 02 24 155 159 EN Shervin Assari Department of Psychiatry, University of Michigan, Ann Arbor, MI, USA. AND Center for Research on Ethnicity, Culture and Health, School of Public Health, University of Michigan, Ann Arbor, MI, USA. Hassan Zandi Medicine and Health Promotion Institute, Tehran, Iran. Khodabakhsh Ahmadi Behavioral Sciences Research Center, Baqiyatallah University of Medical Sciences, Tehran, Iran. Davoud Kazemi Saleh Behavioral Sciences Research Center, Baqiyatallah University of Medical Sciences, Tehran, Iran. 2017 10 19 2017 10 19 Background: The association between coronary angiographic findings and the level of anxiety symptoms among patients who undergo coronary angiography is not known. The aim of this study was to investigate the association between the extent of coronary stenosis and anxiety symptoms in patients who undergo coronary angiography. Methods: In a cross-sectional study, 106 patients who underwent coronary angiography and had varying degrees of coronary artery disease were enrolled. Demographic characteristics (i.e., age and gender), socioeconomic status (i.e., educational attainment, income, and marital status), and traditional risk factors (i.e., hypertension, diabetes mellitus, hyperlipidemia, and smoking) were measured. The independent variable was the extent of coronary stenosis shown by coronary angiography, coded as single-vessel disease (n = 19), 2-vessel disease (n = 28), or 3-vessel disease (n = 59). The main outcome was symptoms of anxiety measured using the Hospital Anxiety Depression Scale (HADS). The Kruskal–Wallis test was used for bivariate analysis, and linear regression was applied for multivariable analysis. Results:  Participants were mostly men (n = 78, 73%), at a mean age of 50.14 ± 10.60 years. We found an inverse association between the extent of coronary stenosis and anxiety symptoms in our samples. Anxiety symptoms were lowest in the patients with 3-vessel disease and highest in those with single-vessel disease. The above association remained significant in a linear regression model, controlled for the demographic, socioeconomic, and traditional risk factors. Conclusion: An inverse association may exist between the extent of coronary stenosis and the severity of anxiety symptoms in patients who undergo coronary angiography. Patients who undergo angiography and have fewer angiographic findings require screening for anxiety symptoms. https://jthc.tums.ac.ir/index.php/jthc/article/view/794 https://jthc.tums.ac.ir/index.php/jthc/article/download/794/643

Tehran University of Medical Sciences The Research in Heart Yield and Translational Medicine (RHYTHM) 3115-7270 12 4 2018 02 24 160 166 EN Barakat Animasahun Department of Paediatrics and Child Health, Lagos State University College of Medicine, Ikeja, Lagos, Nigeria. Akpoembele Madise-Wobo Department of Paediatrics and Child Health, Lagos State University College of Medicine, Ikeja, Lagos, Nigeria. Olusola Kusimo Department of Paediatrics and Child Health, Lagos State University College of Medicine, Ikeja, Lagos, Nigeria. 2017 03 13 2017 07 27 Background: Most of the recent reports on acquired heart diseases (AHDs) among Nigerian children are either retrospective or cover a short period of time with fewer subjects. The last report on AHDs among children in Lagos was about a decade ago; it was, however, not specific to children with AHDs but was part of a report on structural heart diseases among children in Lagos. The present study was carried out to document the prevalence and profile of different AHDs in children and to compare the findings with those previously reported. Methods: We conducted a quantitative, nonexperimental, prospective, and cross-sectional review of all consecutive cases of AHDs diagnosed with echocardiography at the Lagos State University Teaching Hospital between January 2007 and June 2016. Comparisons between the normally distributed quantitative data were made with the Student t test, while the χ2 test was applied for the categorical data. Results: The subjects with AHDs were 73 males and 52 females, with a male-to-female ratio of 1.4:1. The children were aged 15 days to 14 years, with a mean of 6.61 ± 4.26 years. Rheumatic heart disease was the most common AHD, documented in a quarter of the children, followed by dilated cardiomyopathy and pericardial effusion in 20.8% and 17.3%, respectively. Less common lesions encountered were Kawasaki disease, mitral valve prolapse, hyperdynamic circulation, and supraventricular tachycardia. Conclusion: Rheumatic heart disease was still the most common AHD in the children in the present study. Dilated cardiomyopathy and pericardial effusion are on the increase as has been reported earlier. https://jthc.tums.ac.ir/index.php/jthc/article/view/696 https://jthc.tums.ac.ir/index.php/jthc/article/download/696/602

Tehran University of Medical Sciences The Research in Heart Yield and Translational Medicine (RHYTHM) 3115-7270 12 4 2018 02 24 167 170 EN Zahra Khajali Department of Cardiology, Rajaie Cardiovascular, Medical, and Research Center, Iran University of Medical Sciences, Tehran, Iran. Sedigheh Saedi Department of Cardiology, Rajaie Cardiovascular, Medical, and Research Center, Iran University of Medical Sciences, Tehran, Iran. Alireza Alizadeh Ghavidel Department of Cardiology, Rajaie Cardiovascular, Medical, and Research Center, Iran University of Medical Sciences, Tehran, Iran. Hamid Reza Pouraliakbar Department of Cardiology, Rajaie Cardiovascular, Medical, and Research Center, Iran University of Medical Sciences, Tehran, Iran. 2015 09 30 2016 03 01 The aortico-left ventricular tunnel is a rare congenital abnormality resulting in a pathologic connection between the aorta and the left ventricle. It often presents during infancy or early childhood as a cardiac failure symptom or an incidental finding of a cardiac murmur due to severe aortic regurgitation. It is, however, also occasionally found in asymptomatic adults. We describe a 20-year-old female presenting with palpitations in whom clinical evaluations with echocardiography and computed tomography angiography led to the diagnosis of severe aortic regurgitation caused by a tunnel connecting the right sinus of the aorta to the left ventricle. The patient underwent successful obstruction of the tunnel with an autologous pericardial patch and the repair of the dilated aortic root via the reduction aortoplasty technique. She was discharged on the 5th postoperative day with no complications. At 1 month’s follow-up, she remained asymptomatic and echocardiography showed aortic valve competence with no residual regurgitation. https://jthc.tums.ac.ir/index.php/jthc/article/view/1 https://jthc.tums.ac.ir/index.php/jthc/article/download/1/624

Tehran University of Medical Sciences The Research in Heart Yield and Translational Medicine (RHYTHM) 3115-7270 12 4 2018 02 24 171 174 EN Hassan Aghajani Tehran Heart Center, Tehran University of Medical Sciences, Tehran, Iran. Shahrooz Yazdani Clinical Research Development Unit, Shahid Rajaei Hospital, Alborz University of Medical Sciences, Karaj, Iran. Mohammad Ghafaripoor Tehran Heart Center, Tehran University of Medical Sciences, Tehran, Iran. Zahra Shajari Tehran Heart Center, Tehran University of Medical Sciences, Tehran, Iran. 2016 02 11 2017 06 21 Thromboembolism occurs commonly in general practice and leads to significant health burden. Apart from cardiac sources, aortic atherosclerotic plaques contribute considerably to thromboembolism. A 63-year-old diabetic hypertensive woman referred to our center due to exertional chest pain unresponsive to optimal medical therapy and underwent coronary angiography. Owing to resistance during guide-wire advancement, an aortography was performed. Aortic arch injection demonstrated a large suspended mass distal to the left subclavian artery with free movement in the descending thoracic aorta. Echocardiography revealed widespread atherosclerotic changes in the aortic arch with a large hypermobile mass. Dual-source multi-slice (2 × 128:256) computed tomography angiography of the whole aorta revealed a large floating mass (in favor of a thrombus) in the distal portion of the arch. The patient underwent coronary artery bypass grafting due to severe coronary artery disease. The intra-aortic mass, which was actually a large atherosclerotic plaque, was resected at the same session. She was discharged uneventfully and during a 1-year follow-up, she had no embolic events. https://jthc.tums.ac.ir/index.php/jthc/article/view/489 https://jthc.tums.ac.ir/index.php/jthc/article/download/489/623

Tehran University of Medical Sciences The Research in Heart Yield and Translational Medicine (RHYTHM) 3115-7270 12 4 2018 02 24 175 183 EN Mahdi Neshati Department of Cardiothoracic Surgery, Ostad Aalinasab Hospital, Tabriz, Iran. Manizheh Azadeh Institute of Clinical Evaluative Sciences (ICES), Sunnybrook Hospital, University of Toronto, Toronto, Canada. Parinaz Neshati Greater Houston Interventional Pain Associates, Houston, USA. Tyrone Burnett Department of Anesthesiology, University of Texas Health Science Center, Houston, USA. Ryan Saenz Department of Anesthesiology, University of Texas Health Science Center, Houston, USA. Bahman Karbasi Department of Cardiothoracic Surgery, Ostad Aalinasab Hospital, Tabriz, Iran. Ghader Shahmohammadi Department of Cardiothoracic Surgery, Ostad Aalinasab Hospital, Tabriz, Iran. Eskandar Nourizadeh Department of Cardiothoracic Surgery, Ostad Aalinasab Hospital, Tabriz, Iran. Mohsen Rostamzadeh Department of Cardiothoracic Surgery, Ostad Aalinasab Hospital, Tabriz, Iran. 2016 02 19 2016 11 22 Malignant hyperthermia (MH) can develop after contact with volatile anesthetics (halothane, enflurane, isoflurane, sevoflurane, and desflurane) as well as succinylcholine and cause hypermetabolism during anesthesia, which is associated with high mortality when untreated. Early diagnosis and treatment could be life-saving. During cardiac surgery, hypothermia and cardiopulmonary bypass make the diagnosis of MH extremely challenging compared with other settings such as general surgery. We herein report 2 cases of MH, graded as “very likely” or “almost certain” based on the MH clinical grading scale. A 14-month-old infant and a 53-year-old male underwent surgery for severe pulmonary valve stenosis and mitral valve replacement, respectively. Both of them were extubated on the operation day, but they deteriorated with the development of high-grade fever, hypotension, renal failure, and acidosis. The first case had muscle spasms. Unfortunately, the delayed symptoms of MH in the early postoperative course were not diagnosed in these 2 cases, which caused permanent neurologic damage in the first case and death in the second one. However, the infant was discharged from the hospital after 2 months. https://jthc.tums.ac.ir/index.php/jthc/article/view/495 https://jthc.tums.ac.ir/index.php/jthc/article/download/495/644

Tehran University of Medical Sciences The Research in Heart Yield and Translational Medicine (RHYTHM) 3115-7270 12 4 2018 02 24 184 187 EN Mohammad Rafie Khorgami Rajaie Cardiovascular Medical and Research Center, Iran University of Medical Sciences, Tehran, Iran. Maryam Moradian Rajaie Cardiovascular Medical and Research Center, Iran University of Medical Sciences, Tehran, Iran. Negar Omidi Primary Pame> Salehiomran Tehran Heart Center, Tehran University of Medical Sciences, Tehran, Iran. Seyed Hesameddin Abbasi Tehran Heart Center, Tehran University of Medical Sciences, Tehran, Iran. Atefeh Ghiasi Tehran Heart Center, Tehran University of Medical Sciences, Tehran, Iran. 2015 10 13 2015 10 13 Central venous catheter (CVC) insertion is a practical way to assess patients hemodynamic specially in cardiovascular surgery but this relatively simple junior level procedure is not risk free and its common reported complications include; pneumothorax, hydrothorax, hemothorax, local hematoma, cardiac tamponade, vascular injury, thrombosis, embolism, and catheter disruption. Here in this article we are going to present 6 patients with very unusual presentation of CVC complication which was neurological deficit presented by agitation , unconsciousness, disorientation to time and place and  hemiparesis. All patients undergone neurologic consult and brain computed tomography. Final diagnosis was brain ischemic damage and finally we kept them on conservative management; fortunately we did not have any permanent damage. https://jthc.tums.ac.ir/index.php/jthc/article/view/355 https://jthc.tums.ac.ir/index.php/jthc/article/download/355/348

Tehran University of Medical Sciences The Research in Heart Yield and Translational Medicine (RHYTHM) 3115-7270 9 4 2015 10 13 166 173 EN Hamid Reza Bonakdar Heshmat Cardiovascular Medical Center, Guilan University of Medical Sciences, Rasht, Iran. Masoumeh Aslanpour Heshmat Cardiovascular Medical Center, Guilan University of Medical Sciences, Rasht, Iran. Hassan Moladoust Cardiovascular Research Center, Guilan University of Medical Sciences, Rasht, Iran. Parham Sadeghipour Heshmat Cardiovascular Medical Center, Guilan University of Medical Sciences, Rasht, Iran. Fereshteh Mohamadi Razi General Hospital, Guilan University of Medical Sciences, Rasht, Iran. Mohammad Assadian Rad Heshmat Cardiovascular Medical Center, Guilan University of Medical Sciences, Rasht, Iran. Jalal Kheirkhah Heshmat Cardiovascular Medical Center, Guilan University of Medical Sciences, Rasht, Iran. 2015 10 13 2015 10 13 Background: QT interval parameters have been suggested as a predictor of lethal arrhythmia and mortality in patients with myocardial infarction. The aim of the present study was to compare the value of QT interval indices in patients presenting with non-ST-segment elevation myocardial infarction (NSTEMI) between a group of patients with type 2 diabetes mellitus and a nondiabetic group of patients. Methods: This case-control study evaluated QT interval parameters in 115 patients (47 diabetic and 68 nondiabetic patients) diagnosed with NSTEMI between September 2011 and July 2012. The following QT interval indices were analyzed: maximum (max) and minimum (min) QT interval; max and min corrected QT interval (QTc); QT dispersion (QTd); and corrected QT dispersion (QTcd). All the patients were observed for ventricular arrhythmia during their hospital course and underwent coronary angiography. They were selected to undergo coronary artery bypass surgery (CABG) or percutaneous coronary angioplasty (PCI) based on their coronary anatomy. Results: The mean age of the patients was 60.8 ± 11.4 years. The patients were 40.0% female and 60.0% male. There were no significant differences in clinical characters between type 2 diabetic and nondiabetic patients with NSTEMI. Compared with post-myocardial infarction patients without diabetes, those with type 2 diabetes had higher QTc max , QTd and QTcd (p value < 0.05). There was a significant difference in QTd and QTcd in the patients needing coronary revascularization with diabetes as opposed to the nondiabetics (p value = 0.035 and p value = 0.025, respectively) as well as those who had ventricular arrhythmia with diabetes (p value = 0.018 and p value = 0.003, respectively). QTcd was higher in the patients who had higher in-hospital mortality (p value = 0.047). The QTc max, QTd and QTcd were significantly (all p values < 0.05) associated with ventricular arrhythmia, QTcd with need for revascularization and QTc max with in-hospital mortality in the diabetic patients. Conclusion: Based on the findings of this study, it seems that type 2 diabetics with NSTEMI have greater QTc max, QTd, and QTcd and these QT parameters may have a relationship with worse cardiac outcomes and poorer prognoses. https://jthc.tums.ac.ir/index.php/jthc/article/view/351 https://jthc.tums.ac.ir/index.php/jthc/article/download/351/344

Tehran University of Medical Sciences The Research in Heart Yield and Translational Medicine (RHYTHM) 3115-7270 9 4 2015 10 13 191 193 EN Sinan Sabit-Kocabeyoğlu Yüksek İhtisas Cardiovascular Education and Research Hospital, Ankara, Turkey. Arda Özyüksel Department of Cardiovascular Surgery, Medipol University, Istanbul, Turkey. Erdem Çetin Department of Cardiovascular Surgery, Memorial Hospital, Diyarbakır, Turkey. 2015 10 13 2015 10 13 Carney Syndrome (CS) is an autosomal dominant multiple neoplasia syndrome that includes cardiac, endocrine, cutaneous, and neural tumors. Cardiac myxomas can be seen in the course of CS. A 46-year-old female patient was admitted to our clinic with palpitation, cough, and exertional dyspnea. Physical examination revealed pigmented lesions, especially scattered