Tehran University of Medical Sciences The Research in Heart Yield and Translational Medicine (RHYTHM) 3115-7270 17 3 2022 07 28 88 90 Haleh Ashraf Cardiac Primary Prevention Research Center (CPPRC), Cardiovascular Disease Research Institute, Tehran University of Medical Sciences, Tehran, Iran. Sepideh Taghavi Heart Valve Disease Research Center, Rajaie Cardiovascular Medical and Research Center, Iran University of Medical Sciences, Tehran, Iran. Hossein Navid Tehran Heart Center, Cardiovascular Disease Research Institute, Tehran University of Medical Sciences, Tehran, Iran. 2022 09 21 2022 09 28 No Abstrac No Abstrac No Abstrac https://jthc.tums.ac.ir/index.php/jthc/article/view/1723 https://jthc.tums.ac.ir/index.php/jthc/article/download/1723/1022

Tehran University of Medical Sciences The Research in Heart Yield and Translational Medicine (RHYTHM) 3115-7270 17 3 2022 07 28 91 102 Farzad Kamali 1.Rajaie Cardiovascular Medical and Research Center, Iran University of Medical Sciences, Tehran, Iran. 2.Cardiac Electrophysiology Research Center, Rajaie Cardiovascular Medical and Research Center, Iran University of Medical Sciences, Tehran, Iran. Majid Haghjoo 1.Rajaie Cardiovascular Medical and Research Center, Iran University of Medical Sciences, Tehran, Iran. 2.Cardiac Electrophysiology Research Center, Rajaie Cardiovascular Medical and Research Center, Iran University of Medical Sciences, Tehran, Iran. Yeganeh Pasebani 1-Rajaie Cardiovascular Medical and Research Center, Iran University of Medical Sciences, Tehran, Iran. 2-Cardiac Electrophysiology Research Center, Rajaie Cardiovascular Medical and Research Center, Iran University of Medical Sciences, Tehran, Iran. Abolfath Alizadehdiz 1-Rajaie Cardiovascular Medical and Research Center, Iran University of Medical Sciences, Tehran, Iran. 2-Cardiac Electrophysiology Research Center, Rajaie Cardiovascular Medical and Research Center, Iran University of Medical Sciences, Tehran, Iran. Zahra Emkanjoo 1-Rajaie Cardiovascular Medical and Research Center, Iran University of Medical Sciences, Tehran, Iran. 2-Cardiac Electrophysiology Research Center, Rajaie Cardiovascular Medical and Research Center, Iran University of Medical Sciences, Tehran, Iran. Amirfarjam Fazelifar 1-Rajaie Cardiovascular Medical and Research Center, Iran University of Medical Sciences, Tehran, Iran. 2-Cardiac Electrophysiology Research Center, Rajaie Cardiovascular Medical and Research Center, Iran University of Medical Sciences, Tehran, Iran. Farzad Masoudkabir Cardiac Primary Prevention Research Center, Cardiovascular Disease Research Institute, Tehran University of Medical Sciences, Tehran, Iran. Ala Keykhavani 1-Rajaie Cardiovascular Medical and Research Center, Iran University of Medical Sciences, Tehran, Iran. 2-Cardiac Electrophysiology Research Center, Rajaie Cardiovascular Medical and Research Center, Iran University of Medical Sciences, Tehran, Iran. Shabnam Madadi 1. Rajaie Cardiovascular Medical and Research Center, Iran University of Medical Sciences, Tehran, Iran. 2.Cardiac Electrophysiology Research Center, Rajaie Cardiovascular Medical and Research Center,, Iran University of Medical Sciences, Tehran, Iran. 2021 05 26 2022 07 26 The catheter ablation of idiopathic ventricular arrhythmias is accepted as a first-line treatment as it successfully eliminates about 90.0% of such arrhythmias. One of the most challenging ventricular arrhythmias originates from the left ventricular summit (LVS), a triangular epicardial space with the left main bifurcation as its apex. This area accounts for about 14.0% of LV arrhythmias. The complex anatomy of this region, accompanied by proximity to the major epicardial coronary arteries and the presence of a thick fat pad in this region, renders it a challenging area for catheter ablation. This article presents a review of the anatomy of the LVS and relevant regions and discusses novel mapping and ablation techniques for eliminating LVS ventricular arrhythmias. Additionally, we elaborate on the electrocardiographic (ECG) manifestations of arrhythmias from the LVS and their successful ablation via the direct approach and the adjacent structures. https://jthc.tums.ac.ir/index.php/jthc/article/view/1474 https://jthc.tums.ac.ir/index.php/jthc/article/download/1474/1014

Tehran University of Medical Sciences The Research in Heart Yield and Translational Medicine (RHYTHM) 3115-7270 17 3 2022 07 28 103 111 Ata Firouzi Cardiovascular intervention research center, Rajaie Cardiovascular Medical and Research Center, Iran University of Medical Sciences, Tehran, Iran. Zahra Hosseini Cardiovascular intervention research center, Rajaie Cardiovascular Medical and Research Center, Iran University of Medical Sciences, Tehran, Iran. Zeinab Norouzi Cardiovascular intervention research center, Rajaie Cardiovascular Medical and Research Center, Iran University of Medical Sciences, Tehran, Iran. Zohre Hosseini Cardiovascular intervention research center, Rajaie Cardiovascular Medical and Research Center, Iran University of Medical Sciences, Tehran, Iran. Afshin Amirpour Cardiovascular Research Institute, Isfahan University of Medical Sciences, Isfahan, Iran. Hamed Talakoob Cardiovascular Research Center, Alborz University of Medical Sciences, Karaj, Iran. Arash Amin Lorestan Heart Center (Madani Hospital), Lorestan University of Medical Sciences, Khorram Abad, Lorestan, Iran. Abbas Soleimani Sina Hospital, Tehran University of Medical Sciences (TUMS), Thran, Iran. Nasrolah Moradifar Lorestan Heart Center (Madani Hospital), Lorestan University of Medical Sciences, Khorram Abad, Lorestan, Iran. Shahrokh Karbalai Sina Hospital, Tehran University of Medical Sciences (TUMS), Thran, Iran. Mohammadhosseini Mozafarybazargani Cardiovascular Research Center, Alborz University of Medical Sciences, Karaj, Iran. Hamidreza Hekmat Ziaeian Hospital, International Campus, Tehran University of Medical Sciences, Tehran, Iran. Majid Maleki Cardiovascular intervention research center, Rajaie Cardiovascular Medical and Research Center, Iran University of Medical Sciences, Tehran, Iran. Parham Sadeghipour Cardiovascular intervention research center, Rajaie Cardiovascular Medical and Research Center, Iran University of Medical Sciences, Tehran, Iran. Seyedeh Mahnaz Mirbod Cardiovascular Research Institute, Isfahan University of Medical Sciences, Isfahan, Iran. Mina Ghorbanpoor Kohnaki cardiovascular intervention research center, rajaie cardiovascular medical and research center Hooman Bakhshandeh Cardiovascular intervention research center, Rajaie Cardiovascular Medical and Research Center, Iran University of Medical Sciences, Tehran, Iran. Masoomeh KalaeiNia Cardiovascular intervention research center, Rajaie Cardiovascular Medical and Research Center, Iran University of Medical Sciences, Tehran, Iran. Fatemeh Sadat Habibizade Cardiovascular intervention research center, Rajaie Cardiovascular Medical and Research Center, Iran University of Medical Sciences, Tehran, Iran. Sara Iraninejad Cardiovascular intervention research center, Rajaie Cardiovascular Medical and Research Center, Iran University of Medical Sciences, Tehran, Iran. Mohammadreza Baay Cardiovascular intervention research center, Rajaie Cardiovascular Medical and Research Center, Iran University of Medical Sciences, Tehran, Iran. Ehsan Khalilipur Cardiovascular intervention research center, Rajaie Cardiovascular Medical and Research Center, Iran University of Medical Sciences, Tehran, Iran. 2021 12 02 2022 08 24 Background There are limited data about the clinical outcomes of patients with coronavirus disease 2019 (COVID-19) who present with ST-Segment-Elevation Myocardial Infarction (STEMI). Objectives The aim of this multicenter study is to compare baseline clinical and procedural data between the case group (STEMI patients with COVID-19) and the control group (STEMI patients before the COVID-19 pandemic) and to determine in-hospital infarct-related artery thrombus grades; major adverse cardio-cerebrovascular events (MACCE), defined as a composite of deaths from any cause (cardiovascular and non-cardiovascular), nonfatal strokes, and stent thrombosis. Results There were no significant differences between two groups regarding baseline characteristics. Primary PCI was performed in 81% of the case group and 97% of the control group (P=0.043), and primary CABG was performed in 7% of the case group and 1.4% of the control group (P=0.04). The number of successful PCI procedures (final TIMI flow grade III) was significantly lower in the case group (66.5% vs 93%; P=0.0). The baseline thrombus grade before wire crossing was not statistically significantly different between the 2 groups. The summation of thrombus grades IV and V was 75% in the case group and 82% in the control group (P=0.43). The rate of MACCE was 17% and 2.1% in the case and control groups, correspondingly (P=0.002). Conclusions In our study, the thrombus grade had no significant differences between the case group and the control group; however, the in-hospital rates of the no-reflow phenomenon, periprocedural MI, mechanical complications, and MACCE were statistically significantly higher in the case group. https://jthc.tums.ac.ir/index.php/jthc/article/view/1564 https://jthc.tums.ac.ir/index.php/jthc/article/download/1564/1013

Tehran University of Medical Sciences The Research in Heart Yield and Translational Medicine (RHYTHM) 3115-7270 17 3 2022 07 28 112 118 Mohammad Sahebjam Tehran Heart Center, Tehran University of Medical Sciences, Tehran, Iran. Alimohammad Haji Zeinali Tehran Heart Center, Tehran University of Medical Sciences, Tehran, Iran. Kyomars Abbasi Tehran Heart Center, Tehran University of Medical Sciences, Tehran, Iran. Solmaz Borjian Tehran Heart Center, Tehran University of Medical Sciences, Tehran, Iran. 2022 03 12 2022 07 21 Background: Transcatheter tricuspid valve-in-valve (TTViV) replacement has become an alternative treatment in high-risk patients with bioprosthetic valve degeneration. This is the first report on the mid to long-term echocardiographic findings of patients who underwent TTViV replacement in a cardiac referral center in Iran.   Methods: Data of 12 patients, consisting of 11 women and 1 man, who underwent TTViV replacement between 2015 and 2021 were reviewed retrospectively. The patients underwent echocardiography before the procedure and at a mean follow-up time of 3.17±1.75 years. Results: All the patients had New York Heart Association (NYHA) function class III/IV before TTViV. Six patients had tricuspid regurgitation, 1 had tricuspid stenosis, and 5 had both. All the patients had successful TTViV. The mean time from the initial valve surgery to TTViV was 6.25±2.45 years. At follow-up, 2 patients had died: 1 due to COVID-19 pneumonia and 1 without a known cause. The remaining 10 patients experienced improvements in the NYHA functional class. Echocardiographic measures showed significant improvements. Transvalvular mean gradient pressure decreased from 7.08±1.98 mm Hg to 5.29±1.63 mm Hg (P=0.028), tricuspid valve pressure half time decreased from 245.00±49.46 ms to 158.64±57.41 ms (P=0.011), tricuspid regurgitation gradient decreased from 39.91±7.31 mm Hg to 26.72±8.99 mm Hg, and left ventricular ejection fraction increased from 47.71±4.70% to 49.79±4.58% (P=0.046). There was no significant paravalvular or transvalvular leakage at follow-up. Conclusion: This is a single-center report on the mid and long-term echocardiographic follow-up of patients after TTViV replacement.  Our study showed that TTViV was a safe and efficient method in treating high-risk patients with degenerated bioprosthetic tricuspid valves and had favorable echocardiographic and clinical results. https://jthc.tums.ac.ir/index.php/jthc/article/view/1632 https://jthc.tums.ac.ir/index.php/jthc/article/download/1632/1015

Tehran University of Medical Sciences The Research in Heart Yield and Translational Medicine (RHYTHM) 3115-7270 17 3 2022 07 28 119 126 Saeedeh Asgarbeik Metabolic Disorders Research Center, Endocrinology and Metabolism Molecular Cellular Sciences Institute, Tehran University of Medical Sciences, Tehran, Iran. Aida Vahidi Endocrinology and Metabolism Research Center, Endocrinology and Metabolism Clinical Sciences Institute, Tehran University of Medical Sciences, Tehran, Iran. Mandana Hasanzad 1- Medical Genomics Research Center, Tehran Medical Sciences, Islamic Azad University, Tehran, Iran. 2- Personalized Medicine Research Center, Endocrinology and Metabolism Clinical Sciences Institute, Tehran University of Medical Sciences, Tehran, Iran. Mojgan Asadi Metabolomics and Genomics Research Center, Endocrinology and Metabolism Molecular-Cellular Sciences Institute, Tehran University of Medical Sciences, Tehran, Iran. Mahsa M.Amoli Metabolic Disorders Research Center, Endocrinology and Metabolism Molecular Cellular Sciences Institute, Tehran University of Medical Sciences, Tehran, Iran. 2021 10 30 2022 07 26 Background: In-stent restenosis (ISR) is an inevitable complication of percutaneous coronary intervention, with genetic factors thought to play a role in its pathogenesis. The VEGF gene can have an inhibitory effect on ISR development. Accordingly, in the present study, we investigated the role of −2549 VEGF (insertion/deletion [I/D]) variants in ISR formation. Methods: Patients with ISR (ISR+) (n=53) and patients without ISR (ISR-) (n=67) were enrolled in this case-control study based on follow-up angiography 1 year after percutaneous coronary intervention between 2019 and 2020. The clinical characteristics of the patients were evaluated, and the frequencies of the alleles and genotypes of −2549 VEGF (I/D) variants were determined using polymerase chain reaction. The χ2 test was performed for the calculation of genotypes and alleles. A P value of less than 0.05 was considered the level of significance. Results: This study recruited 120 individuals at a mean age of 61.43±8.91 years in the ISR+ group and 62.09±7.94 years in the ISR- group. Women and men, respectively, comprised 26.4% and 73.6% of the ISR+ group and 43.3% and 56.7% of the ISR- group. A significant association was observed between the VEGF −2549 genotype frequency and ISR. The frequency of the insertion/insertion (I/I) allele was significantly higher in the ISR+ group than in the ISR- group, while the frequency of the D/D allele was higher in the latter group. Conclusion: Regarding ISR development, the I/I allele may be a risk allele and the D/D allele a protective allele. https://jthc.tums.ac.ir/index.php/jthc/article/view/1541 https://jthc.tums.ac.ir/index.php/jthc/article/download/1541/1016

Tehran University of Medical Sciences The Research in Heart Yield and Translational Medicine (RHYTHM) 3115-7270 17 3 2022 07 28 127 133 Anahita Babak Department of Community and Family Medicine, School of Medicine, Isfahan University of Medical Sciences, Isfahan, Iran. Narges Motamedi Department of Community and Family Medicine, School of Medicine, Isfahan University of Medical Sciences, Isfahan, Iran. Seyedeh Zeinab Mousavi Psychomatic Research Center, Isfahan University of Medical Sciences, Isfahan, Iran. Nadia Ghasemi Darestani School of Medicine, Isfahan University of Medical Sciences, Isfahan, Iran. 2021 10 06 2022 09 05 Background: Hypertension is one of the most important causes of cardiovascular diseases. Patients with hypertension have a lower quality of life. We aimed to evaluate the effects of mindfulness meditation on blood pressure, mental health, and quality of life in patients with hypertension. Methods: This randomized clinical trial was performed in 2019 in Isfahan. Eighty adult women with Stage I or II hypertension were included and assigned randomly to 2 groups: 12 weeks of mindfulness-based stress reduction (MBSR) and routine care. At baseline and 1 week after the end of the intervention, blood pressure, stress, depression, anxiety, and quality of life of the studied participants were measured using the Depression, Anxiety, and Stress Scale-21 (DASS-21) and 36-Item Short Form Survey (SF-36) questionnaires. The data were analyzed using the independent t-test, the paired t-test, and the MANCOVA test. Results: After the intervention, the mean systolic and diastolic blood pressures decreased significantly in the intervention group compared with the baseline (142.82±11.01 mmHg vs 133.7±510.43 mmHg for systolic pressure and 86.12±8.24 mmHg vs 79.15±6.26 mmHg for diastolic pressure) and the control group (140.18±14.27 mmHg vs 142.15±10.23 mmHg for systolic pressure and 84.62± 9.22 vs mmHg 88.51±8.54 mmHg for diastolic pressure; P=0.001). There was also a significant increase in quality of life, stress, anxiety, and depression scores in the intervention group (P<0.05). Conclusion: The 12-week MBSR program resulted in a significant reduction in the mean systolic and diastolic blood pressures and improvement in mental health and different aspects of quality of life. https://jthc.tums.ac.ir/index.php/jthc/article/view/1526 https://jthc.tums.ac.ir/index.php/jthc/article/download/1526/1017

Tehran University of Medical Sciences The Research in Heart Yield and Translational Medicine (RHYTHM) 3115-7270 17 3 2022 07 28 134 139 Mehrnaz Abdolalian Blood Transfusion Research Center, High Institute for Research and Education in Transfusion Medicine, Tehran, Iran. Elham Khalaf-Adeli Blood Transfusion Research Center, High Institute for Research and Education in Transfusion Medicine, Tehran, Iran. Fatemeh Yari Blood Transfusion Research Center, High Institute for Research and Education in Transfusion Medicine, Tehran, Iran. Saeid Hosseini Heart Valve Disease Research Center, Rajaie Cardiovascular Medical and Research Center, Iran University of Medical Sciences, Tehran, Iran. Hooman Bakhshandeh Rajaie Cardiovascular Medical and Research Center, Iran University of Medical Sciences, Tehran, Iran. 2022 02 08 2022 08 14 Background: Cell-derived microparticles (MPs) as membrane vesicles are procoagulant. They play a role in surgical hemostasis. In this study, the correlations between the circulating level of cell-derived MPs and surgical variables in heart valve surgery were investigated. Methods: The present prospective case-series study was conducted in Rajaie Cardiovascular Medical and Research Center from January through March 2021. Forty patients undergoing heart valve surgery with cardiopulmonary bypass (CPB) were enrolled. Before the induction of anesthesia and 30 minutes after the administration of protamine sulfate, venous blood samples were collected. After MP isolation, the concentration of MPs was determined via the Bradford method. Flow cytometry analysis was performed to determine the MP count and phenotype. Intraoperative variables and postoperative routine coagulation tests were defined as surgical variables. Postoperative coagulopathy was defined as an activated partial thromboplastin time (aPTT) ≥48 seconds or an international normalized ratio (INR) >1.5. Results: The total concentration of MPs and the MP count increased significantly after surgery compared with before surgery. The postoperative concentration of MPs was positively correlated with the CPB time (P=0.030, ρ=0.40). The preoperative concentration of MPs was significantly lower in patients with higher postoperative aPTT and INR (P=0.003, Ρ= −0.50 and P=0.020, Ρ= −0.40, respectively). In multivariate logistic regression analysis, the preoperative MP concentration (OR, 1.00; 95% CI, 1.00 to 1.01; P=0.017) was considered a risk factor for postoperative coagulopathy. Conclusion: The levels of MPs, especially platelet-derived MPs, rose after surgery, in correlation with the CPB time. Given the role of MPs in the induction of coagulation and inflammation, they can be considered therapeutic goals for preventing postoperative complications. In addition, the preoperative levels of MPs are a risk factor for predicting the occurrence of postoperative coagulopathy in heart valve surgery. https://jthc.tums.ac.ir/index.php/jthc/article/view/1615 https://jthc.tums.ac.ir/index.php/jthc/article/download/1615/1018

Tehran University of Medical Sciences The Research in Heart Yield and Translational Medicine (RHYTHM) 3115-7270 17 3 2022 07 28 140 146 Mohadesse Ahmadi Amir-Kabir Hospital, School of Medicine, Arak University of Medical Sciences, Arak, Iran Bita Ghahremani Amirkabir Hospital, School of Medicine, Arak University of Medical Sciences, Arak, Iran Danial Habibi Instructor in Biostatistics, Department of Biostatistics, Faculty of Medicine, Arak University of Medical Sciences, Arak, Iran Saeid Sadrnia Department of Cardiology, School of Medicine, Arak University of Medical Sciences, Arak, Iran Yazdan Ghandi Pediatric Cardiologist, Amirkabir Hospital, Arak University of Medical Sciences, Arak, Iran 2021 03 23 2022 07 25 Background: Patients with mitral valve prolapse (MVP) may reveal symptoms of autonomic dysfunction and heart rate variability (HRV). We sought to explore the autonomic nervous system in children with MVP. Methods: This cross-sectional study enrolled 60 children aged between 5 and 15 years with MVP and 60 age- and sex-matched healthy children as controls. Two cardiologists performed electrocardiography and standard echocardiography. HRV parameters were explored via 24-hour rhythm 3-channel Holter monitoring. The depolarization of ventricular and atrial parameters, comprising QT max and min, QTc intervals, QT dispersion, P maximum and minimum, and P-wave dispersion, was measured and compared. Results: The mean age was 13.12±1.50 years in the MVP group (F/M: 34/26) and 13.20±1.81 years in the control group (F/M: 35/25). The maximum duration and P-wave dispersion in the MVP group were significantly different from the healthy children (P<0.001). The longest and shortest QT dispersion values and QTc values were significantly different between the 2 groups (P=0.004, P=0.043, P<0.001, and P<0.001, respectively). The HRV parameters were significantly different between the 2 groups, too. Conclusion: Decreased HRV and inhomogeneous depolarization showed that our children with MVP were prone to atrial and ventricular arrhythmias. Furthermore, P-wave dispersion and QTc could be used as prognostic markers of cardiac autonomic dysfunction before it is diagnosed by 24-hour Holter monitoring. https://jthc.tums.ac.ir/index.php/jthc/article/view/1438 https://jthc.tums.ac.ir/index.php/jthc/article/download/1438/1023

Tehran University of Medical Sciences The Research in Heart Yield and Translational Medicine (RHYTHM) 3115-7270 17 3 2022 07 28 147 151 Pavan Rasalkar Department of Cardiology, Postgraduate Institute of Medical Education and Research, Chandigarh, India. Krishna Vemuri Departement of Cardiology, Institute of Medical Sciences, Banaras Hindu University, Varanasi, Uttar Pradesh, India. Dinakar Bootla Department of Cardiology, Postgraduate Institute of Medical Education and Research, Chandigarh, India. Pruthvi Revaiah Department of Cardiology, Postgraduate Institute of Medical Education and Research, Chandigarh, India. Anand Mishra Department of Cardiothoracic Surgery, Postgraduate Institute of Medical Education and Research, Chandigarh, India. Neelam Dahiya Department of Cardiology, Postgraduate Institute of Medical Education and Research, Chandigarh, India. Soumitra Ghosh Department of Cardiology, Postgraduate Institute of Medical Education and Research, Chandigarh, India. Parag Barwad Department of Cardiology, Postgraduate Institute of Medical Education and Research, Chandigarh, India. 2021 05 27 2022 08 06 Inadvertent deployment of stent grafts into the false lumen during thoracic endovascular aortic repair (TEVAR) is rare and is associated with catastrophic consequences. We present a case of accidental stent-graft deployment from the true lumen into the false lumen during TEVAR, resulting in hemodynamic collapse and visceral malperfusion. We successfully performed a bailout using the Brockenbrough needle to create new access from the true lumen to the false lumen and implanted another overlapping stent graft. https://jthc.tums.ac.ir/index.php/jthc/article/view/1476 https://jthc.tums.ac.ir/index.php/jthc/article/download/1476/1019

Tehran University of Medical Sciences The Research in Heart Yield and Translational Medicine (RHYTHM) 3115-7270 17 3 2022 07 28 152 155 Reza Shabanian Department of Pediatric Cardiology, Children's Medical Center, Tehran University of Medical Sciences, Tehran, Iran. Amir Amiri Maternal, Fetal, and Neonatal Research Center, Family Health Research Institute, Tehran University of Medical Sciences, Tehran, Iran. Saghi Elmi Maternal, Fetal, and Neonatal Research Center, Family Health Research Institute, Tehran University of Medical Sciences, Tehran, Iran. Toktam Sheykhian Maternal, Fetal, and Neonatal Research Center, Family Health Research Institute, Tehran University of Medical Sciences, Tehran, Iran. 2021 12 04 2022 09 19 Keutel syndrome (KS) as a scarce autosomal recessive disorder is characterized by hearing loss, multiple peripheral pulmonary stenoses, abnormal cartilage calcification, and morphological defects including midface hypoplasia and brachytelephalangism. We herein describe a 5-year-old boy who was referred for the evaluation of incidentally auscultated heart murmurs. He had no obvious abnormalities at birth but suffered from recurrent episodes of infectious otitis media during infancy. Physical examination revealed facial abnormalities, such as a broad nasal bridge, a sloping forehead, maxillary hypoplasia, and brachytelephalangism. Chest radiography showed tracheobronchial tree calcification. Transthoracic echocardiography illustrated peripheral pulmonary artery stenosis, moderate tricuspid regurgitation, and pulmonary hypertension. Computed tomography angiography confirmed calcification and segmental stenosis in the peripheral pulmonary arteries. The patient was diagnosed with KS. Most of these patients have a good prognosis. During the follow-up of these patients and examinations, we should pay attention to their symptoms related to upper respiratory tract infections, the extent of hearing, and the possibility of tracheal and pulmonary artery stenosis development. KS is a disease with a good prognosis, and a careful initial examination of babies, including facial appearance and heart auscultation, may lead to the early diagnosis of this disease. https://jthc.tums.ac.ir/index.php/jthc/article/view/1565 https://jthc.tums.ac.ir/index.php/jthc/article/download/1565/1020

Tehran University of Medical Sciences The Research in Heart Yield and Translational Medicine (RHYTHM) 3115-7270 17 3 2022 07 28 156 158 Usha Kumari Dow University of Health Sciences, Karachi, Pakistan. Fakhar Abbas King Edward Medical University, Lahore, Pakistan. Zara Shirazi Cardiac Surgery, National Institute of Cardiovascular Disorders, Pakistan. Nosheen Hafeez Jinnah Postgraduate Medical Center, Karachi, Pakistan. Sohail Bangash Department of Peadiatrics Cardiac Surgery, National Institute of Cardiovascular Disorders, Pakistan. 2022 03 14 2022 06 13 Accidental penetrating injuries are common among children, either with a sharp or a blunt object. The screwdriver is an uncommon weapon; therefore, injuries caused by it represent an even rarer subset. Inadvertent injuries in the chest with a screwdriver as a stabbing weapon are extremely unusual. Penetrating chest injuries can be fatal if they cause wounds in the cardiac chambers or major thoracic vessels. We describe a 9-year-old child with an unintentional penetrating thoracic injury caused by a screwdriver. An explorative left anterior thoracotomy showed that the tip of the implanted screwdriver was lying near the left subclavian vessels and the apex of the lung, but it did not perforate any of those. The screwdriver was dislodged, and the wound was closed. The patient had an event-free 1-week hospital stay. https://jthc.tums.ac.ir/index.php/jthc/article/view/1630 https://jthc.tums.ac.ir/index.php/jthc/article/download/1630/1021

Tehran University of Medical Sciences The Research in Heart Yield and Translational Medicine (RHYTHM) 3115-7270 17 3 2022 07 28 159 164 EN Arash Amin Assistant professor of interventional Cardiology, Lorestan Heart Center (Madani hospital), Lorestan University of Medical Sciences (LUMS), Khorramabad, Lorestan, Iran Majid Maleki Professor of interventional cardiology and echocardiography, Rajaie Cardiovascular Medical and Research Center, Iran University of Medical Sciences (IUMS), Tehran, Iran Zeinab Norouzi Department of Cardiac Rehabilitation, Rajaie Cardiovascular, Medical and Research Center, Tehran, Iran Mohammad Almasian Instructor of teaching English, School of Medicine, Lorestan University of Medical Sciences (LUMS), Khorramabad, Lorestan, Iran Email: almasian26@gmail.com Mina Ghorbanpoor Resident of Cardiology, Rajaie Cardiovascular Medical and Research Center, Iran University of Medical Sciences (IUMS), Tehran, Iran 2021 08 31 2022 06 13 No Abstrac No Abstrac No Abstrac https://jthc.tums.ac.ir/index.php/jthc/article/view/1516 https://jthc.tums.ac.ir/index.php/jthc/article/download/1516/1024