Tehran University of Medical Sciences The Research in Heart Yield and Translational Medicine (RHYTHM) 3115-7270 3 2 2008 04 15 57 58 Samuel Wann Wisconsin Heart Hospital, Milwaukee, WI, USA. 2015 10 03 https://jthc.tums.ac.ir/index.php/jthc/article/view/84 https://jthc.tums.ac.ir/index.php/jthc/article/download/84/82

Tehran University of Medical Sciences The Research in Heart Yield and Translational Medicine (RHYTHM) 3115-7270 3 2 2008 04 15 59 76 Maryam Esmaeilzadeh Shaheed Rajaie Cardiovascular Medical and Research Center, Tehran, Iran. 2015 10 03 Echocardiography plays a fundamental role in the evaluation of patients with an intracardiac mass. The ability to distinguish tissue characteristics, location, attachment, shape, size, and mobility non-invasively, quickly, and without the use of ionizing radiation makes echocardiography the ideal diagnostic modality. With careful attention to mass location and morphology, and appropriate application of clinical information, echocardiography can usually distinguish between the three principal intracardiac masses: tumor, thrombus, and vegetation. Equivocal transthoracic findings typically indicate the need for a transesophageal evaluation, during which the atria and great vessels might be better imaged. Surgical intervention is often indicated based on possible echocardiographic findings, without the need for additional time-consuming procedures. This review will focus on cardiac tumors. https://jthc.tums.ac.ir/index.php/jthc/article/view/85 https://jthc.tums.ac.ir/index.php/jthc/article/download/85/83

Tehran University of Medical Sciences The Research in Heart Yield and Translational Medicine (RHYTHM) 3115-7270 3 2 2008 04 15 77 82 Kyomars Abbasi Tehran Heart Center, Medical Sciences/University of Tehran, Tehran, Iran. Shapour Shirani Tehran Heart Center, Medical Sciences/University of Tehran, Tehran, Iran. Mohsen Fadaei Araghi Tehran Heart Center, Medical Sciences/University of Tehran, Tehran, Iran. Abbasali Karimi Tehran Heart Center, Medical Sciences/University of Tehran, Tehran, Iran. Hossein Ahmadi Tehran Heart Center, Medical Sciences/University of Tehran, Tehran, Iran. Seyed Hesameddin Abbasi Tehran Heart Center, Medical Sciences/University of Tehran, Tehran, Iran. Naghmeh Moshtaghi Tehran Heart Center, Medical Sciences/University of Tehran, Tehran, Iran. 2015 10 03 Background: The presence of significant carotid stenosis in coronary artery bypass grafting (CABG) patients increases the risk of either transient ischemic attack or stroke. However, there is a dearth of data on the risk for patients with unilateral total occlusion of the carotid artery. We herein report our results of cardiac surgery in patients with unilateral total occlusion of the carotid artery. Methods: We examined 10,000 patients who underwent carotid artery duplex scanning before CABG or other cardiac procedures between January 2001 and September 2006 at Tehran Heart Center. The occlusions were detected via carotid Doppler screening and were confirmed through conventional or MR angiography. Among these patients, 15 (0.15%) patients had unilateral total occlusion of the internal carotid artery, and all of them underwent elective cardiac surgery. During cardiopulmonary bypass, the mean arterial pressure was maintained at above 60 mmHg with vasopressure drugs and increasing flow pump. Results: There were 4 patients with left and 11 patients with right carotid occlusions. Four patients had a history of cerebrovascular accident. The mean cross-clamp time (min) and perfusion time (min) was 50.7±17.3 and 94.2±26.7, respectively. The mean graft number was 4.1±0.9. One of these patients expired intraoperatively because of low cardiac output. In one (6.66%) patient, postoperative cerebrovascular accident occurred on the contralateral side of the totally occluded region. All the patients recovered uneventfully. Conclusion: Our results suggest that CABG can be performed in patients with unilateral total occlusion of the internal carotid artery without ipsilateral stroke using our strategies.                                                                                                                                                                                        https://jthc.tums.ac.ir/index.php/jthc/article/view/86 https://jthc.tums.ac.ir/index.php/jthc/article/download/86/84

Tehran University of Medical Sciences The Research in Heart Yield and Translational Medicine (RHYTHM) 3115-7270 3 2 2008 04 15 83 88 Mohammad Hasan Namazi Modarres Hospital, Shaheed Beheshti University of Medical Sciences, Tehran, Iran. Hassan Kamalzadeh Modarres Hospital, Shaheed Beheshti University of Medical Sciences, Tehran, Iran. Morteza Safi Modarres Hospital, Shaheed Beheshti University of Medical Sciences, Tehran, Iran. Reza Karbasi Afshar Modarres Hospital, Shaheed Beheshti University of Medical Sciences, Tehran, Iran. Mohammad Reza Motamedi Modarres Hospital, Shaheed Beheshti University of Medical Sciences, Tehran, Iran. Habibollah Saadat Modarres Hospital, Shaheed Beheshti University of Medical Sciences, Tehran, Iran. Hossein Vakili Modarres Hospital, Shaheed Beheshti University of Medical Sciences, Tehran, Iran. 2015 10 03 Background: Complete atrioventricular block (AV block) is a serious complication of slow pathway ablation therapy in the treatment of atrioventricular nodal re-entrant tachycardia (AVNRT).  The present study was aimed at determining whether the electroanatomical pace mapping of Koch’s triangle could significantly improve the safety, efficiency, and efficacy of selective slow pathway ablation in the treatment of AVNRT. Methods: A total number of 124 patients were selected to be studied consecutively for radiofrequency (RF) ablation therapy in the treatment of AVNRT.  The subjects were divided into two groups: one, designated Group 1, to serve as the control group, and the other, designated Group 2, to serve as the study group.  Conventional fluoroscopic slow pathway ablation was performed on the Group 1 subjects (n=66), with the Group 2 subjects receiving slow pathway ablation therapy guided by pace mapping of Koch’s triangle.  The slow pathway ablation in Group 2 (n=58) was performed with regard to the pace mapping data obtained on the basis of the St-H interval in the anteroseptal (AS), midseptal (MS), and posteroseptal (PS) regions of Koch’s triangle.  The anterograde fast pathway (AFP) location was determined based on the shortest St-H interval obtained by stimulating the anteroseptal (AS), midseptal (MS), and posteroseptal (PS) aspects of Koch’s triangle. Results: In the Group 2 subjects, AFP location was AS in 50 (86.2%) of the cases, MS in 7 (12%) of the cases, and PS in 1 case (1.7%).  One patient with posteroseptal AFP was administered retrograde fast pathway ablation therapy.  One patient in the control group (Group 1), representing 1.5% of the group, developed persistent AV block in the course of the treatment, but none of the subjects in the study group (Group 2) developed any complications.    Conclusion: It was concluded that an atypical fast pathway location is conducive to the development of atrioventricular block in the ablation therapy in AVNRT, with pace mapping of Koch’s triangle having the capacity to eliminate the risk of any such complication developing.  It follows that it helps to identify the AFP location before ablation therapy is administered in AVNRT, thereby improving the safety of the treatment.     https://jthc.tums.ac.ir/index.php/jthc/article/view/87 https://jthc.tums.ac.ir/index.php/jthc/article/download/87/85

Tehran University of Medical Sciences The Research in Heart Yield and Translational Medicine (RHYTHM) 3115-7270 3 2 2008 04 15 89 94 Hakimeh Sadeghian Tehran Heart Center, Medical Sciences / University of Tehran, Iran. Abbasali Karimi Tehran Heart Center, Medical Sciences / University of Tehran, Iran. Mehran Mahmoodian Tehran Heart Center, Medical Sciences / University of Tehran, Iran. Hossein Ahmadi Tehran Heart Center, Medical Sciences / University of Tehran, Iran. Seyed Hesameddin Abbasi Tehran Heart Center, Medical Sciences / University of Tehran, Iran. 2015 10 03 Background: This study was undertaken to compare the outcome in patients with moderate to severe ischemic mitral regurgitation (IMR) undergoing coronary artery bypass grafting (CABG) with either mitral valve repair or mitral valve replacement. Methods: Between March 2002 and February 2005, 49 consecutive patients (mean age: 62.84±8.42 years; mean EuroSCORE: 10.03±3.12) with coronary artery disease and moderate to severe IMR underwent CABG plus mitral valve replacement or mitral valve repair. The patients with annulus dilatation were more likely to undergo repair. The mean follow-up period was 18.89±2.1 months. Results: 40.8% of the patients underwent CABG plus mitral valve replacement, and 59.2% had CABG concomitant with mitral valve repair. The total rate of mortality in our population was 14.9% (7 patients) including 10.3% (3 patients) early mortalities; all the deceased patients were in the repair group. Both groups had a similar EuroSCORE, but more patients in the repair group had a recent episode of unstable angina (65.5% vs. 35.0%, respectively; P=0.035) and diabetes mellitus (44.8% vs. 10.0%, respectively; P=0.009). After the follow-up period, in the repair group, 11.5% had no features of Mitral regurgitation (MR); while 50% had mild MR, 23.1% moderate MR, 11.5% moderately severe MR, and 3.8% severe MR. Overall, 68.9% had no or mild MR, which we defined as successful repair, and 31.1% had moderate to severe MR. Success of repair and mortality were not statistically related to preoperative ejection fraction (39.2±7.8% vs. 32.5±8.5%; P=0.057). Conclusion: Early mortality was higher in the repair group than that in the replacement group, but this may have been due to the higher frequency of diabetes mellitus and unstable angina in the former group. Future studies are required to determine the benefit of repair versus replacement concomitant with CABG in IMR patients. https://jthc.tums.ac.ir/index.php/jthc/article/view/88 https://jthc.tums.ac.ir/index.php/jthc/article/download/88/86

Tehran University of Medical Sciences The Research in Heart Yield and Translational Medicine (RHYTHM) 3115-7270 3 2 2008 04 15 95 100 Mohammad Asadpour Piranfar Taleghani Hospital, Shahid Beheshti University of Medical Sciences, Tehran, Iran. Mersedeh Karvandi Taleghani Hospital, Shahid Beheshti University of Medical Sciences, Tehran, Iran. Arash Mohammadi Tofigh Imam Hussein Hospital, Shahid Beheshti University of Medical Sciences, Tehran, Iran. 2015 10 03 Background: We sought to assess right ventricular (RV) systolic and diastolic functions via tissue Doppler imaging (TDI) in order to discriminate right-to-left (bidirectional) from left-to-right intracardiac shunts. Methods: A tissue Doppler velocity study via Doppler echocardiography was performed in 20 patients with left-to-right shunt (without evidence of significant pulmonary hypertension) and 20 patients with right-to-left shunt or bidirectional shunt (with significant pulmonary hypertension) or Eisenmenger΄s complex and 20 healthy subjects as the control group. RV myocardial performance index (MPI), S wave velocity, E wave velocity, isovolumic relaxation time (IVRT), and isovolumic contraction time (IVCT) from the lateral tricuspid annulus were measured using TDI. Results: In the patients with left-to-right shunt, the tissue Doppler parameters showed higher S-wave, peak systolic(Sa)/early contraction(Ea) , Sa/IVRT, and Sa/IVCT values; and in the patients with right-to-left or bidirectional shunt tissue, the Doppler parameters showed higher MPI and MPI/Sa value with a high specificity and sensitivity. Conclusion: We conclude that an evaluation of MPI, S wave, E wave, IVRT, and IVCT via tissue Doppler echocardiography is a useful index for the discrimination of right-to-left from left-to-right and bidirectional intracardiac shunts. https://jthc.tums.ac.ir/index.php/jthc/article/view/89 https://jthc.tums.ac.ir/index.php/jthc/article/download/89/87

Tehran University of Medical Sciences The Research in Heart Yield and Translational Medicine (RHYTHM) 3115-7270 3 2 2008 04 15 101 106 Mahdi Najafi Tehran Heart Center, Medical Sciences/University of Tehran, Tehran, Iran. Mehrdad Sheikhvatan Tehran Heart Center, Medical Sciences/University of Tehran, Tehran, Iran. Ali Montazeri Tehran Heart Center, Medical Sciences/University of Tehran, Tehran, Iran. Seyed Hesameddin Abbasi Tehran Heart Center, Medical Sciences/University of Tehran, Tehran, Iran. Mahmood Sheikhfatollahi Tehran Heart Center, Medical Sciences/University of Tehran, Tehran, Iran. 2015 10 03 Background: The Short Form Health Survey (SF-36) and WHO Quality of Life-BREF (WHOQOL-BREF) questionnaires are two common tools to assess changes in quality of life (QOL) over the course of treatment, especially in patients with coronary artery disease (CAD). However, the value of these two instruments among CAD patients has not been studied and compared. The objective of the present study was; therefore, to compare the SF-36 with the WHOQOL-BREF in these patients. Methods: Between May and September 2006, patients with a final diagnosis of CAD who were candidates for isolated coronary artery bypass grafting (CABG) and hospitalized in Tehran Heart Center were randomly divided into two groups of 268 patients (for assessment of QOL with the SF-36) and 275 patients (for assessment of QOL with the WHOQOL-BREF). The correlations between the WHOQOL-BREF domains and SF-36 subscales, in addition to those between the SF-36 components summary scores and WHOQOL-BREF domains, were examined with Pearson's correlation coefficients. Results: The correlations between the physical, psychological, and social domains of the WHOQOL-BREF and physical functioning, mental health, and social functioning of the SF-36 were weak with Pearson's correlation coefficients of 0.015, -0.036, and 0.042, respectively (r<0.3). There were also poor correlations between the physical component summary of the SF-36 and physical domain of the WHOQOL-BREF (r=0.001), and between the mental can, Iran. Alireza Amirzadegan Tehran Heart Center, Tehran University of Medical Sciences, Tehran, Iran. Mohammad Sadeghian Tehran Heart Center, Tehran University of Medical Sciences, Tehran, Iran. Masoumeh Lotfi-Tokalday Tehran Heart Center, Tehran University of Medical Sciences, Tehran, Iran. 2015 10 03 Background: The optimal target for revascularization in patients with history of coronary artery bypass graft surgery (CABG) is unclear. This study was designed to compare the outcome of percutaneous coronary intervention (PCI) on saphenous vein grafts (SVG) and that on native vessels in patients with previous CABG in terms of major adverse cardiac events (MACE). Methods: The study drew upon data on consecutive patients hospitalized for PCI and MACE rate during a nine-month follow- up period. The patients were divided according to the target vessel for PCI into two groups: SVG and native vessel. Results: Between 2003 and 2007, 226 patients underwent PCI 6.57 ± 4.55 years after CABG. Their mean age was 59.52±9.38 years, and 176 (77.9%) were male. PCI was performed on the SVG in 63 (27.9%) patients and on the native coronary artery in the rest. During a nine-month follow-up period, 9 (4%) patients suffered MACE; the prevalence of MACE was not significantly different between the SVG group (4.8%) and the native vessel group (4.9%), (p value = 0.999).  Conclusion: PCI on grafted and native vessels did not affect MACE in patients undergoing PCI after CABG. https://jthc.tums.ac.ir/index.php/jthc/article/view/215 https://jthc.tums.ac.ir/index.php/jthc/article/download/215/213

Tehran University of Medical Sciences The Research in Heart Yield and Translational Medicine (RHYTHM) 3115-7270 6 3 2011 09 15 148 151 Maryam Esmaeilzadeh Echocardiography Research Center, Shaheed Rajaei Cardiovascular, Medical and Research Center, Tehran, Iran Nooshin Hadizadeh Echocardiography Research Center, Shaheed Rajaei Cardiovascular, Medical and Research Center, Tehran, Iran Feridoun Noohi Echocardiography Research Center, Shaheed Rajaei Cardiovascular, Medical and Research Center, Tehran, Iran 2015 10 03 The anomalous origin of the left coronary artery from the pulmonary artery (ALCAPA) is a rare congenital cardiac malformation. It presents predominantly in infancy and its main presenting feature is myocardial ischemia or heart failure. Survival to adulthood is quite uncommon. If untreated, mortality from ALCAPA approaches 90% in infancy; early recognition and surgical correction are, therefore, essential. With early surgical correction, the prognosis is good. There are two types of ALCAPA syndrome: the infant type and the adult type, each of which has different manifestations and outcomes. Infants experience myocardial infarction and congestive heart failure, and approximately 90% die within the first year of life. A literature review regarding this anomaly in teenagers and adults show that only 25 cases have been diagnosed during life and 18 additional cases of ALCAPA in these age groups have been diagnosed post mortem. We present a rare case of a 60-year-old man, who referred to our center due to dyspnea on exertion from the previous year without any history of chest pain and diagnosed as ALCAPA. Given the absence of ischemia and the patient’s age, only medical therapy was recommended. https://jthc.tums.ac.ir/index.php/jthc/article/view/216 https://jthc.tums.ac.ir/index.php/jthc/article/download/216/214

Tehran University of Medical Sciences The Research in Heart Yield and Translational Medicine (RHYTHM) 3115-7270 6 3 2011 09 15 152 154 Ahmad Yaminisharif Tehran Heart Center, Tehran University of Medical Sciences, Tehran, Iran. Akbar Shafiee Tehran Heart Center, Tehran University of Medical Sciences, Tehran, Iran. Mohammad Sahebjam Tehran Heart Center, Tehran University of Medical Sciences, Tehran, Iran. Ali Moezzi Tehran Heart Center, Tehran University of Medical Sciences, Tehran, Iran. 2015 10 03 We introduce a 32-year-old man who was evaluated for a dizziness and headache of unknown origin for at least two months and was referred to our center after ECG findings. He was finally diagnosed as a case of idiopathic, familial, diffuse, persistent atrial standstill, which is a rare arrhythmogenic condition characterized by the absence of electrical and mechanical activity in the atria. He successfully received a single-chamber permanent pacemaker. https://jthc.tums.ac.ir/index.php/jthc/article/view/217 https:/