Huge arteriovenous fistula between a giant aneurismal right coronary artery and coronary sinus

Coronary arteriovenous fistulas are rare and may be congenital, traumatic, or iatrogenic. We report one of these rare congenital anomalies with a giant aneurismal right coronary artery (RCA) in a middle-aged lady who was asymptomatic for a long time

Thrombosis on implanted device for atrial septal defect closure or echocardiographic beam width artifact? A diagnostic enigma!

A 29 year old woman with NYHA functional class II and large secundum type atrial septal defect (ASD) underwent successfully percutaneous ASD closure with Figula ASD occluder (no. 30) without any peri-procedural complication. After 2 days she underwent transthoracic echocardiography and a large hypo-echoic mass was seen on left atrial side of implanted device in multiple views, suggestive of thrombosis or echocardiographic beam width artifact? A diagnostic enigma!. © Springer Science+Business Media, B.V. 2012

Impact of vitamin C supplementation on post-cardiac surgery ICU and hospital length of stay

Background: Prolonged intensive care unit (ICU) and hospital stay after cardiac surgery is vitally important and is influenced by both intraoperative and postoperative factors.Objectives: This randomized clinical trial study was designed to assess whether vitamin C supplementation could reduce the length of ICU and hospital stay in post-cardiac surgery patients.Patients and Methods: Two hundred and ninety patients scheduled for adult cardiac surgery including coronary, valve and congenital operations were randomized into two groups: an intervention group, who received 2 g of vitamin C (ascorbic acid) intravenously, immediately before surgery in the operating theatre, followed by 1 g daily oral doses for the first 4 postoperative days; and a placebo group,who received an equal number of identical tablets in the same shape and size. Results: Hospital length of stay was significantly different between the two groups (10.17 ± 4.63 days in the intervention group vs. 12 ± 4.51 days in the placebo group; P = 0.01), while there was no significant difference in the ICU stay between the groups (3.42 ± 1.06 days in intervention group vs. 3.43 ± 1.09 days in the placebo group; P = 0.88). There were significant differences in the intubation time and the drainage volume in the ICU and the first 24 postoperative hours between the two groups (P for both = 0.003). Conclusions: Vitamin C can decrease the length of hospital stay, drainage volume in the ICU and in the first 24 postoperative hours, intubation time and some complications in patients after cardiac surgery; perhaps by decreasing inflammatory factors. Background: Prolonged intensive care unit (ICU) and hospital stay after cardiac surgery is vitally important and is influenced by both intraoperative and postoperative factors.Objectives: This randomized clinical trial study was designed to assess whether vitamin C supplementation could reduce the length of ICU and hospital stay in post-cardiac surgery patients.Patients and Methods: Two hundred and ninety patients scheduled for adult cardiac surgery including coronary, valve and congenital operations were randomized into two groups: an intervention group, who received 2 g of vitamin C (ascorbic acid) intravenously, immediately before surgery in the operating theatre, followed by 1 g daily oral doses for the first 4 postoperative days; and a placebo group,who received an equal number of identical tablets in the same shape and size. Results: Hospital length of stay was significantly different between the two groups (10.17 ± 4.63 days in the intervention group vs. 12 ± 4.51 days in the placebo group; P = 0.01), while there was no significant difference in the ICU stay between the groups (3.42 ± 1.06 days in intervention group vs. 3.43 ± 1.09 days in the placebo group; P = 0.88). There were significant differences in the intubation time and the drainage volume in the ICU and the first 24 postoperative hours between the two groups (P for both = 0.003). Conclusions: Vitamin C can decrease the length of hospital stay, drainage volume in the ICU and in the first 24 postoperative hours, intubation time and some complications in patients after cardiac surgery; perhaps by decreasing inflammatory factors. © 2015, Iranian Society of Regional Anesthesia and Pain Medicine (ISRAPM)

Relationship between syncope and sudden cardiac death in patients with hypertrophic cardiomyopathy and left ventricular mass index calculated bymagnetic resonant imaging

Study background and objective: Hypertrophic cardiomyopathy (HCM) is the most common genetic cardiovascular disorder and is estimated to have affected one out of every 500 people. The symptoms of HCM can be diagnosed from early childhood and include dyspnea on exertion, chest pain, pre-syncope, and syncope resulting from the left ventricular (LV) outflow tract obstruction, LV systolic and diastolic dysfunction, and ventricular and supraventricular arrhythmia. Material and methods: We assessed the effect of the LV mass index on syncope and sudden death in 60 HCM patients who were more than 16 years of age and referred to Rajaie Cardiovascular, Medical and Research Center between 2009 and 2012. The patients were studied using magnetic resonance imaging. Findings: The study results indicated that the patients were on average 45.53±16.85 years old. The t-test showed that gender exerted no influence on the following variables: palpitations; family history; maximum thickness of the LV wall; sudden death; and syncope. In contrast, the age variable had a meaningful effect on the maximum thickness of the LV wall, LV mass, and LV mass index. There was no significant relationship between the LV mass index and sudden cardiac death. Conclusions: Our results were indicative of a negative and significant relationship between age and all of the aforementioned variables. Also, there was no significant relationship between the LV mass index and sudden cardiac death. © 2015, Iranian Heart Association. All rights reserved

Assessment of pulmonary regurgitation severity in tetralogy of fallot total correction: Comparison between doppler echocardiography and cardiac MRI

Background: Pulmonary regurgitation is a common finding in patients after tetralogy of Fallot total correction (TFTC). Right ventricular enlargement and dysfunction have been ascribed to pulmonary insufficiency (PI), which is an important issue in the follow-up of patients with TFTC. We sought to compare PI measured by echocardiography with data provided by cardiac magnetic resonance imaging (CMR). Methods: We studied 155 selected patients (91 male; median age = 25.65 y, range = 15-55 y) after TFTC. To quantify the pulmonary regurgitant fraction (PRF) by CMR, we performed flow velocity mapping. On Doppler echocardiography, the length, width, and localization of the regurgitant flow, no-flow time, and pressure half-time were measured. The severity of PI on echocardiography was categorized as nonsignificant and significant and was thereafter compared to the data obtained by CMR. Results: In all 155 patients, the measurement of the flow and volume was possible by CMR, and the measurement of PI was possible by Doppler echocardiography. The mean PRF, as determined by CMR, was 33 ± 16.4. Pulmonary regurgitation has been reported to be a causative factor in right ventricular volume enlargement. A PRF > 20 was considered significant and was compared with echocardiographic parameters and also right ventricular size and function and other indices resulted from CMR. The regression analysis showed a significant correlation between PI severity on CMR and right ventricular enlargement on MRI at end diastole (r = 0.746; P < 0.001) and also at end systole (r = 0.71; P < 0.05). Conclusions: There was no significant correlation between right ventricular ejection fraction and PI severity on CMR (r=0.553; P=0.45). On echocardiography, the semiquantitative estimation of pulmonary regurgitation showed that there were 26 patients with mild-to-moderate PI and 99 patients with severe PI. A right ventricular end-diastolic volume index (RVEDVI) of 121 mL/m² was 87 sensitive and 54 specific for severe PI, and an RVEDVI of 180 mL/m² was 90 specific for severe PI. © 2016, Iranian Heart Association. All rights reserved

Echocardiographic assessment of adults with repaired tetralogy of fallot: A cardiovascular magnetic resonance comparison study

Background-Surgical management of the tetralogy of Fallot (TOF) results in anatomic and functional abnormalities in the majority of patients. Right ventricular (RV) dilation from pulmonary regurgitation (PR), residual atrial and/or ventricular septal defect, tricuspid regurgitation, right ventricular outflow tract (RVOT) aneurysm, and pulmonary artery peripheral stenosis are some of the abnormalities frequently encountered in patients with repaired TOF. Cardiovascular magnetic resonance (CMR) can provide assessments of anatomical connections, biventricular function, flow measurement, and more, without ionizing radiation. Echocardiography is the most frequently used modality for the initial assessment and follow-up of most patients with CHD. We sought to evaluate adult patients with repaired TOF by transthoracic echocardiography and compare them with CMR. Methods-156 patients (52 women, mean age= 23 ± 5.5 years) late after TOF repair with severe PR were evaluated. Ventricular size and function and TOF -associated anomalies such as patent ductus arteriosus (PDA), peripheral pulmonary stenosis (PPS), and persistent left superior vena cava (LSVC) were evaluated by transthoracic echocardiography and CMR separately. Results- Mean of LV ejection fraction by CMR was 52 ± 9 and by echocardiography was 47 ± 5.1 . We found a significant correlation between LVEF assessed by CMR and 2D visual assessment in multiple views. Mean of RVEF by CMR was 37± 8 and RV end diastolic volume index was 161± 57.3 mm 3. Linear correlation between CMR-RVEF and RVEF measured by echocardiography was weak. There was almost perfect agreement between CMR and echocardiography for the diagnosis of LSVC (99.2). Agreement was 88.3 in the diagnosis of PDA, 66.4 in the diagnosis of PPS, and 93 in the diagnosis of the right aortic arch was. Conclusion- Adults late after repaired TOF have significantly reduced biventricular systolic function. Despite abnormal LV geometry, visual assessment of LV systolic function by an expert echocardiologist has an acceptable agreement compared to the quantitative measurement of LV systolic function by CMR. However, the correlation between CMR-RVEF and RVEF measured by echocardiography is weak. We found incremental diagnostic value of CMR in PPS and PDA. Atrial septal defect and ventricular septal defect are found more frequently by echocardiography