Retained Jailed Wire: A Case Report and Literature Review

Side branch wiring is not infrequently used to protect side branch flow after main vessel stenting. Rarely, it becomes difficult to retrieve the jailed wire behind the stent and therefore it may even be detached and remained in the circulation. This article presents a report of such a case and reviews treatment options

Estimation of left ventricular end diastolic pressure (lvedp) in patients with ischemic heart disease by echocardiography and compare it with the results of cardiac catheterization

<strong>BACKGROUND:</strong> Doppler echocardiography has been proposed as an appropriate non-invasive<br />assay to estimate left ventricular end diastolic pressure (LVEDP). The aim of present research<br />was to estimate the LVEDP in patients with ischemic heart disease by echocardiography and<br />compare it with the results of cardiac catheterisation and to determine the effect of different<br />echocardiographic variables on its measurement.<br /><strong>METHODS:</strong> In this descriptive-analytic study, patients with diagnosed ischemic heart disease<br />were selected by nonrandomized sampling method. Selected population underwent M-mode<br />and pulse doppler echocardiographic evaluation and parameters such as Q-Mitral valve E<br />(Q-MVE), Q-Aortic valve closure (Q-AVC), Aortic valve closure-E (AVC-E), Q-Mitral valve<br />closure/Aortic valve closure-E (Q-MVC/AVC-E), left ventricle-deceleration time (LV-DT), peak<br />velocity-deceleration time (PV-DT) and A/E velocity time integral (A/E VTI) were evaluated.<br />Immediately after echocardiography all patients underwent left heart catheterization for LVEDP<br />measurement. The relation between different echocardiographic measurements and LVEDP,<br />obtained by cardiac catheterization, was evaluated.<br /><strong>RESULTS:</strong> In this study, 47 patients with ischemic heart disease with mean age (&plusmn;SD) of<br />53 &plusmn; 13 were studied. There was a significant correlation between LVDEP and A/E VTI (r=0.44,<br />P = 0.001, and also between LVEDP and PV-DT in patients with A/E VTI &ge;1.1(r = -0.58, P = 0.02).<br />There was a significant correlation between LVEDP and Q-MVC/AVC-E in patients with LVEDP<br />&gt;18mmHg (r = 0.76, P= 0.03) and those with LVEDP &le;18 mmHg and A/E VTI &lt; 1.1<br />(r = 0.37, P= 0.03). The correlation between LVEDP and A/E VTI was more significant in men,<br />in patients aged &gt; 50 years with EF &gt; 55%, without LVH, without MR and those with coronary<br />artery disease (P &lt; 0.05).<br /><strong>CONCLUSION:</strong> Some echocardiographic indices such as A/E VTI, Q-MVC/AVC-E and PV-DT<br />are able to measure LVEDP especially in male patients aged &gt; 50 years, without LVH, without<br />MR and those with coronary artery disease but it is necessary to determine specific conditions<br />and factors affecting these indices, by further studies.<br /><strong>Keywords:</strong> LVEDP, Coronary Artery Disease, Echocardiography

Immediate results and six-month outcomes after percutaneous coronary intervention in a referral heart center in Isfahan, Iran

BACKGROUND: There is a lack of data in our society on the outcomes, complications, and prognostic factors in patients with coronary artery disease who underwent percutaneous coronary intervention (PCI). We evaluated the success rate, early and late outcomes, and prognostic factors in a referral university center in Isfahan, IRAN. &nbsp;&nbsp; METHODS: This prospective cohort study was conducted in Chamran University Hospital in Isfahan (IRAN) from March 2010 to February 2011. Patients consequently were included if they have the indication for emergent or elective PCI. Outcomes included procedural success, complications, and major adverse cardiovascular events (MACE) during hospitalization and 6 months follow-up. &nbsp;&nbsp; RESULTS: A total of 282 patients (74.1% females) with mean age of 57.0&plusmn;3.2 years were studied. Most of the patients (89.7%) underwent elective PCI. Angiographic and procedure success rates were 95.7% and 94.6%, respectively. In-hospital MACE included two cases of death (0.7%) and one MI (0.3%); 2/29 (6.9%) of the emergent PCI and 1/253 (0.4%) of the elective PCI cases. MACE during follow-up included three cases of death (1.0%) and two MI (0.7%); 2/252 (0.8%) of the elective PCI and 1/28 (3.5%) of the emergent PCI cases. The overall MACE was calculated as 8 cases (2.8%) which included 5/29 (17.2%) of the emergent and 3/253 (1.1%) of the elective cases; P &lt; 0.001. In multivariate analysis, none of the factors including gender, age, emergency of the procedure, lesion type, number of stenotic vessels, or stent type were associated with total MACE (P &gt; 0.05). &nbsp;&nbsp; CONCLUSION: PCI is performed with an acceptable success rate in our center in Isfahan and mortality and complications are within the range reported by other highly specialized centers in IRAN. Further studies with larger sample size are needed to find predictive factors.Keywords: Percutaneous coronary intervention, Myocardial infarction, Acute coronary syndrome, Reperfusion therapy, Outcome, Mortality.</p

Percutaneous transvenous mitral commissurotomy in a patient with situs inversus and dextrocardia: a case report

<p class="abstract"><strong>INTRODUCTION:</strong> Dextrocardia situs inversus refers to the heart being a mirror image situated on the right side of the body. Distorted cardiac anatomy provides technical difficulties during fluoroscopy‐guided transcatheter procedures. This is even more difficult in the case with percutaneous transvenous mitral commissurotomy (PTMC). Mitral valvuloplasty is a minimally invasive therapeutic procedure to correct an uncomplicated mitral stenosis by dilating the valve using a balloon. Here, we describe a case of a 25 years-old male with situs inversus and dextrocardia.</p> <p class="abstract"><strong>CASE REPORT</strong>: A 25 years-old man, having situs inversus and suffering from mitral stenosis was referred to hospital for PTMC. His initial examination findings were unremarkable and an electrocardiographic (ECG), trans-esophageal and transthoracic echocardiographic evaluation were performed. Mitral valve (MV) was dome shape and severely stenotic with mild mitral regurgitation (MR). Left ventricular&nbsp;ejection Fraction (LVEF) was about 40%, Femoral arterial and venous punctures were made on the left side; the left femoral artery and vein were cannulated with a 5F arterial and 6F venous sheaths, respectively. Then special maneuvers were done to solve the mitral valve stenosis. At the end of the procedure, no MR was documented by checking LV angiogram and there were no signs of mitral stenosis (MS).</p> <p class="abstract"><strong>DISCUSSION:</strong> Mirror‐image dextrocardia, as in our case, has been estimated to occur with a prevalence of 1:10,000. However, there are only a few case reports in the literature on PTMC in similar settings. This might be due to the fact that many of these patients undergo surgical commissurotomy due to the technical difficulties involved in a percutaneous procedure in general. Trans-septal catheterization is considered a technical challenge in anatomically malpositioned hearts, as it is fraught with a higher risk of cardiac perforation. Despite the challenging anatomy, PTMC has been demonstrated to be a safe and feasible option for MS in patients with unusual cardiac anatomy.</p> <p class="abstract">&nbsp;</p> <p class="abstract">&nbsp;</p><table cellspacing="0" cellpadding="0" align="left"><tbody><tr><td width="35" height="12">&nbsp;</td></tr><tr><td>&nbsp;</td><td>&nbsp;</td></tr></tbody></table><p class="abstract"><strong>Keywords:</strong> PTMC, Dextrocardia, Surgical Commissurotomy</p

Diagnostic performance of 64-row coronary CT angiography in detecting significant stenosis as compared with conventional invasive coronary angiography

BACKGROUND: The aim of the present study is to evaluate the accuracy of 64-multidetector-row computed tomography angiography (CTA) in comparison to conventional invasive angiography (CIA) in the diagnosis of significant stenosis (≥ 50) of coronary artery tree. METHODS: Assessment of CTA in the detection of coronary artery disease (CAD) was performed in patients referred because of symptoms or stress studies suggestive of ischemia. For this purpose, among more than 1000 cases of coronary CTA in a 20 months period a study population of 54 patients suspected to have significant stenosis of the coronary artery tree was investigated. The CIA procedure was performed in these patients one month after CTA. The accuracy of CTA in detecting significant stenosis was compared to CIA. RESULTS: For vessel based analysis of 179 coronary vessels, CTA had a sensitivity of 96, specificity of 87.5, positive predictive value of 90.5, and negative predictive value of 94.6. For patient-base analysis, the sensitivity, specificity, positive predictive value (PPV), and negative predictive value (NPV) of CTA were 97.9, 28.6, 66.6, and 90.2, respectively. CONCLUSION: The findings of this study reveal that CT angiography with 64-slice scanner could be considered as a suitable technique for rapid triage of patients presenting to hospitals with chest pain. High values of sensitivity and PPV reveal the good performance of CTA in detecting CAD

Magnesium status and the metabolic syndrome: A systematic review and meta-analysis

Objectives: To systematically review the published evidence regarding the association between Mg intake and serum concentrations with MetS and, if possible, to summarize the results using a meta-analysis. Methods: PubMed, ISI Web of Science, Scopus, and Google Scholar were searched to identify related articles. Fully adjusted odds ratios (ORs) of MetS in participants with the highest intake of Mg compared with those who had the least consumption, and the mean difference in serum Mg levels between patients with MetS and their controls were extracted for the meta-analysis. Results: In total, 9 articles with 31 876 participants were included in the meta-analysis regarding the association between dietary Mg intake and MetS, and 8 studies that assessed the mean level of serum Mg in 3487 individuals with and without MetS were eligible. Our analysis found that higher consumption of Mg is associated with lower risk of MetS (OR = 0.73; 95% confidence interval: 0.62, 0.86; P < 0.001); we also could find a significant but heterogeneous association between serum Mg and MetS (mean difference: -0.19; 95% confidence interval: -0.36, 0.03; P = 0.023). Conclusions: The present systematic review and meta-analysis found an inverse association between Mg intake and MetS. However, the inverse association for serum Mg levels was highly heterogeneous and sensitive. The link between Mg status and MetS should be confirmed by prospective cohort studies controlling the association for other nutrients related to MetS risk. © 2016 Elsevier Inc

Evaluating the impact of fractional flow reserve-guided percutaneous coronary intervention in intermediate coronary artery lesions on the mode of treatment and their outcomes: An Iranian experience.

BACKGROUND: Today, the fractional flow reserve (FFR) guides the physician to select suitable patients with intermediate severity coronary lesions in angiography that should be treated or not with stent. The aim of this study was to evaluate the impact of using FFR in the selection of appropriate treatment strategy in angiographic intermediate coronary lesions and their short-term outcome in a sample of Iranian population. METHODS: In a prospective cohort, 34 patients who had intermediate coronary artery lesion(s), defined as having a 40-70% diameter stenosis, as determined by visual estimation or quantitative coronary angiography were enrolled through a convenience sampling method. All patients underwent FFR measurement to decide whether percutaneous coronary intervention should be performed. The results of visual assessment, quantitative coronary angiography, and functional assessment of the severity of coronary stenosis were compared. Significant stenosis was defined as FFR < 0.80. All patients were followed for 6 months for the incidence of major advanced cardiac events. RESULTS: In this study, 34 patients (22 male and 12 female) with mean age of 57 ± 8 (range 45-70) were included. In 26.47% (9/34) of patients, FFR was 0.80 and stenting was done to the other vessels with significant coronary lesions. CONCLUSION: Measurement of FFR is a useful approach in making clinical decisions about revascularization procedures in patients with moderate coronary artery lesion severity, especially in LM and multivessel disease. This study showed that not only FFR can change treatment plan of the patients, but also it would improve clinical outcomes. KEYWORDS: Coronary Angiography; Coronary Stenosis; Fractional Flow Reserve Myocardia

Developing and validating questionnaires to assess knowledge, attitude, and performance toward obesity among Iranian adults and adolescents: TABASSOM study

Abstract BACKGROUND: The present study describes the methods of developing and validating two questionnaires that will be used to investigate the knowledge, attitude and practice of adults, children and adolescents regarding obesity

Right Atrial Thrombus in a COVID-19 Child Treated Through Cardiac Surgery

We herein report a case of large intracardiac thrombus in a child with SARS-CoV-2 infection (COVID-19). The diagnosis of COVID-19 was confirmed through HRCT and RT-PCR. Transthoracic echocardiography revealed a large thrombus in the right atrium treated successfully via cardiac surgery. The underlying mechanisms of this thrombus in the COVID-19 infection may be attributed to the hypercoagulation and inflammatory condition incurred by the COVID-19 virus