Left Ventricular Pseudoaneurysm as a Complication of Myocardial Infarction; A Case Series and Review of the Literature

Introduction: Pseudoaneurysm may occur as a rare complication of myocardial infarction (MI) when a hemorrhagic process is covered by adherence of the visceral or parietal pericardium or of both, preventing the formation of cardiac tamponade. Pseudoaneurysm is prone to rupture because they are not easy to diagnose. Case presentation: Here, we report three cases of left ventricular pseudo-aneurysm (LVP) that all were related to MI. Two patients were managed conservatively, one of them was lost to follow-up, and the other one expired one month later. One patient underwent surgery, but he expired during post-operation period. Conclusions: High mortality rate of LVP emphasizes the importance of looking for it in cardiac evaluation of patients with history of MI. Due to available non-invasive modalities, the ability to differentiate LVP from other cardiac pathologies is improving. Still, the most recommended management of LVP is early surgery

Evaluation of the Ventricular Mechanical Dyssynchrony in Patients with Atrial Septal Defect

Background: There is some evidence indicating improvement in myocardial performance after atrial septal defect closure, either device closure or surgical, but ventricular dyssynchrony has not been evaluated before and after surgical closure. The aim of this study was to evaluate ventricular mechanical dyssynchrony in patients with atrial septal defect before and after surgical closure.Methods: Twenty patients (mean age: 23±11years) with isolated secundum or sinus venosus type atrial septal defect, unsuitable for device closure, were evaluated before and after successful surgical closure. Interventricular and intraventricular dyssynchrony (using 6 basal and 6 mid-segmental models) were determined.Results: A significant reduction in the right atrial and right ventricular dimensions and the tricuspid regurgitation peak gradient was noted after atrial septal defect closure (3.6±0.54 cm versus 4.2±0.7, P=0.009; 3.5±0.29 cm versus 4.3±0.41, P=0.02; and 20.4±10.5 mmHg versus 35.3±6.5, P<0.002; respectively).There was no significant difference in the maximum difference in time-to-peak systolic velocity and the standard deviation of time-to-peak systolic velocity of the l2 left ventricular myocardial segments in the patients with atrial septal defect before and after surgical closure in comparison with the normal subjects (normal: 26±10.64 ms versus before closure: 21.0±33.9 versus after closure: 27±29.5, both P=0.68) and the left ventricular asynchrony index after atrial septal defect closure (normal: 14.9±8.7 versus before closure: 11.46±8.5 versus after closure: 18.12±13.6, both P=0.2). There was a significant positive relation between the tricuspid regurgitation peak gradient and the left ventricular asynchrony index (r=0.67, P=0.03) and an insignificant negative relation between the left ventricular ejection fraction and the asynchrony index before atrial septal defect closure (r=−0.53, P=0.11). No significant relation was found between the total asynchrony index and the atrial septal defect size, the degree of left-to-right shunt, and the tricuspid regurgitation peak gradient.Conclusion: There was no significant ventricular dyssynchrony in the patients with atrial septal defect before and after surgical closure

The outcomes of marginal donor hearts compared with ideal donors: a single-center experience in Iran

Background : Heart transplantation has been considered the gold-standard treatment for patients with end-stage heart failure. This study assessed the survival outcomes of marginal donor hearts compared with ideal donor hearts in Iran. Methods : This retrospective study is based on the follow-up data of heart donors and recipients in the Sina Hospital Organ Procurement Unit. Among the 93 participants, 75 were categorized as ideal donors (group A) and 18 as marginal donors (group B). Group C included heart recipients who received a standard organ, and group D included heart recipients who received a marginal one. To analyze differences in patient characteristics among the groups, posttransplant heart survival was assessed in all groups. All data were obtained from the hospital records. Results : The mean age of the donors was 26.27±11.44 years (median age, 28 years). The marginal age showed a significant association with donor age. The age of recipients had a significant effect on survival days in the ideal group. Most patients survived for at least 1 year, with a median of 645 days in recipients from marginal donors and 689 days in recipients from ideal donors. Conclusions: Considering the lack of organ availability in Iran, it may be possible to use marginal donors for marginal recipients, therefore reducing the number of people on the waitlist. We also recommend establishing a national marginal donor system specifically for Iranian patients to extend the donor pool