Prevalence of Structural Heart Diseases Detected by Handheld Echocardiographic Device in School-Age Children in Iran: The SHED LIGHT Study

Background: Structural heart disease (SHD) has great impacts on healthcare systems, creating further public health concerns. Proper data are scant regarding the magnitude of the affected population by SHD. Objectives: This study aimed to determine the prevalence of SHD among children and adolescents in an Iranian population. Methods: In this population-based study, a multistage cluster-random sampling was used to choose schools from the Tehran urban area. All students were examined using a handheld Vscan device by echocardiographer, and the results were concurrently supervised and interpreted by cardiologists. All the major findings were reevaluated in hospital clinics. Results: Of 15,130 students (6-18 years, 52.2% boys) who were examined, the prevalence of individuals with congenital heart disease (CHD) and cardiomyopathy was 152 (10.046 per 1,000 persons) and 9 (0.595 per 1,000 persons), respectively. The prevalence of definite and borderline rheumatic heart disease (RHD) was 30 (2 per 1,000 persons) and 113 (7.5 per 1,000 persons), correspondingly. Non-rheumatic valvular heart disease (VHD) was also detected in 465 (30.7 per 1,000 persons) students. Of all the pathologies, only 39 (25.6%) cases with CHD and 1 (0.007%) cases with RHD had already been diagnosed. Parental consanguinity was the strongest predictor of CHD and SHD (odds ratio [OR]: 1.907, 95% CI, 1.358 to 2.680; P < 0.001 and OR, 1.855, 95% CI, 1.334 to 2.579; P < 0.001, respectively). The female sex (OR, 1.262, 95% CI, 1.013 to 1.573; P = 0.038) and fathers' low literacy (OR, 1.872, 95% CI, 1.068 to 3.281; P = 0.029) were the strongest predictors of non-rheumatic VHD and RHD, correspondingly. Conclusions: The implementation of echocardiographic examinations for detecting SHD among young population is feasible which detected SHD prevalence in our population comparable to previous reports. Further studies are required to delineate its economic aspects for community-based screening. Keywords: Echocardiography; Prevalence; Screening; Structural heart disease

Comparison of the Response of the Right Ventricle with Endovascular Occlusion and Surgical Closure in Adults with Atrial Septal Defect One Year After Intervention

Background Use of the Amplatzer septal occluder (ASO) for the closure of secundum atrial septal defect (ASD) has recently become the procedure of choice, while earlier the only treatment for ASD was surgical closure. This study compares the right ventricular indices of the ASO group with the surgical closure group one year after intervention in adults. Methods From January 2008 to February 2010, 38 patients with isolated atrial septal defect of the secundum type one year after surgical (n = 20, age = 27 ± 4 years, 13 females, 7 males) or Amplatzer septal occluder closure (n = 18, age = 25 ± 4 years, 12 females, 6 males) were studied. At the same time, thirty-one age-matched normal subjects (age = 26 ± 6 years, 23 females, 9 males) were included as the control group. Strain and strain rate of the right ventricle were measured. Results The mean values of strain of the midportion were −26% ± 11.7%, −8.9% ± 4.2%, and 24.5% ± 7.4% ( P < 0.001). Strain rates of the midportion were −2.19 ± 0.6 s −1 , −1.2 ± 0.4 s −1 , −1.9 ± 0.6 s −1 ( P < 0.001) in ASO, surgery, and control groups, respectively. Conclusion This study showed that the right ventricle might show better performance in the ASO than the surgery group in adults with ASD in midterm follow-up

Differences in right ventricular dysfunction in patients with idiopathic pulmonary hypertension versus secondary pulmonary hypertension

Introduction: Right ventricular (RV) function in the setting of pulmonary hypertension based on different etiologies has not been well studied. In this study, we evaluated the RV function in patients with idiopathic pulmonary hypertension (IPH) versus secon-dary pulmonary hypertension (SPH) due to congestive heart failure. Material and method: Forty-five patients with pulmonary hypertension and New York Heart Association (NYHA) functional class II or III were enrolled. Of these, 22 were diagnosed with IPH and 23 with SPH. Echocardiographic data, including Doppler and Doppler based strain, were assessed according to the American Society of Echocardiography (ASE) guidelines for detailed evaluation of RV function in these two groups. Results: Mean PAP was 60 ± 14.5 mm Hg in patients with IPH versus 43 ± 11.5 mm Hg in patients with SPH (p = 0.001). Considering conventional indexes of RV function, only Sm and dp/dt were significantly better in the first group compared with the second group (p-value for Sm = 0.042 and for dp/dt = 0.039). RV end diastolic dimension was significantly higher in the IPH group (p = 0.013). Using deformation indexes of RV function, the basal and mid portion of RV free wall strain and basal RV strain rates were significantly worse in the chronic systolic heart failure (PH-HF) group in comparison to the IPH group (p &lt; 0.001 in basal RV strain, p = 0.034 in mid RV strain and p = 0.046 in basal RV strain rate respectively).Conclusion: IPH has less impact on RV function in comparison to PH-HF. Considering both entities are in the category of RV pressure overload, we conclude that the etiology of pulmonary hypertension also plays an important role in RV function in addition to pressure overload

Evaluation of left ventricular systolic and diastolic regional function after enhanced external counter pulsation therapy using strain rate imaging

Aims Enhanced external counter pulsation (EECP) is a non-invasive and non-pharmacological therapy for patients with symptomatic coronary artery disease (CAD). There are, however, insufficient data to support the effectiveness of EECP in improving the myocardial mechanical properties of patients with refractory stable angina. We aimed to assess the effects of EECP on myocardial mechanical properties and cardiac functions in CAD patients not eligible for surgical or percutaneous revascularization procedures. Methods and results Twenty patients in New York Heart Association (NYHA) functional Class III and IV angina were evaluated. The mean age of the patients was 63+9 years, and 65% were male. A comprehensive echocardiographic study including an evaluation of the tissue Doppler-based parameters of systolic and diastolic functions was performed before and after the termination of the protocol. EECP was carried out 1 h per day, 5 days per week, for 7 weeks. EECP resulted in a significant increase in peak late diastolic transmitral inflow velocity (0.75+0.14 vs. 0.83+0.20 m/s, P , 0.05), propagation velocity (42.35+6.25 vs. 46.00+5.68 cm/s, P , 0.05), peak early diastolic velocity of mitral annulus (5.35+1.79 vs. 5.95+1.10 cm/s, P , 0.05), peak systolic velocity (2.51+0.28 vs. 2.67+ 0.26, P , 0.05), and early diastolic velocity (3.24+0.18 vs. 3.52+0.26 cm/s, P , 0.01) of all middle segments, peak late diastolic velocity of all basal (4.48+0.58 vs. 4.75+0.70 cm/s, P , 0.05) and middle segments (2.82+0.66 vs. 3.25+0.46 cm/s, P , 0.01), peak systolic strain rate of all basal (0.76+0.07 vs. 0.99+0.08 1/s, P ¼ 0.001) and middle segments (0.75+0.09 vs. 0.94+0.09 1/s, P , 0.001), peak systolic strain of basal (11.64+1.51 vs. 13.97+1.52%, P , 0.01) and middle segments (11.81+1.15 vs.13.73+1.57%, P , 0.001), and left ventricular (LV) ejection fraction (40.25+ 12.72 vs. 46.25+12.97%, P , 0.001).There was also a significant decrease in the ratios of transmitral E/A (0.92+ 0.41 vs. 1.08+ 0.46, P , 0.05) and E/Ea (12.61+4.22 vs. 15.44+6.96, P , 0.05) after EECP therapy. A significant reduction in NYHA angina class ( 1 angina class) was seen in the patients, who completed treatment. Conclusion EECP therapy seemed to improve both regional and global LV systolic and diastolic functions in patients with chronic angina pectoris

Comparison of N-Terminal Pro B-Natriuretic Peptide and Echocardiographic Indices in Patients with Mitral Regurgitation

Introduction Echocardiographic indices can form the basis of the diagnosis of systolic and diastolic left ventricular (LV) dysfunction in patients with Mitral regurgitation (MR). However, using echocardiography alone may bring us to a diagnostic dead-end. The aim of this study was to compare N-Terminal pro B-natriuretic peptide (BNP) and echocardiographic indices in patients with mitral regurgitation. Methods 2D and Doppler echocardiography and BNP serum level were obtained from 54 patients with organic mild, moderate and severe MR. Results BNP levels were increased with symptoms in patients with mitral regurgitation (NYHAI: 5.7 ± 1.1, NYHAII: 6.9 ± 1.5, NYHAIII: 8.3 ± 2 pg/ml, P < 0.001). BNP plasma level were significantly correlated with MPI (myocardial performance index) (r = 0.399, P = 0.004), and following echocardiographic indices: LVEDV (r = 0.45, P < 0.001), LVESV (r = 0.54, P < 0.001), LVEDD (r = 0.48, P < 0.001), LVESD (r = 0.54, P < 0.001), dp/dt (r = −0.32, P = 0.019) and SPAP (r = 0.4, P = 0.006). Conclusion The present study showed that BNP may be useful in patients with MR and may confirm echocardiographic indices

Relationship between QRS complex notch and ventricular dyssynchrony in patients with heart failure and prolonged QRS duration

Background: Cardiac resynchronization therapy (CRT) has been accepted as an established therapy for advanced systolic heart failure. Electrical and mechanical dyssynchrony are usually evaluated to increase the percentage of CRT responders. We postulated that QRS notch can increase mechanical LV dyssynchrony independently of other known predictors such as left ventricular ejection fraction and QRS duration. Methods: A total of 87 consecutive patients with advanced systolic heart failure and QRS duration more than 120 ms with an LBBB-like pattern in V1 were prospectively evaluated. Twelve-lead electrocardiogram was used for detection of QRS notch. Complete echocardiographic examination including tissue Doppler imaging, pulse wave Doppler and M-mode echocardiography were done for all patients. Results: Eighty-seven patients, 65 male (75%) and 22 female (25%), with mean (SD) age of 56.7 (12.3) years were enrolled the study. Ischemic cardiomyopathy was the underlying heart disease in 58% of the subjects, and in the others it was idiopathic. Patients had a mean (SD) QRS duration of 155.13 (23.34) ms. QRS notch was seen in 49.4% of the patients in any of two precordial or limb leads. Interventricular mechanical delay was the only mechanical dyssynchrony index that was significantly longer in the group of patients with QRS notch. Multivariate analysis revealed that the observed association was actually caused by the effect of QRS duration, rather than the presence of notch per se. Conclusions: QRS notch was not an independent predictor of higher mechanical dyssynchrony indices in patients with wide QRS complex and symptomatic systolic heart failure; however, there was a borderline association between QRS notch and interventricular delay

Aortic Valve Area and Strain Measurements by Cardiac MRI and Transthoracic Echocardiography in Severe Aortic Stenosis with Normal Left Ventricular Function

Background: Transthoracic echocardiography (TTE) is the recommended imaging technique for the evaluation of patients with aortic stenosis (AS). However, in cases with inconclusive findings, cardiac magnetic resonance (CMR) planimetry is used to grade AS severity. This study aimed to compare the results derived from TTE and CMR in patients with severe AS with normal left ventricular (LV) function.Methods: In a prospective study, 20 patients with severe AS were recruited and data derived from TTE and CMR modalities were compared with the archived records of 28 age- and sex-matched healthy controls. The data included aortic valve area (AVA), MRI-derived biventricular global strains, and TTE-derived global longitudinal strain (GLS). SPSS software was used to analyze the data with independent samples t test, intraclass correlation coefficient (ICC), and Pearson correlation. P<0.05 was considered statistically significant.Results: An excellent agreement was found in AVA values derived from CMR and TTE with an average ICC of 0.932 (95% CI=0.829-0.973). There was a significant difference in LV-GLS, LV global radial strain (GRS), right ventricular (RV) GRS, and RV global circumferential strain between the groups. A good correlation was found between CMR- and TTE-derived GLS with an average ICC of 0.721 (95% C=0.255-0.896). The mean aortic valve pressure gradient in TTE had a significant inverse linear correlation with LV-GRS in CMR (r=-0.537). All P values were <0.05.Conclusion: There was a good agreement between AVA and strain values derived from cardiac MRI and TTE. The myocardial strain was impaired in patients with severe AS and normal LV function and correlated with disease severity

Comparison of Group and Individual Training on the Patients’ Compliance and Incidence of Warfarin Side Effects after Cardiac Valve Replacement

Introduction: Oral anticoagulant therapies are intended for prevention of thrombotic adverse effects and to maintain the level of drug without bleeding. The probability of risk highly depends on the patient compliance after discharge from hospital. This study was designed to compare the effect of group and individual education on patients’ compliance and incidence of adverse effects of warfarin after cardiac valve replacement surgery. Methods: In this quasi experimental study, 76 inpatients older than 18 years, undergone valve replacement surgery in cardiovascular ward of Shaheed Rajaei Heart Center who met the inclusion criteria were selected randomly. After informed consent, they were randomly allocated to intervention or control groups. The patients in control group received individual education (the regular method) and intervention group was instructed in groups for three sessions each having one week interval. Up to six months, the results of the lab tests (PT, PTT, INR), the number of carried out lab tests, time interval between tests, and the incidence of complications were recorded, and finally compared statistically between the groups. Results: Comparing the compliance to therapy for two groups after six months, a significant difference was noticed (p=0.03). As 88.2% of intervention group vs. 61.2% in control groups had carried out their lab tests completely (p=0.02). Result of lab tests reported abnormal PT and INR in only 2 cases (5.9%) among patients of intervention group while 59.1% of patients in control group had the experience of once or more abnormal results (P=0.00). Three cases of deaths, two cases of hospitalization, and two cases of blood transfusions were reported in control group while none of the above was observed in the intervention group. Conclusion: Group education leads to the improvement of adherence to therapy which results in reduction of mortality among warfarin consumers after valve replacement surgery. Therefore it is highly recommended to nursing administrators to establish education units in hospital and conduct group education sessions for patients to reduce their problems. Simultaneously this leads to the reduction of hospital charges as well as financial and emotional loads on patients

Hemostatic Role of TachoSil Surgical Patch in Cardiac Surgery

Introduction: Excessive bleeding presents a risk for the patient in cardiovascular surgery. Local haemostatic agents are of great value to reduce bleeding and related complications. TachoSil (Nycomed, Linz, Austria) is a sterile, haemostatic agent that consists of an equine collagen patchcoated with human fibrinogen and thrombin. This study evaluated the safety and efficacy of TachoSil compared to conventional technique.Methods: Forty-two patients scheduled for open heart surgeries, were entered to this study from August 2010 to May 2011. After primary haemostatic measures, patients divided in two groups based on surgeon’s judgment. Group A: 20 patients for whom TachoSil was applied and group B: 22 patients that conventional method using Surgicel (13 patients) or wait and see method (9 cases), were performed in order to control the bleeding. In group A, 10 patients were male with mean age of 56.95±15.67 years and in group B, 9 cases were male with mean age of 49.95±14.41 years. In case group 70% (14/20) of the surgeries were redo surgeries versus 100% (22/22) in control group.Results: Baseline characteristics were similar in both groups. In TachoSil group 75% of patients required transfusion versus 90.90% in group B (P=0.03).Most transfusions consisted of packed red blood cell; 2±1.13 units in group A versus 3.11±1.44 in group B (P=0.01), however there were no significant differences between two groups regarding the mean total volume of intra and post-operative bleeding. Re-exploration was required in 10% in group A versus 13.63% in group B (P=0.67).Conclusion: TachoSil may act as a superior alternative in different types of cardiac surgery in order to control the bleeding and therefore reducing transfusion requirement

Isolated double-orifice mitral valve in a young girl

BACKGROUND: Double-orifice mitral valve (DOMV) is an extremely rare cardiac malformation. It has been found to be accompanied by congenital anomalies (CAs), however, it can be detected as an isolated anomaly. The clinical findings of a DOMV are variable and depend predominantly on the associated cardiac abnormalities, particularly atrioventricular septal defects or mitral valve (MV) regurgitation and/or stenosis. CASE REPORT: In this regard, we describe an isolated DOMV in an 18-year-old young girl who complained of a short-term nonspecific chest pain. She underwent transthoracic and transesophageal echocardiographic examinations. The examinations revealed a DOMV without any valvular or structural malformations. Other examinations were unremarkable. The patient did need neither medical nor surgical interventions. CONCLUSION: The isolated cases of DOMV do not need therapy and might be only followed up using echocardiographic examinations. However, a careful echocardiographic examination for detection of concomitant structural malformations would be of great importance in the management of such cases.&nbsp;</p