Tehran University of Medical Sciences The Research in Heart Yield and Translational Medicine (RHYTHM) 3115-7270 3 4 2008 10 25 187 190 Shaukat Ali Jawaid Managing Editor, Pakistan Journal of Medical Sciences, Karachi, Pakistan 2015 10 03 https://rhythm.tums.ac.ir/index.php/jthc/article/view/102 https://rhythm.tums.ac.ir/index.php/jthc/article/download/102/100

Tehran University of Medical Sciences The Research in Heart Yield and Translational Medicine (RHYTHM) 3115-7270 3 4 2008 10 25 191 196 Kyomars Abbasi Tehran Heart Center, Tehran University of Medical Sciences, Tehran, Iran. Iman Abbasi Tehran Heart Center, Tehran University of Medical Sciences, Tehran, Iran. Naghmeh Moshtaghi Tehran Heart Center, Tehran University of Medical Sciences, Tehran, Iran. 2015 10 03 Atrial fibrillation is the most prevalent permanent arrhythmia. It may be associated with other cardiac pathologies which need surgical treatment. Various types of surgery including the traditional cut-sew operations and operations using different energy sources are currently in use. In comparison with medical treatment, surgery is safe, effective, and has reliable results. https://rhythm.tums.ac.ir/index.php/jthc/article/view/103 https://rhythm.tums.ac.ir/index.php/jthc/article/download/103/101

Tehran University of Medical Sciences The Research in Heart Yield and Translational Medicine (RHYTHM) 3115-7270 3 4 2008 10 25 197 204 Reza Forough Bellevue College, Science Division, Bellevue, Washington, USA. Matthew W. Miller College of Veterinary Medicine, The Texas A&M University, USA. Mildred Mattox College of Veterinary Medicine, The Texas A&M University, USA. Wayne Dunlap College of Medicine, The Texas A&M University, USA. Andy Ambrus College of Veterinary Medicine, The Texas A&M University, USA. Rola Barhoumi College of Veterinary Medicine, The Texas A&M University, USA. Cristine L. Heaps College of Veterinary Medicine, The Texas A&M University, USA. Janet L. Parker College of Medicine, The Texas A&M University, USA. 2015 10 03 Background: Angiogenesis gene therapy has long been sought as a novel alternative treatment for restoring the blood flow and improving the contractile function of the ischemic heart in selected clinical settings. Angiogenic fibroblast growth factor-1 (FGF-1) is a promising candidate for developing a promising gene therapy protocol due to its multipotent ability to stimulate endothelial cell (EC) growth, migration, and tube formation. Despite these advantages, however, FGF gene therapy has suffered setbacks mainly due to the inefficient delivery rate of the growth factor in vivo. Given the potent angiogenic effect of FGF-1, we reasoned that constitutively synthesized minute quantities of this polypeptide hormone, when empowered with the ability to escape the cellular constraint, could freely act in a paracrine/autocrine fashion on nearby existing capillary plexuses and lead to neovascularization and restoration of the blood flow to ischemic tissues for reparative purpose. Methods: We report the direct gene transfer of a retroviral-based mammalian expression vector encoding a secreted form of FGF-1 (sp-FGF-1) for the purpose of therapeutic angiogenesis into the porcine myocardium subjected to the surgical placement of an ameroid occluder to induce the chronic coronary occlusion of the left circumflex coronary artery (LCx) and regional myocardial ischemia. Coronary angiography, performed 3 weeks after surgery, confirmed the interruption of the blood flow in the LCx distal to the site of ameroid placement. Results: Immunohistochemical analysis using antibody specific to von Willebrand factor (vWF), an endothelial marker, showed a significant increase (p<0.05) in myocardial vascularity in the sp-FGF-1 hearts compared to the control (vector alone). Importantly, an assessment of the cardiac function by echocardiography, performed 3 weeks after surgery, demonstrated improved cardiac contractility due to increased left ventricular free wall contraction in the sp-FGF-1-treated animals only.  Conclusion: These results suggest that the intramyocardial delivery of our chimeric secretory FGF-1 gene can enhance vascularity and improve cardiac contractility in a chronic ischemic heart. This protocol may serve useful for developing reparative angiogenesis strategies aimed at improving the pumping function of the ischemic hearts in human patients.  https://rhythm.tums.ac.ir/index.php/jthc/article/view/104 https://rhythm.tums.ac.ir/index.php/jthc/article/download/104/102

Tehran University of Medical Sciences The Research in Heart Yield and Translational Medicine (RHYTHM) 3115-7270 3 4 2008 10 25 205 208 Abbas Salehi Omran Tehran Heart Center, Tehran University of Medical Sciences, Tehran, Iran. Abbasali Karimi Tehran Heart Center, Tehran University of Medical Sciences, Tehran, Iran. Setareh Davoodi Imam Khomeini Hospital, Tehran University of Medical Sciences, Tehran, Iran. Hossein Ahmadi Tehran Heart Center, Tehran University of Medical Sciences, Tehran, Iran. Namvar Movahedi Tehran Heart Center, Tehran University of Medical Sciences, Tehran, Iran. Mehrab Marzban Tehran Heart Center, Tehran University of Medical Sciences, Tehran, Iran. Banafsheh Alinejad Tehran Heart Center, Tehran University of Medical Sciences, Tehran, Iran. Neda Ghaffari Marandi Tehran Heart Center, Tehran University of Medical Sciences, Tehran, Iran. 2015 10 03 Background: Prosthetic valve endocarditis (PVE) is an important cause of morbidity and mortality associated with heart valve replacement surgery. The aim of the present study was to describe the early outcome of treatment in patients with PVE in a single center. Methods: The data of all the episodes of PVE registered at our institution between 2002 and 2007 were collected and analyzed retrospectively. The patients were assessed using clinical criteria defined by Durack and colleagues (Duke criteria). The analysis included a detailed study of hospital records. The continuous variables were expressed as mean ± standard deviation, and the discrete variables were presented as percentages. Results: Thirteen patients with PVE were diagnosed and treated at our center during the study period. In all the cases, mechanical prostheses were utilized. The patients' mean age was 46.9±12.8 years. Women made up 53.8% of all the cases.  Early PVE was detected in 6 (46.2%) patients, and late PVE occurred in 7 (53.8 %). Eleven (84.6%) patients were treated with intravenous antimicrobial therapy, and the other two (15.4%) required surgical removal and replacement of the infected prosthesis in addition to antibiotic therapy. Blood cultures became positive in 46.2% of the patients. Mortality rate was 15.4% (2 patients). Conclusion: It seems that in selected cases with PVE, i.e. in those who remain clinically stable and respond well to antimicrobial therapy, a cure could be achieved by antimicrobial treatment alone with acceptable morbidity and mortality risk. https://rhythm.tums.ac.ir/index.php/jthc/article/view/105 https://rhythm.tums.ac.ir/index.php/jthc/article/download/105/103

Tehran University of Medical Sciences The Research in Heart Yield and Translational Medicine (RHYTHM) 3115-7270 3 4 2008 10 25 209 214 Hassan Moladoust Department of Medical Physics, Tarbiat Modares University, Tehran, Iran. Manijhe Mokhtari-Dizaji Department of Medical Physics, Tarbiat Modares University, Tehran, Iran. Zahra Ojaghi-Haghighi Shaheed Rajaie Heart Center, Iran University of Medical Sciences, Tehran, Iran. 2015 10 03 Background: The recent developments in tissue Doppler imaging (TDI) now more than ever permit the quantification of the myocardial function. In the current systems, tissue tracking or displacement curves are generated from color tissue Doppler data through the instantaneous temporal integral of velocity-time curves. Methods: The purpose of the present study was to assess regional myocardial displacement via spectral TDI. Maximum myocardial velocities were extracted from spectral pulsed tissue Doppler images using a developed computer program and were integrated throughout the cardiac cycle. Spectral tissue Doppler echocardiography was performed to evaluate longitudinal and radial functions in 20 healthy men, and the calculated end-systolic displacements were subsequently compared with the displacements measured from the same areas via color tissue tracking. Results: According to the Bland-Altman analysis between spectral tissue tracking and color tissue tracking, the significant arithmetic mean was 7.34 mm with SD mean differences of ±2.24 mm in all of the evaluated segments. Despite significant differences (p<0.001), there was a good significant correlation between the two methods (r=0.79, p<0.001). Conclusion: A verification study showed that the proposed approach had the ability to assess regional myocardial displacement using spectral TDI, which can be used in a wider range of equipment than is currently possible. https://rhythm.tums.ac.ir/index.php/jthc/article/view/106 https://rhythm.tums.ac.ir/index.php/jthc/article/download/106/104

Tehran University of Medical Sciences The Research in Heart Yield and Translational Medicine (RHYTHM) 3115-7270 3 4 2008 10 25 215 218 Hassan Radmehr Imam Khomeini Medical Center, Tehran University of Medical Sciences, Tehran, Iran. Alireza Bakhshandeh Imam Khomeini Medical Center, Tehran University of Medical Sciences, Tehran, Iran. Mehrdad Salehi Imam Khomeini Medical Center, Tehran University of Medical Sciences, Tehran, Iran. Iraj Ghorbandaeipour Imam Khomeini Medical Center, Tehran University of Medical Sciences, Tehran, Iran. Amir Hossein Sadeghpoor Tabai Imam Khomeini Medical Center, Tehran University of Medical Sciences, Tehran, Iran. Mehdi Sanatkarfar Imam Khomeini Medical Center, Tehran University of Medical Sciences, Tehran, Iran. Ahmad Reza Nasr Imam Khomeini Medical Center, Tehran University of Medical Sciences, Tehran, Iran. 2015 10 03 Background: Elderly patients (>75 years) have constituted the fastest growing portion of the coronary artery bypass grafting (CABG) patient population over the last two decades. Of the goals that surgical care for the elderly pursues, cure may be an unfeasible one; nevertheless, palliation and comfort warrant sufficient importance. The present study sought to examine the postoperative course and events in elderly patients undergoing CABG with or without other procedures and to compare the results with those in younger patients. Methods: Demographic, mortality, morbidity, and resource utilization data were collected from the records of the patients undergoing CABG between January 2005 and July 2007 in Imam Khomeini Medical Center, Tehran, Iran. Results: The mean time to extubation was 9.3 and 6.3 hours in the elderly and non-elderly patients, respectively (p<0.01). Blood transfusion was required in 87.8% of the elderly compared to 58.5% of the non-elderly subjects (p<0.01). The mean Intensive Care Unit stay was 2.1 days for the elderly and 1.4 days for the non-elderly patients (p<0.001). In-hospital mortality was 9% for the elderly patients vs. 2.8% for the younger group (p<0.001). Conclusion: The elderly patients undergoing CABG had a significantly higher morbidity rate, with an increased incidence of postoperative renal failure, neurological complications, and in-hospital mortality. https://rhythm.tums.ac.ir/index.php/jthc/article/view/107 https://rhythm.tums.ac.ir/index.php/jthc/article/download/107/105

Tehran University of Medical Sciences The Research in Heart Yield and Translational Medicine (RHYTHM) 3115-7270 3 4 2008 10 25 219 224 Hakimeh Sadeghian Tehran Heart Center, Tehran University of Medical Sciences, Tehran, Iran. Abbasali Karimi Tehran Heart Center, Tehran University of Medical Sciences, Tehran, Iran. Seyed Hosein Ahmadi Tehran Heart Center, Tehran University of Medical Sciences, Tehran, Iran. Masoumeh Lotfi-Tokaldany Tehran Heart Center, Tehran University of Medical Sciences, Tehran, Iran. Nader Fallah Tehran Heart Center, Tehran University of Medical Sciences, Tehran, Iran. Reihaneh Zavar Tehran Heart Center, Tehran University of Medical Sciences, Tehran, Iran. Seyed Hesameddin Abbasi Tehran Heart Center, Tehran University of Medical Sciences, Tehran, Iran. 2015 10 03 Background: Discrete subaortic stenosis (DSS) is a progressive condition. Controversy still rumbles on as to whether the subaortic membrane causes aortic regurgitation (AR) and whether membrane resection reduces AR severity. We investigated the association between the left ventricular outflow tract peak gradient (LVOT-PG) and AR severity preoperatively and changes in AR severity and obstruction recurrence after surgery in DSS patients. Methods: Twenty patients were evaluated before and after surgery for DSS (mean follow-up time: 13.60±9.61 months). The patients were evaluated via transthoracic echocardiography and transesophageal echocardiography, if necessary. The cut-off point for surgery was LVOT-PG ≥50 mmHg or the presence of progressive AR. Results: The mean age of the patients was 28.55±15.23 years, and 35% of them were male. LVOT-PG decreased from a mean of 80.83±42.72 mmHg preoperatively to 19.14±14.03 mmHg postoperatively and to 25.47±16.10 at follow-up. AR was identified in 15 (75%) patients preoperatively: mild in 8 (40%) and moderate in 7 (35%). The postoperative change in AR severity was insignificant. The correlation between preoperative LVOT-PG and the incidence and severity of preoperative AR was not significant. AR severity had no correlation with age. Membrane recurrence occurred in 25% of the patients. Conclusion: Our results indicated no relationship between AR severity and LVOT-PG and the patient’s age. Patient selection for surgery can, therefore, be carried out on the basis of LVOT-PG or AR severity separately. Subaortic resection may reduce AR severity ass 202 204 EN Feridoun Sabzi Cardiovascular Medical Center of Imam Ali Hospital, Kermanshah, Iran. Babak Nasiri Cardiovascular Medical Center of Imam Ali Hospital, Kermanshah, Iran. 2015 10 11 2015 10 11 Myxomas are the most common benign cardiac tumors. Myxomas are more common in the left heart chamber than the right side chamber. An extracardiac origin presenting as a right atrial mass is very rare. We present a case of myxoma originating in the superior vena cava (SVC) in a 24-year-old man, who underwent surgical resection. Preoperative two-dimensional echocardiography demonstrated a mass in the right atrium. Intraoperatively, the tumor was found to have originated from the SVC orifice. The tumor was excised from the SVC by opening the one-third proximal portion of the SVC. Pathological examination revealed a myxoma, and one-year follow-up showed no evidence of the recurrence of any tumors in the SVC. https://rhythm.tums.ac.ir/index.php/jthc/article/view/311 https://rhythm.tums.ac.ir/index.php/jthc/article/download/311/304

Tehran University of Medical Sciences The Research in Heart Yield and Translational Medicine (RHYTHM) 3115-7270 8 4 2015 10 11 205 209 EN Zohreh Annabestani Diabetes Research Center, Endocrinology and Metabolism Clinical Sciences Institute, Tehran University of Medical Sciences, Tehran, Iran. Seyed Ebrahim Kassaian Tehran Heart Center, Tehran University of Medical Sciences, Iran. Mohammad Reza Mohajeri-Tehrani Endocrinology and Metabolism Research Center, Endocrinology and Metabolism Clinical SciencesInstitute, Tehran University of Medical Sciences, Tehran, Iran. Shahrzad Mohseni Endocrinology and Metabolism Research Center, Endocrinology and Metabolism Clinical Sciences Institute, Tehran University of Medical Sciences, Tehran, Iran. Sepideh Saroukhani Tehran Heart Center, Tehran University of Medical Sciences, Iran. Bagher Larijani Endocrinology and Metabolism Research Center, Endocrinology and Metabolism Clinical Sciences Institute, Tehran University of Medical Sciences, Tehran, Iran. 2015 10 11 2015 10 11 Hand ischemia is a rare complication of diabetes and some other chronic vascular diseases. Critical hand ischemia causes painful limbs and disability and requires urgent revascularization. There have been a few reports of successful trans-brachial percutaneous angioplasty in the upper extremity in the radial or ulnar artery. Herein, we report the results of the endovascular treatment of a 68-year-old diabetic patient with an ischemic hand ulcer due to the severe stenotic lesions of the infra-brachial arteries. The patient underwent successful angioplasty via the retrograde trans-femoral technique to avoid the drawbacks. At the first week of post-procedural follow-up, the patient’s finger was warm with a well–healing wound and reduced pain. In the next two months, he had no complaint of pain or active ulceration; the ulcer was well healed, and the hand was warm. The present case shows that history taking and physical examination should be followed by upper-extremity arteriography for the evaluation of hand ischemia. The trans-femoral approach enabled us to perform percutaneous catheterization for both diagnostic and interventional purposes. Not only is this strategy useful even for the severe stenotic disease of the distal parts of below-the-elbow arteries but also it avoids the unpleasant complications of antegrade brachial cannulation. https://rhythm.tums.ac.ir/index.php/jthc/article/view/312 https://rhythm.tums.ac.ir/index.php/jthc/article/download/312/305

Tehran University of Medical Sciences The Research in Heart Yield and Translational Medicine (RHYTHM) 3115-7270 8 4 2015 10 11 210 212 EN Hassan Teimouri Shahid Madani Hospital, Khoram Abad University of Medical Sciences, Khoram Abad, Iran Feridoun Sabzi Imam Ali Hospital, Kermanshah University of Medical Sciences, Kermanshah, Iran. Samsam Dabiri Imam Ali Hospital, Kermanshah University of Medical Sciences, Kermanshah, Iran. 2015 10 11 2015 10 11 True saccular aneurysm is exceptional in coarctation of aorta in children. A 6-year-old girl with headache and systemic arterial hypertension referred to our center for cardiovascular evaluation. Physical examination revealed high blood pressure and weak lower extremity pulses. Two-dimensional and Doppler echocardiography and angiography demonstrated a saccular aneurysm of the descending aorta, 5×4 cm in size, associated with aortic coarctation. Aneurysmectomy was performed without cardiopulmonary bypass. The section of the aorta containing the coarctation and the aneurysm was resected and replaced with a 15-mm woven polyester graft. Histological examination revealed a thin walled aneurysm with hyalinosis changes and decreased elastic fibers. One-year echocardiographic follow-up revealed no gradient across of Dacron tube and hypertension decreased to normal level. https://rhythm.tums.ac.ir/index.php/jthc/article/view/313 https://rhythm.tums.ac.ir/index.php/jthc/article/download/313/306

Tehran University of Medical Sciences The Research in Heart Yield and Translational Medicine (RHYTHM) 3115-7270 8 4 2015 10 11 213 214 EN Farrokh