Tehran University of Medical Sciences The Research in Heart Yield and Translational Medicine (RHYTHM) 3115-7270 9 2 2015 10 11 54 58 EN Kourosh Soleimannejad Shahid Mostafa Hospital, Ilam University of Medical Sciences, Ilam, Iran. Younos Nouzari Tehran Heart Center, Tehran University of Medical Sciences, Tehran, Iran. Alireza Ahsani Imam Khomeini Hospital, Tehran University of Medical Sciences, Tehran, Iran. Mostafa Nejatian Tehran Heart Center, Tehran University of Medical Sciences, Tehran, Iran. Kourosh Sayehmiri Psychosocial Injuries Research Center, Ilam University of Medical Sciences, Ilam, Iran. 2015 10 11 2015 10 11 Background: Exercise and rehabilitation are important methods for decreasing the risk factors of coronary artery disease (CAD). We aimed to evaluate the effect of the cardiac rehabilitation (CR) exercise program on the cardiac structure and physiology in patients undergoing percutaneous coronary intervention (PCI). Methods: In this randomized controlled study, 146 patients with CAD were divided equally into two groups: case group (undertaking CR after PCI) and control group (without rehabilitation after PCI). All the patients in the case group underwent echocardiography (before and after CR), and echocardiography was performed for the control group simultaneously. The CR exercise program encompassed 24 sessions, twice or three times a week, with each session lasting between 15 and 45 minutes, depending on the individual patient’s tolerance. Left ventricular (LV) ejection fraction, LV diastolic function, LV end-systolic and diastolic diameter, and right ventricular (RV) end-diastolic diameter were measured in the CR group before and after rehabilitation and compared to those in the control group at the same times. Results: In this study, 146 patients (46 female and 100 male) were evaluated: 73 in the rehabilitation group and 73 in the control group. The mean age of the patients in the CR and control groups was 58.05 ± 10.27 and 56.76 ± 10.07 years, respectively. The CR exercise program had useful effects on LV diastolic function after PCI. The distribution of LV diastolic dysfunction after the CR exercise program was changed significantly only in the CR group (p value = 0.043). In the CR group, normal, grade I, grade II, and grade III LV diastolic dysfunction were observed in 20.5%, 69.8%, 6.8%, and 2.7%, respectively. This distribution was changed respectively to 30.1%, 61.6%, 5.4%, and 2.7% following CR, which showed a significant improvement due to CR in LV diastolic function, most prominently in the patients with grade I diastolic dysfunction (p value = 0.390). There was no significant change in LV and RV diameter before and after rehabilitation, while the ejection fraction increased significantly (p value < 0.05) in both groups. Conclusion: The RC exercise program can be effective in the augmentation of LV diastolic dysfunction after PCI, withoutsignificant changes in LV diameters. https://rhythm.tums.ac.ir/index.php/jthc/article/view/326 https://rhythm.tums.ac.ir/index.php/jthc/article/download/326/319

Tehran University of Medical Sciences The Research in Heart Yield and Translational Medicine (RHYTHM) 3115-7270 9 2 2015 10 11 82 84 EN Seyfollah Abdi Rajaei Cardiovascular, Medical and Research Center, Iran University of Medical Sciences, Tehran, Iran. Hoseinali Basiri Rajaei Cardiovascular, Medical and Research Center, Iran University of Medical Sciences, Tehran, Iran. Negar Salehi Rajaei Cardiovascular, Medical and Research Center, Iran University of Medical Sciences, Tehran, Iran. Hamid Reza Pouraliakbar Rajaei Cardiovascular, Medical and Research Center, Iran University of Medical Sciences, Tehran, Iran. Anoushiravan Vakili-Zarch Rajaei Cardiovascular, Medical and Research Center, Iran University of Medical Sciences, Tehran, Iran. 2015 10 11 2015 10 11 The coarctation of the aorta (CoA) is rare in adulthood. Diagnosis is made by clinical suspicion and physical findings such as blood pressure difference between the upper and lower extremities, pulse delay in the femoral artery, and systolic murmur over the thoracic spine.The CoA in adulthood and in patients with associated aneurysm is challenging and different complications even with proper treatment can occur. Covered stents are indicated in concomitant aneurysm, older age, and tight coarctation. A 26-year-old male with resistant hypertension due to a CoA diagnosed by computed tomography angiography referred to our center for an attempted stent implantation. Cardiac catheterization and aortography revealed a long CoA after the origin of the left subclavian artery with a 60 mmHg gradient. Moreover, there was a large aneurysm in the site of the coarctation. Under general anesthesia and fluoroscopic guidance, two balloon-expandable covered Cheatham-Platinum stents (size 18 in 44 millimeters and size 18 in 50 millimeters) were successfully implanted across the CoA with no residual gradient. On 2 years' follow-up, the patient had no symptoms except for mild hypertension. In this patient, the use of a covered stent within the aneurysm was safe and effective https://rhythm.tums.ac.ir/index.php/jthc/article/view/331 https://rhythm.tums.ac.ir/index.php/jthc/article/download/331/324

Tehran University of Medical Sciences The Research in Heart Yield and Translational Medicine (RHYTHM) 3115-7270 9 2 2015 10 11 97 98 EN Arash Gholoobi Assistant Professor of Cardiology, Atherosclerosis Prevention Research Center, Imam Reza Hospital, EbneSina Ave., Mashhad, Iran. 2015 10 11 2015 10 11 No Abstract https://rhythm.tums.ac.ir/index.php/jthc/article/view/335 https://rhythm.tums.ac.ir/index.php/jthc/article/download/335/328

Tehran University of Medical Sciences The Research in Heart Yield and Translational Medicine (RHYTHM) 3115-7270 9 2 2015 10 11 59 63 EN Parvin Akbari-Asbagh Breastfeeding Research Center, Tehran University of Medical Sciences, Tehran, Iran. Mohammad Ali Navabi-Shirazi Breastfeeding Research Center, Tehran University of Medical Sciences, Tehran, Iran. Aliakbar Soleimani Breastfeeding Research Center, Tehran University of Medical Sciences, Tehran, Iran. Maryam Razzaz Breastfeeding Research Center, Tehran University of Medical Sciences, Tehran, Iran. Naseradine Akbari-Asbagh Baharloo Hospital, Tehran University of Medical Sciences, Tehran, Iran. Hussein Rayatzadeh Breastfeeding Research Center, Tehran University of Medical Sciences, Tehran, Iran. Mamak Shariat Maternal Fetal and Neonatal Research Center, Tehran University of Medical Sciences, Tehran, Iran. 2015 10 11 2015 10 11 Background: Chylothorax is a rare but serious postoperative condition with a high rate of morbidity and may lead to the mortality of children undergoing congenital heart disease (CHD) surgery. This study evaluated the specific surgical procedures associated with the higher risk of postoperative chylothorax. Methods: We assessed 435 cases undergoing CHD surgery between April 2003 and May 2006. We detected postoperative chylothorax in 6 patients. The diagnosis of chylothorax was established based on the presence of an odorless fluid with the characteristic milky appearance of the fluid (except when the patients were fasting in the immediate postoperative period), a triglyceride level greater than 110 mg/dL or between 50 and 110 mg/dL with a pleural fluid white cell count greater than 1000, and more than 80% lymphocytes on differential when the pleural fluid was not chylous. Results: Over a 37-month period, 435 (mean age = 51.6 months; 232 males) patients underwent various types of surgical procedures for CHD; 6 patients developed chylothorax after the Fontan operation; one patient died due to severe chylothorax;3 patients were managed by nutritional modifications, diuretics, and thoracocentesis; and  2 patients required thoracic duct ligation. The Fisher exact test analysis showed a significant association between the Fontan operation and postoperative chylothorax (p value < 0.0001). Conclusion: Our study showed a significant association between the Fontan surgery and chylothorax. https://rhythm.tums.ac.ir/index.php/jthc/article/view/327 https://rhythm.tums.ac.ir/index.php/jthc/article/download/327/320

Tehran University of Medical Sciences The Research in Heart Yield and Translational Medicine (RHYTHM) 3115-7270 9 2 2015 10 11 85 89 EN Gholamreza Moradi Imam Ali Cardiovascular Surgery Center, Kermanshah University of Medical Sciences, Kermanshah, Iran. Fereydoun Sabzi Imam Ali Cardiovascular Surgery Center, Kermanshah University of Medical Sciences, Kermanshah, Iran. Abdolhamid Zokaei Imam Ali Cardiovascular Surgery Center, Kermanshah University of Medical Sciences, Kermanshah, Iran. Naser Hemati Imam Ali Cardiovascular Surgery Center, Kermanshah University of Medical Sciences, Kermanshah, Iran. 2015 10 11 2015 10 11 Aortic dissection begins with the formation of a tear in the aortic intima, and it directly exposes an underlying diseased medial layer to the driving force of the intraluminal blood. This blood penetrates the diseased medial layer and cleaves the media longitudinally, thereby dissecting the aortic wall. Herein, we report the case of a 38-year-old woman, who presented with chest pain and dyspnea. After physical examination, laboratory evaluation, echocardiography, and CT–angiography, extensive aortic dissection was diagnosed involving the innominate and left common carotid arteries. Accordingly, the debranching of the aortic arch arteries was performed. During the procedure, the patient was monitored with bilateral regional cerebral tissue oximetry. The patient did not show any signs of complications either in the postoperative period or at postoperative three-month weekly follow-up or at subsequent monthly follow-up for the past year. https://rhythm.tums.ac.ir/index.php/jthc/article/view/332 https://rhythm.tums.ac.ir/index.php/jthc/article/download/332/325

Tehran University of Medical Sciences The Research in Heart Yield and Translational Medicine (RHYTHM) 3115-7270 9 2 2015 10 11 64 69 EN Younes Nozari Tehran Heart Center, Tehran University of Medical Sciences, Tehran, Iran. Mostafa Bahrehmand Imam Ali Heart Center, Kermanshah University of Medical Sciences, Kermanshah, Iran. Seyed Kianoosh Hosseini Tehran Heart Center, Tehran University of Medical Sciences, Tehran, Iran. Mehran Mahmoodian Tehran Heart Center, Tehran University of Medical Sciences, Tehran, Iran. Ahmad Sharafi Tehran Heart Center, Tehran University of Medical Sciences, Tehran, Iran. 2015 10 11 2015 10 11 Background: Mean platelet volume (MPV) correlates with platelet activity. The relation between MPV and long-term outcome in patients undergoing percutaneous coronary intervention (PCI) has been investigated in several studies. The aim of the present study was to investigate the utility of MPV in prognosticating the long-term outcome after elective PCI. Methods: The study cohort included 2627 patients undergoing elective PCI between September 2008 and June 2010, whose baseline MPV measurements before PCI were available. The patients were divided into three groups of MPV < 9.1 fL, MPV = 9.1 to 10 fL, and MPV > 10 fL, and they were assessed for developing major adverse cardiac events (MACE), comprising death, myocardial infarction (MI), target vessel revascularization (TVR), and target lesion revascularization (TLR) over a one-year follow-up. Results: Of 2539 patients, major adverse cardiac events (MACE) at one year occurred in 77 (3.0%) patients, including mortality in 26 (1.0%). The patients in the highest tertile (MPV > 10 fL) had no increased frequency of MACE compared to those in the mid (9.1 to 10 fL) and lowest ( < 9.1 fL) tertiles (3.3%, 2.2%, and 3.8%, respectively; p value = 0.14).No significant differences were found for each of the primary endpoints among the MPV tertiles. In multivariate logistic regression, we investigated the association between high MPV and total MACE (OR = 1.10, 95%CI: 0.69-1.77; p value = 0.68), death (OR = 1.14, 95%CI: 0.51-2.54; p value = 0.74), and non-fatal MI (OR = 1.85, 95%CI: 0.73-4.67; p value = 0.19) at one year's follow-up but MPV did not remain in the model in any of the cases.In the diabetic patients, the one-way analysis of variance demonstrated that mortality was 1.6% (4 patients) in the highest tertile, 0.8% (2 patients) in the mid tertile, and 0.5% (one patient) in the lowest tertile. Conclusion: There was no direct correlation between pre-procedural MPV and MACE in elective PCI. MPV can only be considered as an appropriate factor for predicting mortality in diabetic patients undergoing elective PCI. https://rhythm.tums.ac.ir/index.php/jthc/article/view/328 https://rhythm.tums.ac.ir/index.php/jthc/article/download/328/321

Tehran University of Medical Sciences The Research in Heart Yield and Translational Medicine (RHYTHM) 3115-7270 9 2 2015 10 11 90 92 EN Alireza Rostamzadeh Seyyed-al-Shohada Heart Center, Urmia University of Medical Sciences, Urmia, Iran. Kamal Khademvatani Seyyed-al-Shohada Heart Center, Urmia University of Medical Sciences, Urmia, Iran. Yousef Rezaei Seyyed-al-Shohada Heart Center, Urmia University of Medical Sciences, Urmia, Iran. Nariman Sepehrvand National Institute of Health Research, Tehran University of Medical Sciences, Tehran, Iran. 2015 10 11 2015 10 11 Right-sided heart thrombus is a life-threatening condition that necessitates immediate therapy. Detection of right-sided heart thrombus is usually via transthoracic echocardiography. Generally, thrombolysis is considered a treatment of choice, but there is currently no consensus about the optimal therapeutic choice. We present a case of multiple right atrial . The matching rate in the interpretations of myocardial ischemic disorders was high, which means practically all the ischemic cases diagnosed by the device were confirmed by the cardiologists. Only in 12 cases myocardial infarction or ischemic changes were reported by the cardiologists, while they were missed by the device. As regards rhythm disorders, the sensitivity and specificity of the device were 67.7% and 75.7%, respectively. With respect to conductive disorders, the respective sensitivity and specificity of the device were 70% and 96.6%, respectively. Finally, in the case of structural disorders, the interpretations of the device were 92.8% sensitive and 83.3% specific. Conclusion: According to the results of our study and similar researches, it seems that the interpretations of an automated ECG device in diagnosing the ischemic and structural disorders of the heart are reliable. The device, however, should not be relied upon when assessing conduction disorders and dysrhythmias. We, therefore, recommend that the users of digital ECG devices recheck the digital interpretations in those cases.        https://rhythm.tums.ac.ir/index.php/jthc/article/view/80 https://rhythm.tums.ac.ir/index.php/jthc/article/download/80/78

Tehran University of Medical Sciences The Research in Heart Yield and Translational Medicine (RHYTHM) 3115-7270 3 1 2008 01 22 35 38 Seyed Mahmood Sadr Cardiovascular Research Center, Afshar Hospital, Shahid Sadooghi Medical Universit, Yazd, Iran. Seyedeh Mahdieh Namayandeh Cardiovascular Research Center, Afshar Hospital, Shahid Sadooghi Medical Universit, Yazd, Iran. Mansoor Rafiei Cardiovascular Research Center, Afshar Hospital, Shahid Sadooghi Medical Universit, Yazd, Iran. Seyed Mostafa Baghaei Poor Cardiovascular Research Center, Afshar Hospital, Shahid Sadooghi Medical Universit, Yazd, Iran. Maryam Aflatoonian Cardiovascular Research Center, Afshar Hospital, Shahid Sadooghi Medical Universit, Yazd, Iran. Monireh Modares Mosadegh Cardiovascular Research Center, Afshar Hospital, Shahid Sadooghi Medical Universit, Yazd, Iran. Seyed Khalil Foroozannia Cardiovascular Research Center, Afshar Hospital, Shahid Sadooghi Medical Universit, Yazd, Iran. 2015 10 03 Background: Atherosclerosis of the peripheral arteries occurs in 12% of individuals at 65 years of age or older. At least 28% of these patients suffer from coronary heart diseases and 10% of them are afflicted with cerebrovascular diseases. To calculate the agreement between two diagnostic tests for peripheral arterial disease (PAD), namely ankle brachial index (ABI) and ultrasound duplex scanning (USD). Methods: Forty symptomatic PAD patients were enrolled in this study, and their demographic characteristics, risk factors, and symptoms as well as their ABI and USD measurements were recorded. On the basis of the symptoms and ABI and USD findings, the patients were divided into four groups and comparisons were made between them so that the associations between the findings could be analyzed. Results: The study population included 32 (80%) men at a mean age of 62.9+12.8 years (26-90). Smoking (75%) and hypertension (100%) were the most common risk factors in the men and women, respectively, followed by diabetes in both genders. Whereas the agreement between ABI and USD findings in the men was significant (Kappa=0.28, P=0.02), it was not significant (Kappa=-0.91, P=0.68) in the women. Additionally, there was a significant correlation between symptoms and ABI findings (Kappa=0.21, P=0.04), while that between symptoms and USD measurements was not significant (Kappa=0.09, P=0.3) Conclusion: The correlation between ABI findings and symptoms, especially in the men, was better than that between ABI findings and USD measurements. ABI could, therefore, be considered an appropriate tool for the initial screening of arterial stenosis and lower extremity circulation. https://rhythm.tums.ac.ir/index.php/jthc/article/view/81 https://rhythm.tums.ac.ir/index.php/jthc/article/download/81/79

Tehran University of Medical Sciences The Research in Heart Yield and Translational Medicine (RHYTHM) 3115-7270 3 1 2008 01 22 39 42 Seiied Mahmoud Meraji Shahid Rajaei Hospital, Iran University of Medical Sciences, Tehran, Iran. Paridokht Nokhostin Davari Shahid Rajaei Hospital, Iran University of Medical Sciences, Tehran, Iran. Mohammad Yousef Aarabi Shahid Rajaei Hospital, Iran University of Medical Sciences, Tehran, Iran. Ali Akbar Shahmohammadi Shahid Rajaei Hospital, Iran University of Medical Sciences, Tehran, Iran. Hojjat Mortezaeian Shahid Rajaei Hospital, Iran University of Medical Sciences, Tehran, Iran. Ramin Emamzadegan Shahid Rajaei Hospital, Iran University of Medical Sciences, Tehran, Iran. 2015 10 03 Background: Fenestration in the modified Fontan operation allows right-to-left shunting, which reduces the Fontan pathway pressure and improves cardiac output. However, on account of the fact that persistent right-to-left shunting results in cyanosis and paradoxical emboli, fenestration closure is recommended after recovery from the Fontan operation. Methods: This study recruited 3 patients who underwent the transcatheter closure of the Fontan fenestration with the ASD-Amplatzer because of severe cyanosis and significant intracardiac shunts. Results: Fenestration closure was performed at a mean age of 8 yr (6-12 yr) and average of 15 months after the Fontan operation. Aortic O2 saturation increased by an average of 17.6% (9-26%). During more than a two-year period of follow-up (mean: 27 months), two patients had complete occlusion on echocardiography and the other one had a small residual shunt. One of these patients had atrial flutter during the follow-up. Conclusion: The transcatheter closure of the Fontan fenestration is a safe and feasible technique that is effective in elevating systemic O2 saturation and well-being and confers acceptable growth and development in children. https://rhythm.tums.ac.ir/index.php/jthc/article/view/82 https://rhythm.tums.ac.ir/index.php/jthc/article/download/82/80

Tehran University of Medical Sciences The Research in Heart Yield and Translational Medicine (RHYTHM) 3115-7270 3 1 2008 01 22 39 42 Saeed Davoodi National Iranian Oil Company Central Hospital, Tehran, Iran. Yaddollah Dadashi National Iranian Oil Company Central Hospital, Tehran, Iran. Manouchehr Madani Civi National Iranian Oil Company Central Hospital, Tehran, Iran. Seyed Hesameddin Abbasi National Iranian Oil Company Central Hospital, Tehran, Iran. Amir Hossien Sami National Iranian Oil Company Central Hospital, Tehran, Iran. Kyomars Majdi National Iranian Oil Company Central Hospital, Tehran, Iran. 2015 10 0