Tehran University of Medical Sciences The Research in Heart Yield and Translational Medicine (RHYTHM) 3115-7270 10 2 2015 10 13 69 73 EN Payam Safavi-Naeini Department of Cardiology, Texas Heart Institute, Houston, Texas, USA. Mehdi Razavi Department of Cardiology, Texas Heart Institute, Houston, Texas, USA. Mohammad Saeed Department of Cardiology, Texas Heart Institute, Houston, Texas, USA. Abdi Rasekh Department of Cardiology, Texas Heart Institute, Houston, Texas, USA. Ali Massumi Department of Cardiology, Texas Heart Institute, Houston, Texas, USA. 2015 10 13 2015 10 13 The prevalence of atrial fibrillation (AF) is 1-2 % in the general population, and the risk of embolic stroke in AF patients is 4-5 times higher than that in the general population. AF-related strokes are often severe, and the rate of permanent disability is much higher among individuals who have AF-related strokes than in those who have strokes unrelated to AF. In patients with AF, more than 90 % of thrombi originate from the left atrial appendage (LAA). The purpose of this paper is to review the efficacy and safety of performing the LAA closure with the LARIAT Suture Delivery Device to prevent AF-related stroke in patients with contraindications to oral anticoagulant therapy. https://rhythm.tums.ac.ir/index.php/jthc/article/view/369 https://rhythm.tums.ac.ir/index.php/jthc/article/download/369/362

Tehran University of Medical Sciences The Research in Heart Yield and Translational Medicine (RHYTHM) 3115-7270 10 2 2015 10 13 74 79 EN Farzaneh Dastan School of Pharmacy, Tehran University of Medical Sciences, Tehran, Iran. Azita Hajhossein Talasaz School of Pharmacy, Tehran University of Medical Sciences, Tehran, Iran AND Tehran Heart Center, Tehran University of Medical Sciences, Tehran, Iran. Mojtaba Mojtahedzadeh School of Pharmacy, Tehran University of Medical Sciences, Tehran, Iran. Abbasali Karimi Tehran Heart Center, Tehran University of Medical Sciences, Tehran, Iran. Abbas Salehiomran Tehran Heart Center, Tehran University of Medical Sciences, Tehran, Iran. Payvand Bina Tehran Heart Center, Tehran University of Medical Sciences, Tehran, Iran. Arash Jalali Tehran Heart Center, Tehran University of Medical Sciences, Tehran, Iran. Zahra Aghaie School of Pharmacy, Tehran University of Medical Sciences, Tehran, Iran. 2015 10 13 2015 10 13 Background: L-carnitine has been demonstrated to confer cardiac protection against ischemia reperfusion injury in animals. This study evaluates the effects of L-carnitine administration on cardiac biomarkers after coronary artery bypass graft (CABG) surgery. Methods: One hundred thirty-four patients undergoing elective CABG surgery, without a history of myocardial ischemia or previous L-carnitine treatment, were enrolled and randomly assigned to an L-carnitine group ([n = 67], 3000 mg/d, started 2 days preoperatively and continued for 2 days after surgery) or a control group (n = 67). CK-MB (creatine kinase, muscle- brain subunits) and troponin T (TnT) levels were assessed in all the patients before surgery as baseline levels and at 8 and 24 hours postoperatively. Results: Our study included 134 patients (99 [73.8%] males) at a mean ± SD age of 59.94 ± 8.61 years who were candidates for CABG and randomized them into control or L-carnitine groups. The baseline demographic characteristics, including age (60.01 ± 9.23 in the L-carnitine group vs. 59.88 ± 7.98 in the control group) and sex (54 [80.6%] in the L-carnitine group vs. 45 [67.2%] in the control group) did not show any significant differences (p value=0.93 and 0.08, respectively). Patients in the L-carnitine group had lower levels of CK-MB (mean ± SD, 25.06 ± 20.29 in the L-carnitine group vs. 24.26 ± 14.61 in the control group), but the difference was not significant (p value = 0.28). TnT levels also showed no significant differences between the two groups (399.50 ± 378.91 in the L-carnitine group vs. 391.48 ± 222.02 in the control group; p value = 0.34). Conclusion: In this population of intermediate- to high-risk patients undergoing CABG surgery, L-carnitine did not reduce CK-MB and TnT levels. https://rhythm.tums.ac.ir/index.php/jthc/article/view/370 https://rhythm.tums.ac.ir/index.php/jthc/article/download/370/363

Tehran University of Medical Sciences The Research in Heart Yield and Translational Medicine (RHYTHM) 3115-7270 10 2 2015 10 13 80 84 EN Saeed Abrootan Department of Cardiology, Imam Khomeini Hospital, Ahvaz Jundishapur University of Medical Sciences, Ahvaz, Iran. Saeed Yazdankhah Department of Cardiology, Imam Khomeini Hospital, Ahvaz Jundishapur University of Medical Sciences, Ahvaz, Iran. Babak Payami Department of Cardiology, Imam Khomeini Hospital, Ahvaz Jundishapur University of Medical Sciences, Ahvaz, Iran. Mohammad Alasti Department of Cardiology, Bahman General Hospital, Tehran, Iran. 2015 10 13 2015 10 13 Background: Patients with chronic stable angina often have a state of sympathetic hyperactivity. It is considered associated with myocardial ischemia and disappears after ischemia elimination. The aim of this study was to investigate the changes in heart rate variability parameters, a noninvasive technique for the evaluation of the autonomic nervous system activity, after successful revascularization in these patients to evaluate this theory. Methods: The patients were enrolled among those who underwent successful percutaneous coronary intervention. Short- term heart rate variability analyses of all the patients were obtained, and time-domain indices (standard deviation of normal- to-normal intervals [SDNN], standard deviation of differences of successive R-R intervals [SDSD], root-mean square differences of successive R-R intervals [rMSSD], percentage of R-R intervals differing > 10 ms from the preceding one [PNN10 percentage of R-R intervals differing > 20 ms from the preceding one [PNN20],percentage of R-R intervals differing > 30 ms from the preceding one [PNN30]percentage of R-R intervals differing > 40 ms from the preceding one [PNN40],percentage of R-R intervals differing > 50 ms from the preceding one [PNN50percentage of R-R intervals differing > 60 msfrom the preceding one [PNN60 percentage of R-R intervals differing > 70 ms from the preceding one [PNN70])were analyzed. All the measurements were made before and after percutaneous coronary intervention. Results: This study included 64 patients, comprising 27 men and 37 women at a mean age of 56.8 ± 9.1 years. There was a significant difference only between pre- and post-revascularization SDNN (27.5 ± 19.72 vs. 41 ± 41.4; p value = 0.013). The other parameters showed no significant differences after successful coronary intervention. Conclusion: Our data indicate that the increase in SDNN in patients with stable angina pectoris undergoing percutaneous coronary intervention seems to be prominent. https://rhythm.tums.ac.ir/index.php/jthc/article/view/371 https://rhythm.tums.ac.ir/index.php/jthc/article/download/371/364

Tehran University of Medical Sciences The Research in Heart Yield and Translational Medicine (RHYTHM) 3115-7270 10 2 2015 10 13 85 92 EN Saba Ghaffary Department of Pharmacotherapy, Faculty of Pharmacy, Tehran University of Medical Sciences, Tehran, Iran. Azita Hajhossein-Talasaz Department of Pharmacotherapy, Faculty of Pharmacy, Tehran University of Medical Sciences, Tehran, Iran AND Tehran Heart Centre, Tehran University of Medical Sciences, Tehran, Iran. Padideh Ghaeli Department of Pharmacotherapy, Faculty of Pharmacy, Tehran University of Medical Sciences, Tehran, Iran. Abbasali Karimi Tehran Heart Centre, Tehran University of Medical Sciences, Tehran, Iran. Abbas Salehiomran Tehran Heart Centre, Tehran University of Medical Sciences, Tehran, Iran. Alireza Hajighasemi Tehran Heart Centre, Tehran University of Medical Sciences, Tehran, Iran. Payvand Bina Tehran Heart Centre, Tehran University of Medical Sciences, Tehran, Iran. Sayeh Darabi Tehran Heart Centre, Tehran University of Medical Sciences, Tehran, Iran. Arash Jalali Tehran Heart Centre, Tehran University of Medical Sciences, Tehran, Iran. Mehrnoush Dianatkhah Department of Pharmacotherapy, Faculty of Pharmacy, Tehran University of Medical Sciences, Tehran, Iran. Maryam Noroozian Roozbeh Hospital, Tehran University of Medical Sciences, Tehran, Iran. Nazila Shahmansouri Tehran Heart Centre, Tehran University of Medical Sciences, Tehran, Iran. 2015 10 13 2015 10 13 Background: Postoperative cognitive dysfunction (POCD) has been an important complication of cardiac surgery over the years. Neurocognitive dysfunction can affect quality of life and lead to social, functional, emotional, and financial problems in the patient’s life. To reduce POCD, we sought to identify the association between cognitive dysfunction and perioperative factors in patients undergoing cardiac surgery. Methods: One hundred one patients aged between 45 and 75 years undergoing elective cardiac surgery were enrolled in this study. All the surgeries were performed on-pump by the same medical team. A brief Wechsler Memory Test (WMT) was administered before surgery, 3 to 5 days after the surgery, and 3 months after discharge. All related perioperative parameters were collected in order to study the effect of these parameters on the postoperative WMT scores and WMT score change. Results: The study population consisted of 101 patients, comprising 14 (13.8%) females and 87 (86.2%) males aged between 45 and 75 years. In univariate analysis, the baseline WMT score, serum levels of lactate dehydrogenase and T3, cross-clamp time, and preexistence of chronic obstructive pulmonary disease showed significant effects on the postoperative WMT score (p value < 0.05), whereas only the baseline WMT score and chronic obstructive pulmonary disease showed strong effects on the postoperative WMT score in the multiple regression model. In addition, the multiple regression model demonstrated a significant association between the baseline WMT score, serum creatinine level, and nitrate administration and the WMT score change. Conclusion: Our study showed that preexisting chronic obstructive pulmonary disease and preoperative high serum creatinine levels negatively affected cognitive function after surgery. In addition, there was a strong relationship between the patients’ basic cognition and POCD. Preoperative nitrate administration led to a significant improvement in POCD. It is also concluded that the preoperative administration of specific medicines like nitrates can reduce neurological complications after cardiac surgery. https://rhythm.tums.ac.ir/index.php/jthc/article/view/372 https://rhythm.tums.ac.ir/index.php/jthc/article/download/372/365

Tehran University of Medical Sciences The Research in Heart Yield and Translational Medicine (RHYTHM) 3115-7270 10 2 2015 10 13 93 97 EN Mohammad Sadegh Parsaee Mazandaran University of Medical Sciences, Sari, Iran. Maryam Nabati Department of Cardiology, Faculty of Medicine, Mazandaran University of Medical Sciences, Sari, Iran Naser Saffar Student Research Committee, Faculty of Medicine, Mazandaran University of Medical Sciences, Sari, Iran. Morteza Taghavi Student Research Committee, Faculty of Medicine, Mazandaran University of Medical Sciences, Sari, Iran. 2015 10 13 2015 10 13 Background: The drug-eluting stent (DES) decreases the rate of coronary restenosis and re-obstruction. The aim of this study was to assess prospectively the effectiveness of the new generation DES on the left ventricular (LV) systolic and diastolic functions in patients with isolated severe proximal left anterior descending (LAD) coronary artery stenosis. Methods: A prospective study was conducted on 50 patients with isolated severe proximal LAD stenosis. Successful percutaneous coronary intervention (PCI) with Everolimus-eluting stents was performed for the whole study population. All the patients underwent transthoracic echocardiography within 24 hours before and one month after PCI, and LV systolic and diastolic parameters were compared before and after PCI using the paired samples t-test. Results: The mean age of the study population was 57.68 ± 8.82 years. Within the study population, 26 (52%) patients were male and 24 (48%) were female. There was a significant 10.6% and 5.2% increase in the early diastolic mitral annular motion (e') and the LV ejection fraction following PCI, respectively (p value = 0.005 and p value = 0.044, respectively). Before PCI, wall motion abnormality was seen in 2.21 ± 2.91 segments, which significantly decreased to 1.49 ± 2.58 segments (p value = 0.04) after the procedure. Also, the wall motion score index was 1.18 ± 0.26 before PCI, which significantly decreased to 1.13 ± 0.23 after PCI (p value < 0.001).Also, there was a trend toward a higher ratio of transmitral peak early diastolic velocity to peak late diastolic velocity after PCI (p value = 0.068). Conclusion: Our study showed that the use of the Everolimus-eluting stents improved the LV systolic and diastolic functions in patients with isolated severe LAD stenosis. https://rhythm.tums.ac.ir/index.php/jthc/article/view/373 https://rhythm.tums.ac.ir/index.php/jthc/article/download/373/366

Tehran University of Medical Sciences The Research in Heart Yield and Translational Medicine (RHYTHM) 3115-7270 10 2 2015 10 13 98 100 EN Adem Guler Department of Cardiovascular Surgery, Gulhane School of Medicine, Ankara, Turkey. Mehmet Ali-Sahin Department of Cardiovascular Surgery, Gulhane School of Medicine, Ankara, Turkey. Fahri Gurkan-Yesil Department of Cardiovascular Surgery, Gulhane School of Medicine, Ankara, Turkey. Uzeyir Yildizoglu Department of Cardiovascular Surgery, Gulhane School of Medicine, Ankara, Turkey. Sait Demirkol Department of Cardiovascular Surgery, Gulhane School of Medicine, Ankara, Turkey. Mehmet Arslan Department of Cardiovascular Surgery, Gulhane School of Medicine, Ankara, Turkey. 2015 10 13 2015 10 13 The bicuspid aortic valve is known to be the most common congenital cardiac malformation, with an approximate incidence rate of 1-2% in the general population. Most patients are unaware of the disease until the onset of infective endocarditis, which is a life-threatening complication that may affect a heart valve or other cardiac structures at the site of endothelial damage. A 22-year-old man presented to our internal medicine clinic with a complaint of acute onset dyspnea and fatigue. His body temperature was 38 °C. A diastolic murmur was detected at the right sternal border. Two-dimensional transthoracic echocardiography revealed severe aortic insufficiency, and two-dimensional transesophageal echocardiography showed that the aortic valve was bicuspid. There was also a flail lesion extending the left ventricular outflow tract, resulting in pathological coaptation and severe aortic insufficiency. The patient was referred to our cardiovascular department for surgery. We herein present this case of a bicuspid aortic valve complicated by infective endocarditis due to the underlying disease of chronic otitis media related to a rare pathogen: Alloiococcus otitidis. The patient underwent a successful aortic valve replacement surgery due to aortic insufficiency following infective endocarditis. He was discharged on the 16th postoperative day in good condition. https://rhythm.tums.ac.ir/index.php/jthc/article/view/374 https://rhythm.tums.ac.ir/index.php/jthc/article/download/374/367

Tehran University of Medical Sciences The Research in Heart Yield and Translational Medicine (RHYTHM) 3115-7270 10 2 2015 10 13 101 105 EN Seyed Reza Aghili Department of Medical Mycology and Parasitology, and Invasive Fungi Research Center (IFRC), Faculty of Medicine, Mazandaran University of Medical Sciences, Sari, Iran. Tahereh Shokohi Department of Medical Mycology and Parasitology, and Invasive Fungi Research Center (IFRC), Faculty of Medicine, Mazandaran University of Medical Sciences, Sari, Iran. Mohammad-Ali Boroumand Tehran Heart Center, Tehran University of Medical Sciences, Tehran, Iran. Shirinsadat Hashemi-Fesharaki Student Research Committee, Faculty of Medicine, Mazandaran University of Medical Sciences, Sari, Iran. Bahar Salmanian Department of Sciences, Seddigheh Tahereh Branch, Farhangian University, Sari, Iran. 2015 10 13 2015 10 13 The incidence of candidemia due to the uncommon non-albicans Candida species appears to be increasing, and certain species such as Candida (C.) membranaefaciens have been reported in some clinical researches. Vascular catheters are considered the likely culprit for the sudden emergence of hospital-acquired candidemia. The identification of C. membranaefaciens can be problematic in clinical practice owing to its phenotypic resemblance to C. guilliermondii. We report the first case of C. membranaefaciens in Iran, which occurred in a 70-year-old woman, who had coronary artery bypass grafting (CABG). We isolated germ-tube negative yeast from both blood culture and central venous catheter (CVC) tip culture on brain-heart infusion agar, Sabouraud dextrose agar plates, and biphasic brain-heart infusion media bottle; it developed smooth, pink colonies on CHROMagar Candida. By using the polymerase chain reaction and sequencing of theinternal transcribed spacer region of rDNA, we identified C. membranaefaciens. After the removal of the CVC and initiation of Fluconazole treatment, the patient's condition gradually improved and she was discharged from the hospital. The early detection of organisms in the catheter, removal of the catheter, and treatment with anti-fungal antibiotics have an important role in controlling disease and preventing septicemia after CABG. As C. membranaefaciens is an opportunistic Candida species, both clinicians and microbiologists should be aware of the factors that confer fast diagnosis and appropriate treatment. https://rhythm.tums.ac.ir/index.php/jthc/article/view/375 https://rhythm.tums.ac.ir/index.php/jthc/article/download/375/368

Tehran University of Medical Sciences The Research in Heart Yield and Translational Medicine (RHYTHM) 3115-7270 10 2 2015 10 13 106 108 EN Vasileios Patris Heart and Chest Hospital, Liverpool, UK. Orestis Argiriou Medical School, University of Ioannina, Ioannina, Greece. Niki Lama Heart and Chest Hospital, Liverpool, UK. Haris Georgiou Evangelismos General Hospital, Athens, Greece. Constantine Halkias North Middlesex University Hospital, London, UK. Christos Charitos Evangelismos General Hospital, Athens, Greece. 2015 10 13 2015 10 13 Cutaneous complications caused by a pacemaker or defibrillator are widely documented, but the development of a bronchocutaneous fistula has never been described before. We report the case of a 79-year-old man who was admitted to our hospital because of a seemingly superficial cutaneous infection, externalized defibrillator leads, and hemoptysis. Bronchoscopical investigation proved the existence of the fistula, which connected the epicardium, the left main bronchus, and the aforementioned site of skin infection. The patient refused an operation for the complete removal of the epicardial defibrillator and was treated conservatively. This case demonstrated that the long-term presence of foreign bodies in the epicardium may cause serious complications https://rhythm.tums.ac.ir/index.php/jthc/article/view/376 https://rhythm.tums.ac.ir/index.php/jthc/article/download/376/369

Tehran University of Medical Sciences The Research in Heart Yield and Translational Medicine (RHYTHM) 3115-7270 10 2 2015 10 13 109 112 EN Naser Hemati Imam Ali Hospital, Kermanshah University of Medical Sciences, Kermanshah, Iran. Alireza Poormotaabed Imam Ali Hospital, Kermanshah University of Medical Sciences, Kermanshah, Iran. Samsam Dabiri Imam Ali Hospital, Kermanshah University of Medical Sciences, Kermanshah, Iran. Feridoun Sabzi Imam Ali Hospital, Kermanshah University of Medical Sciences, Kermanshah, Iran. 2015 10 13 2015 10 13 Acute left atrial thrombosis at the site of the resection of the primary cribriform septum is an exceedingly rare and important complication after atrial septal defect (ASD) closure with a pericardial or synthetic patch. This case report presents a mobile thrombus noted on the left atrium at the raw surface site of a resected cribriform primary septum that was not caught in the suture line with the pericardial patch for the closure of the ASD in a 30-year-old woman with an uncomplicated ASD surgery. The patient had no symptoms in the postoperative period, and routine postoperative transesophageal echocardiography revealed a large pedunculated and mobile mass (thrombosis) at the left atrial side of the interatrial septum at the level of the implanted pericardial patch. The thrombus was successfully treated with surgery. The patient had an uneventful recovery in the postoperative period and was discharged from the hospital 15 days after admission. One-year follow-up showed no evidence of clot recurrence in the left or right atrium. https://rhythm.tums.ac.ir/index.php/jthc/article/view/377 https://rhythm.tums.ac.ir/index.php/jthc/article/download/377/370

Tehran University of Medical Sciences The Research in Heart Yield and Translational Medicine (RHYTHM) 3115-7270 10 2 2015 10 13 113 114 EN Arash Gholoobi Atherosclerosis Prevention Research Center, Imam Reza Hospital, Mashhad University of Medical Sciences, Mashhad, Iran. 2015 10 13 2015 10 13 No Abstract https://rhythm.tums.ac.ir/index.php/jthc/article/view/378 https://rhythm.tums.ac.ir/index.php/jthc/article/download/378/371

Tehran University of Medical Sciences The Research in Heart Yield and Translational Medicine (RHYTHM) 3115-7270 10 2 2015 10 13 115 116 EN Zargham Hossein-Ahmadi Chronic Respiratory Diseases Research Center, National Research Institute of Tuberculosis and Lung Diseases (NRITLD),Shahid Beheshti University of Medical Sciences, Tehran,Iran. Hamid Ghaderi Department of Cardiovascular Surgery, Shahid Modarress Hospital, Shahid Beheshti University of Medical sciences, Saadat Abad,Tehran, Iran. Seyedeh Adeleh Mirjafari Brain and Spinal Injury Research Center (BASIR), Imam Khomeini Hospital Complex,End of Keshavarz Blv, Tehran, Iran. Tahereh Parsa Brain and Spinal Injury Research Center (BASIR), Imam Khomeini Hospital Complex, End of Keshavarz Blv, Tehran, Iran. 2015 10 13 2015 10 13 Letter to the Editor https://rhythm.tums.ac.ir/index.php/jthc/article/view/379 https://rhythm.tums.ac.ir/index.php/jthc/article/download/379/372