Tehran University of Medical Sciences The Research in Heart Yield and Translational Medicine (RHYTHM) 3115-7270 10 3 2015 12 17 117 121 EN Anil Ozen Türkiye Yüksek Ihtisas Hospital, Cardiovascular Surgery Department, Ankara, Turkey. Muhammet Onur Hanedan Türkiye Yüksek Ihtisas Hospital, Cardiovascular Surgery Department, Ankara, Turkey. Çetin Murat Songur Türkiye Yüksek Ihtisas Hospital, Cardiovascular Surgery Department, Ankara, Turkey. Emre Boysan Türkiye Yüksek Ihtisas Hospital, Cardiovascular Surgery Department, Ankara, Turkey. Ertekin Utku Unal Türkiye Yüksek Ihtisas Hospital, Cardiovascular Surgery Department, Ankara, Turkey. Serkan Mola Türkiye Yüksek Ihtisas Hospital, Cardiovascular Surgery Department, Ankara, Turkey. Halil Ibrahim Erkengel Türkiye Yüksek Ihtisas Hospital, Cardiovascular Surgery Department, Ankara, Turkey. Emre Kubat Türkiye Yüksek Ihtisas Hospital, Cardiovascular Surgery Department, Ankara, Turkey. Zafer Iscan Türkiye Yüksek Ihtisas Hospital, Cardiovascular Surgery Department, Ankara, Turkey. Ufuk Tutun Türkiye Yüksek Ihtisas Hospital, Cardiovascular Surgery Department, Ankara, Turkey. Ahmet Sarıtas Türkiye Yüksek Ihtisas Hospital, Cardiovascular Surgery Department, Ankara, Turkey. Cemal Levent Birincioglu Türkiye Yüksek Ihtisas Hospital, Cardiovascular Surgery Department, Ankara, Turkey. 2015 12 17 2015 12 17 Background: Surgical treatment of a ruptured abdominal aorta aneurysm (RAAA) continues to present a significant challenge to surgeons. There are some patient factors such as age and gender that cannot be changed, and comorbid conditions can be optimized but not eliminated.  The purpose of this study was to identify the risk factors affecting high mortality after the surgical repair of an RAAA. Methods: Data on 121 patients who underwent surgical repair for RAAAs between January 1997 and June 2011 in our institution were collected retrospectively. All the patients had been diagnosed by computed tomography (CT) scans, and intraoperative extra-luminal blood was visualized intraoperatively. Variables studied comprised demographic data; preoperative, operative, and postoperative data; and the causes of mortality. Multivariate regression analysis was used to determine the predictors of mortality. Results: One hundred eight (89.2%) patients were male and 13 (10.7%) were female at an average age of 68.9 ± 10.5 years. Totally, 121 patients underwent surgery for RAAAs. Fifty-four patients had aortic tube grafts, 32 aortobiiliac grafts, 20 aortobifemoral grafts, 1 aortoiliac graft, and 1 aortofemoral graft for the replacement of the RAAAs. Seven patients had only surgical exploration. Operative mortality was 41.3% (50 patients). The factors associated with mortality were preoperative shock, free blood, positive inotropic agent, hematocrit value, and need for blood and plasma. In the multivariate analysis, preoperative shock and positive inotropic agents were found to be significant as the predictors of death (OR: 19.8, 95%CI: 3.2-122.8 and OR: 8.6, 95% CI: 2.9-26.3, respectively). Conclusion: This study revealed that the preoperative clinical findings affected the mortality associated with RAAAs. https://rhythm.tums.ac.ir/index.php/jthc/article/view/424 https://rhythm.tums.ac.ir/index.php/jthc/article/download/424/374

Tehran University of Medical Sciences The Research in Heart Yield and Translational Medicine (RHYTHM) 3115-7270 10 3 2015 12 17 163 164 EN Khosro Barkhordari Tehran Heart Center, Tehran University of Medical Sciences, Tehran, Iran. Akbar Shafiee Tehran Heart Center, Tehran University of Medical Sciences, Tehran, Iran. 2015 12 17 2015 12 17 - https://rhythm.tums.ac.ir/index.php/jthc/article/view/438 https://rhythm.tums.ac.ir/index.php/jthc/article/download/438/388

Tehran University of Medical Sciences The Research in Heart Yield and Translational Medicine (RHYTHM) 3115-7270 10 3 2015 12 17 122 128 EN Mehrnoush Dianatkhah Department of Pharmacotherapy, Faculty of Pharmacy, Tehran University of Medical Sciences, Tehran, Iran. Padideh Ghaeli 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. Abbasali Karimi Tehran Heart Centre, Tehran University of Medical Sciences, Tehran, Iran. Abbas Salehiomran Tehran Heart Centre, Tehran University of Medical Sciences, Tehran, Iran. Peyvand Bina Tehran Heart Centre, Tehran University of Medical Sciences, Tehran, Iran. Arash Jalali Tehran Heart Centre, Tehran University of Medical Sciences, Tehran, Iran. Saba Ghaffary Department of Pharmacotherapy, Faculty of Pharmacy, Tehran University of Medical Sciences, Tehran, Iran. Nazila Shahmansouri Tehran Heart Centre, Tehran University of Medical Sciences, Tehran, Iran. Shaghayegh Vejdani Department of Pharmacotherapy, Faculty of Pharmacy, Tehran University of Medical Sciences, Tehran, Iran. 2015 12 17 2015 12 17 Background: Postoperative neurological injuries, including cognitive dysfunction, sleep disorder, delirium, and anxiety, are the important consequences of coronary artery bypass graft surgery (CABG). Evidence has shown that postoperative sleep disturbance is partly due to disturbed melatonin secretion in the perioperative period. The aim of this study was to evaluate the effect of melatonin on postoperative sleep disorder in patients undergoing CABG. Method: One hundred forty-five elective CABG patients participated in a randomized double-blind study during the preoperative period. The patients were randomized to receive either 3 mg of melatonin or 10 mg of Oxazepam one hour before sleep time. Each group received the medication from 3 days before surgery until the time of discharge. Sleep quality was evaluated using the Groningen Sleep Quality Score (GSQS), and the incidence of delirium was evaluated by nursing records. Sleep quality and anxiety scores were compared before and after surgery through the Wilcoxon signed-rank test. The analysis of covariance (ANCOVA) and independent t-test were used to compare the sleep and anxiety scores between the groups. P values ≤ 0.05 were considered statistically significant. Results: Totally, 137 patients at a mean age of 60 years completed the study (76% male). The analysis of the data showed that sleep was significantly disturbed after surgery in both groups. The patients in the Oxazepam group demonstrated significantly higher disturbance in their mean postoperative GSQS score than did their counterparts in the melatonin group (p value < 0.001). A smaller proportion of the participants experienced delirium in the melatonin group (0.06%) than in the Oxazepam group (0.12%); however, this difference was not statistically significant. Conclusion: The result of the present study revealed that melatonin improved sleep in post-cardiac surgery patients more than what was observed with Oxazepam. Therefore, melatonin may be considered an effective alternative for Benzodiazepines in the management of postoperative sleep disorder. https://rhythm.tums.ac.ir/index.php/jthc/article/view/425 https://rhythm.tums.ac.ir/index.php/jthc/article/download/425/375

Tehran University of Medical Sciences The Research in Heart Yield and Translational Medicine (RHYTHM) 3115-7270 10 3 2015 12 17 165 166 EN Ali Hosseinsabet Tehran Heart Center, Tehran University of Medical Sciences, Tehran, Iran. 2015 12 17 2015 12 17 - https://rhythm.tums.ac.ir/index.php/jthc/article/view/439 https://rhythm.tums.ac.ir/index.php/jthc/article/download/439/389

Tehran University of Medical Sciences The Research in Heart Yield and Translational Medicine (RHYTHM) 3115-7270 10 3 2015 12 17 129 133 EN Nooredin Mohammadi Department of Critical Care Nursing, School of Nursing and Midwifery, Iran University of Medical Sciences, Center for Nursing Care Research, Tehran, Iran. Mohammad Abbasi International Campus, Iran University of Medical Sciences, Tehran, Iran. Alireza Nikbakht Nasrabadi Tehran University of Medical Sciences, Tehran, Iran. Abbas Salehiomran Tehran University of Medical Sciences, Tehran, Iran. Saeid Davaran Tehran University of Medical Sciences, Tehran, Iran. Reza Norouzadeh Shahed University, Nursing and Midwifery Faculty, Tehran, Iran. 2015 12 17 2015 12 17 Background: Coronary artery bypass graft surgery (CABG) improves the quality of life, increases survival, and influences the patient's mental and emotional aspects. Little information is available on the lived experience of Iranian patients after this surgery. Understanding the lived experiences of patients will help health professionals with better provision of high quality care. Methods: This hermeneutic phenomenological study aimed to understand the lived experience of patients after CABG.  Van Manen's method was used to conduct the study. A semi-structured, face-to-face interview technique was employed to explore the experiences of the patients following surgery. Seven men and 4 women between 49 and 80 years old were interviewed. Results: Passion for life was the main theme extracted from the participants’ interviews. This theme comprised the three sub-themes of receiving attention from family, being hopeful, and being spiritually oriented. Conclusion:  The results showed that the participants experienced passion for life after their surgery. This finding reveals that patients tend to find a new perspective on life and their health after surgery. https://rhythm.tums.ac.ir/index.php/jthc/article/view/440 https://rhythm.tums.ac.ir/index.php/jthc/article/download/440/390

Tehran University of Medical Sciences The Research in Heart Yield and Translational Medicine (RHYTHM) 3115-7270 10 3 2015 12 17 134 139 EN Parvin Akbariasbagh Imam Khomeini Complex, Tehran University of Medical Sciences, Tehran, Iran. Mohammad Reza Mirzaghayan Imam Khomeini Complex, Tehran University of Medical Sciences, Tehran, Iran. Naseredin Akbariasbagh Baharlo Hospital, Tehran University of Medical Sciences, Tehran, Iran. Mamak Shariat Maternal-Fetal and Neonatal Research Center, Tehran University of Medical Sciences, Tehran, Iran. Bita Ebrahim Valiasr Hospital, Breastfeeding Research Center, Tehran, Iran 2015 12 17 2015 12 17 Background: Injured phrenic nerve secondary to cardiac surgeries is the most common cause of diaphragmatic paralysis (DP) in infants. The aim of this study was to determine the risk factors for DP caused by congenital heart defect corrective surgeries in pediatrics. Methods: This cross-sectional study, conducted in a 2-year period (2006–2008), included 451 children with congenital heart diseases admitted to the Pediatric Cardiac Surgery Ward of Imam Khomeini Hospital. The diaphragmatic function was examined via fluoroscopy, and the frequency of DP and its relevant parameters were evaluated. Results: Of the 451 patients, comprising 268 males and 183 females at an age range of 3 days to 204 months (28.2 ± 33.4 months), 25 (5.5%) infants (60% male and 40% female, age range = 15 days to 132 months, 41.2 ± 28.1 months) had DP as follows: 48% unilateral right-sided and 36% unilateral left-sided. Additionally, 68% had cyanotic congenital heart disease and 84% had DP following total correction surgery.  The highest prevalence rates of DP resulting in phrenic hemiparesis were observed after arterial switch operation, Fontan procedure, and Blalock–Taussig shunt surgery, respectively. Thirteen (52%) of the 25 DP patients underwent surgical diaphragmatic plication because of severe respiratory distress and dependency on mechanical ventilation, and most of the cases of plication underwent arterial switch operation. The rate of mortality was 24% (6 patients). Conclusion: DP with a prevalence of 5.5% was one of the most common complications secondary to cardiac surgeries in the infants included in the present study. Effective factors were age, weight, cyanotic congenital heart defects, and previous cardiac surgery. Diaphragmatic plication improved prognosis in severe cases. https://rhythm.tums.ac.ir/index.php/jthc/article/view/427 https://rhythm.tums.ac.ir/index.php/jthc/article/download/427/377

Tehran University of Medical Sciences The Research in Heart Yield and Translational Medicine (RHYTHM) 3115-7270 10 3 2015 12 17 140 148 EN Somayeh Nejati Behavioral Sciences Research Center, Shahid Beheshti University of Medical Sciences, Tehran, Iran. Alireza Zahiroddin Behavioral Sciences Research Center, Shahid Beheshti University of Medical Sciences, Tehran, Iran. Gita Afrookhteh Azad University of Sciences and Research, Tehran, Iran. Soheila Rahmani title locale="en_US">Relationship between the Severity of Coronary Artery Disease and Catheter-Associated Urethral Stricture in Patients with Acute Coronary Syndrome 113 118 İbrahim YILDIZ Cardiology Clinic, Osmaniye Government Hospital, Osmaniye, Turkey. Fatih Gokalp Urology Clinic, Osmaniye Government Hospital, Osmaniye, Turkey. Cengiz BURAK Department of Cardiology, Medical Faculty, Kafkas University, Kars, Turkey. Sinan KARAZINDIYANOGLU Urology Clinic, Osmaniye Government Hospital, Osmaniye, Turkey. Pinar YILDIZ Cardiology Clinic, Osmaniye Government Hospital, Osmaniye, Turkey. Ibrahim RENGUZOGULLARI Department of Cardiology, Medical Faculty, Kafkas University, Kars, Turkey. Yavuz KARABAG Department of Cardiology, Medical Faculty, Kafkas University, Kars, Turkey. Metin CAGDAS Department of Cardiology, Medical Faculty, Kafkas University, Kars, Turkey. 2019 09 15 2020 04 25 Background: Different arterial segments throughout the vascular system develop similar grades of atherosclerosis concomitantly. Urethral ischemia has been proposed as a cause of urethral stricture. Therefore, we aimed to investigate the relationship between coronary artery disease severity using a SYNTAX score and urethral stricture occurrence after urethral catheterization in patients with non–ST-segment-elevation acute coronary syndrome (ACS). Methods: This retrospective study consisted of 306 men with urethral catheters that were diagnosed with ACS and underwent coronary angiography between January 2016 and January 2018 in Kars Kafkas University and Osmaniye Government Hospital, Turkey.  Hospital records were reviewed to collect the follow-up data of the patients regarding the occurrence of urethral stricture after urethral catheterization. The study population was divided into 2 groups according to urethral stricture development, and both groups were compared statistically. Results: SYNTAX scores were significantly higher in patients with urethral stricture than in those without urethral stricture (14.86±7.11 vs. 29.25±9.79; P<0.001). The SYNTAX score (OR=1.27; 95% CI: 1.16–1.39; P<0.001), diabetes, and serum albumin were found to be the independent predictors of urethral stricture. The receiver operating characteristic curve analysis showed that the cutoff value of the SYNTAX score for urethral stricture prediction was greater than 22.5, with 76.7% sensitivity and 85.1% specificity (AUC=0.88, 95% CI: 0.84–0.91; P<0.001). Conclusion: Coronary artery disease severity graded according to the SYNTAX score is an independent predictor of urethral stricture occurrence in ACS patients with a urethral catheter inserted. https://rhythm.tums.ac.ir/index.php/jthc/article/view/1146 https://rhythm.tums.ac.ir/index.php/jthc/article/download/1146/914

Tehran University of Medical Sciences The Research in Heart Yield and Translational Medicine (RHYTHM) 3115-7270 15 3 2020 07 15 136 141 Truong Hoang Department of Internal Diseases, Medical Institute, RUDN University, Moscow, Russia. Pavel Lazarev Department of Internal Diseases, Medical Institute, RUDN University, Moscow, Russia. Victor Maiskov Department of Internal Diseases, Medical Institute, RUDN University, Moscow, Russia. AND Vinogradov City Clinical Hospital, Moscow, Russia. Meray Imad Department of Internal Diseases, Medical Institute, RUDN University, Moscow, Russia. AND Vinogradov City Clinical Hospital, Moscow, Russia. Zhanna Kobalava Department of Internal Diseases, Medical Institute, RUDN University, Moscow, Russia. 2019 12 16 2020 05 12 While atherosclerotic plaque disruption remains the hallmark of type 1 myocardial infarction (T1MI), multiple other mechanisms provoking myocardial supply/demand mismatch (eg, anemia and tachyarrhythmias) are recognized as the potential causes of type 2 myocardial infarction (T2MI). In clinical practice, angiography is underutilized in patients with MI that have typical T2MI triggers, although the presence of these triggers and various forms of atherosclerotic coronary artery disease is not mutually exclusive. We describe a 70-year-old man that developed MI during hospitalization for gastrointestinal bleeding. He was treated conservatively without angiography due to posthemorrhagic anemia, which is a recognized T2MI trigger, and subsequently developed refractory cardiogenic shock. Autopsy revealed atherothrombosis, which is characteristic of T1MI. https://rhythm.tums.ac.ir/index.php/jthc/article/view/1196 https://rhythm.tums.ac.ir/index.php/jthc/article/download/1196/918

Tehran University of Medical Sciences The Research in Heart Yield and Translational Medicine (RHYTHM) 3115-7270 15 3 2020 07 15 119 127 Teuku Muhammad Haykal Putra Faculty of Medicine, Universitas Indonesia, National Cardiovascular Center Harapan Kita, Jakarta, Indonesia. Renan Sukmawan Faculty of Medicine, Universitas Indonesia, National Cardiovascular Center Harapan Kita, Jakarta, Indonesia. Dwita Rian Desandri Faculty of Medicine, Universitas Indonesia, National Cardiovascular Center Harapan Kita, Jakarta, Indonesia. Celly Atmadikoesoemah Faculty of Medicine, Universitas Indonesia, National Cardiovascular Center Harapan Kita, Jakarta, Indonesia. Elen Elen Faculty of Medicine, Universitas Indonesia, National Cardiovascular Center Harapan Kita, Jakarta, Indonesia. Manoefris Kasim Faculty of Medicine, Universitas Indonesia, National Cardiovascular Center Harapan Kita, Jakarta, Indonesia. 2020 01 05 2020 06 06 Background: Patients with rheumatic mitral stenosis (MS) experience changes in left ventricular (LV) dimensions after mitral valve surgery. We sought to investigate changes in LV dimensional parameters after mitral valve surgery and find out whether the same changes occurred in different extents of myocardial fibrosis. Methods: This prospective observational study comprised 43 patients with rheumatic MS planned for mitral valve surgery between October 2017 and April 2018 in National Cardiovascular Center Harapan Kita (NCCHK) Jakarta. All the patients underwent cardiac magnetic resonance imaging based on the late gadolinium enhancement (LGE) protocol for myocardial fibrosis assessment prior to surgery. The patients were classified according to the estimated fibrosis volume considered to influence hemodynamic performance (myocardial fibrosis <5% and myocardial fibrosis ≥5%). Serial transthoracic echocardiographic examinations before and after surgery were performed to detect changes in LV dimensional parameters. Results: This study consisted of 31 (72.1%) women and 12 (27.9%) men at a mean age of 46±9 years. The LGE protocol revealed myocardial fibrosis of less than 5% in 32 (74.4%) patients. A significant increase was detected in the LV end-diastolic diameter postoperatively, specifically in the patients with myocardial fibrosis of less than 5% (44.0±4.8 mm vs 46.6±5.6 mm; P value=0.027). A similar significant increase was not found in the other group (45.0±6.6 mm vs 46.7±6.9 mm; P value=0.256). Other changes in echocardiographic parameters showed similar patterns in both groups. Conclusion: Our patients with rheumatic MS who had myocardial fibrosis of less than 5% demonstrated better improvements in terms of increased preload. Myocardial fibrosis of less than 5% is associated with more favorable improvements in LV geometry. https://rhythm.tums.ac.ir/index.php/jthc/article/view/1203 https://rhythm.tums.ac.ir/index.php/jthc/article/download/1203/915

Tehran University of Medical Sciences The Research in Heart Yield and Translational Medicine (RHYTHM) 3115-7270 15 3 2020 07 15 142 146 GÖKHAN AKSAN Department of Cardiology, Samsun Education and Research Hospital, Samsun; Turkey. Osman Yontar Department of Cardiology, Samsun Education and Research Hospital, Samsun; Turkey. Ahmet Yanık Department of Cardiology, Samsun Education and Research Hospital, Samsun, Turkey. Uğur Arslan Department of Cardiology, Samsun Education and Research Hospital, Samsun, Turkey. Mustafa Yenerçağ Department of Cardiology, Samsun Education and Research Hospital, Samsun, Turkey. 2020 01 05 2020 06 06 Focal atrial tachycardias (ATs) arising from the left atrium (LA) most commonly originate from the ostium of the pulmonary vein, the superior mitral annulus, the body of the coronary sinus, the LA septum, and the LA appendage. Focal ATs originating from the posterior wall of the LA are extremely rare. A 34-year-old male patient presented to the cardiology outpatient clinic complaining of palpitation. Electrocardiography showed a tachycardia at a ventricular rate of 150 bpm and a narrow QRS complex. Therefore, an electrophysiological study was performed, which was consistent with an AT. The patient underwent an electrophysiological study in tachycardias with narrow QRS complexes. The diagnostic electrophysiological findings were consistent with an AT. The AT cycle length was found to be 405 ms with variability in the ventriculoatrial interval. Simultaneous LA anatomical and activation mapping was performed during the AT using a 3D electroanatomic mapping system (CARTO) and a quadripolar unidirectional irrigated tip catheter. The activation mapping revealed that the earliest endocardial activation site was at the posterior wall of the LA, where the local electrogram was 72 ms and 35 ms before the coronary sinus reference and the P-wave onset, respectively. The activation mapping also showed centrifugal spreading and mid-diastolic, fractionated signals on the posterior wall. Radiofrequency ablation was successfully performed with 30-watt power at the site of the earliest atrial activation, with a fractionated electrogram terminating the tachycardia. LA posterior ATs are a rare form of AT. The electro