Tehran University of Medical Sciences The Research in Heart Yield and Translational Medicine (RHYTHM) 3115-7270 18 3 2023 07 30 232 233 Masoud Tarbiat Fellowship of Cardiac Anesthesia, Associate Professor, Department of Anesthesiology Sayed Ahmad Reza Salimbahrami Fellowship of Cardiac Anesthesia, Assistant Professor, Department of Anesthesiology Mahmoud Rezaei Anesthesiologist, Assistant professor, Department of Anesthesiology, Hamid Reza Khorshidi Department of Surgery, School of Medicine, Hamadan University of Medical Sciences, Hamadan, Iran. 2023 04 09 2023 07 16 No Abstract No Abstract No Abstract   https://rhythm.tums.ac.ir/index.php/jthc/article/view/1837 https://rhythm.tums.ac.ir/index.php/jthc/article/download/1837/1078

Tehran University of Medical Sciences The Research in Heart Yield and Translational Medicine (RHYTHM) 3115-7270 18 3 2023 07 30 154 169 Babak Bagheri Department of Cardiology, Faculty of Medicine, Cardiovascular Research Center, Mazandaran University of Medical Sciences, Sari, Iran. Abbas Alipour Community Medicine Department, School of Medicine, Mazandaran University of Medical Sciences, Sari, Iran. Mojtaba Yousefi Department of Cardiology, Faculty of Medicine, Cardiovascular Research Center, Mazandaran University of Medical Sciences, Sari, Iran. Rozita Jalalian Department of Cardiology, Faculty of Medicine, Cardiovascular Research Center, Mazandaran University of Medical Sciences, Sari, Iran. Minoo Moghimi Department of Clinical pharmacy, Faculty of Pharmacy, Mazandaran University of Medical Sciences, Sari, Iran. Mahsa Mohammadi Rajaie Cardiovascular Medical and Research Center, School of Medicine, Iran University of Medical Sciences, Tehran, Iran. Negar Hassanpour Rajaie Cardiovascular Medical and Research Center, School of Medicine, Iran University of Medical Sciences, Tehran, Iran. Mohammadreza Iranian Rajaie Cardiovascular Medical and Research Center, School of Medicine, Iran University of Medical Sciences, Tehran, Iran. 2023 03 11 2023 08 23 Background: Many studies have evaluated thromboembolic events in COVID-19 patients, and most of them have reported a high estimation of the prevalence of such events. The present study sought to evaluate the prevalence of thromboembolic events in patients with COVID-19. Methods: This study is a systematic review with meta-analysis that investigated thromboembolic events in patients with COVID-19 from the start of the pandemic to August 31, 2021. The 4 main databases for collecting articles were Medline, Scopus, Google Scholar, and Web of Science. Deep vein thrombosis, pulmonary embolism, arterial thrombosis, and the overall rate of thromboembolic events were considered primary outcomes. Results: In a total of 63 studies (104 920 patients with COVID-19), the overall thrombosis rate was 21% (95% CI, 18% to 25%), the rate of deep vein thrombosis was 20% (95% Cl, 16% to 25%), the rate of pulmonary embolism was 8% (95% Cl, 6% to 10%), and the rate of arterial thrombosis was 5% (95% Cl, 3% to 7%). The prevalence of all primary outcomes in critically ill patients admitted to the intensive care unit (ICU) was significantly higher (P<0.05). In older patients, the prevalence of overall thrombosis, pulmonary embolism, or deep vein thrombosis was significantly higher (P<0.05). Conclusion: This study showed that COVID-19 increases the risk of thromboembolic events, especially in elderly and critically ill patients admitted to the ICU. Therefore, more strategies are needed to prevent thromboembolic events in patients with COVID-19, especially in ICU-admitted and elderly patients. https://rhythm.tums.ac.ir/index.php/jthc/article/view/1819

Tehran University of Medical Sciences The Research in Heart Yield and Translational Medicine (RHYTHM) 3115-7270 18 3 2023 07 30 170 176 Fatemeh Taheri Department of Clinical Nutrition, School of Nutritional Sciences and Dietetics, Tehran University of Medical Sciences, Tehran, Iran. Mohammad Javad Hosseinzadeh-Attar Department of Clinical Nutrition, School of Nutritional Sciences and Dietetics, Tehran University of Medical Sciences, Tehran, Iran. Elham Alipoor 1-Department of Clinical Nutrition, School of Nutritional Sciences and Dietetics, Tehran University of Medical Sciences, Tehran, Iran. 2-Cardiac Primary Prevention Research Center, Cardiovascular Diseases Research Institute, Tehran University of Medical Sciences, Tehran, Iran. Elaheh Honarkar-Shafie Department of Clinical Nutrition, School of Nutritional Sciences and Dietetics, Tehran University of Medical Sciences, Tehran, Iran. Mehdi Yaseri Department of Epidemiology and Biostatistics, School of Public Health, Tehran University of Medical Sciences, Tehran, Iran. Ali Vasheghani Farahani Cardiac Primary Prevention Research Center, Cardiovascular Diseases Research Institute, Tehran University of Medical Sciences, Tehran, Iran. 2023 05 24 2023 08 15 Background: Neuregulin-4 (Nrg4), a novel brown fat-enriched factor, has been reported to play a crucial role in developing metabolic disorders. The current case-control study aimed to investigate the association between serum Nrg4 and coronary artery disease (CAD). Methods: This study enrolled 43 patients with CAD and 43 subjects with normal coronary arteries diagnosed by coronary angiography. Anthropometric and biochemical parameters were measured and recorded. The serum Nrg4 level was determined using the enzyme-linked immunosorbent assay. The relationships between circulating Nrg4 and CAD and other clinical parameters were analyzed. A receiver operating characteristic analysis was applied to assess the utility of Nrg4 in identifying CAD. Results: The study population comprised 86 patients, including 64 men (74.4%), at a mean age of 57.83±6.01 years. Patients with CAD had significantly lower serum Nrg4 than the control group (P<0.001). The serum Nrg4 level was negatively correlated with anthropometric variables, including the body mass index, waist circumference, and the waist-to-hip ratio, fasting blood glucose, and the triglyceride-glucose index (P<0.05). In multivariable-adjusted regression analysis, the odds of CAD decreased by 46% per 1 SD elevation in the serum Nrg4 level (OR, 0.54; 95% CI, 0.40 to 0.73; P<0.001) after controlling for potential confounders. Nrg4 showed a significantly high area under the curve value (AUC, 0.85; 95% CI, 0.75 to 0.94) with 81.4% sensitivity and 95.3% specificity to identify CAD. Conclusion: Generally, the serum level of Nrg4 declines in patients with CAD, which might be an independent risk factor for CAD. https://rhythm.tums.ac.ir/index.php/jthc/article/view/1863

Tehran University of Medical Sciences The Research in Heart Yield and Translational Medicine (RHYTHM) 3115-7270 18 3 2023 07 30 177 182 Neda Roshanravan Cardiovascular Research Center, Tabriz University of Medical Sciences, Tabriz, Iran. Faezeh Tarighat Students’ Research Committee, Tabriz University of Medical Sciences, Tabriz, Iran. Sara Pahlavan Department of Stem Cells and Developmental Biology, Cell Science Research Center, Royan Institute for Stem Cell Biology and Technology, Tehran, Iran. Mahdi Parvizi Faculty of Medicine, Semmelweis University, Budapest, Hungary. Erfan Banisefid Students’ Research Committee, Tabriz University of Medical Sciences, Tabriz, Iran. Somayeh Abolhasani Department of Biochemistry, Faculty of Medicine, Urmia University of Medical Sciences, Urmia, Iran. Amir Hadi 1-Halal Research Center of IRI, Food and Drug Administration, Ministry of Health and Medical Education, Tehran, Iran.. 2-Ministry of Health and Medical Education, Tehran, Iran. Rezayat Parvizi Cardiovascular Research Center, Tabriz University of Medical Sciences, Tabriz, Iran. 2022 06 07 2023 08 26 Background: Aortic valve replacement (AVR) may complicate conduction abnormalities and require permanent pacemaker (PPM) implantation. New techniques that lessen this challenge may lead to the development of new approaches. Our objective was to evaluate the contemporary incidence of early postoperative PPM implantation in patients undergoing isolated AVR and root disease with the standard AVR surgical technique compared with the novel suture AVR technique. Methods: The clinical data of 354 patients (250 male, 104 female) who underwent surgery for isolated AVR and root disease in different referral cardiology departments in Tabriz, Iran, over 4 years were analyzed. Patients with preoperative significant conduction abnormalities were excluded from the study. The patients were evaluated for in-hospital mortality, postoperative PPM implantation, and their stay in the ICU after surgery. Results: The mean age of the patients was 52.46±16.13 years. Totally, 183 patients (51.7%) were operated on with the new suture AVR technique. In-hospital mortality was lower in this group than in the group that underwent the “classic” surgical technique (2.5% vs 3.7%). PPM implantation was required in 3 patients (0.8%) after the novel suture AVR technique, whereas it was needed in 12 patients (3.4%) in the other group (P=0.024). The mortality rate was 9 patients (2.5%) in group 1 and 13 patients (3.7%) in group 2, which was not statistically significant (P=0.296). According to the logistic regression, the survival rate in the group operated on with the classical surgical method was 0.27 times higher than that in the patients operated on with the new method. Conclusion: Permanent complete AV block is a critical complication after AVR surgery. A lower PPM requirement and higher survival in patients operated on with the new method was the main finding of this study. New techniques with lower PPM requirements may be suitable for cardiac surgery. https://rhythm.tums.ac.ir/index.php/jthc/article/view/1659 https://rhythm.tums.ac.ir/index.php/jthc/article/download/1659/1081

Tehran University of Medical Sciences The Research in Heart Yield and Translational Medicine (RHYTHM) 3115-7270 18 3 2023 07 30 183 195 Arezoo Khosravi Atherosclerosis Research Center, Baqiyatallah University of Medical Sciences, Tehran, Iran Saeed Ghodsi 1-Atherosclerosis Research Center, Clinical Sciences Institute, Baqiyatallah University of Medical Sciences, Tehran, Iran. 2- Department of Cardiology, Sina Hospital, Tehran University of Medical Sciences, Tehran, Iran. 3- Cardiovascular Diseases Research Institute, Tehran Heart Center, School of Medicine, Tehran University of Medical Sciences, Tehran, Iran. Mohammadreza Memarjafari Cardiovascular Intervention Research Center, Rajaie Cardiovascular Medical and Research Center, Iran University of Medical Sciences, Tehran, Iran. Alireza Nematollahi Cardiovascular Diseases Research Institute, Tehran Heart Center, School of Medicine, Tehran University of Medical Sciences, Tehran, Iran. Reza Sharbafan Cardiovascular Diseases Research Institute, Tehran Heart Center, School of Medicine, Tehran University of Medical Sciences, Tehran, Iran. Seyed-Ali Sadre-Bafghi Afshar Hospital, School of Medicine, Shahid Sadoughi University of Medical Sciences, Yazd, Iran. Seyed-Vahid Moosavi Atherosclerosis Research Center, Clinical Sciences Institute, Baqiyatallah University of Medical Sciences, Tehran, Iran. Mansour Abdollahzadeh Atherosclerosis Research Center, Clinical Sciences Institute, Baqiyatallah University of Medical Sciences, Tehran, Iran. Arash Jalali Cardiovascular Diseases Research Institute, Tehran Heart Center, School of Medicine, Tehran University of Medical Sciences, Tehran, Iran. Maryam Moshkani Farahani Atherosclerosis Research Center, Clinical Sciences Institute, Baqiyatallah University of Medical Sciences, Tehran, Iran. 2023 03 15 2023 08 23 Background: Limited data exist regarding the status of long-term cardiovascular disease (CVD) outcomes of hospitalized COVID-19 patients. We aimed to examine the efficacy of early statin use after SARS‑CoV‑2 pneumonia and the impact of prior CVD on the incidence of cardiovascular events. Methods: A prospective cohort study was performed on hospitalized COVID-19 patients. The primary endpoint was major adverse cardiovascular events (MACE) as a composite of cardiovascular mortality, stroke, heart failure, venous thromboembolism (VTE), revascularization, and nonfatal myocardial infarction (MI). The secondary endpoints comprised MACE components, all-cause mortality, readmission for COVID-19, and impaired functional classes. Results: The mean age of the 858 participants was 55.52±13.97 years, and the median follow-up time was 13 months (11.5-15). Men comprised 63.9% of the patients. Overall, MACE occurred in 84 subjects (9.8%), and 98 patients (11.4%) received ventilation. A multivariate Cox regression model was employed to explore the association between statin use and outcomes, and the following hazard ratios were obtained: MACE (0.831 [0.529 to 0.981]; P=0.044), All-cause mortality (1.098 [0.935 to 1.294]; P=0.255), stroke (0.118 [0.029 to 0.48]; P=0.003), revascularization (0.103 [0.029 to 0.367]; P<0.0001), poor functional capacity (0.827 [0.673 to 1.018]; P=0.073), nonfatal MI (0.599 [0.257 to 1.394]; P=0.234), VTE (0.376 [0.119 to 1.190]; P=0.096), and decompensated heart failure (0.137 [0.040 to 0.472]; P=0.002). Prior CVD predicted MACE (2.953 [1.393 to 6.271]; P=0.005), all-cause death (1.170 [0.960 to 1.412]; P=0.102), and VTE (2.770 [0.957 to 8.955]; P=0.051). Conclusion: Previous CVD is a robust predictor of long-term MACE and VTE. Early statin use might decrease the incidence rates of MACE, ischemic stroke, revascularization, and readmission for heart failure. https://rhythm.tums.ac.ir/index.php/jthc/article/view/1820 https://rhythm.tums.ac.ir/index.php/jthc/article/download/1820/1073

Tehran University of Medical Sciences The Research in Heart Yield and Translational Medicine (RHYTHM) 3115-7270 18 3 2023 07 30 196 206 Danesh Soltani Cardiac Primary Prevention Research Center (CPPRC), Cardiovascular Diseases Research Institute, Tehran University of Medical Sciences, Tehran, Iran. Azar Hadadi Department of Infectious Diseases, Sina Hospital, Tehran University of Medical Sciences, Tehran, Iran. Shahrokh Karbalai Saleh Department of Cardiology, Sina Hospital, Tehran University of Medical Sciences, Tehran, Iran. Alireza Oraii Department of Cardiology, Sina Hospital, Tehran University of Medical Sciences, Tehran, Iran. Azadeh Sadatnaseri Department of Cardiology, Sina Hospital, Tehran University of Medical Sciences, Tehran, Iran Mostafa Roozitalab Department of Cardiology, Sina Hospital, Tehran University of Medical Sciences, Tehran, Iran. Zahra Shajari Department of Cardiology, Sina Hospital, Tehran University of Medical Sciences, Tehran, Iran. Shima sadat Ghaemmaghami Research Development Center, Sina Hospital, Tehran University of Medical Sciences, Tehran, Iran. Haleh Ashraf 1- Cardiac Primary Prevention Research Center (CPPRC), Cardiovascular Diseases Research Institute, Tehran University of Medical Sciences, Tehran, Iran. 2- Research Development Center, Sina Hospital, Tehran University of Medical Sciences, Tehran, Iran. 2022 10 26 2023 10 14 Background: The present study aimed to investigate the association between acute cardiac injury (ACI) and outcomes in hospitalized patients with coronavirus disease 2019 (COVID-19) in Iran. Methods: The current cohort study enrolled all consecutive hospitalized patients with COVID-19 (≥ 18 y) who had serum high-sensitivity cardiac troponin-I (hs-cTnT) measurements on admission between March 2020 and March 2021. ACI was determined as hs-cTnT levels exceeding the 99th percentile of normal values. Data on demographics, comorbidities, clinical and laboratory characteristics, and outcomes were collected from Web-based electronic health records. Results: The study population consisted of 1413 hospitalized patients with COVID-19, of whom 319 patients (22.58%) presented with ACI. The patients with ACI had a significantly higher mortality rate than those without ACI (48.28% vs 15.63%; P<0.001) within a mean follow-up of 218.86 days from symptom onset. ACI on admission was independently associated with mortality (HR, 1.44; P=0.018). In multivariable logistic regression, age (OR, 1.034; P<0.001), preexisting cardiac disease (OR, 1.49; P=0.035), preexisting malignancy (OR, 2.01; P=0.030), oxygen saturation reduced to less than 90% (OR, 2.15; P<0.001), leukocytosis (OR, 1.45; P=0.043), lymphopenia (OR, 1.49; P=0.020), reduced estimated glomerular filtration rates (eGFRs) (OR, 0.99; P=0.008), and treatment with intravenous immunoglobulin during hospitalization (OR, 4.03; P=0.006) were independently associated with ACI development. Conclusion: ACI occurrence on admission was associated with long-term mortality in our hospitalized patients with COVID-19. The finding further underscores the significance of evaluating ACI occurrence on admission, particularly in individuals more prone to ACI, including older individuals and those with preexisting comorbidities, reduced oxygen saturation, and increased inflammatory responses. https://rhythm.tums.ac.ir/index.php/jthc/article/view/1745

Tehran University of Medical Sciences The Research in Heart Yield and Translational Medicine (RHYTHM) 3115-7270 18 3 2023 07 30 207 213 EN Mehdi Goudarzi Medicinal Plant Research Center, Ahvaz Jundishapur University of Medical Sciences, Ahvaz, Iran Jafar Fatahi Asl Department of Radiologic Technology, Faculty of Paramedicine, Ahvaz Jundishapur University of Medical Sciences, Ahvaz, Iran. Hamed Shoghi Department of Physiology, Pharmacology and Medical physics, Faculty of Medicine, Qom University of Medical Sciences, Qom, Iran. 2023 01 14 2023 09 09 Background: Electromagnetic radiation (EMR) causes stable aggregation of reactive oxygen species (ROS), producing oxidative stress. Rosmarinic acid (RA), a plant-origin antioxidant, has been proposed against the side effects of cell phone and ultrahigh-frequency waves. Methods: Forty-two male Wistar rats were randomly divided into 6 groups. Group 1 (controls) received 5 mL of normal saline with the gavage method, Group 2 received 915 MHz radiation, Group 3 received 2450 MHz radiation, Group 4 received RA plus 915 MHz radiation, Group 5 received RA plus 2450MHz radiation, and Group 6 received oral RA (5 mg/kg). Treatment and radiation (1 hour per day) continued for up to 30 days. Results: EMR significantly reduced the activities of superoxide dismutase (SOD), catalase (CAT), and glutathione peroxidase (GPx), the content of glutathione (GSH), and the level of total antioxidant capacity (TAC) and significantly increased oxidative stress indices, such as the levels of malondialdehyde (MDA) and nitric oxide (NO), and the content of protein carbonyl (PC). In contrast, RA significantly elevated TAC level (all groups), GSH content (the RA/cell phone radiation group), GPx activity (the RA/ultrahigh-frequency radiation group), SOD activity (all groups), and CAT activity (RA/ultrahigh-frequency radiation group) and conversely reduced MDA level (all groups), NO level (all groups), and PC content (all groups) in the RA/cell phone and RA/ultrahigh-frequency radiation groups compared with the NS/cell phone and NS/ultrahigh-frequency radiation groups, respectively. The administration of RA resulted in a significant reversal of cardiac markers in EMR-intoxicated rats. Conclusion: RA treatment showed a significant protective effect against EMR-induced cardiotoxicity. https://rhythm.tums.ac.ir/index.php/jthc/article/view/1794

Tehran University of Medical Sciences The Research in Heart Yield and Translational Medicine (RHYTHM) 3115-7270 18 3 2023 07 30 214 217 Yavuzer Koza Department of Cardiology, Faculty of Medicine, Atatürk University Faculty of Medicine, Erzurum, Turkey. Oğuzhan Birdal Department of Cardiology, Faculty of Medicine, Atatürk University Faculty of Medicine, Erzurum, Turkey. Rauf Macit Department of Cardiology, Faculty of Medicine, Atatürk University Faculty of Medicine, Erzurum, Turkey. Hakan Taş Department of Cardiology, Faculty of Medicine, Atatürk University Faculty of Medicine, Erzurum, Turkey. Ednan Bayram Department of Cardiology, Faculty of Medicine, Atatürk University Faculty of Medicine, Erzurum, Turkey. 2022 10 11 2023 07 03 We report a case of a myocardial infarction (MI) due to multiple culprit vessels in a young woman. MI caused by more than 1 culprit vessel is very rare. Oral contraceptives (OCSs) are used for birth control. Despite a few case reports, the association between the new-generation OCS use and the MI risk remains controversial. A 53-year-old woman who had been consuming combined OCS-Yasmin (30 µg of ethinyl estradiol and 3 mg of drospirenone) for 2 years was admitted to our hospital with chest pain. Her past medical history revealed no coronary risk factors except for smoking. No hemodynamic instability was noted at admission. The admission electrocardiogram revealed slight ST elevations in D1 and aVL leads. An urgent coronary angiography showed distal occlusions in the right coronary, left anterior descending, first diagonal, and left circumflex coronary arteries. Unfractionated heparin and abciximab were administered during the procedure, with the latter continued for 12 hours after the procedure. During the hospital course, the patient complained of recurrent anginal attacks. A repeat coronary angiography demonstrated the persistence of thrombotic occlusions. After 24 hours, she experienced chest pain, and her electrocardiogram revealed diffuse ST elevations with a blood pressure of 60/40 mm Hg. She was urgently transferred to the catheterization laboratory. Multiple balloon inflations with intracoronary alteplase (10 mg over 5-10 min) injections failed to restore coronary flow, and she developed cardiovascular collapse. Despite maximal mechanic and mechanical support, she passed away.   https://rhythm.tums.ac.ir/index.php/jthc/article/view/1730 https://rhythm.tums.ac.ir/index.php/jthc/article/download/1730/1074

Tehran University of Medical Sciences The Research in Heart Yield and Translational Medicine (RHYTHM) 3115-7270 18 3 2023 07 30 218 223 EN Mehrnoush Toufan Tabrizi Cardiovascular Research Center, Tabriz University of Medical Sciences, Tabriz, Iran. Rezayat Parvizi Cardiovascular Research Center, Tabriz University of Medical Sciences, Tabriz, Iran. Elnaz Javanshir Cardiovascular Research Center, Tabriz University of Medical Sciences, Tabriz, Iran. 2023 04 07 2023 09 03 Bacteria, especially staphylococcal groups, cause aortic graft infection. Infection stems from synthetic materials that repair aneurysms or artery blockages. Aortic stent infection and vegetation formation are rare, and heterogeneous presentations and ambiguous findings in routine diagnostic modalities render the diagnosis challenging. A 25-year-old man with a history of catheter-based aortic stenting for hypertension associated with severe aortic coarctation was referred to our tertiary care hospital. Five months before the presentation, the patient had been infected with COVID-19, but he recovered after mild symptoms. Nevertheless, 3 months later, he developed erythematous lesions, progressive anorexia, epigastric pain, fever, and weakness. The results of blood tests, blood cultures, transthoracic echocardiography, plain chest radiography, computed tomography angiography, and electrocardiography were unremarkable. We found severe infectious aortitis, crescent thickness surrounding the aorta, pseudoaneurysm development, and a mass with dimensions of 17 mm×8 mm within the aortic stent on transesophageal echocardiography (TEE). Broad-spectrum antibiotic therapy was initiated, and the patient was transferred to the operating room, where the infected stent and adhesive vegetation were removed. The patient recovered remarkably after the surgery and was discharged. At 6 months’ follow-up, he was in good condition. Our findings highlight the significance of maintaining vigilance and a high level of clinical suspicion for the possibility of vegetation formation and aortitis as the possible sequelae of COVID-19, particularly in patients with an implanted stent. Furthermore, we strongly suggest TEE in patients with implanted stents to detect vegetation and aortitis. https://rhythm.tums.ac.ir/index.php/jthc/article/view/1831 https://rhythm.tums.ac.ir/index.php/jthc/article/download/1831/1082

Tehran University of Medical Sciences The Research in Heart Yield and Translational Medicine (RHYTHM) 3115-7270 18 3 2023 07 30 224 227 EN Mogtaba Gorji Department of Pediatric Cardiology, Children’s Medical Center (Pediatric Center of Excellence), Tehran University of Medical Sciences, Tehran, Iran Maryam Taraz Department of Pediatric Cardiology, Tehran University of Medical Sciences, Tehran, Iran. Behdad Gharib Department of Pediatric Cardiology, Tehran University of Medical Sciences, Tehran, Iran. Vahid Ziaee Pediatric Rheumatology Research Group, Rheumatology Research Center, Tehran University of Medical Sciences, Tehran, Iran. 2023 05 12 2023 11 06 Kawasaki disease is an acute self-limiting systemic vasculitis in childhood, resulting in arterial swelling or inflammation and eventually leading to cardiovascular problems, such as coronary artery aneurysms. Based on previous studies, serum sodium ≤133 mmol/L, albumin ≤3.2 g/dL, alanine transaminase ≥80 U/L, and neutrophil percentage ≥80% at diagnosis are risk factors for intravenous immunoglobulin (IVIg). However, the prevalence of resistance to Ig among children with Kawasaki disease varies among different countries due to diversity in evaluation, treatment, and diagnosis. Approximately, 10% to 20% of patients have IVIg-resistant Kawasaki disease. As the probability of coronary artery damage associated with IVIg-resistant Kawasaki disease is higher than that with IVIg-sensitive Kawasaki disease, the early detection and appropriate treatment of IVIg-resistant Kawasaki disease can decrease the probability of damage to coronary arteries and hospital lengths of stay and cost. Kawasaki disease in early infancy is uncommon, and sometimes it occurs with thrombosis and peripheral gangrene. A positive genetic background may play a role in susceptibility to thrombosis. We herein describe a patient suffering from an IVIg-resistant Kawasaki disease with severe coronary artery thrombosis and positive genetic mutation. Medical treatment resolved the thrombosis, but the coronary arteries remained dilated. https://rhythm.tums.ac.ir/index.php/jthc/article/view/1856 https://rhythm.tums.ac.ir/index.php/jthc/article/download/1856/1076

Tehran University of Medical Sciences The Research in Heart Yield and Translational Medicine (RHYTHM) 3115-7270 18 3 2023 07 30 228 231 EN Elahe Radmehr 1-Colorectal Research Center, Imam Khomeini Hospital Complex, Tehran University of Medical Sciences, Tehran, Iran. 2-Universal Scientific Education and Research Network (USERN), Tehran, Iran. Hassan Radmehr Department of Pediatric Cardiac Surgery, Children’s Medical Center, Tehran University of Medical Sciences, Tehran, Iran. Mohsen Shahidi Department of Pediatrics, Besat Hospital, Kurdistan University of Medical Sciences, Sanandaj, Iran. Keyhan Sayadpour Zanjani Department of Pediatrics, Children’s Medical Center, Tehran University of Medical Sciences, Tehran, Iran. 2023 08 21 2023 10 05 Partial anomalous pulmonary venous return (PAPVR) is a rare congenital heart malformation in which 1 or more pulmonary veins drain into the systemic venous circulation or directly into the right atrium instead of the left atrium. It may occur alongside other congenital heart defects, including atrial septal defect (ASD). All patients with newly diagnosed ASD must be evaluated thoroughly for the likelihood of PAPVR to select surgical or percutaneous procedures. Here, we describe a 10-year-old girl with PAPVR who underwent percutaneous device closure of her secundum ASD with her PAPVR neglected at 3 years of age. We had to correct the anomalous venous connection by removing the device during an intricate procedure. The typical connection of the pulmonary veins to the left atrium was reported on her postoperative echocardiography 1 day after surgery. The patient was discharged without complications, and her first follow-up visit 7 days after discharge was unremarkable. While the most accurate diagnostic tools for PAPVR are cardiovascular magnetic resonance imaging and computed tomographic angiography, a careful examination of the pulmonary veins during pulmonary angiography or transesophageal echocardiography in children helps identify PAPVR in patients with ASD. https://rhythm.tums.ac.ir/index.php/jthc/article/view/1913 https://rhythm.tums.ac.ir/index.php/jthc/article/download/1913/1077

Tehran University of Medical Sciences The Research in Heart Yield and Translational Medicine (RHYTHM) 3115-7270 18 3 2023 07 30 234 1236 Parham Sadeghipour Department of Peripheral Vascular DiseasesRajaie Cardiovascular Medical and Research Center Bahram Mohebbi Interventional Cardiology Research Center, Rajaie Cardiovascular Medical and Research Center, Iran University of Medical Sciences, Tehran,Iran. Parham Rabiei Interventional Cardiology Research Center, Rajaie Cardiovascular Medical and Research Center, Iran University of Medical Sciences, Tehran,Iran. Ata Firouzi Interventional Cardiology Research Center, Rajaie Cardiovascular Medical and Research Center, Iran University of Medical Sciences, Tehran, Iran. Mohammadreza Iranian Interventional Cardiology Research Center, Rajaie Cardiovascular Medical and Research Center, Iran University of Medical Sciences, Tehran, Iran. Faeghe Hoseini Interventional Cardiology Research Center, Rajaie Cardiovascular Medical and Research Center, Iran University of Medical Sciences, Tehran, Iran. Zahra Khajali Interventional Cardiology Research Center, Rajaie Cardiovascular Medical and Research Center, Iran University of Medical Sciences, Tehran, Iran. Sedigheh Saedi Interventional Cardiology Research Center, Rajaie Cardiovascular Medical and Research Center, Iran University of Medical Sciences, Tehran, Iran. Stephan Haulon Department of Cardiac and Vascular Surgery, Hôpital Marie Lannelongue, Groupe Hospitalier Paris Saint Joseph, Université Paris Saclay, Paris, France. Jamal Moosavi Cardiovascular Intervention Research Center, Rajaie Cardiovascular Medical and Research Center, Iran University of Medical Sciences, Tehran, Iran. 2023 08 04 2023 10 05 No Abstract No Abstract No Abstract https://rhythm.tums.ac.ir/index.php/jthc/article/view/1905