A One-year old infant with multiple cardiac masses and congenital heart disease

A One-year old infant with multiple cardiac masses and congenital heart disease Case Report We present a one-year old male infant with heart murmurs discovered at birth. Transthoracic echocardiography revealed a perimembranous ventricular septal defect (VSD) as well as multiple cardiac masses. Pediatric cardiologists recommended clo- sure of the VSD and biopsy of the uncertain cardiac masses. The VSD was repaired, and one of the masses was excised and sent for histopathological examination. Here, we discuss a case of multiple rhabdomyomas in an infant whose associated find- ing was congenital heart disease, rather than tuberous sclerosis. He was discharged in good clinical condition and his parents were given instructions to have routine follow- up visits for the evaluation of the possible regression of the remaining masses. Congenital heart disease-Cardiac masses -Rhabdomyoma 57 58 http://www.iscs.org.ir/journals/vol.3/no.1/302/

Chylothorax secondary to Obstruction of the Superior vena Cava: A late Complication of the Atrial Septal Defect Repair Case Report A case of thorombosis of the superior vena cava (SVC) was complicated by unilateral chylothorax . Removal of the SVC clot and repairing its stenosis with geor-tex patch led to the prompt resolution of the chylothorax . Chylothorax is an uncommon result of obstruction of the SVC. The most reported cause is the placement of the central venous catheters.(1-6) We describe a case of chylothorax after atrial septal defect( ASD) repair with single pericardial patch. - 55 56 http://www.iscs.org.ir/journals/vol.3/no.1/301/

Surgical repair of congenital mitral valve malformations in infancy and childhood: A single-center 36-year experience Review Objective: We sought to evaluate the results of surgical re- pair and determine predictors for the late outcome of con- genital mitral valve dysplasia. Methods: Preoperative, operative and postoperative data were obtained from an institutional database; follow-up data came from regular clinical evaluation at our institu- tion or elsewhere. Patients were divided into isolated and complex cases according to the complexity of associated lesions. - 0 0 http://www.iscs.org.ir/journals/vol.3/no.1/300/

Long-term coronary artery outcome after arterial switch operation for transposition of the great arteries Review Objective: To analyse the long-term patency of coronary ar- teries after neonatal arterial switch operation (ASO). Meth- ods: A retrospective study of the operative reports, follow- up and postoperative catheterisation data of 119 patients, who underwent the great arteries (TGA) repair since 1991, has been carried out. Patient population: Among the 133 survivors of the 137 ASOs performed between 1991 and 2007, 119 patients have been studied by routine control car- diac catheterisation and form the study population. Median time between repair and the coronary angiography was 2.9 ± 1.9 years. A comparison between the eight patients (6.7% out of the entire study population), known to have postop- erative coronary obstructions (group I) and the rest of the cohort with angiographic normal coronary vessels (group II) was performed by univariate analysis of variance and logistic regression models. One patient had surgical plasty of the left coronary main stem with subsequent percutane- ous angioplasty, three patients had primary coronary stent implantation and four patients had no further intervention at all. In group I, all but one patient denied symptoms of chest pain and echocardiography failed to show any difference between the two groups in terms of left ventricular systolic function (ejection fraction group I 61 ± 2% vs 62 ± 6% of group II, p = 1.0). Results: The association of coronary ob- struction with complex native coronary anatomy (Yacoub type B to E) was evident at both univariate (62% of group I vs 22% of group II, p = 0.04) and logistic regression (p = 0.007, odds ratio (OR) 8.1) models. The type of coronary reimplantation (i.e., coronary buttons on punch vs trap-door techniques) was similar between the two groups (punch re- implantation in 25% of patients of group I vs 31% of group II, p = 0.1) as was the relative position of the great vessels (aorta anterior in 100% of patients of group I vs 96% of group II; univariate, p = 0.1). Conclusions: The late out- come in terms of survival and functional status after ASO is excellent. Nevertheless, the risk of a clinically silent late coronary artery obstruction of the reimplanted coronary ar- teries warrants a prolonged follow-up protocol involving invasive angiographic assessment. Transposition of the great arteries • Arterial switch operation • Coronary arteries 0 0 http://www.iscs.org.ir/journals/vol.3/no.1/299/

Deep Hypothermic circulatory arrest does not impair neurodevelopmental outcome in school-age children after infant cardiac surgery Review Background: The purpose of this study was to assess deep hypothermic circulatory arrest (DHCA) as a modifier of neurodevelopmental (ND) outcomes in preschool children after cardiac surgery in infancy for repair of congenital heart defects (CHD). - 0 0 http://www.iscs.org.ir/journals/vol.3/no.1/298/

Blood Transfusion After Pediatric Cardiac Surgery Is Associated with Prolonged Hospital Stay Review Background: Red blood cell transfusion is associated with morbidity and mortality among adults undergoing cardiac surgery. We aimed to evaluate the association of transfusion with morbidity among pediatric cardiac surgical patients. Methods: Patients discharged after cardiac surgery in 2003 were retrospectively reviewed. The red blood cell volume administered during the first 48 postoperative hours was used to classify patients into nonexposure, low exposure ( 15 mL/kg), or high exposure (>15 mL/kg) groups. Cox proportional hazards modeling was used to evaluate the as- sociation of red blood cell exposure to length of hospital stay (LOS). - 0 0 http://www.iscs.org.ir/journals/vol.3/no.1/297/

Do Patients with Complete Transposition of the Great Arteries and Severe Pulmonary Hypertension Benefit From an Arterial Switch Operation? Review Background: Whether an arterial switch operation benefits patients with transposition of the great arteries and se- vere pulmonary hypertension (PH) remains controversial. Therefore, we evaluated the relationship between preopera- tive PH and early and midterm clinical outcomes after an arterial switch procedure. - 0 0 http://www.iscs.org.ir/journals/vol.3/no.1/296/

Complete atrioventricular septal defect: Outcome of pulmonary artery banding improved by adjustable device Review Objective: We sought to evaluate pulmonary artery banding 40 days [range, 81-187 days]; mean weight, 4.3 ± 1.2 kg in infants with complete atrioventricular septal defects. [range, 3.2-6.1 kg]). There was no statistical difference in Methods: From 2000 to 2009, 20 infants with complete age or weight. Preoperative mechanical ventilation was re- atrioventricular septal defects underwent pulmonary artery quired in 3 (23%) of 13 infants in the conventional PAB banding because of unsuitable anatomy (unbalanced ven- group and 5 (71%) of 7 infants in the FloWatch-PAB group tricles, associated lesions, or both) or clinical condition (in- (P < .05). fection, chronic lung disease, or noncardiac malformation). Results: Ten (77%) of 13 infants in the conventional PAB Patients were divided into 2 groups: the conventional PAB group died versus 0 (0%) of 7 infants in the FloWatch-PAB group (n = 13 [65%]; mean age, 74 ± 56 days [range, 6-187 group (P < .001). Sternal closure was delayed in 6 (46%) days]; mean weight, 3.3 ± 1.1 kg [range, 2.1-5.8 kg]) and of 13 infants in the conventional PAB group and 0 (0%) of the FloWatch-PAB group (n = 7 [35%]; mean age, 111 ± 7 infants in the FloWatch-PAB group (P < .05). The mean - 0 0 http://www.iscs.org.ir/journals/vol.3/no.1/295/

ventricular Performance in Long-Term Survivors After Fontan Operation Review Background: Ventricular function and arrhythmia in pa- tients with Fontan circulation in long-term follow-up are still unknown. - 0 0 http://www.iscs.org.ir/journals/vol.3/no.1/294/

Comparative effects of norepinephrine and vasopressin on internal thoracic arterial graft flow after off-pump coronary artery bypass grafting Review Objective: Vasoconstrictors such as norepinephrine and va- sopressin are commonly used to raise the blood pressure during myocardial revascularization. The internal thoracic artery is commonly used for coronary artery grafting be- cause of its long-term patency. However, the internal tho- racic artery is a living conduit that responds to vasoactive substances. The objective of this study was to measure change in internal thoracic arterial flow after infusion of norepinephrine or vasopressin. - 0 0 http://www.iscs.org.ir/journals/vol.3/no.1/293/

Impact of Off-Pump Coronary Artery Bypass Graft Surgery on Postoperative Pulmonary Complications in Patients with Chronic Lung Disease Review Background: Off-pump coronary artery bypass graft surgery (OPCAB) has proven to be beneficial in many high-risk subgroups. This study aims to determine whether OPCAB lowers the incidence of pulmonary complications among patients with chronic lung disease (CLD) when compared with on-pump coronary artery bypass graft surgery (ON- CAB). - 0 0 http://www.iscs.org.ir/journals/vol.3/no.1/292/

Intermediate-term clinical outcomes of primary biventricular repair for left ventricular outflow tract obstruction and ventricular septal defect Review Objective: Primary biventricular repair for left ventricular outflow tract obstruction and ventricular septal defect re- mains challenging. The intermediate-term outcomes and risk factors for mortality remain undefined. Methods: All patients undergoing primary biventricular re- pair of left ventricular outflow tract obstruction and ven- tricular septal defect from 1995 to 2008 at the C. S. Mott Children's Hospital, University of Michigan Health Sys- tems were analyzed. - 0 0 http://www.iscs.org.ir/journals/vol.3/no.1/291/

The role of ascorbic acid in the prevention of atrial fibrillation after elective on pump myocardial revascularization surgery: a single center experience-pilot study Review Atrial fibrillation (AF) is a common arrhythmia that oc- curs postoperatively in cardiac surgery. There is evidence for the role of oxidative stress in the etiology of AF. In our study, we examined whether antioxidant ascorbic acid (vi- tamin C), could help in the reduction of the incidence of postoperative AF. Patients who were scheduled to undergo elective isolated on-pump coronary artery bypass grafting (CABG) were included in our study. One hundred and sev- enty patients were randomly divided in two groups: Group A (n=85) received vitamin C preoperatively and post- operatively whereas Group B (n=85) did not receive any (control group). The incidence of AF was 44.7% in the vi- tamin C group and 61.2% in the control group (P=0.041). The hospitalization time, the intensive care unit stay and the time interval for the conversion of AF into sinus rhythm was significantly shorter in the vitamin C group. Patients that developed AF also had longer hospital length of stay (9.5±2.8 days vs. 6.7±1.9, P=0.034). Supplemen- tation of vitamin C reduces the incidence of postCABG AF, and decreases the time needed for rhythm restoration and length of hospital stay. Keywords: PostCABG atrial fibrillation; Oxidative stress; Ascorbic acid; Vitamin C class I or II, and 61.2% had some degree of persistent mi- tral regurgitation or stenosis, despite stable hemodynamics. Stenosis is a statistically significant risk factor for surgi- cal intervention at less than 1 year of age and is related to higher overall mortality and incidence of late cardiac failure and mitral dysfunction; parachute mitral valve is related to higher mortality and morbidity. - 0 0 http://www.iscs.org.ir/journals/vol.3/no.1/290/

Predictors for hemodynamic improvement with temporary pacing after pediatric car-for hemodynamic improvement with temporary pacing after pediatric car-diac surgery Review Objectives: Temporary epicardial pacing wires are com- monly placed during pediatric cardiac surgery. Data are sparse on postoperative pacing in this population. The ob- jective of this study was to determine the frequency of use and identify predictors for the use of temporary epicardial pacing wires. - 0 0 http://www.iscs.org.ir/journals/vol.3/no.1/289/

Left Atrial Ganglion Ablation as an Adjunct to Atrial Fibrillation Surgery in valvular Heart Disease Review Our aim was to evaluate early results of gan- plexus (GP) ablation with modified Cox maze le- sets for concomitant atrial fibrillation (AF) during cor- e valve surgery. - 0 0 http://www.iscs.org.ir/journals/vol.3/no.1/288/

myocardial injury is decreased by late remote ischaemic preconditioning and aggravated by tramadol in patients undergoing cardiac surgery: a randomised controlled trial Review The purpose of this study was to test, whether the late phase of remote ischaemic preconditioning (L-RIPC) improves myocardial protection in coronary artery bypass grafting (CABG) with cold-crystalloid cardioplegia and whether preoperative tramadol modifies myocardial ischaemia-rep- erfusion injury using the same group of patients in a single- blinded randomized controlled study. One hundred and one adult patients were randomly assigned to either the L-RIPC, control or tramadol group. L-RIPC consisted of three five- minute cycles of upper limb ischaemia and three five-min- ute pauses using blood pressure cuff inflation 18 hours pri- or to the operation. Patients in the tramadol group received 200 mg tramadol retard at 19:00 hours, the day before the operation and at 06:00 hours. Serum troponin I levels were measured at eight, 16 and 24 hours after surgery. Myocar- dial samples for inducible and endothelial nitric oxide syn- thases (iNOS, eNOS) estimation were drawn twice: before and after cannulation for cardiopulmonary bypass from the auricle of the right atrium. We found that L-RIPC can reduce injury beyond the myocardial protection provided by cold-crystalloid cardioplegia, and tramadol worsened myocardial injury after CABG. Expressions of iNOS were increased in the control (significantly) and L-RIPC groups and dampened in the tramadol group. Key Words: Myocardial protection; Ischaemic precondi- Troponin tioning; Troponin I; Inducible nitric oxide synthases; En-dothelial nitric oxide synthases 0 0 http://www.iscs.org.ir/journals/vol.3/no.1/287/

Extracorporeal membrane Oxygenation in Primary Graft Failure After Heart Transplantation Review operative delirium. Keywords: Brain; Coronary artery by-pass surgery; Stroke 0 0 http://www.iscs.org.ir/journals/vol.3/no.1/286/

Robotic repair of posterior mitral valve prolapse versus conventional approaches: Potential realized Review - 0 0 http://www.iscs.org.ir/journals/vol.3/no.1/285/

what type of valve replacement should be used in patients with endocarditis? Review Review; Endocarditis; Bioprosthetic valve; Mechanical valve; Reinfection 0 0 http://www.iscs.org.ir/journals/vol.3/no.1/284/

Outcomes of Surgical Aortic valve Replacement in High-Risk Patients: A multiinstitu-of Surgical Aortic valve Replacement in High-Risk Patients: A multiinstitu-tionalStudy Review - 0 0 http://www.iscs.org.ir/journals/vol.3/no.1/283/

Aortic root aneurysm: Principles of repair and long-term follow-up Review - 0 0 http://www.iscs.org.ir/journals/vol.3/no.1/282/

Influences of Posterior Pericardiotomy in Early and Late Postoperative Effusion of Pericardium. Original Article Background:Pericardial effusion resulting in cardiac tamponade is uncommon after open heart surgery and is associated with significant morbidity and mortality. Methods: In a clinical randomized trial 80 patients that have undergone CABG, were divided in two groups, posterior pericardectomy group and control group. Both groups were evaluated after operation by TEE and clinical parameters for early and late post- operative pericardial effusion. Results: In this study 45% of control group and 5% in study group developed postop- erative pericardial effusion, also the incidence of late pericardial effusion was 10% in study group and 57% in control group. Age, Gender, Smoking, Diabetes Mellitus and the Number of grafts didn't have any effect on the incidence of pericardial effusion. Conclusion: Posterior pericardiotomy as a safe and simple procedure can significantly reduce the incidence of early and late pericardial effusion. Pericardial effusion, posterior pericardiotomy. 42 43 http://www.iscs.org.ir/journals/vol.3/no.1/281/

The Addition of a Tramadol Infusion to morphine Patient-Controlled Analgesia after Coronary Artery Bypass Graft Original Article Background: Patient-controlled analgesia (PCA) has been advocated as superior to conventional controlled analgesia with less risk to patients in cardiac surgery. In this double-blinded, randomized controlled trial, we tested whether the addition of Trama- dol to morphine for patient-controlled analgesia (PCA) resulted in improved analgesia efficacy and smaller morphine requirements compared with morphine PCA alone after Coronary Artery Bypass Graft (CABG) surgery in adults. Methods: Seventy patients who were randomly allocated into two groups underwent anesthesia by Total IV anesthesia, midazolam, fentanyl and atracurim and, in end of surgery each group received morphine sulfat 0.2 mg/kg after arrived in ICU, morphin PCA was started with demand (bolus) dose 1mg, lockout interval 10 minutes. The Tra- madol group after separated from cardiopulmonary bypass received an intra operative initial loading dose of Tramadol (1mg/kg) and a postoperative infusion of Tramadol at 0.2 mg• kg-1• h-1. The control group received an intra operative equivalent volume of normal saline and a postoperative saline infusion (placebo). The demographic data of both groups were the same. Post-operative data were recorded in the cardiac intensive care unit at 30 min, 1 h, 2 h, 4 h, 12 h and 24 h after extubation by the same anesthesiol- ogist, who had no knowledge of the groups, and the side-effects were also evaluated. patient control analgesia, tramadol, CABG 36 41 http://www.iscs.org.ir/journals/vol.3/no.1/280/

Intraoperative magnesium Sulfate can Reduce Narcotic Requirement after Coronary Bypass Surgery. Original Article Background: Narcotics are the most common drugs that have been used after cardiac surgery. Everyone knows that their side effects including respiratory depression, he- modynamic instability, and nausea, vomiting and itching are dose dependent. Magne- sium is both N Methyl D Aspartate (NMDA) - receptor and calcium receptor antago- nist and can modify important mechanisms of nociception. The purpose of this study was to investigate the effect of magnesium sulfate on pain score and reducing narcotic requirement in coronary artery bypass surgery patients. Magnesium Sulfate, Coronary Artery Bypass, Narcotics. 31 35 http://www.iscs.org.ir/journals/vol.3/no.1/279/

Evaluation of 56 Cases of Long Segment Anastomosis of Left Internal Thoracic Artery to Left Anterior Descending Artery in Rajaei Heart Center Original Article Background: Long segment reconstruction of the diffusely diseased Left Anterior De- scending Artery (LAD) with Left Internal Thoracic Artery (LITA) has been shown to be beneficial for patients that have complicated, multiple and long segment lesions in LAD. In this prospective study we analyzed the results obtained with this technique. Left Anterior Descending artery (LAD), Left Internal Thoracic Artery (LITA), Long segment anastomosis. 27 30 http://www.iscs.org.ir/journals/vol.3/no.1/278/

Stem Cell Transplantation and CardiacRepair: A Review of Its Current and Future Status Original Article After myocardial infarction, injured cardiomyocytes are replaced by fibrotic tissue pro- moting the development of heart failure. Stem cells are multipotent, undifferentiated cells capable of multiplication and differentiation. Preliminary experimental evidence suggests that stem cells derived from embryonic or adult tissues (especially bone mar- row) may develop into myocardial cells. The overall clinical experience also suggests that stem cell therapy can be safely performed, if the right cell type is used in the right clinical setting. Preliminary efficacy data indicate that stem cells have the potential to enhance myocardial perfusion and/or contractile performance in patients with acute myocardial infarction, advanced coronary artery disease, and chronic heart failure. However, at the present time, the results have been mixed and inconclusive, and the mechanism of stem cell transplantation therapy remains unclear. This review discusses the controversies and problems that need to be addressed in future investigations. - 15 26 http://www.iscs.org.ir/journals/vol.3/no.1/275/

Assessment of Papillary muscle Repositioning in mitral valve Replacement in Patients with Ischemic mitral Regurgitation Original Article Background: The aim of this study was to investigate the feasibility of performing papillary muscle repositioning (PMR) for subvalvular-sparing mitral valve replace- ment procedures in patients with ischemic mitral regur-gitation and to determine the early and late effects of this procedure on the clinical outcome and left ventricular mechanics. - 8 14 http://www.iscs.org.ir/journals/vol.3/no.1/274/

Evaluation and Comparison of Using Low Dose Aprotinin and Tranexamic Acid in CABGS: A Double –Blinded, Prospective, Randomized Study of 150 Patients Original Article Background. Cardiovascular operations are associated with an inherented bleeding tendency that some time leads to severe bleeding and transfusion requirement. Phar- macologic intervention to minimize post bypass bleeding and blood product transfu- sions has received increasing attention for both medical and economic attention. - 3 7 http://www.iscs.org.ir/journals/vol.3/no.1/273/