en 2008-2290 gregorian 2011 7 30 jalali 3 2 online 11 fulltext

Original Article <p>Clopidogrel treatment is associated with a reduction in thrombotic complications in<br />coronary stent placement, improved outcome after acute coronary syndromes and decreased<br />mortality in patients with coronary artery disease. The purpose of this study<br />was to analyze the effect of preoperative clopidogrel exposure on bleeding complications,<br />blood transfusion requirement and reoperations and ICU and ward stay and mediastinitis<br />in patients undergoing coronary artery bypass grafting (CABG).</p> CABG; clopidogrel; postoperative blood loss 25 29 http://www.iscs.org.ir/journals/vol.3/no.2/334/

Review <p>Congenital rubella syndrome (CRS) has a wide variety of severe systemic complications.<br />Cardiovascular defects have always been a part of the rubella syndrome. Patent<br />ductus arteriosus (PDA) remains the most frequent cardiac anomaly. It may occur<br />alone or accompany other heart defects. Pulmonary stenosis and septal defects have<br />been noted with greater frequency since the earlier reports. The classic triad is hearing impairment,<br />heart defect, and cataract.<br />Here we report an infant girl with classic presentations of CRS. We discuss about her malformations<br />and compared them with other combination of manifestations in the literature.</p> Congenital, Rubella infection, Cardiac anomaly 0 0 http://www.iscs.org.ir/journals/vol.3/no.2/333/

Review <p>Cardiac Echinococcosis is a rare and the most serious of all Hydatid manifestation. We<br />report here the case of 12 year old boy who had Hydatid Cyst in the liver, lung , left<br />ventricle &amp; inter ventricular septum .<br />The patient underwent cardiac surgery after 2 months medical therapy with Albendazole.</p> - 0 0 http://www.iscs.org.ir/journals/vol.3/no.2/332/

Review <p>The optimal operation for aortic valve disease<br />in children and young adults remains controversial.<br />The Ross operation offers avoidance of anticoagulation and<br />the potential for growth but is technically demanding and<br />creates double-valve disease. The goal of this study is to<br />report our experience with the Ross operation and the need<br />for reintervention at intermediate follow-</p> - 0 0 http://www.iscs.org.ir/journals/vol.3/no.2/331/

Review <p>The aim of the study was to analyze immediate<br />results, rate of complications and re-interventions during<br />medium-term outcome in pediatric patients with native or<br />recurrent aortic coarctation. We focused on an age-related<br />therapeutic approach comparing surgical and trans-catheter<br />treatment.</p> Aortic coarctation, Pediatric cardiac surgery,Stent, Trans-catheter treatment, Balloon dilatation. 0 0 http://www.iscs.org.ir/journals/vol.3/no.2/330/

Review <p>In neonatal and infant cardiac surgery with cardiopulmonary<br />bypass (CPB), hemodilution with reduction<br />of plasma albumin concentration and low colloid oncotic<br />pressure (COP) are the main factors associated with tissue<br />edema and postoperative weight gain. The aim of our study<br />was to evaluate the influence of two different COP regulatory<br />strategies on post-bypass body weight gain, fluid balance,<br />and clinical outcomes.</p> Infant and neonatal cardiopulmonary bypass,Colloid oncotic pressure, Albumin concentration, Fluid balance 0 0 http://www.iscs.org.ir/journals/vol.3/no.2/329/

Review <p>One-and-a-half ventricle repair is a surgical<br />option for complex cardiac anomalies characterized by<br />right-ventricle hypoplasia or dysfunction. The long-term<br />result analyses or large clinical reviews are rare. The aim<br />of this study is to evaluate the long-term functional results<br />of this surgical procedure.</p> One-and-a-half-ventricle repair, Right-tricular venhypoplasia, Right-ventricular dysfunction. 0 0 http://www.iscs.org.ir/journals/vol.3/no.2/328/

Review <p>Repair of total anomalous pulmonary venous<br />drainage (TAPVD) in neonates remains a challenge as it-is often associated with severe obstruction. We describe a<br />large cohort of neonates who underwent TAPVD repair ata single institution.</p> - 0 0 http://www.iscs.org.ir/journals/vol.3/no.2/327/

Review <p>Tranexamic acid (TXA) and -aminocaproic acid<br />(EACA) are used for antifibrinolytic therapy in cardiac surgery,<br />although data directly comparing their blood sparing<br />effect and their side effects, especially in paediatric cardiac<br />surgical patients, are still missing.</p> Tranexamic acid, Aminocaproic acid, Paedi-atric cardiac surgery, Blood loss, Outcome. 0 0 http://www.iscs.org.ir/journals/vol.3/no.2/326/

Review <p>A best evidence topic was written according to a structured<br />protocol. The question addressed was 'Is it safe to perform<br />coronary angiography (CA) in acute endocarditis?' Three<br />hundred and ninety-seven papers were found using the reported<br />search, of which six represented the best evidence to<br />answer the clinical question. The authors, journal, date and<br />country of publication, patient group studied, study type,<br />relevant outcomes, key results and limitations of these pa-are tabulated. One of the papers is a case report, which<br />reported a fatal vegetation embolism from an infected aortic<br />valve into the left main coronary artery 14 h after angiography.<br />The remaining five papers are cohort studies. Four<br />of these studies were performed in 1970s-1980s before<br />the era of echocardiography and were aimed at quantifying<br />the severity of valvular regurgitation. No embolic complications<br />or dislodgement of vegetations occurred in any<br />of the five studies (186 patients). Guidelines published bythe European Society of Cardiology (ESC) in 2009 recommended<br />CA in the context of infective endocarditis (IE) for<br />men &gt;40 years old, postmenopausal women, and patients<br />with at least one cardiovascular risk factor or a history of<br />coronary artery disease. Exceptions include patients with<br />large aortic vegetations which may be dislodged during<br />catheterisation, and when emergency surgery is necessary<br />- 1) native aortic or mitral IE with severe acute regurgitation<br />or valve obstruction, or prosthetic valve IE with severe<br />prosthetic dysfunction (dehiscence or obstruction) causing<br />refractory pulmonary oedema or cardiogenic shock; 2) native<br />aortic, mitral, or prosthetic valve IE with fistula into a cardiac chamber or pericardium causing refractory pulmonary<br />oedema or shock. This is reiterated by the guidelines<br />on the management of valvular heart disease published by<br />the ESC in 2007. From the findings of the six papers, it can<br />be concluded that coronary angiography can be performed<br />safely in IE and should be performed if deemed necessary,<br />unless the patients are haemodynamically unstable requiring<br />emergency surgery, or have large vegetations of the<br />aortic valve. This is consistent with the ESC guidelines.</p> Coronary angiography; Infective endocardi-tisSafety 0 0 http://www.iscs.org.ir/journals/vol.3/no.2/325/

Review <p>The Surgical Management of Arterial Revascularization<br />Therapies trial was conceived to rigorously<br />compare completeness of revascularization, clinical outcomes<br />and resource utilization in unselected patients referred<br />for elective, primary coronary artery bypass grafting<br />randomly assigned to undergo off-pump (OPCAB) or conventional<br />on-pump coronary artery bypass grafting using<br />cardiopulmonary bypass (CPB). The goal of this follow-up<br />study was to compare long-term survival, graft patency,<br />myocardial ischemia, and clinical outcomes among survivors<br />who volunteered to return for clinical evaluation and<br />imaging studies.</p> - 0 0 http://www.iscs.org.ir/journals/vol.3/no.2/324/

Review <p>Catheter-based ablation is often recommended<br />for treatment of atrial fibrillation (AF), but there are no<br />data that directly compare late results to those of the Cox-<br />Maze procedure. Although catheter ablation avoids operation,<br />lack of reliable transmurality may reduce effectiveness.<br />We compared clinical outcomes of the cut-and-sew<br />Cox-Maze procedure with catheter ablation.</p> - 0 0 http://www.iscs.org.ir/journals/vol.3/no.2/323/

Review <p>Sinus node dysfunction is commonly associated<br />with atrial fibrillation. There is little information about the<br />long-term results of pulmonary vein isolation in relation to<br />sinus node function. The present study was conducted to<br />investigate whether sinus node dysfunction affects the late<br />outcome of pulmonary vein isolation in patients with persistent/<br />permanent atrial fibrillation.</p> - 0 0 http://www.iscs.org.ir/journals/vol.3/no.2/322/

Review <p>Aortic arch replacement remains a surgical<br />challenge because of prolonged operative times, bleeding<br />complications, and a considerable risk of neurologic morbidity<br />and mortality. This study investigates our clinical<br />results after modification of perfusion technique for cardiopulmonary<br />bypass as well as temperature management for<br />these high- risk patients.</p> - 0 0 http://www.iscs.org.ir/journals/vol.3/no.2/321/

Review <p>Pregnancy has been reported to be an independent<br />risk factor for 50% of acute aortic dissections recorded<br />in women younger than 45 years of age. The present epidemiologic<br />study aimed to identify whether this putative<br />association of pregnancy and acute type A dissection could<br />be an artifact of selective reporting.</p> Aorta, Aortic dissection, Pregnancy, Prognosis. 0 0 http://www.iscs.org.ir/journals/vol.3/no.2/320/

Review <p>Extracorporeal membrane oxygenation (ECMO) is increasingly<br />applied as rescue-therapy for patients with severe<br />acute respiratory distress syndrome (ARDS). Here,<br />we evaluate the effect of different configuration strategies<br />(venovenous vs. venoarterial vs. veno-venoarterial) on the<br />outcome. From 2006 to 2008, 30 patients received ECMO<br />for severe ARDS. Patients were divided into three groups<br />according to the configuration: veno-venous (vv; n=11),<br />venoarterial (va; n=8) or veno-venoarterial (vva; n=11).<br />Data were prospectively collected and endpoint was 30-day<br />mortality. To identify independent risk factors, univariate<br />analysis was performed for clinical parameters, such as<br />age, body mass index, gender, configuration, low-pH, oxygenation<br />index (pO2/FiO2) and underlying disease. Thirty- mortality was 53% (n=16) for all comers: 63% (n=7)<br />died in the vv-group, 75% (n=6) in the va-group and 27%<br />(n=3) in the vva-group. Although univariate analysis could<br />not rule out a significant predictor for the outcome, there<br />was a trend visible to decreased mortality in the vva-group<br />when compared to vv- and va-groups (27% vs. 63% vs.<br />75%; P=0.057). ECMO provides a survival benefit in patients<br />when considering a predicted mortality rate of 80% in<br />ARDS. The configuration mode appears to impact the outcome<br />as the veno-venoarterial appears to further improve<br />the survival in this subset of patients.</p> Extracorporeal membrane oxygenation; Acute respiratory distress syndrome; Configuration mode. 0 0 http://www.iscs.org.ir/journals/vol.3/no.2/319/

Review <p>Trans-catheter aortic valve implantation has<br />emerged and rapidly gained credibility as a valuable alternative<br />to treat patients with severe aortic stenosis and no surgical<br />option; however, these patients are often affected also by<br />severe iliac-femoral arteriopathy, rendering the transfemoral<br />approach unemployable. From May 2008, 92 patients with<br />severe, symptomatic aortic stenosis and no reasonable surgical<br />option because of excessive risk underwent trans-catheter<br />aortic valve implantation at our center. Eighty patients (34<br />male) with mean age 82 &plusmn; 8 years were eligible for Core-<br />Valve percutaneous femoral implantation. Twelve patients,<br />mean age 81 &plusmn; 8 years, were excluded from percutaneous<br />femoral CoreValve implantation because of iliac-femoral arteriopathy.</p> Aortic stenosis • Trans-catheter valve replace-ment Axillary artery • Aortic valve. 0 0 http://www.iscs.org.ir/journals/vol.3/no.2/318/

Review <p>Levosimendan has been reported to exert cardioprotection.<br />In this study, we have examined the cardiac<br />effects of different doses of intracoronary levosimendan on<br />ischemia/reperfusion injuries, and the involvement of KATP<br />channels and nitric oxide (NO).</p> Akt, Apoptosis, ERK, Levosimendan, NO,Potassium channels. 0 0 http://www.iscs.org.ir/journals/vol.3/no.2/317/

Review <p>In cardiac transplantation longer ischemic times relate to poorer<br />outcomes. However, brain death also promotes donor organ<br />injury. The aim of this study was to ascertain if there was an<br />association between longer time periods between donor brain<br />death and organ retrieval with recipient mortality. This retrospective<br />single centre study included 157 cardiac transplants<br />performed between February 1999 and 2009. The time between<br />the second brain stem death test and the cross-clamp<br />time at organ retrieval was noted in hours. This was compared<br />with survival time in years. Cox regression analysis was performed.<br />The following variables were included: donor and recipient<br />sex, age and cytomegalovirus status; donor smokinghistory; ischemic time and number of rejection episodes. Of<br />the 157 transplants, 37 recipients have died. The mean followup<br />was 4.1 years. The mean time between brain stem death test<br />and cross-clamp time was 13.2&plusmn;3.96 hours. Considering the<br />above variables, the most significant finding is: increased time<br />between brain stem death test and organ retrieval cross-clamp<br />time, predicted a greater recipient mortality [HR=1.15; 95%<br />confidence interval (CI)=1.06-1.24; P&lt;0.001]. Longer delays<br />between donor brain death and cross-clamp time are associated<br />with a higher-risk of mortality in cardiac transplant recipients.</p> Brain death; Donor and heart transplant 0 0 http://www.iscs.org.ir/journals/vol.3/no.2/316/

Review <p>Early and late mortality have significantly improved<br />during recent decades in pediatric patients after heart<br />transplantation (HTx). Nevertheless early and late morbidity<br />and mortality are influenced by acute rejection, cardiac<br />allograft vasculopathy (CAV), malignancy, renal failure,<br />and graft failure. Methods: We evaluated our results after<br />HTx in children under the age of 18 years with 23 years of<br />follow-up. Perioperative characteristics, probability of survival,<br />and time-related morbidity were retrospectively analyzed.<br />Results: We included 169 pediatric HTx recipients,<br />transplanted between 05/1986 and 05/2010. One hundred<br />and one were males with a median age of 8.7 (0.02-23.2)<br />years at the time of HTx. Main preoperative diagnoses were<br />cardiomyopathy (CMP) (n = 139) with a median survival of<br />7.0 (0-23.2) years and congenital heart disease (CHD) (n =<br />30), median survival 11.3 (0-19.9) years. Overall survival<br />at 1, 5, 10, and 15 years was 87%, 76%, 68%, and 50%,<br />respectively. Patient survival was significantly reduced<br />in patients with 0-1 year at the time of HTx versus 1-10<br />and 11-18 years: 2.3 (0-13.2) years versus 1-10 years =<br />8.6 (0-23.2) years; 11-18 years = 5.9 (0.003-18.5) years.<br />Fifty-one patients were on mechanical circulatory support<br />as a bridge-to-HTx with increased early but not late mortality.<br />Ten patients underwent retransplant due to acute or<br />chronic graft failure after a median posttransplant time of<br />12.25 (0.3-17.45) years. Late mortality was influenced by<br />rejection, infection, posttransplant lymphoproliferative disease<br />(PTLD) (11.8%), or CAV with an incidence of 25%<br />at 5 years, 50% at 10 years, and approximately 75% at 15<br />years. Conclusions: Pediatric HTx is a safe and effective<br />treatment for terminal heart failure. In our experience, there<br />is no adverse effect of previous cardiac assist device implantation<br />in long-term follow-up. Virtually all anatomic<br />malformations are amenable to orthotopic HTx. Significant<br />progress has been achieved in controlling rejection through<br />improved immunosuppression and noninvasive rejection<br />monitoring.</p> Heart transplantation, Pediatric, Cardiacallograft vasculopathy, Acute rejection, PTLD, Survival,23 years. 0 0 http://www.iscs.org.ir/journals/vol.3/no.2/315/

Review <p>We investigated the prevalence, risk factors, and optimal<br />timing of treatment for advanced periodontitis in patients<br />undergoing elective heart valve surgery. Dental examinations<br />were given to 209 patients (aged 65&plusmn;10 years)<br />scheduled for valve surgery. Patients with no or mild periodontitis<br />were assigned as controls (n=105). Patients with<br />advanced periodontitis underwent tooth extraction and curettage<br />(n=104), 68 of whom underwent tooth extraction<br />within two weeks (short wait) and 36 of whom underwent<br />extraction longer than two weeks, before surgery. The three<br />groups (control, short, and long wait) were similar in age,<br />gender, diseased valve, and type of surgery received. The<br />average number of teeth extracted was 2.3&plusmn;2.3. In both univariate<br />and multivariate analysis, risk factors for advancedperiodontitis were history of smoking and heart failure. No<br />complications arose from the extractions. Length of postoperative<br />hospital stay, intrafebrile days, white blood cell<br />count and serum C-reactive protein (assessed at postoperative<br />days 1, 3 and 7) were similar among the three groups.<br />During the mean follow-up period of 60&plusmn;16 months, no<br />patient developed prosthetic valve endocarditis, and there<br />were no postoperative deaths. In conclusion, we found no<br />evidence that receipt and timing of dental treatment affected<br />surgical success rates and postoperative course.</p> Heart valve; Endocarditis; Perioperative care; Infection 0 0 http://www.iscs.org.ir/journals/vol.3/no.2/314/

Review <p>To investigate the incidence of postoperative<br />generalized seizures in patients undergoing aortic valve<br />replacement (AVR) under extracorporeal circulation, who<br />received either high-dose tranexamic acid (TXA) or epsilon<br />aminocaproic acid (EACA) as an antifibrinolytic agent.</p> Antifibrinolytic agent , Aortic valve replace-mentSeizure , Tranexamic acid 0 0 http://www.iscs.org.ir/journals/vol.3/no.2/313/

Review <p>A best evidence topic was written according to a structured<br />protocol. The question addressed was whether the reimplantation<br />(David) technique or the remodeling (Yacoub)<br />technique provides the optimum event free survival in patients<br />with an aortic root aneurysm suitable for an aortic<br />valve-sparing operation. In total, 392 papers were found<br />using the reported search criteria, of which 14 papers proprovided<br />the best evidence to answer the clinical question. A<br />total of 1338 patients (Yacoub technique in 606 and David<br />technique in 732) from 13 centres were included. In most<br />series, cardiopulmonary bypass time and aortic cross-clamp<br />time were longer for the David technique compared to the<br />Yacoub technique. Early mortality was comparable between<br />the two techniques (0-6.9% for the Yacoub technique<br />and 0-6% for the David technique). There is a tendency fora higher freedom from significant long-term aortic insufficiency<br />in the David group than the Yacoub group, which<br />does not necessarily result in a higher reoperation rate in<br />the Yacoub group. In the largest series reported by David et<br />al., freedom from a moderate-to-severe aortic insufficiency<br />at 12 years was 82.6&plusmn;6.2% in the Yacoub and 91.0&plusmn;3.8%<br />in the David group (P=0.035). Freedom from reoperation<br />at the same time point was 90.4&plusmn;4.7% in the Yacoub group<br />and 97.4&plusmn;2.2% in the David group (P=0.09). In another series<br />reported by Erasmi et al., freedom from reoperation at<br />a follow-up time of about four years was 89&plusmn;4% in the Yacoubauthors merely preferred the Yacoub technique for a bicuspid<br />aortic valve, the accumulated evidence in the current<br />review indicates comparable results for both techniques in<br />a bicuspid aortic valve. Current evidence is in favour of the<br />David rather than the Yacoub technique in pathologies such<br />as Marfan syndrome, acute type A aortic dissection, and<br />excessive annular dilatation that may impair aortic root integrity.<br />Careful selection of patients for each technique and<br />successful restoration of normal cusp geometry are the keys<br />to success in aortic valve-sparing operations. Keywords:<br />Aortic valve-sparing operation; Remodeling; Reimplantation;<br />Aortic root aneurysm<br />group and 98&plusmn;2% in the David group. Although some</p> - 0 0 http://www.iscs.org.ir/journals/vol.3/no.2/312/

Review <p>We hypothesize that concomitant tricuspid annuloplasty<br />in patients with tricuspid annular dilatation who<br />undergo mitral valve repair could prevent progression of<br />tricuspid regurgitation and right ventricular remodeling.</p> - 0 0 http://www.iscs.org.ir/journals/vol.3/no.2/311/

Review <p>Delayed sternal closure (DSC) has been shown to be useful following<br />cardiac surgeries in case of indications including hemodynamic instability, noticeable<br />myocardial edema, respiratory compromise, stubborn bleeding, placement of extracorporeal<br />support device,and persistent arrhythmias. In this review, we summarize the<br />investigations on this topic to analyze the controversial aspects of DSC in pediatrics<br />and adults.</p> - 34 45 http://www.iscs.org.ir/journals/vol.3/no.2/310/

Original Article <p>Although pulmonary artery banding (PAB) seems to be a technically<br />simple procedure it presents several peculiarities and is related to a significant morbidity<br />and mortality. We lack information on this procedure in our center.</p> - 30 33 http://www.iscs.org.ir/journals/vol.3/no.2/309/

Original Article <p>We would report the results of 112 mechanical valve replacements in the<br />position of pulmonary valve during 6 years in the Rajaie Heart Center.</p> TOF: Tetralogy of Fallout, PVR: pulmonary valve replacement, SK: Streptokinase 18 24 http://www.iscs.org.ir/journals/vol.3/no.2/307/

Original Article <p>The quality of myocardial protection during Coronary Artery Bypass<br />Grafting (CABG) has a direct effect on post-operative cardiac function, recovery and<br />complications. The optimal route for delivery of cardioplegia is still in debate in patients<br />with ischemic heart disease. This prospective randomized clinical study was<br />designed to assess and compare the use of combined antegrade-retrograde cardioplegia<br />versus antegrade cardioplegia in providing adequate myocardial preservation during<br />coronary artery bypass graft surgery.</p> Antegrade Cardioplegia, Myocardial Protection, Retrograde Cardiople-gia.CABG 12 17 http://www.iscs.org.ir/journals/vol.3/no.2/306/

Original Article <p>Complete Atrioventricular Septal Defect (CAVSD) is a congenital heart<br />disease treated by surgical repair. There are two strategies for surgery: 1) Primary repair<br />at lower ages (one-stage repair). 2) PA banding in lower age and then complete<br />repair after normalization of PAP (Two-stage repair).The purpose of this study was<br />comparison of mortality rate and short term complications of these two strategies.</p> Complete Atrioventricular Septal Defect; Primary Repair; Two StageRepair; Pulmonary Artery Banding. 7 11 http://www.iscs.org.ir/journals/vol.3/no.2/305/

Original Article <p>Cardiac involvement is the major cause of morbidity and death in (&beta;)-<br />thalassemia Major. We aimed to compare echocardiography findings in early diagnosis<br />of cardiac involvement.</p> Beta (β)-thalassemia Major; Systolic and diastolic dysfunction; Echocar-diography 3 6 http://www.iscs.org.ir/journals/vol.3/no.2/304/