Journal of Tehran University Heart Center最新文献

Kawasaki disease (KD) is a febrile vasculitis and is considered a leading cause of acquired coronary artery disease in children. A clinically critical complication is the coronary artery aneurysm, which may progress and lead to coronary stenosis or even obstruction. Herein, we describe a 14.5-year-old boy with a history of KD at 6 months old, who developed multiple aneurysms along all the coronary branches. During the follow-up at the age of 14 years, the left coronary artery aneurysms regressed, while the aneurysm of the right coronary artery persisted and was complicated by obstruction at its proximal part, according to computed tomography angiography. However, the patient at the last follow-up was asymptomatic and well. The serious nature of KD coronary complications warrants follow-up visits. Since echocardiography alone may fail to reveal stenosis or obstruction, other adjunct follow-up imaging modalities such as conventional, computed tomography, and magnetic resonance angiography should be performed in patients with coronary aneurysms.

Coronaviruses can cause viral pneumonia with extrapulmonary manifestations and complications. Many patients have either underlying cardiovascular disease or cardiac risk factors. Acute heart attacks are also frequent in severe cases of coronavirus disease 2019 (COVID-19), which is associated with high mortality. In this paper, we describe a patient with COVID-19 who presented with myocardial infarction (MI) symptoms but lacked the initial symptoms of the infection such as fever and cough. COVID-19 and myocardial infarction were diagnosed. The patient underwent thrombolytic treatment and fully recovered.

Coronary artery aneurysms (CAAs) are rare, and aneurysms of the left main coronary artery are extremely rare. Atherosclerosis is the main cause of CAAs. An 87-year-old man with atypical chest pain of 1 month's duration presented to a hospital. Physical examinations of the patient's cardiopulmonary system and vital signs were unremarkable. Electrocardiography showed a right bundle branch block and an atypical ST-segment elevation in the inferior leads. Coronary angiography demonstrated a huge aneurysm in the left main without any clots. Additionally, there were no remarkable findings in cardiac monitoring and spiral chest computed tomography scanning. Ultimately, after he received nitroglycerin, β-blockers, Ca⁺⁺ channel blockers, Aspirin (ASA), and clopidogrel (Plavix), his pain was relieved.

Ligation of the left innominate vein (LIV) expands the surgeon's surgical field for ascending aorta and aortic arch procedures. Although it is considered a safe technique by most surgeons in that it is associated with only minor drawbacks, conflicting views exist regarding this method. We herein describe a 70-year-old woman who underwent ascending aorta replacement due to an aneurysm with subsequent cerebral dysfunction caused by extended brain edema, possibly related to LIV ligation, leading to her death.

Severe Coronavirus disease 2019 (COVID-19) infection presents with acute respiratory distress syndrome and multiorgan dysfunction. Cardiac involvement is seen in about a quarter of patients, and it can present as acute coronary syndromes, arrhythmias, myocarditis, and thromboembolic events. Ventricular arrhythmias in the setting of COVID-19 infection are usually multifactorial in etiology. There are only a few reports of ventricular tachycardia (VT) storms in patients with COVID-19 infection. We hereby report a case of an elderly man with severe left ventricular systolic dysfunction and a stable cardiac status for the last few years who, following coronary artery bypass graft surgery and implantable cardioverter-defibrillator (ICD) implantation, experienced a VT storm after a COVID-19 infection. The VT storm was controlled using multiple ICD shocks, along with antiarrhythmic drugs. Following his recovery from COVID-19 infection, the patient was asymptomatic at a 3-month follow-up.

Background: Preoperative anemia is an independent risk factor for higher rates of blood transfusion in cardiac surgery. This study aimed to evaluate the effects of intravenous iron sucrose and erythropoietin on transfusion requirements in patients with preoperative iron deficiency anemia (IDA) undergoing on-pump coronary artery bypass graft (CABG) surgery. Methods: In this open-label, randomized clinical trial, patients with preoperative IDA who were candidates for on-pump CABG were randomized into intervention (iron plus erythropoietin) or control groups. Iron sucrose was administered as a 200 mg intravenous dose and erythropoietin as a 100 IU/kg bolus 1 to 2 days before surgery. The primary outcome was the amount of blood transfusion during the first 4 postoperative days. Results: The study population consisted of 114 patients. The mean age was 64.11±8.18 years in the intervention group and 63.35±8.70 years in the control group. Twenty-seven patients (47.4%) in the intervention group and 25 (43.9%) in the control group were males. The number of red blood cell units transfused per patient exhibited a significant fall in the intervention group compared with the control group (P˂0.001). The ferritin level showed a significant rise in the intervention group on postoperative day 7 (P=0.027). The length of stay in the intensive care unit and the hospital was significantly lower in the intervention arm (P=0.041 and P=0.006, respectively). No adverse events were reported in both groups. Conclusion: The use of erythropoietin and iron sucrose 1 to 2 days before surgery significantly decreased the need for blood transfusion in patients with IDA undergoing CABG without any significant adverse events.

Background: Acute myocardial infarction is an important cause of morbidity. This study aimed to investigate the effects of the administration of potassium chloride (KCl) on reperfusion-induced injuries in a rat model of myocardial ischemia/reperfusion. Methods: Thirty-six male Wistar rats, weighing 200 to 250 g, were randomly assigned to 3 experimental groups: control, K1 (10 µg/kg of KCl), and K2 (20 µg/kg of KCl). Twenty minutes before ischemia, a single dose of 10 and 20 µg/kg of KCl was intraperitoneally administered in the K1 and K2 groups, respectively. The coronary artery was occluded for 30 minutes (ischemia); thereafter, it was opened for 60 minutes (reperfusion) to measure hemodynamic parameters and ventricular arrhythmias. Blood sampling was performed after the reperfusion period to determine the serum levels of lactate dehydrogenase, troponin I, creatine kinase (CK)-MB, malondialdehyde, and pro-oxidant-antioxidant balance. Results: Serological parameters significantly decreased in the potassium groups compared with the control group. In particular, the decline was more pronounced for the serum levels of lactate dehydrogenase (1180.25±69.48 vs 1556.67±77.02 U/L; P=0.011), troponin I (21.98±0.61 vs 28.76±1.65 ng/mL; P=0.020), and pro-oxidant-antioxidant balance (15.51±0.72 vs 20.63±1.42 HK; P=0.041) in the K2 group compared with the K1 group. Moreover, the administration of 20 µg/kg of KCl significantly decreased the incidence of ventricular tachycardias and fibrillations compared with the control group (P=0.002). Additionally, no considerable differences were observed between the control group and the groups with 10 µg/kg and 20 µg/kg of KCl regarding the number of ventricular ectopic beats. Conclusion: The administration of KCl before ischemia could reduce ventricular arrhythmias and reperfusion-induced injuries by reducing oxidative stress.

Background: Computed tomography pulmonary angiography (CTPA) as the gold-standard examination in the detection of pulmonary embolism (PE) is contraindicated or unavailable in certain cases. The current study aimed to assess the accuracy of unenhanced CT in the diagnosis of PE. Methods: This cohort study was conducted between October 2020 and March 2021 in Birjand, Iran, on 195 participants with clinical suspicion of PE examined with multidetector computed tomography (MDCT) scanning and CTPA. The patients were categorized into 2 groups based on the diagnosis PE in CTPA results. Imaging variables in unenhanced CT scans, including hyper/hypodense intraluminal signs, pulmonary trunk enlargements, peripheral wedge-shaped opacities, and pleural effusions, were independently reviewed by 2 radiologists and then compared between the groups. Results: There were 82 men (42.1%) and 113 women (57.9%) at a mean age ± standard deviation of 56.00±0.24 years. Based on CTPA results, PE was diagnosed in 24.1% of the study population (47/195). However, only 20 cases (42.5%) were detected by MDCT: 17 cases (85.0%) with central PE and 3 cases (15.0%) with peripheral PE. Concerning the intraluminal clot density, 12 patients (60.0%) had hyperdense signs, 3 (15.0%) had hypodense signs, and 5 (25.0%) had mixed hyper/hypodense signs. There was a significant difference between central PE and peripheral PE detected by MDCT. Intraluminal signs had the highest specificity and sensitivity (98.6% and 42.5%, area under the curve =0.734). Conclusion: Unenhanced MDCT has a remarkable performance in detecting PE, specifically central clots, and can, therefore, be considered an alternative modality when CTPA is not available or indicated.