Homocysteine level in CAD patients of Iranian population

Coronary flow reserve [CFR] is defined as a maximal [hyperemic] to resting ratio of coronary blood flow. It is a physiologic parameter of coronary circulation and depends on the patency of the epicardial coronary arteries and integrity of the microvascular circulation.CFR measurement has many clinical applications including functional assessment of intermediate stenosis, detection of critical stenosis monitoring of coronary flow in the post angioplasty period, assessment of post infarct blood flow and assessment of coronary graft patency. The aim of this study was to measure CFR in the coronary sinus through the transthoracic echocardiographic approach, in patients who were candidate for coronary artery bypass graft surgery [CABG] before and one month after operation. The present study included 19 patients [mean age=56 +/- 9.1] including 15 males and 4 females, admitted for CABG. All patients had a sinus rhythm, normal wall thickness, normal RV systolic pressure, and tricuspid valvular regurgitation equal or less than grade 2. The antegrade phase of coronary flow in the coronary sinus moving into the right atrium was analyzed in two phases [systolic and diastolic]. Each wave was determined considering the peak velocity and velocity time integral [VTI]. The volumetric blood flow in the coronary sinus calculated at the baseline and then in hyperemic phase was used for determination of CFR both before and after CABG. There was a significant increase in the diameter of the coronary sinus after CABG [9.4 +/- 1.2mm] compared with that of before CABG values [8.6 +/- 1.05mm]. Also there was a trend of increasing the diameter in the hyperemic phase before and after CABG. The absolute increase in mean coronary sinus diameter was 0.5 mm before and 1.5 mm after CABG. Coronary flow reserve [CFR] was significantly higher after surgery, despite a significant increase in systolic velocity ratio [hyperemic/baseline] after CABG. This is also true for systolic velocity time integral [VTI] and diastolic VTI ratios, but there was an insignificant increase in diastolic velocity ratio. Our study in accordance with previous studies, denotes that transthoracic measurement of the coronary flow reserve can be used as a feasible and reproducible method to monitor the changes in cardiac perfusion after revascularization

Routine use of cerebral protection [filter wire] during carotid artery stenting: results of a single center registry of 37 patients

To evaluate the short-term outcome of patients who underwent carotid stenting with the routine use of cerebral protection devices. In our center, 36 successful carotid stenting procedures [of 38 at tempted] were performed in 37 patients [23 men; aged 66 +/- 7 years]. Cerebral protection involved distal filter devices [n = 36] of which 12 were Accunet and 24 were EZ filter wires. The protection devices were positioned successfully in 36 of the 38 attempted vessels. The 30-day incidence of stroke and neurological death was three. Neurological complications included one major stroke, and one minor stroke. There was also one [sudden cardiac death on the first day]. The proportion of stroke or death was two for symptomatic lesions and one for asymptomatic lesions, and two in patients aged < 80 years and one in those aged >/= 80 years. Protection device-related vascular complications included mild spasm, which occurred after three procedures [8%], none of which led to neurological symptoms. There were another four cardiogenic deaths in 30-day follow-up. In this uncontrolled study, routine cerebral protection during carotid artery stenting was technically feasible and clinically safe. The incidence of major neurological complications in this study was lower than in previous reports of carotid artery stenting without cerebral protection

[Pulmonary trunk hydatidosis secondary to lung involvement; A sheperdys tale]

Hydatid cyst of the heart is a rare disease which seems endemic among rural areas and countries exporting muttow. The established theory regarding heart involvement in hydrated cyst is because of involvement of the coronary arteries due to Echinococcus granulosis disease. Here a case is reported where hydrated cyst initially affected the areas adjacent to the pulmonary valve, later spreading to the right and left pulmonary arteries and eventually metastasizing to both lungs, and because of this rare course, this spread in this patient could be considered as a retrograde spread [from heart to lungs]. The site of origin and the spread raises this question as to whether E.granulosa can directly station itself at the pulmonary valve and resist the blood current and thus produces the mother cyst at that particular site