Complex ebstein's anomaly in an 86-year-old iranian man: a case report

Ebstein's anomaly is defined as the significant apical displacement of the tricuspid valve causing tricuspid regurgitation. Although a variety of concomitant lesions have been previously described, we herein introduce an unusual presentation. Our patient was an 86-year-old man with a primary presentation of typical chest pain in the setting of recently diagnosed coronary artery disease with concomitant Ebstein's anomaly. We found mild-to-moderate tricuspid regurgitation, bicuspid aortic valve, persistent left superior vena cava, and patent foramen ovale. The patient had suffered from chest discomfort on exertion for 2 months with good functional capacity prior to diagnosis. Coronary angiography revealed two-vessel disease. The patient refused surgery. He was treated with medical anti-ischemic therapy. He had good exercise tolerance with relief of chest pain at the latest follow-up

The features demonstrated in this case report suggest that there may be several adult survivors of complex congenital heart diseases requiring individualized surgical treatment plans

Conservative Management of Left Atrial Intramural Hematoma after Catheter Ablation

Left atrial intramural hematoma is a very rare complication of radiofrequency ablation procedures. A patient with tachyarrhythmia underwent radiofrequency catheter ablation. Echocardiography performed the following morning showed a large mass in the left atrium, suggestive of intramural hematoma formation. The patient was in a stable condition; therefore, it was decided that follow-up should be conservative and her anticoagulation therapy was continued. The size of the hematoma decreased significantly over the following 50 days. This case highlights a rare complication of a complex catheter ablation procedure in the left atrium that was managed via a noninvasive approach, with which all interventionists should be familiar.

Physician-related factors affecting cardiac rehabilitation referral

Despite the positive impact of cardiac rehabilitation [CR] on quality of life and mortality, the majority of people who could benefit from this program fail to participate in it. The lack of referral from the physician is a common reason that patients give for not seeking CR. The objective of this study was to compare factors affecting CR referral by cardiologists. A cross-sectional survey of 122 cardiologists, including 89 general cardiac specialists and 33 fellows in cardiology from 11 major cardiology training centers in Iran, was done in 2010. They responded to the 14- item investigatorgenerated survey, examining the physician's attitudinal and knowledge factors affecting CR referral. 47.9% of the subjects reported having available CR centers but only 6.6% reported continuous medical education on the topic. 90.7% of the physicians reported that less than 15% of patients are referred to CR centers. The main factor affecting the low referral rate was limited general knowledge about CR programs [79.5%] such as program attributes and benefits, methods of reimbursement. Lack of insurance coverage, unavailability of CR centers in the community and low physicians' fee were other factors reported by the physicians. Cardiologists' inadequate general knowledge of and attitude toward CR programs seem to be a potential threat for cardiac prevention and rehabilitation in some societies

Factors associated with failure to complete phase ii cardiac rehabilitation: survey registry in rajaie cardiovascular medical and research center

A significant proportion of patients who begin CR [cardiac rehabilitation] do not complete the program. The purpose of this study was to determine the predicting factors that interfere with adherence and completion of an outpatient CR program. A cross-sectional survey was conducted with all 128 patients who entered the CR program at the Rajaie Cardiovascular Medical and Research Center in Tehran, IR Iran, from March 2009 to March 2010. The demographic variables included age, sex, education, employment status, insurance status, and return to work. These variables were compared in patients who completed and did not complete phase II CR. The reason for CRincompletion was asked in follow-up phone interviews. The most frequent clinical diagnosis among the patients enrolled in the CR program was coronary artery disease. 83.6% of patients who participated had a CABG or PCI procedure during the last year. CR participation increased when cardiac revasculariza-tion procedures were performed during the first hospitalization. 88 of the 128 patients dropped out, yielding a dropout rate of 68.7%, which was significantly [P < 0.01] higher than the same study in other countries. Sex and age did not predict the completion rate. As education increased, cardiac rehabilitation utilization and completion increased. Unemployed patients were less likely than employed patients to complete the program. Our data indicate a low rate of CR completion, with lower rates among unemployed, uninsured, and less educated patients