Correlation between 64-slice CT angiography and conventional coronary angiography

64-slice CT coronary angiography is now available as a valuable technology in evaluating patients, both with and without symptoms for the detection of coronary lesions and in making decision whether or not further invasive testing is needed. The aim of our study was to evaluate the diagnostic performance of 64-slice CT angiography for detection of significant coronary artery stenoses in comparison with conventional coronary angiography. During a period of 20 months [April 2007-November 2008] we studied 565 patients with 64-slice CT angiography of coronary arteries who fulfilled following criteria; having a positive stress test such as thallium-scan or stress echocardiography if symptomatic, sinus heart rhythm and able to hold breath for 15 seconds. We scheduled coronary angiography for 58 of these patients with mean age of 52 +/- 10.5 years [37 men and 21 women] who have one or more significant stenoses of coronary arteries. A significant lesion was assumed if the diameter reduction of vessel was = 50%. The overall sensitivity and specificity of 64-slice CT for detection of significant coronary artery stenoses in this study were 95% and 94% respectively. The positive predictive value was 85% and negative predictive value was 94%. We found that 64-slice CT correctly identified all patients with three vessel disease. This technique was reliable to classify 90% of patients [52/58] as having one, two or three vessel disease correctly. In conclusion 64-slice CT coronary angiography has a high degree of both sensitivity and specificity in detection of significant coronary artery stenoses

Pulmonary artery angioplasty and stenting of anastomotic pulmonary hypertension after single lung transplantation for idiopathic pulmonary fibrosis

To determine the feasibility and safety of percutaneous stent angioplasty of pulmonary arterial anastomotic stenosis in post lung transplant recipient. We describe a case of pulmonary hypertension recurring in a lung transplant recipient secondary to arterial anastomotic stenosis and not recurrence of primary diseases. The condition completely improved after pulmonary artery balloon angioplasty and Stenting.Vascular anastomotic stenosis is a rare but serious complication associated to high mortality after lung transplantation. Pulmonary artery stenosis at anastomotic site should be suspected in patients with unexplained increasing dyspnea on exertion and breathlessness with evidence of pulmonary hypertension diagnosed by transesophageal echocardiography in transplant patients. The diagnosis can be confirmed using pulmonary angiography. Surgical repair has known as a main therapeutic option in these patients. However, pulmonary artery interventional procedure including balloon angioplasty and Stenting can considered as an alternative and an effective treatment in pulmonary arterial anastomotic stenosis in post lung transplant patients, to avoid surgery and its associated morbidity and mortality

Prevalence of renal artery stenosis and it's predictors in patients undergoing coronary angiography

Renal artery stenosis]RAS[is a frequent finding in patients with CAD. Although the prevalence of RAS in Europe and America has been reported as high as 13.5-18% in patients with suspected coronary artery disease, there is limited information about the prevalence of this disease in IRAN. To evaluate the prevalence of RAS in Iranian patients suspected of cardiovascular disease and the relationships among the vascular risk factors, renal angiography was performed in 301 patients receiving diagnostic coronary angiography, in Lalch Pars and Sasan hospitals during 10 months from Deceniber, 2006 to October 2007. RAS with stenosis diameter equal or more than 70% was considered significant. The prevalence of significant RAS was 6%]l8/301[including 15%]5[cases of unilateral stenosis and 3%]1[of bilateral stenosis]. Among to the number of diseased coronary arteries, the prevalence of RAS was, 7%, 6%, 10% and 3% of 0, 1, 2 and 3-vessel disease respectively. Thus our study showed the RAS is not significantly common in patients with established CAD, except for in those with 2-vessel disease. The prevalence in patient with hypertension was 7% and 3% in normotensive patients. So our study showed that hypertension does not have a close relationship with RAS

Autologous in vitro expanded mesenchymal stem cell therapy for human old myocardial infarction

Stem cell transplantation after myocardial infarction has been claimed to restore cardiac function. Mesenchymal stem cells attract a lot of attention because of the feasibility of in vivo and ex vivo differentiation to cardiomyocytes and endothelial cells as well as their trophic effect on tissue repair. In this study, we investigated the efficacy of autologous bone marrow derived mesenchymal stem cells in improving heart function in patients with old myocardial infarction. Eight patients with old myocardial infarction and proper inclusion criteria were injected with mesenchymal stem cells at the time of coronary artery bypass grafting or percutaneous coronary intervention [test group] and compared with eight matched patients who received the same treatment without mesenchymal stem cell injection [control group]. Evaluation of heart function was done by echocardiography plus single-photon emission computed tomography before and six months after the procedure. Serial clinical examination was performed every month through New York Heart Association class. The mean New York Heart Association class and single-photon emission computed tomography scan results decreased significantly in the test group [P=0.000 and 0.002, respectively] and in the control group [P=0.049 and 0.007, respectively] after the procedure at six months follow-up. Left ventricular ejection fraction increased significantly in the test group [P< 0.005] but not in the control group. In comparison between the test and control groups the results of New York Heart Association class assessment and single-photon emission computed tomography demonstrated significant improvement in the test group [P=0.005 and 0.013, respectively]. There were no significant differences between the baseline variables in the two groups. In conclusion transplantation of ex vivo expanded bone marrow derived mesenchymal stem cell in patients with old myocardial infarction is a safe and feasible procedure. These cells improve the cardiac fimction without serious adverse effects

Repeat percutaneous mitral valvuloplasty [PMV] in patients with restenosis following to previous PMV

Symptomatic mitral restenosis developed in 4% to 39% of patients after PMV. It is unknown that these patients may benefit from repeat percutaneous mitral valvuloplasty [PMV]. This study assesses the immediate and early outcomes of redo PMV in patients with restenosis after prior PMV. Our study report the immediate and early outcome of 54 patients [mean age 38 +/- K2 years, 14 women and 40 male] with symptomatic mitral restenosis after prior PMV, who were treated with a repeat PMV at 3.8+2.4 years after the initial PMV. After the procedure there was a substantial increase in mitral valve area [MVA] from 1.0 + 0.2 to2.2 +/- 0.4 cm [p<0.001] and a decrease in left atrial pressure from 27+8 to 15 +/- 6mm Hg [p<0.001] and in mitral valve gradient from 17+4 to 2+1 mm Hg [P <0.001]. Mean pulmonary artery pressure did not change significantly with redo-PMV. No patient developed severe mitral regurgitation [3+] after redo PMV. Successful procedural outcome [post-PMV mitral valve area>=l .5 cm[2], pulmonary /systemic flow ratio=

Angioplasty and stenting of basilar artery with short term results

Symptomatic basilar artery stenosis has a poor prognosis. Surgical bypasses are technically demanding and of no proven benefit. A new generation of intravascular stents that are flexible enough to navigate the tortuosities of the vertebral artery may provide a new therapeutic approach. Our two cases, 57 and 52 year-old men experienced a vertebrobasilar ischemia with repeat vertigo and falls. Magnetic resonance angiography from vertebrobasilar arteries revealed severe middle basilar artery stenosis in case 1 and Transcranial Doppler [TCD] shown severe vertebrobasilar artery stenosis in the other one. The patients underwent uncomplicated angioplasty and stenting of the basilar arteries, with excellent angiographie results. During follow-up [12 months in case I and 8 months in case 2], the patients were well and free of symptoms. The new flexible intravascular stents provides a novel therapeutic approach for patients with basilar artery stenosis

Cardiac cystic hydatid disease: report of eight cases

Eight cases of cardiac hydatid cyst diagnosed from 1982 to 1988 are reported from Imam Khomeini Hospital, Tehran University of Medical Sciences. The patient's age ranged from 15 to 38 years. Four were male and four female. Clinical, laboratory, and surgical follow-up were performed in all cases. 2-D echocardiography was the main diagnostic tool in this study, supplemented by CT-scan and cardiac catheterization. Surgical interventions were performed with satisfactory results