Echocardiographic findings in thalassemia major: a case report and literature review

We introduce a 28-year-old woman with Thalassemia major whose clinical assessment, including two-dimensional Doppler echocardiography demonstrated severe left ventricular hypertrophy with severe biventricular enlargement and systolic dysfunction as well as severe diastolic dysfunction. We hereby address these issues from an echocardiographic point of view.

Cardiac MRI in a patient with coincident left ventricular non-compaction and hypertrophic cardiomyopathy

Left ventricular non-compaction cardiomyopathy is a rare congenital cardiomyopathy that affects both children and adults. Since the clinical manifestations are not sufficient to establish diagnosis, echocardiography is the diagnostic tool that makes it possible to document ventricular non-compaction and establish prognostic factors. We report a 47-year-old woman with a history of dilated cardiomyopathy with unknown etiology. Echocardiography showed mild left ventricular enlargement with severe systolic dysfunction [EF = 20-25%]. According to cardiac magnetic resonance imaging findings non-compaction left ventricle with hypertrophic cardiomyopathy was considered, and right ventricular septal biopsy was recommended. Right ventricular endomyocardial biopsy showed moderate hypertrophy of cardiac myocytes with foci of myocytolysis and moderate interstitial fibrosis. No evidence of infiltrative deposition was seen

Heme oxygenase-2 gene mutations and blood bilirubin level in Iranian patients with premature atherosclerosis

Heme oxygenase-2 [HO-2] is a critical antioxidative stress enzyme found in endothelial cells and adventitial nerves. This enzyme in conjunction with other HOs [1 and 3] metabolize heme molecule into ferrous iron, carbon monoxide [CO], and biliverdin which is further converted to bilirubin. Both biliverdin and bilirubin are potent antioxidants, reducing the risk of atherosclerosis. HO-2 also induces endothelial relaxation by synthesizing CO. This is the first study to evaluate the association of HO-2 gene mutation in patients affected with atherosclerosis. Blood samples from patients [n=137] and normal controls [n=100] were collected. Three pairs of primers were designed to amplify exons 2 to 4 related to human HO-2 gene. The PCR products were analyzed by SSCP and sequencing to find out mutations. Iron and bilirubins [Total, Direct and Indirect] levels were determined in patients and controls. Two nucleotide substitutions were found among 10% of patients, consisted of a newly reported transversion mutation, C to A substitution in codon A70D [GCC to GAC] [Ala to Asp] and a previously reported transition mutation, A to G substitution in codon K89E [AAG to GAG] [Leu to Glu]. Significant associations were obtained between risk of atherosclerosis and A437G substitution in codon K89E of HO-2 gene [P<0.006 and X[2] >6.82] and reduced level of total [P<0.016 and X [2] >6.01], and indirect [P< 0.016 and X [2] >5.99] bilirubins with no significant association with serum iron and direct bilirubin. No significant associations were observed among C381A substitution in codon [A70D, P< 0.11 and ?[2] >2.97], level of serum iron, bilirubin and risk of atherosclerosis. These findings indicate the importance of A437G substitution in the development of atherosclerosis. Further studies are required to study the association of HO-2 gene mutations with atherosclerosis in other populations

Percutaneous mitral balloon valvotomy; single center experience: a review of outcome

Percutaneous balloon mitral valvotomy [BMV] has been accepted as an alternative to surgical mitral commissurotomy in the treatment of patients with symptomatic rheumatic mitral stenosis. Despite the worldwide use of the BMV technique, no studies have been hitherto designed to assess the outcome of the patients undergoing BMV in Iran. The present study reports the outcome of 3138 BMV procedures at Shaheed Rajaei Cardiovascular, Medical and Research Center during a 15-year time period. A total of 2531 patients underwent 3138 BMV procedures at Shaheed Rajaei Cardiovascular, Medical and Research Center between 1992 and 2006. Seventy-three percent [2278] of the cases were followed for 48 +/- 41 months. Recurrent stenosis in 802 [25.8%], mitral valve replacement [MVR] in 213 [6.9%], immediate good result in 3110 [99.1%], and successful outcome in 2000 [72.9%] cases were the outcome of the BMV procedures in the current study. Concordant to the similar studies, we concluded that BMV produces a good clinical outcome in a high percentage of patients. The recent study demonstrated that the successful outcome of BMV was multi factorial and the selection of patients with rheumatic mitral stenosis is recommended to be based on both anatomic and clinical characteristics of the individuals. The procedure-related variables must also be considered in order to predict the outcome

Timely diagnosis of left ventricular posterior wall rupture by echocardiography: a case report

Left ventricular free wall rupture is responsible for up to 10% of in-hospital deaths following myocardial infarction. It is mainly associated with posterolateral myocardial infarction, and its antemortem diagnosis is rarely made. One of the medical complications of myocardial infarction is the rupture of the free wall, which occurs more frequently in the anterolateral wall in hypertensives, women, and those with relatively large transmural myocardial infarction usually 1-4 days after myocardial infarction. We herein present the case of a 66-year-old man suffering inferior wall myocardial infarction with abrupt hemodynamic decompensation 9 days after myocardial infarction. Emergent transthoracic echocardiography revealed massive pericardial effusion with tamponade, containing a large elongated mass measuring 1 x 8cm suggestive of hematoma secondary to cardiac rupture. In urgent cardiac surgery, the posterior wall between the left coronary artery branches was ruptured