Echocardiographic assessment of myocardial infarction: comparison of a rat model in two strains

The purpose of this study was to induce myocardial infarction [MI] and compare the echocardiographic parameters and mortality ratio of Lewis inbred and Wistar outbred strain before and after the procedure to help choose the best one for MI studies. In this study MI was induced in 46 Lewis and 34 Wistar by occlusion of left anterior descending artery [LAD]. Doppler, two-dimensional [2-D] and 2-D guided M-mode images were recorded from parasternal long-axis and parasternal short-axis and apical four-chamber views. The following parameters were acquired. Interventricular septum diastolic and systolic dimension [IVSd, s], diastolic and systolic left ventricular internal diameter [LVIDd, s], diastolic and systolic left ventricular posterior wall dimension [LVPWd, s], ejection fraction [EF], and fractional shortening [FS]. The significant changes were observed in systolic IVS, LVID and EF and FS before and after MI and no significant difference was detected between Lewis and Wistar. The high mortality rate of 51% was seen in the procedure, including anesthesia in Lewis compared to 34% in Wistar. As a conclusion the echocardiographic parameters of these two strains were similar, but according to mortality rate and more cardiac anatomic variation in Lewis rats, Wistar is better for MI studies

Assessment of statistical relationship of ejection time and acceleration time with the severity of valvular aortic stenosis

Valvular aortic stenosis is a relatively common disease among valvular heart diseases and can be rheumatic, degenerative or congenital. Evaluation of the severity of the disease is sometimes challenging and problematic. Besides, the use of more parameters of non-invasive methods for the assessment of valvular disease and its severity seems attractive and helpful. Transthoracic echocardiography [TTE] is an appropriate modality for the evaluation of the aortic valve. In this study, TTE was performed for 80 patients with valvular aortic stenosis. The goals were to assess the statistical relationships between ejection time [ET] and acceleration time [AT] and their ratio [AT/ET] with the four traditional parameters of the echocardiographic severity of aortic valvular stenosis [aortic jet velocity, aortic valve area, mean pressure gradient and LVOT VTI/aortic VTI ratio]. There was a meaningful relationship between adjusted ET with the four above-mentioned parameters, d. ET [ET-adjusted ET according to heart rate and stroke volume] was inversely related with the aortic valve area [calculated with continuity equation]. AT/ET was significantly correlated with the four mentioned parameters. The regression equations were calculated. The cut-off value of AT/ET for the echocardiographic diagnosis of severe valvular stenosis was 0.36 [with 95% level of confidence]

Gelatin, ringer or modern hydroxyethyl starch solutions: which is better after coronary artery bypass graft?

Hemodynamic stability in patients after coronary artery bypass graft surgery [CABG] with the cardiopulmonary bypass pump [CPB], especially during transfer to ICU ward and the early hours of ICU admission is very important. Adequate fluid therapy and intravascular volume maintenance as a matter of principle is essential using various intravenous fluids, but there is always the question of what is the ideal intravenous fluid?. The aim of this study is to compare the effects of gelatin, hydroxyethyl starch [HES 6%, Voluven], and Ringer's solution to maintain hemodynamic status after cardiopulmonary bypass in patients undergoing coronary artery bypass surgery. In this randomized double blind clinical trial, 92 patients who were candidates for onpump CABG were studied. After discontinuation of CPB, all patients were transferred to the ICU and were put randomly into three groups. The first group received Ringer's solution, the second group gelatin 4%, and the third group HES 6% [Voluven]. Hemodynamic parameters like heart rate, mean arterial pressure, systolic blood pressure, diastolic blood pressure, central venous pressure, cardiac output and the presence of arrhythmias were documented. The volume that was needed for maintaining normal blood pressure and central venous pressure [CVP] in the range of 10 to 14 mmHg was less in the HES group than the other groups, but was similar in the gelatin 4% and Ringer's groups in the first 24-hours after surgery. Urinary output in the first four hours and 24 hours after surgery were significantly higher in the HES group than the other two groups, and mean creatinine levels were significantly lower in the HES group. HES 6% has better volume-expanding effects than gelatin 4% and Ringer's solution and its short-term effects on renal function are also better

Cardiac MRI in a patient with myocarditis

A 19-year-old man presented with atypical chest pain, history of flu-like symptoms for the previous 14 days, and a rise in cardiac enzymes. His electrocardiogram revealed inferolateral ST elevation with mild PR depression. Cardiac MRI demonstrated focal myocarditis following his viral illness

12-year experience with primary cardiac tumors

We report our experience with 117 patients with primary cardiac tumors who underwent surgery at our institute [a referral center] between March 1995 and February 2006.The patients comprised 47 men and 70 women with a mean age of 44.97 years [range: 2.5- 81 years]. The predominant symptom was dyspnea on exertion and palpitation. In all the patients, echocardiography was the main diagnostic tool, but magnetic resonance imaging [MRI] and CT scan and coronary angiography were also performed if indicated. Most of the tumors were found in the left atrium [LA] [77.77%], but the other chambers were also involved with lesser prevalence [right atrium: 7.5%, left ventricle: 5.1%, and right ventricle: 2.5%]. Involvement of multiple chambers was found in 8 [6.8%] patients.All the patients survived the surgical procedure and were discharged from hospital. Follow-up ranged from 1-10 years [mean: 2.4 years]. The most prevalent tumor was myxoma [104 cases], followed by sarcoma [4 cases] and fibroma [2 cases]. Four patients had secondary [metastatic] cardiac tumors [two Hodgkin lymphoma, one renal cell carcinoma, and one osteosarcoma] and were consequently excluded from the study

Cardiac MRI in a patient with amyloidosis

A 42-year-old man presented with orthopnea, paroxysmal nocturnal dyspnea, and ascites, which had progressed for the previous two months. Electrocardiogram was low voltage. Transthoracic echocardiography showed concentric left ventricular hypertrophy and increased brightness and speckling pattern in the ventricular septum, consistent with amyloidosis. Cardiac magnetic resonance imaging confirmed the echocardiographic findings, and gingival biopsy was positive for amyloidosis

Clinical and echocardiographic evaluation of regional systolic function detected by tissue doppler imaging in hypertrophic cardiomyopathy

Hypertrophic cardiomyopathy [HCM] is the most common type of the genetic cardiovascular diseases. Regarding to tremendous heterogeneity in the phenotypic expression of HCM, which is generally unrelated to genotype, we aimed to study, clinical and echocardiographic parameters such as Tissue Doppler Imaging [TDI] in various subtypes of HCM patients and evaluate the influence of race and gender in Iranian patients. Patients with HCM underwent a complete clinical and echocardiographic study including TDI to assess regional systolic contraction [in the 12 segments] and early diastolic annular velocity [Em] from the septal mitral annulus. The study comprised 41 patients [20 women, mean age = 41 +/- 15 years] with mean LVEF 55% +/- 4.8% and mean maximal septal thickness 2.07cm. Considering LVOT gradient>30mmHg, hypertrophic obstructive cardiomyopathy [HOCM] was found in 18 [455]. Asymmetric septal hypertrophy [ASH] existed in 27 patients [67%], systolic anterior motion of anterior mitral leaflet [SAM] in 25 persons [64%]. Nineteen patients [46.3%] were included in NYHA function class [FC] II and 6 [14.7%] in FC III or higher. We found syncope in 10 [24.4%], chest pain in 4 [9.8%], atrial fibrillation in 14.6% and ventricular arrhythmias in [17.1%] of patients. History of ICD was seen in 7 [17.1%] and PPM in 9 cases. Mean E'velocity was 5.44 +/- 1.65 cm/sec and S velocity 5.70 +/- 1.49 cm/sec with significant lower S velocity and E' in syncope patients. Overall, HOCM patients had grade II diastolic dysfunction with E/E>15 [17.54 +/- 7.46]. Majority [25] of cases [61%] were categorized in type III of HCM. RV involvement was observed in 11 patients [28.2%]. No significant differences existed between prevalence of syncope and dysrhythmia among HCM and HOCM patients. In our study, we found lower detection of latent HOCM, compared to other studies, suggestive of inadequate use of appropriate provocative maneuvers such as exercise stress echocardiography and amyl nitrate. We detected remarkably lower S velocity [5.70 +/- 1.49 cm/sec] and E'velocity [5.44 +/- 1.65 cm/sec] in HCM patients compared to normal subjects, with more significant reduction in patients with syncope

Comparative study of pulmonary function tests before and after successful percutaneous transvenous mitral commissurotomy

Mitral stenosis [MS] causes elevation of left atrial and pulmonary venous pressures. Persistent elevation of pulmonary venous pressure causes anatomical and physiological changes in lung vasculature and tissue, and change in lung volumes thereafter. Studies showed improvement of lung function with improvement of mitral stenosis and decrease in left atrial pressure and pulmonary congestion. This study was performed to evaluate lung volumes before and after percutaneous transvenous mitral commissurotomy [PTMC], including FEV1, PVC, SVC, and their percent and FEF of 25, 50, 75, 25-27 percent and PEFR before and within 48 h after PTMC, and to evaluate correlation of each with valve area. 26 from 51 patients with inclusion criteria stayed in the study with non-random consequential selection and the others were excluded. All of the patients had moderate to severe MS, good mitral valve morphology, echo score below 11, and absence of clot in the left atrium. Spirometery was done in all of the patients before and after PTMC and FEV1, FCV, SVC, FEF25%, FEF59%, FEF75%, FEF25-75% FEF1/FVC, and PEFR were measured. There were 26 patients [12 female, 14 male] with a mean age of 38.38 years old, miral valve area was 0.88 cm2 before and 1.46 cm2 after PTMC [mean 0.58 cm2 increase [p<.000]. Mean value of lung volumes and flow changes were: SVC change= 100 ml [p<0.1], FVC= 230 ml [p<0.0005], FEV1= 250 ml [p<0.003], FEF50%= 0.85 [p<0.004], FEF25%= 0.98 [p<0.003], and FEF25-75%= 0.71 [p<0.01]. Values for SVC, PEFR, and FEF75% and PEFR had no significant improvement. This may suggest improvement of small airway function due to a decrease in lung congestion

Health state valuation in Iran: an exercise on cardiovascular diseases using visual analogue scale method

Disability Weights [DWs] are main components for computing summary measure of population health [SMPH] and economic studies. They are specific for each community, but there are no previous studies in Iran. In this study, we investigated the feasibility of health state valuation [HSV] in Iranian population. Twelve cardiologists in 3 sessions of expert panels, defined 25 states, related to cardiovascular diseases [3 major and 22 specific diseases]. From January to March 2008, 80 persons in 4 groups including: physicians, patients, patients' families and general publics [each group 20], were interviewed and valuated the states, using visual analogue scale [VAS] method. SPSS[Registered] 15 for window[Registered] [SPSS Corporation, Chicago, Illinois] was used for statistical analysis. Data showed that the defined health states had various severities. All the 4 groups ranked the "3 major-diseases" and "very-mild" and "very-severe" states, similarly. Non-physicians were not able to differentiate among "valvular-diseases" and "pacemakers" properly. The reliability of responses was acceptable. VAS is an appropriate and reliable method for HSV in Iranian population. Non-physicians' opinions can be consider in major cardiac diseases. Valuation of more specific situations must perform by physicians

Prevalence of left ventricular diastolic asynchrony in patient with systolic heart failure

To study the occurence of left ventricular [LV] diastolic asynchrony in patients with systolic heart failure [HP] and its relationship to diastolic function regardless of QRS duration. Recent work has demonstrated that intraventricular asynchrony is a common finding in patients with systolic heart failure. Little attention has been paid to diastolic asynchrony in patients with systolic heart failure. We have therefore decided to determine the extent to whuch patients with systolic heart failure have evidence of diastolic asynchrony and wheather or not diastolic asynchrony is correlated with diastolic dycfunction. Tissue Doppler echocardiography was performed in 50 HF patients [LV EF=23 +/- 8%]. Diastolic and systolic asynchrony was determined by tissue synchronization imaging using a 6 basal, 6 mid-segmental model. Systolic and diastolic asynchrony were assessed by the maximal difference in time to peak systolic and early diastolic velocities between any two of 12 LV segments, and the standard deviation of time to peak systolic and early diastolic velocities of the 12 LV segments. The mean +/- SD maximal difference in time to peak systolic velocity [controls: 17.2 +/- 9.6 ms versus narrow QRS: 66.7 +/- 38.0 ms versus wide QRS: 76.5 +/- 34.6 ms, both P<0.05 versus controls] and in standard deviation of time to peak systolic velocity of 12 LV segments [controls: 15 +/- 6.1 ms versus narrow QRS: 25.9 +/- 15.3 ms versus wide QRS: 28.6 +/- 14.4ms, both P<0.05 versus controls] was prolonged in both the narrow and wide QRS groups compared with normal controls. Similarly, the maximal difference in time to peak diastolic velocity [controls: 39 +/- 16.8 ms versus narrow QRS: 73.1 +/- 58ms versus wide QRS: 108.5 +/- 168 ms, both P<0.05 versus controls] and in standard deviation of time to peak early diastolic velocity of 12 LV segments [controls: 15.3 +/- 5.8ms versus narrow QRS: 25.1 +/- .13.8ms versus wide QRS: 25.5 +/- 14.9ms, both P<0.05 versus controls] was prolonged in both the narrow and wide QRS groups. The respective prevalence of systolic and diastolic asynchrony was 31.4% and 20%, in the narrow QRS group, and 40% and 28.6%, in the wide QRS group respectively.Stepwise multiple regression analysis showed that low ejection fraction and low mitral annular early diastolic velocity were independent predictors of both systolic and diastolic asynchrony. QRS complex duration was found to correlate only with diastolic asynchrony. LV systolic and diastolic mechanical asynchrony is common in patients with HF regardless of QRS duration. Selection for cardiac resynchronization treatment should also be based on information about systolic and diastolic synchronicity

Comparison of transesophageal echocardiographic assessment of right and left atrial appendage functions

To define right atrial appendage functional parameters and comparing them with those of left atrial appendage. A consecutive series of 154 patients [76 males and 78 females] with mean age of 42 years were referred for transesophageal echocardiography. Ejection and filling velocities of right and left atrial appendages were measured at 120 and 70 degrees respectively. The left and right ventricles size and function, right atrial size, tricuspid regurgitation severity, and pulmonary artery systolic pressure were prospectively measured and calculated during transthoracic echocardiography. Mean right and left atrial appendages velocities were 42 +/- 18 cm/s and 50 +/- 26 cm/s respectively [PV<0.001]. Statistically significant positive association [PV<0.001] was found between right atrial appendage velocity and right ventricle ejection fraction and statistically negative relationship was observed between right atrial appendage velocity and smoke pattern [PV<0.001]. Also, the results suggested marginally significant associations between right atrial appendage velocity and right atrium size [PV = 0.05] and pulmonary artery systolic pressure [PV = 0.07]. It was also found that right atrial appendage measures were relatively independent on right ventricle size and tricuspid regurgitation severity. Our study showed right atrial appendage measures were relatively dependent on right ventricle function, right atrium size and pulmonary artery systolic pressure and relatively independent on right ventricle size and tricuspid regurgitation severity. In patients with right atrium smoky pattern right atrial appendage velocity was significantly reduced

Unusual intraoperative fracture of a 21mm Regentr St. Jude Medical [SJM] Valve

A case of aortic valve replacement [AVR] with St. Jude Medical [SJM] Regent_ valve no 21, that was fractured intraoperatively and replaced with a SJM Regent_ valve no 19, is reported here.The fracture point was ring part of the valve that has not been reported yet

Correlation of right ventricular DP/DT with functional capacity and RV function in patients with mitral stenosis

Evaluation of right ventricular [RV] contractility and systolic function in patients with right sided heart disease is an essential component of clinical management. The aim of this study was to assess RV systolic function by qualitative and quantitative methods and compare it to rate of ventricular pressure change during the isovolumic contraction period [dP/dt] as RV contractility index in patients with rheumatic mitral stenosis. In 56 consecutive patients with moderate to severe mitral stenosis, RV systolic function, RV dP/dt and dP/dt/Pmax, were calculated and compared. There was significant correlation between RV dP/dt and RV function [P < 0.001] and between RV dP/dt and New York Heart Association [NYHA] functional capacity [P < .001]. The mean of dP/dt was decreased with increasing severity of RV dysfunction [mean dP/dt was 648 +/- 159 for normal RV function, 592 +/- 126 for mild RV dysfunction, 319 +/- 146 for moderate RV dysfunction and 166 +/- 150 for severe RV dysfunction] Severity of tricuspid regurgitation and pulmonary hypertension had no significant effect on RV dP/dt and RV function. RV dP/dt/Pmax had also significant relationship with RV function and functional capacity [P < 0.001]. Measurements of dP/dt and dP/dt/Pmax, are practical methods for estimating RV contractility and results have a good correlation with RV systolic function and functional capacity

Coronary artery bypass graft in porcelain aorta

A 48 years old male, with porcelain ascending aorta, and diffuse and severe stenosis of great vessels who underwent coronary artery bypass graft [CABG], and the challenges surgeons may encounter in relation to these patients are discussed along with the review of corresponding literature on this challenging entity in cardiac surgery

Myocardial viability assessment: comparison between resting two dimensional visual assessment of dobutamine stress echocardiography and strain rate imaging

Patients with ischemic left ventricular dysfunction are increasingly referred for the assessment of myocardial viability. The issue of identifying dysfunctional but viable myocardium has crucial clinical importance, since revascularization increases survival only in patients with viable myocardial tissue. The aim of this study was to compare resting two-dimensional visual assessment of myocardial viability with dobutamine stress echocardiography and strain rate imaging. In this cross-sectional study, thirty-two consecutive patients [age: 55.3 +/- 22.7, 4 females] with ischemic left ventricular dysfunction were referred for myocardial viability assessment. Viability was evaluated using resting two-dimensional echocardiograms, dobutamine stress echocardiography and strain rate imaging. Viability was defined by the absence of brightness and thinning [<6 mm thickness] in akinetic segments, improvement by at least one grade or a biphasic response during dobutamine stress echocardiography or an increase in the peak systolic strain rate [more than -0.23 1/s]. A total of 254 segments were studied. Seventy- nine segments by dobutamine stress echocardiography, 70 segments by two-dimensional visual assessment, and 63 segments by strain rate were classified as non-viable [P< 0.001]. There was an almost perfect agreement among these diagnostic methods. Two-dimensional visual assessment with measurement of wall thickness is simple and practical methods for viability assessment, with almost perfect agreement with dobutamine stress echocardiography and strain rate imaging

[ study of factors and kinds of acute occupational injuries in Shohada Hospital]

Tools and instrument were developed with progress and development of societies. Whereas inattention to acquire of correct principles of job with these new tools may increased injuries in agriculturists and workers. Occupational hand injuries are one of the most common causes of time lost from work in agriculture and industry. The goal of this study was to investigate the prevalent causes bringing about acute hand injuries in accidents resulting from work in the above mentioned professions and also types and intensity of the injuries caused in the suffering workers and farmers and the time of absence from work. This is a discreptive prospective study. The population that was selected for this included 1130 case. Patients managed for acute occupational hand injuries during summer 1999- 2003 in Shohada hospital and patients assayed in view of kinds and factors of injuries. From 1130 patients, who admitted in Shohada hospital, 405 cases [35.8%] were related to agriculture injuries and 725 [64.2%] cases industrial injuries. The most common causes of agriculture injuries was lawn mower [38.3%] and the seconde cause was fall of heavy material [29.6%]. In industrial injuries the most common cause was fall of heavy material [38.3%], the seconde was press or turnery machins [31.7%]. The most victoms were in the first or seconde decade of life. Average time of hospitalization was 5 days [1-24 days], and average of follow-up time was 2 months [1 weak- 5 month]. We concluded that inadequate experience, training and protective devices incraese the possibility of occupational injuries