Perventricular muscular ventricular septal defect [VSD] closure under epicardial echocardiography guidance: a case report

Ventricular septal defects [VSDs] are among the most common congenital cardiac lesions. Large defects at apicomuscular regions, especially in young patients, are far from accessible to surgeons for conventional surgery. Moreover, the transcatheter closure of VSDs in these patients is difficult and carries a high risk of complications because of the large sheath size relative to the patient's size. The periventricular approach simplifies VSD closure and, thus, eliminates the potential complications of cardiac catheterization and fluoroscopy as it is performed under echocardiographic guidance. A 3-year-old girl with a body weight of 11 kg [failure to thrive] was referred to us. She had multiple adjacent apicomuscular VSDs, the largest one being about 19 mm in diameter, and subsystemic pulmonary artery pressure [PAP]. The patient underwent periventricular apicomuscular VSD closure with a Lifetech muscular VSD occluder [size 22 mm] under epicardial echocardiography guidance without cardiopulmonary bypass. Post procedure, the PAP was decreased to mild level. The residual shunt was mild across the adjacent small defects. She was discharged after 7 days without complications. At 2 years' follow-up, the patient was hemodynamically stable and had a normal PAP [PAP = about 16 mmHg] by transthoracic echocardiographic assessment

effect of atherogenic diet with or without enzyme inhibitors on the incidence and progress of atherosclerosis in rabbits

PON1 [Paraoxonase – 1] is an esterase enzyme which is associated with high density lipoprotein [HDL]. The enzyme prevents the peroxidation of low density lipoprotein [LDL]. The susceptibility of LDL for oxidation is the proven risk factor for coronary artery diseases. The aim of this study is to survey the effect of atherogenic diet with or without enzyme inhibitors on the incidence and progression of atherosclerosis in rabbits. Twenty four New Zealand white rabbits divided into three groups [control, under the atherogenic diet, atherogenic diet and nandrolone decanoate - paraoxonase inhibitor therapy] and were treated for two months. At the beginning and end of the treatment, 5 mL of blood was obtained to determine the levels of total antioxidant capacity [TAC], HDL, mallon dialdehide [MDA] and PON1. After sixty days rabbits anesthetized under standard conditions, and sampling carried out from heart arteries for pathological examinations. Data were analyzed using statistical software SPSS/15 and one way ANOVA and paired t-test statistical tests. The results showed that the plasma levels of TAC, HDL, MDA and PON1 had significant changes in this study [P<0.05]. The pathological study showed that in the presence of PON1, the formation and progression of atheroma is diminished. The results of this study showed that cholesterol-rich diet decreased serum level of PON1 which in turn led to a reduction in formation and progression of atheroma. It was shown that the enzyme inhibitor helps accelerating the development of atheroma.

Aortocaval tunnel to the superior vena cava: a case report

A 20-year old female with a rare anomaly of aortocaval tunnel to superior vena cava is presented. Rare cases of congenital communications between aorta and right sided of the heart has been reported previously. The patient underwent surgical repair and had uneventful recovery

Erythropoietin prevention effect on induced apoptosis by ischemia- reperfusion in myocytes of rat

Ischemia- reperfusion is the common cause of apoptosis in most of cells specially myocytes. Prevention and reduction of apoptosis in myocardium can be one of the main medical goal before surgical operation, angioplasty and after infarction. Erythropoietin receiving effect 24 hours before hypoxia beginning on myocytes apoptosis rate and inflammatory process following half an hour hypoxia and 1.5 hour reperfusion are aim of this study. 40 Rats were divided randomly into two groups. 24 hours before surgical operation, 5000 Iu/Kg erythropoietin was injected to experimental group. During operation 12 rats from experimental group and 11 rats from control group were lost. After anesthesia, using ligation in left coronary artery for 30 minutes hypoxia and 1.5 hours reperfusion were applied. Then Thorax was opened and after bleeding, the animal's heart was isolated and two tissue samples of infarct and non-infarct area were separated and fixed. Then blood serum samples separated and incubated in -76[degree] C. Apoptosis intensity in heart tissue was measured by tunel method CK-MB level by method and DGKC, hsCRP by Elisa using Immunodiagnostic kit. The results were calculated Mean +/- SD. Then using paired student's t- test their deference were shown. Level of statistical significant was considered P< 0.05. Activity level of CK-MB [1550U/L to 340] in experimental group was less than control group [P

Transcranial and carotid doppler study in coronary artery bypass graft patients

Atherosclerosis is a pathogenesis which is common in both coronary and intracranial arterial diseases. Therefore, we designed a group of coronary artery bypass graft [CABG] surgery patients for transcranial Doppler [TCD] to assess intracranial artery diseases and carotid duplex studies to assess carotid artery diseases. In a prospective randomized study, 129 elective CABG patients with proven coronary artery disease by angiography, were examined by TCD and 45 patients by carotid duplex preoperatively. Neurologic examination was carried out pre- and post- operatively. This study was carried out from April 2001 to August 2002 at Imam Hospital of Tabriz Medical Science University, Iran. Out of the 129 CABG patients, there were 105 males and 24 females, with an average age of 57'9.9 years. Risk factors were as follows: smoking in 44.8%, hypertension in 38%, hypercholesterolemia in 29%, and diabetes mellitus in 18.6%. The TCD findings of 30 patients [23.2%, 11 female and 19 male] revealed the following abnormalities: stenosis of basilar artery in 7 patients [5.4%], carotid siphon in 3 [2.3%], intracranial internal carotid in 5 [3.9%], middle cerebral artery in 3 [2.3%] and vertebral artery in one patient [0.8%]. Multiple vessel abnormality was detected in 11 patients [8.5%]. There was a significant correlation between severity of coronary artery disease in angiography and abnormality in TCD [p=0.008]. The TCD abnormality was detected more in females [p=0.008] or hypertensive patients [p=0.004]. In the carotid duplex study of the randomized 45 patients, 23 [51.1%] had abnormal results as follows: stenosis <50% in 17 [38%] cases, stenosis between 50-70% in 5 [11%], and hemodynamically significant stenosis [>70%] only in one [2%] patient. There was also significant correlation between severity of coronary involvement and carotid involvement [p<0.01]. No stroke occurred in the first postoperative week following CABG surgery. Stenosis of intracranial and carotid arteries was more common in CABG patients with more than 2-coronary vessel involvement or hypertensive or female patients. We recommend TCD and carotid duplex studies in these patients for prevention of probable cerebrovascular accidents

Effects of Ramadan fasting on serum lipid profiles on 2 hyperlipidemic groups with or without diet pattern

The effects of Ramadan fasting, with low fat and low calorie diet, on blood lipid and lipoprotein levels were studied. Results revealed reduction of plasma lipid levels and anthropometric parameters in the hyperlipidemic cases. To find out whether such reductions were due to nutritional diet or Ramadan fasting, we conducted a study to evaluate effects of Ramadan fasting on 2 separate hyperlipidemic groups with or without nutritional diet regimen. This study was carried out at Madani Heart Hospital, Tabriz, Iran, during the year 1998. Thirty-eight hyperlipidemic healthy men voluntarily enrolled into 2 groups, group I, 22 men on low fat and low calorie diet and group II, 16 men without any special diet interference. The blood lipid profile tests were measured 4 times [3 weeks before, first week, last week and one month after Ramadan]. To evaluate nutritional composition, 12 times in non-successive days, 24 hour nutrition recalls were obtained from all individuals during the study. Analysis of data revealed that only triglyceride in both groups reduced in the beginning of Ramadan compared to 3 weeks before. During Ramadan, with a reduction of 300 Kcal/day in comparison to before Ramadan, no changes were seen concerning anthropometric parameters and serum lipids levels. It seems that the effect of Ramadan fasting on serum lipid levels may be closely related to the nutritional diet. For reduction of plasma lipid levels, it would be necessary to omit at least one term meal or reduce energy by 500 Kcal or more per day

Effects of low fat and low calorie diet on plasma lipid levels in the fasting month of Ramadan

In Ramadan, which is one month of the Hijra year, Muslims change their eating habits from 3 times to 2 times daily. The aim of this study was to evaluate the effects of fasting with low fat and low calorie diet on anthropometric parameters and plasma lipid profiles in hyperlipidemic men during the month of Ramadan. This study was carried out at the Madani Heart Hospital, Tabriz University of Medical Sciences, Tabriz, Iran during the year of 1997. Twenty-eight hyperlipidemic healthy men in a fasting group and 10 healthy men with top normal lipid levels in a non-fasting group were voluntarily enrolled for study. They were encouraged to use low fat and low calorie diet. The study started 20 days before and lasted one month after Ramadan. Laboratory tests including plasma total cholesterol, cholesterol-low density lipoprotein, cholesterol-high density lipoprotein and triglyceride were measured 4 times; 20 days before Ramadan, first day of Ramadan, on the last day of Ramadan and 30 days after Ramadan. Data analysis in fasting group revealed a significant reduction in energy intake and nutrient materials during Ramadan month [P<0.05] and plasma total cholesterol, cholesterol-low density lipoprotein and triglyceride levels decreasing towards the end of Ramadan [P<0.01]. In the non-fasting group, there were no significant changes in the above-mentioned parameters. It seems that Islamic fasting in Ramadan with low fat and low calorie diet leads to plasma lipids reduction in hyperlipidemic men

Study ofMDA, antioxidant vitamins, lipoproteins serum levels and anthropometry parameters in coronary artery disease patients

To compare the serum level of MDA [malondialdehyde], antioxidant vitamins, lipoproteins and anthropometry parameters, of 40 patients with coronary artery disease [CAD] and at least one vessel stenosis more than 70% and 40 healthy persons [control group] with mean age of 53.7 +/- 9.45 years were selected for this study. All patients and the healthy controls were evaluated in aspects of anthropometry parameters including weight, height, Basal Metabolic Index [BMI] and waist to hip ratio, angiographic status of coronary arteries [only in patient group], serum levels of triglyceride, cholesterol, LDL-C, HDL2, HDL3, MDA and vitamins E and C. Results showed that BMI and waist to hip ratio in patients were significantly elevated in control group [p<0.01] whereas serum levels of antioxidant vitamins were lower [p<0.001]. Serum levels of MDA in the patients were increased significantly in comparison with the control group [p<0.001]. LDL/HDL ratios were higher and Vitamin E/Cholesterol ratios were lower of patients compared to the control group. These results suggest that decrease of antioxidant vitamins and increase of MDA serum levels play important roles in the pathogenesis of CAD