Transcatheter coil embolization of coronary artery fistula

A 46-year-old man was admitted with chief complaint of chest pain and fatigue on exertion for the last 2 years. Physical examination was normal. Thransthoracic echocardiography showed mild right ventricular dilatation and ejection fraction of 50%. Coronary angiogram [CAG] was done that revealed significant lesion at mid part of left anterior descending artery [LAD] and a fistula arising from the mid part of LAD artery communicating with main pulmonary artery. Transcatheter coil embolism was successfully performed. The patient was free of symptoms during 12 months follow up

Role of tissue-doppler imaging to assess left ventricular function in patients with right ventricular pacing

Right ventricular apical [RVA] pacing has been reported to impair diastolic and systolic function. These changes were usually studied by conventional echocardiography, while tissue-doppler imaging [TDI] has provided a new way to evaluate global and regional systolic left ventricular [LV] function and abnormal LV relaxation. We designed this study to evaluate the changes of TDI-derived indices of asynchrony after RVA pacing. We followed 41 patients with LV ejection fraction [LVEF] >/= 45% and LV end-diastolic dimension [LVEDD] œ 56 mm who underwent single- or dual-chamber RVA pacemaker implantation for performing pacemaker analysis and second 2-dimensional [2D] echocardiography and TDI, at least 4.2 months later. 2D measurements included LVEDD, LV end-systolic dimension [LVESD], left atrial [LA] volume and septum to lateral asynchrony, while TDI measurements were the peak velocities of myocardial shortening [Sm] and early myocardial relaxation [Em]. Considering the exclusion criteria, 20 patients entered the study with the mean age of 66.05 years and follow-up of 7.86 months [4.20-12.25]. The reduction of Sm, Em and LVEF, and the increment of LVEDD, LVESD, septum to lat asynchrony and LA volume were statistically significant. Changes of all these parameters, however, were independent of pacing duration, frequency or mode [single- or dual- chamber]. RVA pacing has deleterious effects on both LV systolic and diastolic parameters of not only conventional echocardiography but also TDI even in patients with normal LV function. Furthermore, LA volume increases significantly

Anomalous right coronary artery originating from the left main coronary artery

A 50-year-old woman presented to our center with effort angina. Angiography showed normal left main coronary artery, normal left circumflex [LCX] artery and critical discrete lesion [99% stenosis] in mid part of left anterior descending [LAD] artery with good distal flow. However, the right coronary artery [RCA] originated from the left main coronary artery. There was no evidence of external compression of the proximal portion of the RCA during systole or diastole. Consult with cardiac surgeon was done but the patient refuse from the operation

influence of right ventricular apical pacing on left atrial volume in patients with normal left ventricular function

Right ventricular apical [RVA] pacing has been reported to induce several deleterious effects particularly in the presence of structural heart disease but can also involve patients with normal left ventricular [LV] function. Left atrial [LA] enlargement is one of these effects, but the majority of studies have measured LA dimension rather than volume. The present prospective study was designed to assess the effect of RVA pacing on LA volume in patients with normal LV function. The study comprised 41 consecutive patients with LV ejection fraction >= 45% and LV end diastolic dimension <= 56 mm who underwent single-or dual- chamber pacemaker implantation in RVA and followed for LA volume measurement and pacemaker analysis at least during the ensuing 4.2 months. In all, 21 patients were excluded from the study due to five spontaneous wide QRS complex [>=120msec], one recent acute coronary syndrome,one significant valvular heart disease, three pacing frequency <90%, eight death or losing follow up in three cases. In remaining 20 patients, LA volume ragned from 21 to 54 mm3 with mean of 37.3 +/- 9.7 mm3 prior to pacemaker implantation that increased to 31 to 103 mm3 [54.3 +/- 17.0] during follow-up [P<0.001]. RVA pacing might lead to an increase in LA volume even in patients with normal LV function

Serum levels of sialic acid and neuraminidase activity in cardiovascular, diabetic and diabetic retinopathy patients

Sialic acid is a component of serum that is elevated in diseases such as diabetes and certain malignancies. The normal range of SSA concentration and serum neuraminidase activity in different populations are varied, probably due to racial differences. The purpose of the present study was to obtain the average SSA concentration and serum neuraminidase activity, in an Iranian population, and to show whether these indices could indicate the severity, and serve as risk factors, for diabetes and CVD. Serum sialic acid [SSA] concentration and neuraminidase activity were measured in 214 male and female patients and 150 normal individuals. The patient groups were composed of diabetics, diabetics with vascular disease and CVD patients. A mean +/- SEM value of 60.06 +/- 3.36 mg/100 ml for SSA and 50.82 +/- 2.93 mU/ml for serum neuraminidase activity were obtained in the randomly selected normal controls. SSA was significantly higher in the patient groups as compared to the values in the age and sex-matched controls. Increased SSA in the diabetics with vascular complications was significantly higher than that for diabetics without retinopathy. The serum neuraminidase activity was also increased in the patient groups. In contrast to the pattern for SSA levels, serum neuraminidase activity in the diabetic patients was not significantly lower than that for diabetics with retinopathy. While serum neuraminidase activity may serve as a factor which tends to increase in CVD, diabetic and retinopathic patients, it may not be as reliable as the SSA level which correlates the severity or monitoring of these diseases. However, it can be a useful index to be used along with SSA measurements

Mitral valve prolapse in Graves' disease

The prevalence of mitral valve prolapse was investigated by echocardiography in 191 Graves' disease patients from southern Iran. One hundred and fifty-eight asymptomatic healthy subjects were selected as a control group. Fifty-three patients [27.7%] with Graves' disease had mitral valve prolapse compared with 18 [11.39%] in the control group. The difference was statistically significant [p<0.05]