[Ten-year evaluation of cardiac myxoma in Shahid Modarres Hospital]

Background: Primary cardiac tumors are rare tumors which should be operated urgently. In this study, cardiac myxoma have been evaluated from diagnosis until discharge in a 10 years period and then results including presenting symptoms, approach to the patients were compared with similar study in this center a decade ago

Methods: Patients who underwent operation for myxoma from year 2003 until 2013 in the Shahid Modarres Hospital were included in this study

Results: Eighteen patients included in the study, 11 female and seven male. Patients' ages were in the range of 13 to 76 years [mean 53 years]

Mean time from diagnosis to operation was 5.8 days and mean time from surgery to discharge was 8.6+/-6.1 days. Most common presenting symptoms were first clinical presentation in four patients. In all patents echocardiography was the main diagnostic modality. In addition to trans thoracic echocardiography [TTE], in five patients TEE was used and in 13 patients coronary angiography was used to rule out concomitant coronary artery disease. 94.4% of all tumors [17 cases] were primary cardiac tumors and only one tumor [5.6%] was recurrent. In 16 patients [88.9%] tumor were found in the Left Atrium [L.A] and in one case, tumor was found in both atria and in another case, tumor was in the ventricle. After tumor excision, atrial septum was repaired primarily in seven cases [38.9%] and with pericardial patch in 9 cases. One patient underwent concomitant coronary artery bypass graft [CABG] and another patient underwent concomitant pulmonary valve repair. 14 patients [77.8%] discharged from hospital without any post operative complication. Heart block occurred in one patient and cerebral emboli with secondary cere-brovascular accident [CVA] developed in two patients. One patient died [5.6%]

Conclusion: Comparing results from two similar studies in two consecutive decades revealed that mean time from diagnosis to operation obviously was reduced but advances in diagnostic modalities were unable to change clinical presentation or reduce age of tumor diagnosis or complications or size

Evaluation of the effect of elective percutaneous coronary intervention as a treatment method on the left ventricular diastolic dysfunction in patients with coronary artery disease

Although percutaneous coronary intervention [PCI] is an excellent therapy for coronary artery disease, there is a paucity of information on the efficacy of PCI in improving diastolic function, especially in Iran. Because of the high prevalence of left diastolic dysfunction in coronary artery disease patients and its probable progression to heart failure, an evaluation of the role of PCI in improving diastolic function is required. Thirty patients scheduled for elective PCI were enrolled in this study providing that their systolic ejection fraction was > 40%. Before PCI and 48 hours and 3 months after PCI, echocardiography was done to evaluate some diastolic values in these patients. The mean age of all the patients was 54 +/- 10 year, and 20 patients were male. All the patients had a low degree of left ventricular diastolic dysfunction. Isovolumic relaxation time [115 +/- 10 before treatment versus 120 +/- 1 and 119 +/- 3 respectively 48 hours and 3 months after treatment], mitral E wave velocity in septal [0.70 +/- 0.05 before treatment vs. 0.71 +/- 0.15 and 0.72 +/- 0.12 respectively 48 hours and 3 months after treatment], and the peak velocity of late filling due to atrial contraction [mitral A wave velocity] in septal [0.74 +/- 0.02 before treatment vs. 0.73 +/- 0.01 and 0.68 +/- 0.16 respectively 48 hours and 3 months after treatment] showed improvement after PCI. It is notable that early diastolic mitral annulus velocity [E'] wave velocity in the septal part of the mitral annulus improved significantly 48 hours and 3 months after PCI [p value < 0.05]. The early-to-late diastolic tissue velocity ratio of the mitral annulus [E/A] ratio of the mitral inflow improved 48 hours after PCI; it was statistically significant [p value = 0.05]. Also, mitral A wave velocity in septal and the E/A ratio of the mitral inflow improved significantly 3 months after PCI [p value < 0.05]. Improvement in some of values related to left ventricular diastolic function followed by PCI shows thai this method can be used to improve cardiac diastolic function in patients with symptomatic coronary artery disease

Hydatid cyst in a 10-year-old boy: an unusual location

Hydatid disease, caused by echinococcus granulosus, is a common infectious disease in endemic areas such as Southern Europe and the Middle East. The incidence of this disease, however, is on the increase in Northern Europe due to the migration of labor and also tourism. We report a case of the hydatid cyst of the mediastinum, the diagnosis of which was established by the hemagglutinin test and echocardiography and confirmed by histological examinations. The cyst was totally removed during surgery on beating heart. The patient presented herein demonstrates that the mediastinal and cardiac involvement in hydatid disease could manifest in children with fast growth and rupture

Supravalvular and valvular aortic stenosis in heterozygous familial hypercholesterolemia

To report calcified aortic stenosis due to hyper-cholesterolemia in two siblings. Case Presentation and Intervention: A 13-year-old boy with a history of dyspnea on exertion and a systolic murmur of aortic stenosis was referred to our center. Echocardiography showed combined valvular and supravalvular aortic stenoses with a good left ventricle systolic function and severe left ventricular hypertrophy. Two years later his 17-year-old sister was referred to the clinic with similar symptoms. Severe valvular aortic stenosis was detected by echocardiography. Selective coronary angiography showed significant involvement. The father had a history of hypercholesterolemia and confirmed coronary artery disease involving 3 vessels. Angiography showed anterioapical and inferiobasal hypokinesis with preserved left ventricle systolic function. The mother and the other two siblings did not have hyperlipidemia, thereby indicating heterozygous familial hypercholesterolemia in the two affected siblings. The siblings were managed with atrovastatin and nicotinic acid and cholestyramine was added stepwise. The father was treated with lovostatin. This report shows that severe hyperlipidemia in very young patients may be a risk factor for valvulopathy