Diagnosis of aortic interruption by CT angiography.

BACKGROUND: Interrupted aortic arch (IAA) is a rare congenital malformation of the aortic arch, which might be accompanied with other coexisting cardiovascular anomalies. CASE REPORT: Many cases with IAA are diagnosed at their neonatal and newborn period but in rare cases the diagnosis is not established until adulthood. The patients may have no clinical symptoms but the signs of heart failure will gradually appear and may cause death. RESULTS: The development of imaging methods such as computed tomography (CT) and magnetic resonance (MR) imaging has dramatically changed the diagnostics. Here we report a 20-year-old young man with IAA associated with sinus venosus atrial septal defect (SVD) and partial anomalous pulmonary venous connection (PAPVC) referred to our hospital.

Impact of Angiotensin-converting enzyme inhibitors and Angiotensin receptor blockers on mortality of coronary artery bypass grafting.

BACKGROUND: There is controversy over the potential benefits/harms of the usage of angiotensin-converting enzyme inhibitors (ACEIs) or angiotensin receptor blockers (ARBs) as regards the postoperative mortality of coronary artery bypass grafting (CABG). This study investigates the correlation between the in-hospital mortality of CABG and the preoperative administration of ACEI/ARB. METHODS: Out of 10055 consecutive patients with isolated CABG from 2006 to 2009, 4664 (46.38%) patients received preoperative ACEI/ARB. Data were gathered from the Cardiac Surgery Registry of Tehran Heart Center. In-hospital mortality was defined as death within the same admission for surgery. Adjusted for confounders, multivariable logistic regression models were used to evaluate the impact of preoperative ACEI/ARB therapy on in-hospital death. RESULTS: The mean age of the patients was 60.04 ± 9.51 years and 7364 (73.23%) were male. Eighty-seven (0.86%) patients expired within 30 days. Multivariate analysis revealed that the administration of ACEI/ARB significantly protected against in-hospital deaths inasmuch as there were 33 (0.70%) vs. 54 (1.0%) deaths in the ACEI/ARB positive and negative groups, respectively (OR: 0.628; p value = 0.09). Patients without ACEI/ARB were more likely to have a higher global ejection fraction. CONCLUSION: Preoperative ACEI usage in patients undergoing CABG can be associated with decreased in-hospital mortality. Large-scale randomized clinical trials are suggested.

Etiological characteristics of people with intellectual disability in Iran.

OBJECTIVE: To describe the etiological characteristics of intellectual disability in one Iranian center. METHODS: In a cross-sectional study, 64 cases with mental retardation (MR) were examined in the Intellectual Rehabilitation & Welfare Care Center of Vardavard, Iran between April and September 2008. Cases were diagnosed with MR or showed delay/regression of developmental milestones. We studied the records of patients and interviewed their families. RESULTS: A total of 64 cases were screened (most were children). The number of male patients was 19 (29.7%) and the females was 45 (70.3%). First degree relatives with mental retardation were found in the families of studied patients, among these relatives 48% were female and 52% were male. Up to 77% of the marriages were between relatives, approximately half between first cousins. The illiteracy rate reached 34% in the families of MR children. Hard labor, hypoxia during labor, mother`s preexisting systemic disease, and maternal and neonatal infection were the most important factors for MR. Furthermore, most of the families were found to have low socioeconomic class. CONCLUSION: Cognitive disabilities in children are multifactorial. Consanguinity was the main risk factor for MR and considering its high rate in our country due to traditional marriages, it should be modified.

Can opium abuse be a risk factor for carotid stenosis in patients who are candidates for coronary artery bypass grafting?

BACKGROUND: Over the centuries, opium has been the most frequent substance abused in the Middle East. There are many controversial aspects about the effects of opioids on the atherosclerosis process, which is still unclear. METHODS: All patients who were candidates for coronary artery bypass graft in Tehran Heart Center were registered and evaluated for risk factors such as diabetes mellitus, hypertension, smoking status and duration, opium abuse, involved coronary arteries and left main branch lesion > 50%, carotid stenosis > or = 70%. RESULTS: A total of 1,339 patients were enrolled in the study, of whom 400 (29.9%) were female and the other 939 (70.1%) male. Female patients were omitted from analysis due to the low numbers of female opium addicts. Our study revealed that in the addicted population, the risk of diabetes and hypertension was lower than in the non-addicted group (p < 0.05 for each variable) and fasting blood sugar tended to be less in addicted ones, but the number of involved coronary arteries, left main stenosis > 50% and extent of carotid stenosis was not significantly different between the two groups. CONCLUSIONS: Our investigations demonstrate that opium is not cardioprotective, as has been claimed by some previous studies, and does not even decelerate atherosclerosis of carotid arteries in opium-addicted patients, but more evidence is still needed to completely prove the case.

Sonographic prediction of body fat volume (subcutaneous and visceral fat) in cardiovascular patients.

BACKGROUND: Inappropriate body composition represents impaired energy and nutrient intake and can be a risk factor for many diseases, especially for cardiovascular disease. Different methods have been suggested for the estimation of body fat volume and its distribution. However, they may be either expensive or hazardous for some groups of patients. Sonography is a very accessible technique, which may be used for the evaluation of visceral and subcutaneous fat volume. The purpose of this study was to evaluate the sonographic prediction of body fat and its distribution in subcutaneous and visceral compartments. METHODS: During a three-month period, we conducted sonographic evaluations for visceral and subcutaneous fat in 106 patients who were admitted to our hospital. The subcutaneous fat was measured at the para-umbilical region and visceral fat was measured in the right para-renal space. The results were compared with the data obtained from the body mass index (BMI) and bioelectric impedance analysis. RESULTS: The mean age of the patients was 58.8 years, and the mean BMI was26.48 ± 0.33. The mean values of fat percent and fat mass obtained by the electric-method were 31.07 ± 0.81% and 22.12 ± 0.68 kg, respectively. The respective mean values of subcutaneous and visceral fat obtained by sonography were 20.50±0.56 mm and 24.14 ± 0.58 mm. The correlation between BMI and subcutaneous fat was 0.85 (p value < 0.0001) and the correlation between BMI and visceral fat was0.46 (p value < 0.0001). CONCLUSION: Sonography is a reliable and available method for the estimation of body fat and its distribution in cardiovascular patients, in subcutaneous and visceral compartments.

Ultrasonographic screening for abdominal aortic aneurysms in Iranian candidates for coronary artery bypass graft surgery.

BACKGROUND: To evaluate the prevalence of abdominal aortic aneurysm in Iranian candidates for coronary artery bypass graft surgery and its associated factors. METHODS: Totally, 2843 consecutive candidates for coronary artery bypass graft surgery underwent ultrasonography of abdominal aorta. The relation between abdominal aortic aneurysm with gender, age, smoking, dyslipidemia, hypertension, diabetes, and carotid and coronary stenosis was evaluated. RESULTS: The prevalence of abdominal aortic aneurysm was 2.7% and 0.7% in men and women subgroups, respectively. The prevalence was 3.8% in men older than 65 years. The largest diameter of abdominal aortic aneurysm was 61.7 mm. Only two men had aneurysm larger than 55 mm, which led to changing their surgery schedule to stenting. Gender, age, smoking, smoking more than 40 years, diabetes , hypertension, and significant carotid stenosis were associated factors of abdominal aortic aneurysm. CONCLUSION: Compared with the results sited in Western studies, the prevalence of abdominal aortic aneurysm is lower in Iran (P<0.0001). Its associated factors in our study were similar to previously published studies. Significant carotid stenosis, a factor not reported previously, was an associated factor in our study. Because of the low prevalence of abdominal aortic aneurysm in our population, screening the candidates for coronary artery bypass graft surgery is not recommended.

Is preoperative serum creatinine a reliable indicator of outcome in patients undergoing coronary artery bypass surgery?

OBJECTIVE: Evaluating renal function by calculating creatinine clearance as an alternative measure to serum creatinine may give a better estimation of postoperative renal function in patients undergoing coronary artery bypass grafting. METHODS: Using our database, we conducted a retrospective review of the records of all 11,884 patients aged 21 years or older undergoing pure bypass grafting who required cardiopulmonary bypass. Preoperative renal function was categorized as normal renal function (serum creatinine 60 mL/min), occult renal insufficiency (serum creatinine 1.5 mg/dL and creatinine clearance 7 days) was higher in patients with occult renal insufficiency than in the normal group in univariable analysis. Multivariable logistic regression analysis demonstrated that patients with occult renal insufficiency compared with the group with normal renal function were at higher risk for mortality (odds ratio = 2.59, 95% confidence interval 1.15-5.86; P = .022) and prolonged hospital stay (>7 d) (odds ratio = 1.30, 95% confidence interval 1.08-1.57; P = .005). CONCLUSIONS: To identify higher-risk patients requiring special intensive care, and in whom new interventions can be performed to improve outcome, we recommend the preoperative calculation of creatinine clearance, especially in older women with a lower body mass index.