Post coronary artery bypass graft surgery
Post coronary artery bypass graft surgery
Post coronary artery bypass graft surgery
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ABSTRACTS PRESENTED BY TEHRAN HEART CENTER PHYSICIANS 2006<br />
ROW<br />
1<br />
TITLE<br />
First experience of local<br />
implantation of autologus<br />
CD 133+ bone marrow<br />
stem cell transplantation<br />
for myocardial<br />
regeneration Iran<br />
Prsented by:<br />
Ahmadi M.D et.al<br />
Congress<br />
16th world congress<br />
of the world society of<br />
cardio thoracic surgeons,<br />
Aug 2006, Canada<br />
Page<br />
3<br />
2<br />
Magnesium infusion and<br />
its relationship with the<br />
incidence of post<br />
<strong>coronary</strong> <strong>artery</strong> <strong>bypass</strong><br />
<strong>graft</strong>ing arrhythmias<br />
NajafiM.D et.al<br />
16th world congress<br />
of the world society<br />
of cardio thoracic<br />
surgeons,<br />
Aug 2006, Canada<br />
4<br />
3<br />
4<br />
Diabetes mellitus role in<br />
impeding prophylactic<br />
effects of magnesium on<br />
post <strong>coronary</strong> <strong>artery</strong><br />
<strong>bypass</strong> <strong>graft</strong>ing atrial<br />
fibrillation<br />
Correlation between total<br />
plasma homocysteine<br />
level and grading of<br />
<strong>coronary</strong> <strong>artery</strong><br />
disease<br />
Najafi M.D etal<br />
Ahmadi M.D,et.al<br />
16th world congress<br />
of the world society of<br />
cardio thoracic surgeons,<br />
Aug 2006, Canada<br />
16th world congress<br />
of the world society<br />
of cardio thoracic<br />
surgeons,<br />
Aug 2006, Canada<br />
5<br />
6<br />
5<br />
Various surgical<br />
approaches to porcelain<br />
aorta in <strong>coronary</strong> <strong>artery</strong><br />
<strong>bypass</strong> <strong>graft</strong>ing (CABG),<br />
a single institute<br />
experience<br />
Marzban M.D,et.al<br />
16th world congress<br />
of the world society<br />
of cardio thoracic<br />
surgeons,<br />
Aug 2006, Canada<br />
7<br />
6<br />
Comparative outcome of<br />
CABG in diabetes<br />
patients versus non<br />
diabetic with poor left<br />
ventricular function<br />
Ahmadi M.D, et.al<br />
16th world congress<br />
of the world society<br />
of cardio thoracic<br />
surgeons,<br />
Aug 2006, Canada<br />
8<br />
7<br />
Pentoxyfyline improves<br />
reoxygenation induced<br />
contractile recovery<br />
through a nitric oxide<br />
dependent mechanism in<br />
rat papillary muscles<br />
Ahmadi M.D,et.al<br />
16th world congress<br />
of the world society<br />
of cardio thoracic<br />
surgeons,<br />
Aug 2006, Canada<br />
9
ROW<br />
8<br />
TITLE<br />
Experience with 36<br />
transvenous <strong>coronary</strong><br />
sinus lead implantation<br />
for cardiac<br />
resynchronization therapy<br />
Prsented by:<br />
Yamini sharif M.D , et.al<br />
Congress<br />
8th Asian pacific<br />
symposium<br />
on cardiac pacing and<br />
electrophysiology, Aug<br />
2006, Indonesia<br />
Page<br />
10<br />
9<br />
10<br />
Mid term follow up of<br />
sixty patients with<br />
implantable cardioverter<br />
defibrillator<br />
Induced myocardial<br />
infarction using ligation<br />
of the left anterior<br />
descending <strong>coronary</strong><br />
<strong>artery</strong> major diagonal<br />
branch: development of<br />
an ovine model<br />
Yamini sharif M.D, et.al<br />
Rabani M.D , et.al<br />
8th Asian pacific<br />
symposium<br />
on cardiac pacing and<br />
electrophysiology, Aug<br />
2006, Indonesia<br />
6th biennial international<br />
conference of Pakistan<br />
society of cardiovascular<br />
&<br />
thoracic surgeons, Dec<br />
2006, Karachi<br />
11<br />
12<br />
11<br />
First experience of local<br />
implantation of autologus<br />
CD 133+ bone marrow<br />
stem cell transplantation<br />
for myocardial<br />
regeneration Iran<br />
Ahmadi M.D, et.al<br />
Stem cell therapy for the<br />
failing heart, Dec 2006,<br />
Thailand<br />
13<br />
12<br />
PCL scaffold <strong>graft</strong>ed onto<br />
Infracted myocardium in<br />
sheep animal model: a<br />
vehicle for<br />
cardiomyocytes<br />
Soleymani M.D ,et.al<br />
Stem cell therapy for the<br />
failing heart, Dec<br />
2006,<br />
Thailand<br />
14<br />
13<br />
Improvement of cardiac<br />
function and tissue<br />
viability following<br />
expanded autologus<br />
marrow derived CD133<br />
stem cell transplantation<br />
in patients with ischemic<br />
cardiomyopathy<br />
undergoing <strong>coronary</strong><br />
<strong>bypass</strong> <strong>surgery</strong><br />
Ahmadi M.D,et.al<br />
Stem cell therapy for the<br />
failing heart, Dec 2006,<br />
Thailand<br />
15<br />
14<br />
Normal values for<br />
ventricular synchrony<br />
measured by tissue<br />
Doppler imaging and<br />
tissue Doppler<br />
synchronization imaging<br />
in structurally normal<br />
hearts<br />
Sadeghian H, M.D et.al<br />
10th anniversary Euro<br />
echo, Dec 2006<br />
17
ROW<br />
15<br />
TITLE<br />
Clinical characteristics of<br />
women with premature<br />
<strong>coronary</strong> <strong>artery</strong> disease<br />
requiring CABG<br />
compared with that of<br />
young men<br />
Prsented by:<br />
Daryani M.D , et.al<br />
Congress<br />
European heart congress,<br />
Barcelona , spanin ,2006<br />
Page<br />
19<br />
16<br />
Impact of risk factors for<br />
development of <strong>coronary</strong><br />
<strong>artery</strong> disease in patients<br />
undergoing CABG in<br />
Iran compared with that<br />
in USA<br />
Daryani M.D ,et.al<br />
European heart congress,<br />
Barcelona , spanin ,2006<br />
20<br />
17<br />
Association of<br />
lipoprotein(a) levels with<br />
the severity of <strong>coronary</strong><br />
<strong>artery</strong> stenosis in an<br />
Iranian population<br />
(according to Gensini<br />
score)<br />
Broumand M.D , et.al<br />
European heart congress,<br />
Barcelona , spanin ,2006<br />
22<br />
18<br />
19<br />
Fast track method in<br />
cardiac <strong>surgery</strong> :<br />
evaluation of risks<br />
and benefits<br />
Relationship between<br />
serum magnesium level<br />
and post <strong>coronary</strong> <strong>artery</strong><br />
<strong>bypass</strong> <strong>graft</strong> <strong>surgery</strong><br />
arrhythmias<br />
Najafi M.D ,et.al<br />
Najafi M.D, et.al<br />
European congress of<br />
anesthesiology Madrid ,<br />
spain ,2006<br />
European congress of<br />
anesthesiology Madrid ,<br />
spain ,2006<br />
23<br />
24<br />
20<br />
Carotid stenting in<br />
candidates for <strong>coronary</strong><br />
<strong>artery</strong> <strong>bypass</strong> <strong>surgery</strong>:<br />
Results of a heart hospital<br />
registry<br />
Kazemi saleh M.D,et.al<br />
Angioplasty Summit,<br />
2006,<br />
25<br />
21<br />
Predictors of the major<br />
adverse cardiac events<br />
(MACE) after<br />
percutaneous <strong>coronary</strong><br />
intervention- A single<br />
center registry<br />
Salari far M.D , et.al<br />
15th congress of the<br />
Iranian<br />
heart association, 2006,<br />
Iran<br />
27<br />
22<br />
Comparative study of<br />
success rate &<br />
complications frequency<br />
in two streptokinase trade<br />
forms: "A Randomized<br />
Double Blind Study”<br />
Salari far M.D, et.al<br />
15th congress of the<br />
Iranian<br />
heart association, 2006,<br />
Iran<br />
29
ROW<br />
23<br />
TITLE<br />
Study of factors affecting<br />
in- hospital mortality of<br />
patients with acute<br />
myocardial infarction<br />
Prsented by:<br />
Salari far M.D, et.al<br />
Congress<br />
15th congress of the<br />
Iranian<br />
heart association, 2006,<br />
Iran<br />
Page<br />
31<br />
24<br />
Risk factors for<br />
complications of delay in<br />
<strong>surgery</strong> in staged carotid<br />
stenting and <strong>coronary</strong><br />
<strong>bypass</strong> <strong>graft</strong> <strong>surgery</strong><br />
Kassaian M.D,et.al<br />
15th congress of the<br />
Iranian<br />
heart association, 2006,<br />
Iran<br />
33<br />
25<br />
26<br />
Angiographic profile and<br />
lesion characteristics in<br />
young patients with<br />
percutaneous <strong>coronary</strong><br />
intervention<br />
Short and long-term<br />
outcome of PCI in<br />
diabetic patients using<br />
drug eluting stents<br />
(DES)-A single center<br />
registry<br />
Kassaian M.D et.al<br />
Kassaian M.D, et.al<br />
15th congress of the<br />
Iranian<br />
heart association,<br />
2006,<br />
Iran<br />
15th congress of the<br />
Iranian<br />
heart association, 2006,<br />
Iran<br />
34<br />
35<br />
27<br />
Short and long-term<br />
outcome of PCI on the<br />
saphenous vein <strong>graft</strong>s a<br />
case series with 9 months<br />
follow up<br />
Kassaian M.D, et.al<br />
15th congress of the<br />
Iranian<br />
heart association, 2006,<br />
Iran<br />
36<br />
28<br />
Short and long-term<br />
outcomes following<br />
percutaneous <strong>coronary</strong><br />
intervention in young<br />
patient<br />
Kassaian M.D, et.al<br />
15th congress of the<br />
Iranian<br />
heart association, 2006,<br />
Iran<br />
37<br />
29<br />
Sensitivity and specificity<br />
of Q wave for diagnosis<br />
of wall motion<br />
abnormality in patients<br />
with <strong>coronary</strong> <strong>artery</strong><br />
disease<br />
sadeghian H. M.D, et.al<br />
15th congress of the<br />
Iranian<br />
heart association, 2006,<br />
Iran<br />
38<br />
30<br />
The prognosis of non-Qwave<br />
versus Q-wave<br />
myocardial infarction<br />
sadeghian H M.D, et.al<br />
15th congress of the<br />
Iranian<br />
heart association, 2006,<br />
Iran<br />
39<br />
31<br />
Normal values for<br />
ventricular synchrony<br />
measured by tissue<br />
Doppler synchronization<br />
imaging in structurally<br />
normal hearts<br />
sadeghian H M.D,et.al<br />
15th congress of the<br />
Iranian<br />
heart association, 2006,<br />
Iran<br />
40
ROW<br />
32<br />
TITLE<br />
Discrete subvalvular aortic<br />
stenosis: severity of aortic<br />
insufficiency and rate of<br />
recurrence after <strong>surgery</strong><br />
Prsented by:<br />
sadeghian H M.D , et.al<br />
Congress<br />
15th congress of the<br />
Iranian<br />
heart association, 2006,<br />
Iran<br />
Page<br />
42<br />
33<br />
Repositioning of dislodged<br />
atrial pacing lead with a<br />
specially designed<br />
urologic basket<br />
Yamini sharif M.D , et.al<br />
15th congress of the<br />
Iranian<br />
heart association, 2006,<br />
Iran<br />
̊ 43<br />
34<br />
Radiofrequency ablation<br />
of cardiac arrhythmia<br />
using a three-dimensional<br />
real-time position<br />
management and mapping<br />
system<br />
Yamini sharif M.D,et.al<br />
15th congress of the<br />
Iranian<br />
heart association, 2006,<br />
Iran<br />
45<br />
35<br />
Higher dose of heparin<br />
administration for<br />
prevention of catheterinduced<br />
thrombo -embolic<br />
events during cardiac<br />
catheterization & <strong>coronary</strong><br />
angiography<br />
Yamini sharif M.D , et.al<br />
15th congress of the<br />
Iranian<br />
heart association, 2006,<br />
Iran<br />
46<br />
36<br />
Early complications of<br />
permanent pacemaker<br />
implantation<br />
Yamini sharif M.D , et.al<br />
15th congress of the<br />
Iranian<br />
heart association, 2006,<br />
Iran<br />
47<br />
37<br />
Effect of completion of<br />
exercise training sessions<br />
in cardiac rehabilitation of<br />
physical functioning: A<br />
Historical Cohort Study<br />
Soleimani M.D, et.al<br />
15th congress of the<br />
Iranian<br />
heart association, 2006,<br />
Iran<br />
48<br />
38<br />
Coronary <strong>artery</strong> disease<br />
pattern in young adults<br />
compared with older<br />
patients<br />
Soleimani M.D, et.al<br />
15th congress of the<br />
Iranian<br />
heart association, 2006,<br />
Iran<br />
49<br />
39<br />
Physical functioning<br />
recovery following cardiac<br />
rehabilitation in post<br />
valvular <strong>surgery</strong> patients<br />
Soleimani M.D, et.al<br />
15th congress of the<br />
Iranian<br />
heart association, 2006,<br />
Iran<br />
50<br />
40<br />
Influence of complete<br />
cardiac rehabilitation on<br />
physical functioning after<br />
percutaneous transluminal<br />
<strong>coronary</strong> angioplasty<br />
Soleimani M.D, et.al<br />
15th congress of the<br />
Iranian<br />
heart association, 2006,<br />
Iran<br />
51
ROW<br />
41<br />
TITLE<br />
Correlation between 12-<br />
lead rest ECG and severe<br />
and very severe single<br />
<strong>coronary</strong> <strong>artery</strong> stenosis in<br />
patients with stable angina<br />
hospitalized in Tehran<br />
Heart Center<br />
Prsented by:<br />
Soleimani M.D, et.al<br />
Congress<br />
15th congress of the<br />
Iranian<br />
heart association, 2006,<br />
Iran<br />
Page<br />
52<br />
42<br />
The association between<br />
Hepatitis B surface<br />
antibody seropositivity<br />
and <strong>coronary</strong> <strong>artery</strong><br />
disease<br />
Amir zadegan M.D ,et.al<br />
15th congress of the<br />
Iranian<br />
heart association, 2006,<br />
Iran<br />
53<br />
43<br />
Frequency and prognosis<br />
of patients with segmental<br />
back flow of the contrast<br />
material in<br />
<strong>coronary</strong> arteries<br />
Amir zadegan M.D ,et.al<br />
15th congress of the<br />
Iranian<br />
heart association, 2006,<br />
Iran<br />
54<br />
44<br />
The relation between<br />
androgen levels in men<br />
and different stages of<br />
heart failure<br />
Davoodi M.D, et.al<br />
15th congress of the<br />
Iranian<br />
heart association, 2006,<br />
Iran<br />
55<br />
45<br />
Is there any gender<br />
difference in location of<br />
<strong>coronary</strong> involvement<br />
Davoodi M.D, et.al<br />
15th congress of the<br />
Iranian<br />
heart association,<br />
2006, Iran<br />
56<br />
46<br />
Influence of cigarette<br />
smoking on the risk of<br />
metabolic syndrome, body<br />
weight and waist<br />
circumferences in men<br />
with premature <strong>coronary</strong><br />
<strong>artery</strong> disease<br />
Davoodi M.D, et.al<br />
15th congress of the<br />
Iranian<br />
heart association, 2006,<br />
Iran<br />
57<br />
47<br />
The association between<br />
levels of male androgenic<br />
hormones and severity of<br />
<strong>coronary</strong> <strong>artery</strong> disease<br />
Davoodi M.D, et.al<br />
15th congress of the<br />
Iranian<br />
heart association, 2006,<br />
Iran<br />
58<br />
48<br />
Parental cardiovascular<br />
disease as a risk factor for<br />
acute <strong>coronary</strong> syndromes<br />
in adult offspring<br />
Hoseini M.D ,et.al<br />
15th congress of the<br />
Iranian<br />
heart association, 2006,<br />
Iran<br />
59
ROW<br />
49<br />
TITLE<br />
Is there any difference in<br />
EKG findings in responder<br />
and non- responder groups<br />
of CRT recipients<br />
Prsented by:<br />
Kazemi saied M.D,et.al<br />
Congress<br />
15th congress of the<br />
Iranian<br />
heart association, 2006,<br />
Iran<br />
Page<br />
60<br />
50<br />
Comparison between the<br />
effects of sedative drugs<br />
and placebo for <strong>coronary</strong><br />
angiography on<br />
patients'anxiety and<br />
hemodynamic status<br />
Kazemi saied M.D,et.al<br />
15th congress of the<br />
Iranian<br />
heart association, 2006,<br />
Iran<br />
61<br />
51<br />
Prevalence of CAD and<br />
related risk factors in first<br />
degree relatives of patients<br />
with premature CAD<br />
admitted in Tehran Heart<br />
Center in 2003-2004<br />
Kazemeni M.D,et.al<br />
15th congress of the<br />
Iranian<br />
heart association, 2006,<br />
Iran<br />
62<br />
52<br />
Left ventricular ejection<br />
fraction by left<br />
ventriculography before or<br />
after <strong>coronary</strong><br />
angiography correlation<br />
with left ventricular<br />
ejection fraction<br />
by echocardiography<br />
Kazemi saied M.D,et.al<br />
15th congress of the<br />
Iranian<br />
heart association, 2006,<br />
Iran<br />
63<br />
53<br />
Cardiovascular morbidity<br />
in relation to educational<br />
level in patients with chest<br />
pain presentation<br />
Yamini sharif M.D , et.al<br />
15th congress of the<br />
Iranian<br />
heart association, 2006,<br />
Iran<br />
64<br />
54<br />
Cardiopulmonary<br />
resuscitation; early results<br />
and success predictors- A<br />
single center registry<br />
Najafi M.D ,et.al<br />
15th congress of the<br />
Iranian<br />
heart association, 2006,<br />
Iran<br />
65<br />
55<br />
Early clinical result of<br />
double endarterectomy<br />
and reconstruction<br />
combined with multiple<br />
<strong>bypass</strong>es <strong>graft</strong>ing for<br />
severe <strong>coronary</strong> <strong>artery</strong><br />
disease: A single<br />
institute experience<br />
Marzban M.D , et.al<br />
15th congress of the<br />
Iranian<br />
heart association, 2006,<br />
Iran<br />
67<br />
56<br />
Non use of left internal<br />
mammary <strong>artery</strong>: It's a<br />
contributing factor<br />
Marzban M.D , et.al<br />
15th congress of the<br />
Iranian<br />
heart association, 2006,<br />
Iran<br />
68
ROW<br />
57<br />
TITLE<br />
Out come of <strong>coronary</strong><br />
<strong>artery</strong> <strong>bypass</strong> <strong>surgery</strong> in<br />
diabetic and non diabetic<br />
patients: A Comparative<br />
Study<br />
Prsented by:<br />
Ahmadi M.D , et.al<br />
Congress<br />
15th congress of the<br />
Iranian<br />
heart association, 2006,<br />
Iran<br />
Page<br />
69<br />
58<br />
Results of <strong>coronary</strong> <strong>artery</strong><br />
<strong>bypass</strong> <strong>graft</strong>ing in dialysis<br />
patients<br />
Ahmadi M.D , et.al<br />
15th congress of the<br />
Iranian<br />
heart association, 2006,<br />
Iran<br />
70<br />
59<br />
The impact of low serum<br />
triglyceride on LDLcholesterol<br />
estimation<br />
Ahmadi M.D , et.al<br />
15th congress of the<br />
Iranian<br />
heart association, 2006,<br />
Iran<br />
71<br />
60<br />
61<br />
Twenty four hours inhospital<br />
mortality<br />
predictions in <strong>coronary</strong><br />
<strong>artery</strong> <strong>bypass</strong> <strong>graft</strong>ing<br />
<strong>surgery</strong> patients<br />
Evidence for higher<br />
mortality in women after<br />
<strong>coronary</strong> <strong>artery</strong> <strong>bypass</strong><br />
<strong>graft</strong> <strong>surgery</strong><br />
Ahmadi M.D , et.al<br />
Sadeghian M.D ,et.al<br />
15th congress of the<br />
Iranian<br />
heart association, 2006,<br />
Iran<br />
15th congress of the<br />
Iranian<br />
heart association, 2006,<br />
Iran<br />
72<br />
73<br />
62<br />
A new risk factor for<br />
<strong>coronary</strong> <strong>artery</strong> disease<br />
Sadeghian M.D ,et.al<br />
15th congress of the<br />
Iranian<br />
heart association, 2006,<br />
Iran<br />
74<br />
63<br />
Direct costs of invasive<br />
cardiac procedures for<br />
heart diseases in the<br />
Islamic republic of Iran<br />
Sadeghian M.D ,et.al<br />
15th congress of the<br />
Iranian<br />
heart association, 2006,<br />
Iran<br />
75<br />
64<br />
Results on noninvasive<br />
tests compared with results<br />
of angiography in young<br />
patients<br />
Sadeghian M.D ,et.al<br />
15th congress of the<br />
Iranian<br />
heart association, 2006,<br />
Iran<br />
77<br />
65<br />
The association between<br />
left main <strong>coronary</strong> <strong>artery</strong><br />
disease and ischemic heart<br />
disease risk factors<br />
Darabian M.D , et.al<br />
15th congress of the<br />
Iranian<br />
heart association, 2006,<br />
Iran<br />
78<br />
66<br />
Evaluation of preoperative<br />
CRP serum level and<br />
CABG outcome in acute<br />
<strong>coronary</strong> syndrome<br />
patients<br />
Abbasi M.D ,et al<br />
15th congress of the<br />
Iranian<br />
heart association, 2006,<br />
Iran<br />
79<br />
67<br />
Developing a <strong>surgery</strong><br />
database: design and<br />
operation<br />
Abbasi M.D ,et al<br />
15th congress of the<br />
Iranian heart association,<br />
2006,<br />
80
ROW<br />
TITLE<br />
Prsented by:<br />
Congress<br />
Iran<br />
Page<br />
68<br />
Mediastinitis after<br />
<strong>coronary</strong> <strong>artery</strong> <strong>bypass</strong><br />
<strong>surgery</strong> (CABG), an<br />
evaluation of effect of<br />
different factors on<br />
developping ediastinitis<br />
after CABG in more than<br />
9000 cases<br />
Salehi Omran M.D , et.al<br />
15th congress of the<br />
Iranian heart association,<br />
2006,<br />
Iran<br />
81<br />
69<br />
Comparison of short and<br />
long-term outcomes<br />
between Sirolimus eluting<br />
stents and Paclitaxel<br />
eluting stents<br />
Ali doosti M.D , et.al<br />
15th congress of the<br />
Iranian heart association,<br />
2006, Iran<br />
82<br />
70<br />
Comparison of outcomes<br />
of percutaneous <strong>coronary</strong><br />
intervention on proximal<br />
versus non-proximal left<br />
anterior descending<br />
<strong>coronary</strong> <strong>artery</strong>, proximal<br />
left circumflex and<br />
proximal right <strong>coronary</strong><br />
<strong>artery</strong><br />
Alidoosti M.D,et.al<br />
15th congress of the<br />
Iranian heart association,<br />
2006,<br />
Iran<br />
83<br />
71<br />
Comparison of utcomes of<br />
direct stenting versus<br />
stenting with predilation<br />
Ali doosti M.D,et.al<br />
15 th congress of the<br />
Iranian heart association<br />
, 2006, Iran<br />
84<br />
72<br />
73<br />
Comparison of short and<br />
long-term outcomes and<br />
success rate of drugeluting<br />
stents with nondrug<br />
eluting stents<br />
Association of<br />
lipoprotein (a) levels with<br />
the severity of <strong>coronary</strong><br />
<strong>artery</strong> stenosis in an<br />
Iranian population<br />
(According to Gensini<br />
Score)<br />
Ali doosti M.D,et.al<br />
Broumand M.D, et.al<br />
15th congress of the<br />
Iranian heart association,<br />
2006,<br />
Iran<br />
15th congress of<br />
the Iranian heart<br />
association, 2006,<br />
Iran<br />
85<br />
́86<br />
74<br />
Interventional closure of<br />
patent foramen ovale with<br />
amplatzer PFO occluder in<br />
patients with paradoxical<br />
cerebral embolism<br />
Haje zeinali M.D, et.al<br />
15th congress of the<br />
Iranian heart association,<br />
2006,<br />
Iran<br />
87
ROW<br />
75<br />
TITLE<br />
Self-expandable stent<br />
implantation for severe<br />
native coarctation of aorta<br />
in adults<br />
Prsented by:<br />
Haje zeinali M.D, et.al<br />
Congress<br />
15th congress of the<br />
Iranian heart association,<br />
2006,<br />
Iran<br />
Page<br />
88<br />
76<br />
Echocardiographic<br />
predictors of left atrial<br />
appendage contraction<br />
velocity<br />
Saheb jam M.D ,et.al<br />
15th congress of the<br />
Iranian heart association,<br />
2006,<br />
Iran<br />
89<br />
77<br />
Magnesium infusion and<br />
its relationship with the<br />
incidence of post <strong>coronary</strong><br />
<strong>artery</strong> <strong>bypass</strong> <strong>graft</strong>ing<br />
arrhythmias<br />
Najafi M.D,et.al<br />
15th congress of the<br />
Iranian heart association,<br />
2006,<br />
Iran<br />
90<br />
78<br />
Results of <strong>coronary</strong> <strong>artery</strong><br />
<strong>bypass</strong> <strong>graft</strong>ing dialysis<br />
patients<br />
Ahmadi M.D, et.al<br />
15th congress of the<br />
Iranian heart association,<br />
2006,<br />
Iran<br />
91<br />
79<br />
80<br />
Late outcomes in patients<br />
with uncorrected moderate<br />
mitral regurgitation at the<br />
time of isolated <strong>coronary</strong><br />
<strong>artery</strong> <strong>bypass</strong><br />
The adverse effects of<br />
Milrinone in the elderly<br />
patients who underwent<br />
CABG<br />
Davoodi M.D, et.al<br />
Davoodi M.D, et.al<br />
15th congress of the<br />
Iranian heart association,<br />
2006,<br />
Iran<br />
15th congress of the<br />
Iranian heart association,<br />
2006,<br />
Iran<br />
92<br />
93<br />
81<br />
Correlation between net<br />
atrioventricular<br />
compliance and<br />
pulmonary <strong>artery</strong> pressure<br />
in mitral valve stenosis<br />
Saheb jam M.D , et.al<br />
15th congress of the<br />
Iranian heart association,<br />
2006,<br />
Iran<br />
94<br />
82<br />
Diabetes mellitus role in<br />
impeding prophylactic<br />
effects of magnesium on<br />
post atrial fibrillation<br />
Najafi M.D,et.al<br />
15th congress of the<br />
Iranian heart association,<br />
2006,<br />
Iran<br />
95<br />
83<br />
Beta-blocker<br />
administration<br />
for preventing post<br />
<strong>coronary</strong> <strong>artery</strong> <strong>bypass</strong><br />
<strong>graft</strong> arrhythmias" The<br />
role of diabetes mellitus<br />
Najafi M.D,et.al<br />
15th congress of the<br />
Iranian heart association,<br />
2006,<br />
Iran<br />
96
ABSTRAKT PRESENTED BY TEHRAN HEART CENTER PHYSICIANS<br />
2005<br />
ROW<br />
1<br />
2<br />
TITLE<br />
Coronary endartrectomy<br />
with off pump <strong>coronary</strong><br />
<strong>bypass</strong> <strong>surgery</strong><br />
(OPCAB): safe and<br />
feasible<br />
Prsented by:<br />
Marzban M.D ,et.al<br />
Davoodi M.D , et.al<br />
Congress<br />
3rd winter workshop,<br />
Shanghai, 2005<br />
Page<br />
99<br />
100<br />
3<br />
4<br />
Centrifugal pump as a<br />
temporary assist device<br />
for postcardiotomy heart<br />
failure<br />
Evaluation of correlation<br />
between serum level of<br />
lipoprotein (a) and<br />
cervical carotid <strong>artery</strong><br />
stenosis<br />
Evaluation of correlation<br />
between serum level of<br />
lipoprotein (a) and<br />
cervical carotid <strong>artery</strong><br />
stenosis<br />
Broumand M.D ,et.al<br />
Broumand M.D ,et.al<br />
58em congres de la<br />
societe francaise de<br />
chirurgie thoracique et<br />
cardiovasculaire, Parsi,<br />
2005<br />
ESC congress,<br />
Stockholm, 2005<br />
XXIII. World Congress<br />
of Pathology and<br />
Laboratory Medicine,<br />
Istanbul, 2005<br />
101<br />
102<br />
5<br />
Asymptomatic<br />
bacteriuria in type 2<br />
diabetic women in iran<br />
Broumand M.D ,et.al<br />
XXIII. World Congress<br />
of Pathology and<br />
Laboratory Medicine,<br />
Istanbul, 2005<br />
103<br />
6<br />
7<br />
Prognostic value of<br />
quantitative C-reactive<br />
protein in assessing intra<br />
– hospital MI in stable<br />
angina patients<br />
Predictive factors of the<br />
cardiopulmonary<br />
resuscitation results<br />
Broumand M.D et.al<br />
Najafi M.D ,et.al<br />
XXIII. World Congress<br />
of Pathology and<br />
Laboratory Medicine,<br />
Istanbul, 2005<br />
The 4th international<br />
congress of the Iranian<br />
society of cardiac<br />
surgeons, Tehran, 2005<br />
104<br />
105<br />
8<br />
<strong>Post</strong> <strong>coronary</strong> <strong>artery</strong><br />
<strong>bypass</strong> <strong>graft</strong> <strong>surgery</strong><br />
(CABG) atrial<br />
fibrillation : evaluating<br />
predisposing and<br />
preventive factors<br />
Najafi M.D , et.al<br />
The 4th international<br />
congress of the Iranian<br />
society of cardiac<br />
surgeons, Tehran, 2005<br />
106
ROW<br />
9<br />
TITLE<br />
Fast tract methods in<br />
carotid <strong>surgery</strong> :evaluation<br />
of risk and benefils<br />
Prsented by:<br />
Najafi M.D et.al<br />
Congress<br />
The 4th international<br />
congress of the Iranian<br />
society of cardiac<br />
surgeons, Tehran, 2005<br />
Page<br />
107<br />
10<br />
Effect of CABG on elderly<br />
patients: mortality,<br />
morbidity<br />
& mid term follow up<br />
Davoodi M.D,et.al<br />
The 4th international<br />
congress of the<br />
Iranian<br />
society of cardiac<br />
surgeons, Tehran, 2005<br />
108<br />
11<br />
Various surgical<br />
approaches to complex<br />
aortic arch<br />
aneurysim, a single<br />
institute experience<br />
Abbasi M.D,et.al<br />
The 4th international<br />
congress of the Iranian<br />
society of cardiac<br />
surgeons, Tehran, 2005<br />
109<br />
12<br />
Have diabetes worsen the<br />
outcome of CABG<br />
Ahmadi M.D ,et.al<br />
The 4th international<br />
congress of the Iranian<br />
society of cardiac<br />
surgeons, Tehran, 2005<br />
111<br />
13<br />
Comparison of eurologic<br />
and psychologic<br />
complications between<br />
conventional CABG and<br />
off-pump CABG<br />
Abbasi M.D , et.al<br />
The 4th international<br />
congress of the Iranian<br />
society of cardiac<br />
surgeons, Tehran, 2005<br />
112<br />
14<br />
In vitro effects of<br />
cardioplegia on<br />
saphenous<br />
vein <strong>graft</strong>s during CABG<br />
Ahmadi M.D, et.al<br />
The 4th international<br />
congress of the<br />
Iranian society of cardiac<br />
surgeons, Tehran, 2005<br />
113
ROW<br />
15<br />
TITLE<br />
Outcomes and long term<br />
survival for patients<br />
undergoing mitral valve<br />
repair versus replacement<br />
concomitant <strong>coronary</strong><br />
<strong>bypass</strong><br />
Prsented by:<br />
Sadeghian .h M.D ,et.al<br />
Congress<br />
The 4th international<br />
congress of the Iranian<br />
society of cardiac<br />
surgeons, Tehran, 2005<br />
Page<br />
114<br />
16<br />
Moderate nonorganic<br />
mitral regurgitation and<br />
<strong>coronary</strong> disease:<br />
treatment by<br />
<strong>coronary</strong> <strong>bypass</strong> alone<br />
Sadeghian .h M.D ,et.al<br />
The 4th international<br />
congress of the Iranian<br />
society of cardiac<br />
surgeons, Tehran, 2005<br />
115<br />
17<br />
Mid-term follow up of<br />
sixty patients with<br />
implantable cardiovertor<br />
defibrillator<br />
Yamini sharif<br />
M.D,et.al<br />
The 4th international<br />
congress of the Iranian<br />
society of cardiac<br />
surgeons, Tehran, 2005<br />
116<br />
18<br />
Evaluation of the effect of<br />
NMDA receptor inhibitors<br />
in<br />
controlling post <strong>coronary</strong><br />
<strong>artery</strong> <strong>bypass</strong> <strong>graft</strong> <strong>surgery</strong><br />
pain of addicted patients<br />
Najafi M.D, et.al<br />
The 4th international<br />
congress of the Iranian<br />
society of cardiac<br />
surgeons, Tehran, 2005<br />
117<br />
19<br />
Relationship between<br />
serum magnesium level<br />
and post <strong>coronary</strong> <strong>artery</strong><br />
<strong>bypass</strong> <strong>graft</strong> <strong>surgery</strong><br />
arrhythmias<br />
Najafi M.D,et.al<br />
The 4th international<br />
congress of the Iranian<br />
society of cardiac<br />
surgeons, Tehran, 2005<br />
118
ROW<br />
20<br />
TITLE<br />
First experience of local<br />
implantation of autologus<br />
AC133+ bone marrow<br />
stem cell transplantation<br />
for developing country<br />
Prsented by:<br />
Ahmadi M.D ,et.al<br />
Congress<br />
The 4th international<br />
congress of the Iranian<br />
society of cardiac<br />
surgeons, Tehran, 2005<br />
Page<br />
119
ROW<br />
1<br />
ABSTRAKT PRESENTED BY TEHRAN HEART CENTER PHYSICIANS<br />
2004<br />
TITLE<br />
Prsented by:<br />
Congress<br />
Comparison of two Marzban M.D,et.al meeting of the Asian<br />
surgical techniques for<br />
society for<br />
radial <strong>artery</strong> harvesting in<br />
cardiovascular <strong>surgery</strong>,<br />
<strong>coronary</strong> <strong>artery</strong> <strong>bypass</strong><br />
Istanbul, 2004<br />
<strong>surgery</strong><br />
Page<br />
123<br />
2<br />
Seven year follow-up of<br />
<strong>coronary</strong> <strong>artery</strong> <strong>surgery</strong> in<br />
young adults (
ROW<br />
6<br />
TITLE<br />
Long-term evaluation of<br />
laser-treated silicone(lts)<br />
membrane as a ericardial<br />
substitute an experimental<br />
study<br />
Prsented by:<br />
Ahmadi M.D, et.al<br />
Congress<br />
The 14th world congress<br />
of<br />
international society of<br />
cardio-thoracic<br />
surgeons,<br />
China, Oct 2004<br />
Page<br />
128<br />
7<br />
Preparation of chitosan<br />
derived from sherimp's shell<br />
of Persian gulf as a blood<br />
hemostasis agent<br />
Ahmadi M.D,et.al<br />
The 14th world congress<br />
of<br />
international society of<br />
cardio-thoracic<br />
surgeons,<br />
China, Oct 2004<br />
129<br />
8<br />
Evaluation of cardiac<br />
adhesions after pericardial<br />
substitution by laser-treated<br />
silicon (its)membrane<br />
Ahmadi M.D,et.al<br />
XXXI Annual<br />
ESAO Congress,<br />
Warsaw, 2004<br />
130<br />
9<br />
Steal phenomena from<br />
mammary side branches:<br />
real or imaginary<br />
Marzban M.D ,et.al<br />
The 14th congress of<br />
Iranian Heart<br />
Association<br />
in collaboration with<br />
British Cardiac Society,<br />
Tehran, 2004<br />
131
ROW<br />
10<br />
TITLE<br />
Treatment of mitral<br />
regurgitation and <strong>coronary</strong><br />
disease by <strong>coronary</strong> <strong>bypass</strong><br />
alone<br />
Prsented by:<br />
Sadeghian .H.<br />
M.D,et.al<br />
Congress<br />
The 14th congress of<br />
Iranian Heart<br />
Association<br />
in collaboration with<br />
British Cardiac ociety,<br />
Tehran, 2004<br />
Page<br />
132<br />
11<br />
Chronic total occlusion of<br />
left main <strong>coronary</strong> <strong>artery</strong>: a<br />
case series<br />
Marzban M.D ,et.al<br />
The 14th congress of<br />
Iranian Heart<br />
Association<br />
in collaboration<br />
with British Cardiac<br />
Society, Tehran, 2004<br />
133<br />
12<br />
Results of CABG<br />
concomitant with mitral<br />
valve replacement versus<br />
repair in patients with<br />
moderate to severe mitral<br />
regurgitation accompanying<br />
<strong>coronary</strong> <strong>artery</strong> disease<br />
Sadeghian .H. M.D<br />
,et.al<br />
The 14th congress of<br />
Iranian Heart<br />
Association<br />
in collaboration with<br />
British Cardiac Society,<br />
Tehran, 2004<br />
134<br />
13<br />
Effects of oral entoxifylline<br />
in cardiopulmonary <strong>bypass</strong><br />
surgeries<br />
Abbasi M.D ,et.al<br />
The 14th congress of<br />
Iranian Heart<br />
Association<br />
in collaboration with<br />
British Cardiac ociety,<br />
Tehran, 2004<br />
135
ROW<br />
14<br />
TITLE<br />
Evaluation of risk factors for<br />
CAD in young patients<br />
undergoing CABG<br />
Prsented by:<br />
Davoodi<br />
M.D,et.al<br />
Congress<br />
The 14th congress of<br />
Iranian Heart<br />
Association<br />
in collaboration with<br />
British Cardiac Society,<br />
Tehran, 2004<br />
Page<br />
136<br />
15<br />
Preoperative screening for<br />
carotid <strong>artery</strong> stenosis in<br />
patients who underwent<br />
cardiac <strong>surgery</strong><br />
Abbasi M.D ,et.al<br />
The 14th congress of<br />
Iranian Heart<br />
Association<br />
in collaboration with<br />
British Cardiac Society,<br />
Tehran, 2004<br />
137<br />
16<br />
Analysis of effective factors<br />
on mortality of CABG<br />
patients in hospital<br />
Sadeghian .H M.D,<br />
et.al<br />
The 14th congress of<br />
Iranian Heart<br />
Association<br />
in collaboration with<br />
British Cardiac Society,<br />
Tehran, 2004<br />
138<br />
17<br />
Long term evaluation of<br />
laser-treated silicone(lts)<br />
membrane as a ericardial<br />
substitute: An xperimental<br />
study<br />
Ahmadi M.D et.al<br />
The 14th congress of<br />
Iranian Heart<br />
Association<br />
in collaboration with<br />
British Cardiac<br />
Society,Tehran, 2004<br />
139
ROW<br />
18<br />
TITLE<br />
Autologus bone marrow<br />
stem cell transplantation for<br />
myocardial regeneration<br />
Prsented by:<br />
Ahmadi M.D, et.al<br />
Congress<br />
The 14th congress of<br />
Iranian Heart<br />
Association<br />
in collaboration with<br />
British Cardiac Society,<br />
Tehran, 2004<br />
Page<br />
140<br />
19<br />
Rest and stress<br />
echocardiography evaluation<br />
of patients with AVR for<br />
estimation of mismatch<br />
between effective orifice<br />
area<br />
and body surface area<br />
Sadeghian H M.D et.l<br />
The 14th congress of<br />
Iranian Heart<br />
Association<br />
in collaboration with<br />
British Cardiac Society,<br />
Tehran, 2004<br />
141<br />
20<br />
Relation between age<br />
and sex of CABG patients<br />
and kind and number of risk<br />
factors<br />
Sadeghian H M.D et.l<br />
The 14th congress<br />
Of Iranian Heart<br />
Association<br />
in collaboration with<br />
British Cardiac Society,<br />
Tehran, 2004<br />
142<br />
21<br />
Early results and 12 months<br />
follow-up of PTMC<br />
Salarifar M.D , et.al<br />
The 14th congress of<br />
Iranian Heart<br />
Association<br />
in collaboration with<br />
British Cardiac Society,<br />
Tehran, 2004<br />
143<br />
22<br />
Prevalence of left main<br />
<strong>coronary</strong> <strong>artery</strong> disease and<br />
the effective risk factors on<br />
its development<br />
Karimi M.D ,et.al<br />
The 14th congress of<br />
Iranian Heart<br />
Association<br />
in collaboration with<br />
British Cardiac Society,<br />
Tehran, 2004<br />
144
ROW<br />
23<br />
TITLE<br />
Effect of antioxidants on<br />
reducing the damaging effect<br />
of cardiopulmonary <strong>bypass</strong>:<br />
a clinical study<br />
Prsented by:<br />
Marzban M.D,et.al<br />
Congress<br />
The 14th congress of<br />
Iranian Heart<br />
Association<br />
in collaboration with<br />
British Cardiac Society,<br />
Tehran, 2004<br />
Page<br />
145<br />
24<br />
Cardiac resynchronization<br />
therapy (CRT) in patients<br />
with severe heart failure.<br />
Could MRI predict the<br />
results of CRT<br />
Yamini sharif M.D<br />
et.al<br />
The 14th congress of<br />
Iranian Heart<br />
Association<br />
in collaboration with<br />
British Cardiac Society,<br />
Tehran, 2004<br />
146<br />
25<br />
High-dose Heparin to<br />
prevent deep venous<br />
thrombosis in slow pathway<br />
ablation<br />
Yamini sharif M.D<br />
,et.al<br />
The 14th congress of<br />
Iranian Heart<br />
Association<br />
in collaboration with<br />
British Cardiac<br />
Society,Tehran, 2004<br />
147<br />
26<br />
How safe or feasible is post-<br />
CABG PCI<br />
Kazemi saleh M.D<br />
et.al<br />
The 14th congress of<br />
Iranian Heart<br />
Association<br />
in collaboration with<br />
British Cardiac<br />
Society,Tehran, 2004<br />
148<br />
27<br />
A report of first fractional<br />
flow reserve(FFR)<br />
measurements in Iran<br />
Kassaian M.D,et.al<br />
The 14th congress of<br />
Iranian Heart<br />
Association<br />
in collaboration with<br />
British Cardiac<br />
Society,Tehran, 2004<br />
149
ROW<br />
28<br />
TITLE<br />
Implication of small<br />
reference vessel diameter in<br />
patients undergoing<br />
percutaneous <strong>coronary</strong><br />
revascularization<br />
Prsented by:<br />
Ali doosti M.D,et.al<br />
Congress<br />
The 14th congress of<br />
Iranian Heart<br />
Association<br />
in collaboration with<br />
British Cardiac<br />
Society,Tehran, 2004<br />
Page<br />
150<br />
29<br />
Elevated serum<br />
lipoprotein(a) is a risk<br />
factor for left atrial thrombus<br />
in patients with chronic<br />
atrial fibrillation<br />
Kazemi saied M.D<br />
,et.al<br />
The 14th congress of<br />
Iranian Heart<br />
Association<br />
in collaboration with<br />
British Cardiac Society,<br />
Tehran, 2004<br />
151<br />
30<br />
Correlation between blood<br />
groups, <strong>coronary</strong> <strong>artery</strong><br />
disease risk factors and CAD<br />
Amir zadegan M.D<br />
et.al<br />
The 14th congress of<br />
Iranian Heart<br />
Association<br />
in collaboration with<br />
British Cardiac Society,<br />
Tehran, 2004<br />
152<br />
31<br />
Stem cell transplantation in<br />
patients with acute<br />
myocardial infarction; a<br />
single center registry<br />
Salarifar M.D ,et.al<br />
The 14th congress of<br />
Iranian Heart<br />
Association<br />
in collaboration with<br />
British Cardiac<br />
Society,Tehran, 2004<br />
153<br />
32<br />
Short-term results of renal<br />
<strong>artery</strong> ngioplasty(stenting)<br />
on blood pressure and serum<br />
creatinine<br />
Haji zeinali M.D et.al<br />
The 14th congress of<br />
Iranian Heart<br />
Association<br />
in collaboration with<br />
British Cardiac<br />
Society,Tehran, 2004<br />
154
ROW<br />
33<br />
TITLE<br />
Outcome of primary<br />
percutaneous <strong>coronary</strong><br />
intervention in acute<br />
myocardial infarction<br />
Prsented by:<br />
Ali doosti M.D ,et.al<br />
Congress<br />
The 14th congress of<br />
Iranian Heart<br />
Association<br />
in collaboration with<br />
British Cardiac<br />
Society,Tehran, 2004<br />
Page<br />
155<br />
34<br />
Comparing success rate,<br />
complications and late<br />
outcome in <strong>coronary</strong><br />
intervention for total and<br />
non-total occlusion<br />
Kazemi saleh M.D<br />
et.al<br />
The 14th congress of<br />
Iranian Heart<br />
Association<br />
in collaboration with<br />
British Cardiac<br />
Society,Tehran, 2004<br />
156<br />
35<br />
Slow pathway ablation with<br />
no <strong>coronary</strong> sinus and His<br />
bundle catheters-Is it safe<br />
Yamine sharif M.D<br />
et.al<br />
The 14th congress of<br />
Iranian Heart<br />
Association<br />
in collaboration with<br />
British Cardiac<br />
Society,Tehran, 2004<br />
157<br />
36<br />
37<br />
Relation between the<br />
number of involved <strong>coronary</strong><br />
arteries<br />
in patients and the kind and<br />
multiplicity of risk factors<br />
Angiographic findings in<br />
401 very premature CAD<br />
patients(age
ROW<br />
38<br />
TITLE<br />
Analysis of the patency of<br />
<strong>coronary</strong> arteries in<br />
Heberkinase treatment<br />
Prsented by:<br />
Sadeghian M.D ,et.al<br />
Congress<br />
The 14th congress of<br />
Iranian Heart<br />
Association<br />
in collaboration with<br />
British Cardiac Society,<br />
Tehran, 2004<br />
Page<br />
160<br />
39<br />
Short-term results of carotid<br />
<strong>artery</strong> stenting: A single<br />
center registry<br />
Kassaian M.D ,et.al<br />
The 14th congress of<br />
Iranian Heart<br />
Association<br />
in collaboration with<br />
British Cardiac<br />
Society,Tehran, 2004<br />
161<br />
40<br />
41<br />
Comparing background and<br />
confounding factors in the<br />
mace and non-mace patients;<br />
late outcome assessment of<br />
PCI<br />
Comparison of in-hospital<br />
and 9-month outcomes in<br />
patients with significant left<br />
ventricular dysfunction<br />
having percutaneous<br />
<strong>coronary</strong> intervention<br />
Salari far M.D, et.al<br />
Ali doosti M.D et.al<br />
The 14th congress of<br />
Iranian Heart<br />
Association<br />
in collaboration with<br />
British Cardiac Society,<br />
Tehran, 2004<br />
The 14th congress of<br />
Iranian Heart<br />
Association<br />
in collaboration with<br />
British Cardiac Society,<br />
Tehran, 2004<br />
162<br />
163<br />
42<br />
American or Europeanbased<br />
Bare stent: Which one<br />
is preferred<br />
Kassaian M.D, et.al<br />
The 14th congress of<br />
Iranian Heart<br />
Association<br />
in collaboration with<br />
British Cardiac Society,<br />
Tehran, 2004<br />
164
ROW<br />
43<br />
TITLE<br />
Short and long-term results<br />
after multi-vessel PCI<br />
Prsented by:<br />
Kassaian M.D, et.al<br />
Congress<br />
The 14th congress of<br />
Iranian Heart<br />
Association<br />
in collaboration with<br />
British Cardiac Society,<br />
Tehran, 2004<br />
Page<br />
165<br />
44<br />
45<br />
Short and long-term<br />
outcomes after PCI in<br />
patients with acute <strong>coronary</strong><br />
syndrome<br />
Are there any differences in<br />
mortality, complications,<br />
and late outcomes of PCI in<br />
patients with different<br />
educational levels<br />
Kassaian M.D, et.al<br />
Kazemi saleh M.D<br />
,et.al<br />
The 14th congress of<br />
Iranian Heart<br />
Association<br />
in collaboration with<br />
British Cardiac<br />
Society,Tehran, 2004<br />
The 14th congress of<br />
Iranian Heart<br />
Association in<br />
collaboration with<br />
British Cardiac Society,<br />
Tehran, 2004<br />
167<br />
166<br />
46<br />
Biopump as a temporary<br />
assist device for post<br />
cardiotomy heart failure<br />
Davoodi M.D, et.al<br />
The 14th congress of<br />
Iranian Heart<br />
Association<br />
in collaboration with<br />
British Cardiac<br />
Society,Tehran, 2004<br />
168<br />
47<br />
Effect of body mass index<br />
on in-hospital mortality in<br />
<strong>coronary</strong> <strong>artery</strong> <strong>bypass</strong><br />
<strong>surgery</strong><br />
Marzban M.D, et.al<br />
The 14th congress of<br />
Iranian Heart<br />
Association<br />
in collaboration with<br />
British Cardiac<br />
Society,Tehran, 2004<br />
169
ROW<br />
48<br />
TITLE<br />
Study of the rate of CAD<br />
patients without risk factors<br />
Prsented by:<br />
Sadeghian M.D, et.al<br />
Congress<br />
The 14th congress of<br />
Iranian Heart<br />
Association<br />
in collaboration with<br />
British Cardiac Society,<br />
Tehran, 2004<br />
Page<br />
170<br />
49<br />
Developmental ultrastructure<br />
of mouse emberyonic stem<br />
cell derived cardiomyocytes<br />
in vitro<br />
Baharvand M.D, et.al<br />
The 14th congress of<br />
Iranian Heart<br />
Association<br />
in collaboration with<br />
British Cardiac Society,<br />
Tehran, 2004<br />
171<br />
50<br />
Dose routine magnesium<br />
administration prevent<br />
preoperative <strong>coronary</strong> <strong>artery</strong><br />
<strong>bypass</strong> <strong>graft</strong> <strong>surgery</strong><br />
arrhythmias<br />
Najafi M.D ,et.al<br />
2nd international<br />
congress<br />
of anesthesiology&<br />
intensive care, Tehran,<br />
2005<br />
172<br />
51<br />
Furosmide administration in<br />
cardiac <strong>surgery</strong>: The best<br />
result with the least dosage<br />
Najafi M.D ,et.al<br />
2nd international<br />
congress of<br />
anesthesiology&<br />
intensive care, Tehran,<br />
2005<br />
173
First experience of local implantation of autologus CD 133+<br />
bone marrow stem cell transplantation for myocardial<br />
regeneration in a developing country<br />
Ahmadi H, Baharvand H, Kazemi Ashtiani S, Ardakani, Salehi Omran M,<br />
Sadeghian H, Madjd Ardakani J, Marzban M, Zareh N, Kohkan A, Madani-Civi<br />
M, Namiri M and Kamangari A<br />
Tehran Heart Center, Medical Sciences/University of Tehran, Tehran, Iran<br />
Abstract<br />
Background: Experimental studies suggest that autologous bone marrow stem cell<br />
transplantation (CD 133+) in patients with myocardial infarction (MI) may improve<br />
cardiac function. The aim of this study was to assess feasibility, safety of this therapy and<br />
cardiac performance as well.<br />
Methods: Between June 2004- June 2005, 21 patients with history of acute myocardial<br />
infarction within 3 months who were candidate for <strong>coronary</strong> <strong>artery</strong> <strong>bypass</strong> <strong>graft</strong>ing<br />
(CABG), were entered in our study. The patients randomly divided into two groups;<br />
control group (n=9, CABG alone) and BMC group (n=20, CABG with intramyocardial<br />
injection of autologus CD133+ bone marrow stem cell in the infracted border zone). For<br />
all patients, dobutamine stress echo (DSE) and thallium scan were performed before, 3<br />
and 9 months after CABG to determine perfusion and viability of the heart.<br />
Results: There were no significant differences between demographic factors of two<br />
groups. Left ventricular ejection fraction (LVEF) improved from 34.3r1.5 to 38r1.3 % in<br />
case group (p
Magnesium infusion and its relationship with the incidence of<br />
post <strong>coronary</strong> <strong>artery</strong> <strong>bypass</strong> <strong>graft</strong>ing arrhy thmias<br />
Najafi M, Haghighat B, Ahmadi H, Salehi Omran A, Soltaninia H, Ghiasi A,<br />
Boroomand MA, Fallah N, Fayazzadeh E, Ahmadi M and Mojtahed M<br />
Tehran Heart Center, Medical Sciences/University of Tehran, Tehran, Iran<br />
Abstract<br />
Background: Atrial and ventricular arrhythmias are among the most common<br />
complications following <strong>coronary</strong> <strong>artery</strong> <strong>bypass</strong> <strong>graft</strong>ing (CABG). Previous studies have<br />
demonstrated that serum magnesium (Mg) levels decreases following CABG, specially<br />
after cardiopulmonary <strong>bypass</strong> (CPB). In current study, we evaluated the prophylactic<br />
effect of Mg infusion on post-CABG arrhythmias.<br />
Methods: 345 patients (113 diabetic; 229 non-diabetic), candidates for isolated<br />
<strong>coronary</strong> <strong>artery</strong> <strong>bypass</strong> <strong>graft</strong>ing (CABG) with normal renal function, were randomly<br />
divided into two groups. Group A (case; 48.1%) received 2 g of Mg from induction of<br />
anesthesia to cardiopulmonary <strong>bypass</strong> (CPB) beginning and 8 g following CPB to 24 h<br />
there after. In group B (control; 51.9%), no supplemental Mg was administered. Mg<br />
serum levels were measured in all patients four times (at the onset of induction, and hours<br />
0, 24, and 48 after ICU admission). Patients were then followed for developing cardiac<br />
arrhythmias until their discharge from the hospital.<br />
Results: 79 patients (22.9%) developed post-operative arrhythmias (i.e. AF in 34<br />
[9.9%]; other supraventricular arrhythmias in 23 [6.7%]); and ventricular arrhythmias in<br />
47[13.6%] patients).Except for the first occasion (induction time), there were significant<br />
statistical differences in Mg serum levels in subsequent three measurements (p
Diabetes mellitus role in impeding prophylactic effects of<br />
magnesium on post<strong>coronary</strong> <strong>artery</strong> <strong>bypass</strong> <strong>graft</strong>ing atrial<br />
fibrillation<br />
Najafi M and Salehi Omran A<br />
Tehran Heart Center, Medical Sciences/University of Tehran, Tehran, Iran<br />
Abstract<br />
Background: Hypomagnesemia is a well known issue in diabetics. Recent studies have<br />
suggested the promising role of supplemental magnesium (Mg) administration in<br />
preventing post-surgical atrial fibrillation (AF); however, there is no evidence on<br />
differences between diabetic and non-diabetic patients in response to prophylactic<br />
administration of Mg supplements.<br />
Methods: Three hundred forty-five patients (115 diabetic; 230 non-diabetic), candidates<br />
for isolated <strong>coronary</strong> <strong>artery</strong> <strong>bypass</strong> <strong>graft</strong>ing (CABG) with normal renal function, were<br />
randomly divided into two groups. Group A (case; 48.1%) received 2 g of Mg after<br />
induction of anesthesia until cardiopulmonary <strong>bypass</strong> (CPB) onset and 8 g following CPB<br />
to 24 h thereafter. In group B (control; 51.9%), no supplemental Mg was administered.<br />
Mg serum levels was measured in all the patients four times (at the onset of induction,<br />
and hours 0, 24, and 48 after ICU admission).Patients were then followed for developing<br />
AF after the end of <strong>surgery</strong> until their discharge.<br />
Results: Thirty-four patients (9.9%) developed AF: 12 in group A and 22 in group B.<br />
Of 12 patients in group A, 8 (67%) were diabetic, whereas there were just 6 diabetic ones<br />
(27.3%) in group B (p=0.026). Serum Mg level were not statistically different between<br />
the groups. There was no significant difference statistically for the rate of DM in nonarrhythmic<br />
patients between the two groups (31% in group A vs. 34% in group B).<br />
Conclusions: DM has a major role in impeding prophylactic effects of Mg infusion on<br />
developing AF. This effect has no correlation with perioperative serum Mg levels.<br />
Keywords: magnesium, diabetes mellitus, atrial fibrillation<br />
5
Correlation between total plasma homocysteine level and<br />
grading of <strong>coronary</strong> <strong>artery</strong> disease<br />
Mirhoseini J, Radmehr H, Ahmadi H, Salehi M, Sattarzadeh R and Sanatkar M<br />
Tehran Heart Center, Medical Sciences/University of Tehran, Tehran, Iran<br />
Abstract<br />
Background: Elevated total plasma homocystein (tHcy) levels constitute a risk factor<br />
for <strong>coronary</strong> <strong>artery</strong> disease (CAD). A possible relationship was investigated between<br />
admission plasma homocystein level and the angiographic severity and extension of<br />
<strong>coronary</strong> <strong>artery</strong> disease in patients with CAD. This study looks at the relationship<br />
between total plasma homocystein and severity of <strong>coronary</strong> <strong>artery</strong> disease.<br />
Methods: From April 2004 to December 2004, 100 consecutive patients (65male 35<br />
female) that referred to our institution for <strong>coronary</strong> <strong>artery</strong> <strong>bypass</strong> <strong>graft</strong> <strong>surgery</strong> were<br />
enrolled. Fasting blood samples for homocystein were obtained on admission. Plasma<br />
homocystein concentration was measured with high performance liquid chromatography<br />
(HPLC). Our patients presented in Group with homocystein level >12 micromoles per<br />
liter and Group with total plasma homocystein =< 12 micromoles per liter. Vessel score<br />
assessed the number of vessels with significant stenosis … grading of atherosclerosis<br />
(Extent score) was intended to the atherosclerotic involvement of the entire arterial length<br />
circumscribe.<br />
Results: Our study was shown age > 60 years was correlated with tHcy, but gender,<br />
hypertension, history of smoking, hypercholesterolemia, family history and diabetes<br />
mellitus have not statistically difference between two groups. A poor correlation was<br />
found between abnormal homocystein level and vessel score ( r=0.35; p
Various surgical approaches to porcelain aorta in <strong>coronary</strong><br />
<strong>artery</strong> <strong>bypass</strong> <strong>graft</strong>ing (CABG), a single institute experience<br />
Marzban M, Abbasi K, Karimi A, Ahmadi H, Davoodi S, Movahedi N,<br />
Salehiomran A, Abbasi SH, Madani M and Rahnamayeazar A<br />
Tehran Heart Center, Medical Sciences/University of Tehran, Tehran, Iran<br />
Abstract<br />
Background: A heavily calcified aorta (the so called porceian aorta) is still a<br />
challenging dilemma for the surgeons with respect to <strong>bypass</strong> techniques, choice of<br />
conduit and handling of diseased aorta. In this article we present our experiences in<br />
management of eight patients.<br />
Methods: In 8 cases candidated for elective isolated CABG or in combined with aortic<br />
valve replacement we encountered porcelain aorta. Their management strategies include:<br />
1. off pump CABG as anastamosa of left internal mammary <strong>artery</strong> (LIMA) to the left<br />
anterior descending <strong>artery</strong> (LAD) and a jump SCG <strong>graft</strong> from proximal right <strong>coronary</strong><br />
<strong>artery</strong> (RCA) to the distal part.2. off pump CABG as Saphenus vein <strong>graft</strong> from proximal<br />
of innominate <strong>artery</strong> to LAD & from the SVG to OM, RCA and diagal branch.3. insertion<br />
of aortic valve in supra <strong>coronary</strong> position and anastomosis of LIMA to LAD and SVG to<br />
OM, RCA with proximal anastomosis to innaminate <strong>artery</strong>.4.and 5. aortic root<br />
replacement + CABG 6. hemiarch arch+root replacement + CABG.7. off pump CABG<br />
sequential LIMA to LAD and diagonal, RIMA to RCA radial to OM 1 and proximal of<br />
radial <strong>artery</strong> to the side of LIMA.8. off pump CABG as sequential LIMA to LAD and<br />
diagonal, RIMA to RCA.<br />
Results: The post operative course was uneventful in all patient no patient experienced<br />
a cerebrovascular accident or visceral organ injury as a result of atheroembolism.<br />
Conclusion: Although porcelin aorta is a difficult & cumbersome situation for CABG<br />
but with using different management strategies including offpump and no touch<br />
techniques of atherosclerotic aorta it can be managed <strong>graft</strong>ing results.<br />
7
Comparative outcome of CABG in diabetic patients versus<br />
non-diabetics with poor left ventricular function<br />
Ahmadi SH, Karimi AA, Davoodi S, Marzban M, Abbasi K, Movahedi N,<br />
Soleimani A, Abbasi SH, Alinejad B, Najafi M, Rahnemayeazar A and Fallah N<br />
Abstract<br />
Background: Although diabetes is commonly regarded as a risk factor for mortality<br />
and morbidity after CABG, the relationship between diabetes and mortality of CABG<br />
among patients with severe left ventricular dysfunction is less certain. This study was<br />
designed to assess this relationship.<br />
Methods: Between February 2002 and January 2006, 11197 CABG were done at our<br />
center, 1178 of those operations were isolated <strong>coronary</strong> <strong>artery</strong> <strong>bypass</strong> on patients with<br />
severe low ejection fraction. Of these 1178 patients, 434 patients had diabetes and 744<br />
patients were non-diabetics. We compared the diabetic and non-diabetic patients in this<br />
group in regard to gender, age, cerebrovascular accident, renal dysfunction, chronic<br />
pulmonary disease, significant left main <strong>coronary</strong> <strong>artery</strong> stenosis and postoperative inhospital<br />
mortality and morbidity. To analyze these data, univariate and multivariate<br />
analysis were done to compare the results.<br />
Results: Diabetic patients were older (59.55 y vs. 55.94 y), included more women<br />
(25.1% vs. 11.7%) and had more renal failure (4.1% vs. 2.2%), prolonged ventilation<br />
(2.6% vs. 0.9%), in-hospital mortality (4.6% vs. 1.9%) in comparison with non-diabetic<br />
patients (p
Pentoxifylline improves reoxygenation-induced contractile<br />
recovery through a nitric oxide dependent mechanism in rat<br />
papillary muscles<br />
Dehpour AR, Ebrahimi F, Hajrasouliha AR , S Tavakoli, Sadeghipour H, Ghasemi<br />
M, Ahmadi SH and Ziabakhsh Sh<br />
Mazandaran Heart Center, Sari, Iran.<br />
Tehran Heart Center, Medical Sciences/University of Tehran, Tehran, Iran<br />
Abstarct<br />
Background: In this study, the protective effect of pentoxifylline against hypoxiareoxygenation<br />
injury and the possible involvement of nitric oxide (NO)-mediated<br />
pathways in this protection were investigated in isolated rat papillary muscles.<br />
Methods: Papillary muscles were excised and isolated in Krebs-Henseleit solution<br />
aerated with 95% O2 and 5% CO2. Hypoxia was simulated by substituting O2 with<br />
argon. Three sets of experiments, testing 30, 60, and 90 min of hypoxia, were performed.<br />
The effects of different pentoxifylline concentrations on papillary muscle contractile<br />
parameters and responsiveness to isoproterenol were assessed. To investigate the role of<br />
NO, N(omega)-nitro-L-arginine methyl ester was added before pentoxifylline treatment.<br />
Results: Pentoxifylline did not show any inotropic effect on papillary muscles. Hypoxia<br />
caused a profound depression of contractile parameters, which was not affected by<br />
pentoxifylline treatment. Reoxygenation resulted in significant partial recovery of<br />
contractile parameters after 30 and 60 but not 90 min of hypoxia. In experiments with 30<br />
and 60 min of hypoxia, reoxygenation-induced contractile recovery and responsiveness to<br />
isoproterenol were improved by pentoxifylline in a concentration-dependent fashion.<br />
These functional improvements were completely blocked by N(omega)-nitro-L-arginine<br />
methyl ester pretreatment. No improvement was observed in 90-min hypoxia experiment.<br />
Conclusion: In conclusion, pentoxifylline improved contractile recovery during<br />
reoxygenation and postreoxygenation responsiveness to beta-adrenergic stimulation<br />
through the NO-dependent mechanism.<br />
9
Experience with 36 transvenous <strong>coronary</strong> sinus lead implantation for<br />
cardiac resynchronization therapy<br />
Yamini Sharif A, Kazemi Saeed A, Davoudi G, Sadegian S and Abbassi k<br />
Tehran Heart Center, Medical Sciences/University of Tehran, Tehran, Iran<br />
Abstract<br />
Background: Cardiac resynchronization therapy (CRT) using <strong>coronary</strong> sinus (CS)<br />
leads is a new method for the therapy of congestive heart failure (CHF) in case of inter<br />
and intraventricular conduction delay. Because the intervention is more complex than<br />
regular pacemaker implantation, more information on the feasibility of this intervention<br />
are of interest.<br />
Methods: From 09-08-2003 to 12-07-2005, 36 transvenous <strong>coronary</strong> sinus lead<br />
implantation was performed in 36 patients (mean age 57.53±11.33 years) (19-37 years<br />
spectrum) with EF 20.03±5.43%. The leads were preshaped and over the wire.<br />
Perioperative data were analyzed retrospectively. Twenty eight patients with LBBB (78<br />
%), 5 patients with RBBB (14%) and 2 patients with IVCD intraventricular conduction<br />
delay in ECG. All the patients had wide QRS in ECG•130 mmsec except one case with<br />
narrow QRS but intraventricular delay in TDI (tissue Doppler imaging). In 10 cases<br />
CRT+D were implanted in the others pure 3 chamber pace maker. Eleven patients (30%)<br />
had history of CABG. All the patients NYHA FC were 3 or 4. Seventy five percent were<br />
impalanted from right subclavian vein the others from left side. Coronary sinus leads<br />
were positioned according to variable vein anatomies 16x lateral 8x anterolateral 5x<br />
posterolateral 2x anterior.<br />
Results:In 5 patients CS lead implantation were unsuccessful transvenously. So<br />
epicardial LV leads were implanted because in 3 cases there were no suitable vein for CS<br />
lead implantation and in 2 cases <strong>coronary</strong> sinus perforation occurred. CS dissection<br />
occurred in 3 patients. In 7 casese phrenic nerve or diaphragmatic stimulation occurred<br />
during implantation, we solved this problem with repositoning of CS lead into other vein<br />
or by decreasing the threshold to minimum acceptable threshold. The mean operation<br />
time was 127±33 minutes (min) mean fluoroscopy time 35.5±19.3 min. Mean CS<br />
cannulation time 12.5±10.2 min and mean positioning time for lead 14±8 min in 29<br />
patients. Eighty percent showed an improvement in their NYHA class and could be<br />
classified as responder.<br />
Conclusion: Coronary sinus lead implantation is complex procedure with some hazard.<br />
Procedure time, fluoroscopy time and complication rate is noticeable therefore CRT<br />
should be offered to otherwise untreatable CHF patients NYHA class 3 or 4. At persent<br />
time, it is questionable to recommend CRT for CHF patient with mild symptom (NYHA<br />
class2). According to our experiences and reports from some other centers, it is not our<br />
policy to recommend CRT for patients with CHF and mild symptoms (NYHA class2).<br />
10
Mid term follow up of sixty patients with implantable<br />
cardioverter defibrillator<br />
Yamini Sharif A, Kazemi Saeed A, Davoudi Gh, Sadegian S and Moughaddam M<br />
Tehran Heart Center, Medical Sciences/University of Tehran, Tehran, Iran<br />
Abstract<br />
Background: This study assessed the results of ICD implantation in 60 patients with<br />
different etiology, age, ejection fraction and different venous access.<br />
Methods: From May 2002 to July 2005 60 ICDs were implanted in 60 patients who<br />
need to have ICD for secondary or primary prevention (except MADITII inclusion<br />
criteria). Their age were between (16 to 79years) mean 51±16 years (13% over 70 years).<br />
Follow up period was between (1 month to 38 months) mean 18±7 months. 75% of<br />
patients were male. EF in 22% of patients was 30-50% in 41%,
6 th biennial international conference of Pakistan society of cardiovascular & thoracic<br />
surgeons, Dec 2006, Karachi<br />
Induced myocardial infarction using ligation of the left<br />
anterior descending <strong>coronary</strong> <strong>artery</strong> major diagonal branch:<br />
development of an ovine model<br />
Rabbani Sh<br />
Tehran Heart Center, Medical Sciences/University of Tehran, Tehran, Iran<br />
Abstract<br />
Background: we report experimental myocardial infarction by occluding <strong>coronary</strong><br />
arteries in ovine models.<br />
Methods: Twelve ewes were included in the study. After the chest was opened by left<br />
lateral thoracotomy incision, the second diagonal branch of the left anterior descending<br />
<strong>coronary</strong> <strong>artery</strong> was ligted at a point approximately 40% distant from its base.<br />
Prophylactic antiarrhythmics were administered. Animals were mechanically ventilated<br />
during <strong>surgery</strong> and stayed at ICU for 24h afterwards. Experiments were then evaluated by<br />
echocardiographic, electrocardiographic, hemodynamic, serologic and morphologic<br />
investigations. Echocardiographic measurements were repeated after two months and<br />
animals were then sacrificed for postmortem cardiac examinations.<br />
Results: All animals survived the surgical procedure. Cyanotic discoloration and<br />
hypokinesia in the cardiac tissue in an area of 3*4 cm plus ST-segment elevations was<br />
detected immediately after vessel ligation. More over, there were pathologic Q-waves 2<br />
months later. Echocardiographic evaluations revealed an average of 30% relative<br />
decrease in cardiac ejection fraction. Wall motion analysis demonstrated anteroapical<br />
hypokinesia and akinesia in all animals one day and two months after operation. Thin<br />
walled infracted areas with tissue fibrosis were evident in pathologic investigations two<br />
months after <strong>surgery</strong>.<br />
Conclusion: In conclusion, we developed a practical and safe method of producing<br />
myocardial infarction in large animal models.<br />
12
First experience of local implantation of autologus CD 133+<br />
bone marrow stem cell transplantation for myocardial<br />
regeneration in Iran<br />
Ahmadi H, Baharvand H, Kazemi Ashtiani S, Soleimani M, Sadeghian H, Majd<br />
Ardekani J, Marzban M, Zareh N, Kouhkan A, Madani-Civi M, Namiri M and<br />
Kamangari A<br />
Tehran Heart Center, Medical Sciences/University of Tehran, Tehran, Iran Royan institute, stem cell<br />
department, tehran, Iran.<br />
Abstract<br />
Background: Experimental studies suggest that autologus bone marrow stem cell<br />
transplantation (CD 133+) in patients with myocardial infarction (MI) may improve<br />
cardiac function. The aim of this study was to assess feasibility, safety of this therapy and<br />
cardiac performance as well.<br />
Methods: Between June 2004 - June 2005, 29 patients with history of acute myocardial<br />
infarction within 3 months who were candidate for <strong>coronary</strong> <strong>artery</strong> <strong>bypass</strong> <strong>graft</strong>ing<br />
(CABG), were entered in our study. The patients randomly divided into groups: control<br />
group (n=9, CABG alone) and BMC group (n=20, CABG with intramyocardial injection<br />
of autologus CD 133+ bone marrow stem cell in the infracted border zone). For all<br />
patients, dobutamine stress echo and thallium scan was performed before, 3 and 9 months<br />
after CABG to determine improvement in regional viability and contractility of the heart.<br />
Results: There were no significant differences between demographic factors of two<br />
groups. Thallium scan and echocardiography reinvestigation showed improvement in<br />
global LV function, regional wall motion and perfusion of infracted area. Left ventricular<br />
ejection fraction (LVEF) improved from 34.3r1.5 to 38r1.3 in BMC group (p
PCL scaffold <strong>graft</strong>ed onto infarcted myocardium in sheep<br />
animal model: a vehicle for cardiomyocytes<br />
Soleimani M, Ahmadi SH, Rabbani Sh, Fayazzadeh E, Sahebjam M, Ahmadi ZH,<br />
Forozannia , Broumand MA, Sotudeh M, Karimi AA, Marzban M, Movahedi N,<br />
Abbasi K and Sadeghian S<br />
Experimental research lab, Tehran Heart Center, Medical Sciences/University of Tehran, Tehran, Iran<br />
Abstract<br />
Background: The emerging fields of tissue engineering and biomaterials have begun to<br />
provide potential treatment of cardiac infarcts. Tissue engineering approaches are<br />
designed to repair damaged cardiac tissue through the use of cellular transplantation, and<br />
biomaterial scaffolds.<br />
Methods: This study was designed to investigate the effectiveness of cardiomyocytesseeded<br />
patch <strong>graft</strong> on infracted area of the heart. MI in a sheep was induced by ligation of<br />
the distal portion of left <strong>coronary</strong> <strong>artery</strong>. A piece of left ventricular muscle and jugular<br />
vein were obtained. The samples were cultured and expanded. Expanded cardiomyocites<br />
and endothelial cells were seeded on 8 layers polycaprolactone material patches. After<br />
two months, the patch was sutured on the surface of infracted myocardium.<br />
Results: Eight weeks after patch transplantation, in echocardiography evaluation, there<br />
was no significant improvement in cardiac function; but in tissues evaluation by<br />
pathology and immunohistochemistry, a substantial amount of neovascularization and a<br />
tiny myogensis was seen in the infracted region and in the scaffold. There were no signs<br />
of acute inflammation.<br />
Conclusion: Our data demonstrate that <strong>graft</strong>ing of cell-seeded patch <strong>graft</strong> can induce<br />
angiogenesis and myogenesis in MI region. Such tissue engineered cell-sealed is the<br />
promising concept of tissue cardiomyoplasty to the field of regenerative medicine. This<br />
approach gives an overview of the current progress in the treatment of failing heart.<br />
14
Improvement of cardiac function and tissue viability following<br />
expanded autologus marrow derived CD133 stem cell<br />
transplantation in patients with ischemic cardiomyopathy<br />
undergoing <strong>coronary</strong> <strong>bypass</strong> <strong>surgery</strong><br />
Ahmadi SH, Soleimani M, Sahebjam M, Ahmadbeigi N, Madani-Civi M,<br />
Fayazzadeh E, Najafi M, Karimi AA, Abbasi K, Marzban M, Shirzad M and<br />
Forouzannian KH<br />
Tehran Heart Center, Medical Sciences/University of Tehran, Tehran, Iran<br />
Abstract<br />
Background: Ischemic cardiomyopathy comprises nearly two thirds of cases with<br />
heart failure. Coronary revascularization through surgical <strong>bypass</strong> <strong>graft</strong>ing is now a days<br />
routinely performed to improve life quality of such patients. Simultaneous transplantation<br />
of stem cells in patients undergoing CABG has been described in some recent studies<br />
with promising results. In present randomized controlled trail, we investigated short term<br />
efficiency of stem cell transplantation on cardiac function as an adjuvant to conventional<br />
CABG technique in patients with congestive heart failure.<br />
Methods: After institutional review and university approval, 20 patients with ischemic<br />
cardiomyopathy (NYHA class III or IV) and low ejection fraction (
There was also a meaningful relative decrease in percentage of the nonviable area on<br />
echocardiography and scintigraphy in patients in the stem cell group comparing to those<br />
in the control group.<br />
Conclusion: Expanded autologous CD133 stem cell transplantation led to significant<br />
improvement in cardiac function and tissue viability in patients undergoing CABG for<br />
16
Normal values for ventricular synchrony measured by tissue<br />
Doppler imaging and tissue Doppler synchronization imaging<br />
in structurally normal hearts<br />
Sadeghian H, Saheb Jam M, Yamini Sharif A, Kazemisaied A, Fallah N, Goodarzynejad<br />
H and Raissi Dehkordi M<br />
Tehran Heart Center, Medical Sciences/University of Tehran, Tehran, Iran<br />
Abstract<br />
Background: We studied normal values for intraventricular and interventricular delay<br />
by tissue Doppler imaging (TDI) and tissue synchronization imaging (TSI).<br />
Methods: We evaluated 25 healthy adults volunteers (26.30±5.68 years, 16% male).<br />
Tissue Doppler Echocardiography was performed (system VIVID 7D, GE) using a 6-<br />
basal, 6 mid-segmental model to assess the time to peak systolic contraction (Ts). We<br />
also evaluated the right ventricle at basal and mid portion levels. We measured Ts both<br />
manually and with TSI.<br />
Results: Anterior basal and mid-portion had the shortest Ts and interventricular septum<br />
had the longest Ts with both methods. Correlation between manual and TSI method was<br />
significant (p
Table 1. Ts in anterior septal and RV free wall<br />
Std. Deviation<br />
Mean<br />
Maximum<br />
Minimum<br />
29.39<br />
88.40<br />
200<br />
TDI:60<br />
Anterior basal<br />
10.25<br />
79.08<br />
103<br />
TSI: 61<br />
29.25<br />
9.01<br />
88.40<br />
77.28<br />
200<br />
98<br />
TDI: 60<br />
TSI: 61<br />
Anterior<br />
midportion<br />
47.26<br />
153.60<br />
210<br />
TDI: 24<br />
Septal basal<br />
39.88<br />
141.56<br />
216<br />
TSI: 78<br />
40.89<br />
37.09<br />
161.60<br />
125.40<br />
210<br />
216<br />
TDI: 80<br />
TSI: 82<br />
Septal<br />
midportion<br />
38.10<br />
181.20<br />
230<br />
TDI: 40<br />
RV basal<br />
24.26<br />
176.04<br />
228<br />
TSI: 129<br />
52.56<br />
20.89<br />
173.60<br />
175.12<br />
260<br />
217<br />
TDI: 12<br />
TSI:129<br />
RV<br />
midportion<br />
18
Clinical characteristics of women with premature <strong>coronary</strong> <strong>artery</strong><br />
disease requiring CABG compared with that of young men<br />
Daryani YP and Daryani YP<br />
Tehran Heart Center, Medical Sciences/University of Tehran, Tehran, Iran London, United Kingdom<br />
Abstract<br />
Background: Significant atherosclerotic CAD requiring CABG is uncommon in young<br />
adults and it is even rarer in young females. Here we present and compare detail<br />
characteristics of young female patients with premature CAD undergoing CABG with<br />
that of young male patients in Iran.<br />
Methods: In this study data from consecutive patients undergoing CABG only <strong>surgery</strong><br />
in a university affiliated tertiary referral centre in Tehran during twelve moths period<br />
were obtained. Premature CAD was defined as development of atherosclerotic CAD<br />
requiring <strong>bypass</strong> <strong>surgery</strong> before the age of 45 in men and before the age of 50 in women.<br />
Their characteristics including main CAD risk factors (smoking, DM, hypertension,<br />
hyperlipidemia, and family history), gender, BMI, creatinine levels, history of previous<br />
MI, angina, heart failure, and prior cardio-vascular intervention were assessed and<br />
compared. Standard criteria similar to those used by ACC/AHA were used to define the<br />
patient's characteristics. However in this study a family history of CAD in first degree<br />
relatives (both males and females) before the age of 55 was considered as positive.<br />
Categorical data were compared using Chi-squared and continuous data were compared<br />
using Student t test. P value
Impact of risk factors for development of <strong>coronary</strong> <strong>artery</strong><br />
disease in patients undergoing CABG in Iran compared with<br />
that in USA<br />
Daryani YP and Daryani YP<br />
Tehran Heart Center, Medical Sciences/University of Tehran, Tehran, Iran London, United Kingdom<br />
Abstract<br />
Background: CAD is the leading cause of death in the US and in Iran. Although it is<br />
suggested that the known risk factors for development of CAD is similar throughout the<br />
world their impact may be different among nations with different social and cultural<br />
background. Therefore different strategies may be required to tackle and prevent CAD in<br />
different countries.<br />
Methods: Here we present and compare clinical profiles of patients with CABG in Iran<br />
with those in the USA. Data for the US were obtained from Society of Thoracic Surgery<br />
National Database website, 1997 CABG only patients. Data for Iran were obtained from<br />
Cardiac Surgery Database of Tehran Heart Center, a university affiliated hospital.<br />
Patients were referred from all over the country to the centre. All consecutive patients<br />
undergoing CABG for established CAD between Oct 03 and Sep 04 had their data<br />
collected on standardized forms by a qualified physician. They were then entered into a<br />
computerized database.<br />
Results: Pt population 2,213 (1yr) Iran 174,806 (8yr) USA: Mean (median) age 58.6<br />
(59) 64.8(65), Male 74.7% 70.8%, Smoking HX 39.9% 58.3%, Family HX 25.2%<br />
46.6%, DM 29.3% 30.5%, hyperchol 55.6% 52.8%, Hypertension 37.1% 65.9% .<br />
Morbid obesity 1.0% 11.8%, CVA 2.1% 6.4%, PVD 1.0% 14.3%, 1VD 5.1% 9.5%,<br />
2VD 21.7% 20%, 3VD 73.2% 70.5%, LMD 11.2% 20.6%. Age 61-65 vs
We conclude that major risk factors of CAD have different impacts on development of<br />
CAD in different countries. Therefore different approaches are required to tackle and<br />
prevent CAD.<br />
21
Association of lipoprtein (a) levels with the severity of <strong>coronary</strong><br />
<strong>artery</strong> stenosis in an Iranian population (according to Gensini<br />
score)<br />
Tehran Heart Center, Medical Sciences/University of Tehran, Tehran, Iran<br />
Absract<br />
Background: Lipoprotein (a) [LP (a)] is a known risk factor for developing <strong>coronary</strong><br />
<strong>artery</strong> disease. However, the pattern of LP (a) distribution in various racial and genetic<br />
groups has been found to be different. Furthermore, the association of LP (a) and the<br />
severity of <strong>coronary</strong> <strong>artery</strong> disease in different populations has not been clearly assessed.<br />
This study has been done to determine the relationship between LP (a) and the severity of<br />
<strong>coronary</strong> <strong>artery</strong> stenosis in an Iranian population.<br />
Methods: Between July 2004 and March 2005, 826 patients who had been candidates<br />
for angiography at Tehran Heart Center were included. The severity of their <strong>coronary</strong><br />
<strong>artery</strong> stenosis was assessed through Gensini score. At the first part of the study, to check<br />
interobserver reliability, 60 angiographies were reported and their Gensini scores were<br />
determined by two cardiologists. During hospitalization, LP (a), triglyceride, cholesterol,<br />
high density lipoprotein, low density lipoprotein and quantitative C reactive protein levels<br />
were measured and their correlation with <strong>coronary</strong> <strong>artery</strong> stenosis were assessed.<br />
Results: Among 826 participants, 510 (62%) patients were male and 316 (38%) were<br />
female. Coronary angiography was normal in 283 (34%), while 543 (66%) patients<br />
showed atherosclerosis. Mean LP (a) levels in both normal and atherosclerotic<br />
participants showed a significant difference (P
Fast track method in cardiac <strong>surgery</strong>: evaluation of risks and<br />
benefits<br />
Najafi M, Soleimanzadeh M and Haghighat B<br />
Tehran Heart Center, Medical Sciences/University of Tehran, Tehran, Iran<br />
Abstract<br />
Background: Fast Track (FT) method is recommended for accelerating the recovery<br />
phase, but it may not work because of some respiratory complications. This study<br />
compares the routine and FT method for managing post CABG patients in Intensive<br />
Care Unit (ICU).<br />
Methods: One hundred cases were divided into two groups. In FT group, fentanyl<br />
(0.05-0.15 Pg/kg/min) and Propofol (10-50 Pg/kg/min) infusions were started since<br />
induction time. Atracurium infusion started one hour later, no bolus drug was<br />
administered during operation. Muscle relaxants were neutralized at the end of <strong>surgery</strong>.<br />
Fentanyl infusion continued up to 12 hours post <strong>surgery</strong>. The above two groups were<br />
evaluated for time of alertness and extubation in ICU, total analgesic dosage<br />
administered during 24 hours post operation, ABG and SpO2 pre-and post-extubation.<br />
Inclusion and exclusion criteria for FT method as well as extubation criteria were<br />
explained to the ICU, staff.<br />
Results: Time period between ICU admition and alertness was significantly different in<br />
FT (1.3 hour) and control group (3.3 hours) (P
Relationship between serum magnesium level and post<br />
<strong>coronary</strong> <strong>artery</strong> <strong>bypass</strong> <strong>graft</strong> <strong>surgery</strong> arrhythmias<br />
Najafi M<br />
Tehran Heart Center, Medical Sciences/University of Tehran, Tehran, Iran<br />
Abstract<br />
Background: Atrial and ventricular arrhythmias are among the most common<br />
complications after <strong>coronary</strong> <strong>artery</strong> <strong>bypass</strong> <strong>graft</strong> (CABG) <strong>surgery</strong>. Previous studies<br />
demonstrated that cardiopulmonary <strong>bypass</strong> itself, results in reduced serum magnesium<br />
level. In this study, we wanted to evaluate the effect of total blood magnesium level<br />
(TMG) on preventing perioperative arrhythmias by routine regimens of 2-4 grams<br />
supplemental magnesium (SMG).<br />
Methods: TMG was measured in patients who were scheduled for CABG on 3<br />
occasions [just before anesthesia, just after entering intensive care unit (ICU)<br />
postoperatively and on the first morning after operation]. Patients were evaluated for<br />
primary cardiac rhythm and other variables that could have an influence on magnesium<br />
level (serum creatinine, urine output in operating room and diuretic therapy). SMG was<br />
also recorded in operating room and ICU.Then the patients were evaluated for the rate<br />
and kind of arrhythmia through next 3 days.<br />
Results: Mean TMG level in 174 cases was 2.2 (0.5), 2.6 (0.6) and 2.4 (0.6) mg/dl on<br />
three occasions respectively. Mean SMG was 2.5 (1.2) grams. 47 out of 157 patients<br />
developed post-operative arrhythmia (%30) [AF* (%6.4), Non-AF SVA** (%14.6) and<br />
Ventricular arrhythmia (%16.6)]. Mean serum creatinine level and urine output were 1.2<br />
mg/dl and 1800ml respectively. Although there was a significant difference between<br />
TMG on three occasions (P
Carotid stenting in candidates for <strong>coronary</strong> <strong>artery</strong> <strong>bypass</strong><br />
<strong>surgery</strong>: results of a heart hospital registry<br />
Kassaian SE, Kazemisaleh D, Alidoosti M, Salarifar M, Haji Zeinali AM, Hakki<br />
E, Sahraian AM, Gheini MR and Abbasi SH<br />
Abstract<br />
Background: In patients with severe coexisting <strong>coronary</strong> and carotid <strong>artery</strong> disease, 2<br />
treatment strategies may be used: simultaneous endarterectomy and <strong>coronary</strong> <strong>bypass</strong><br />
<strong>surgery</strong> or carotid stenting with delayed <strong>coronary</strong> <strong>bypass</strong> <strong>surgery</strong> after a few weeks. We<br />
sought to evaluate the safety and efficacy of carotid stenting with delayed <strong>coronary</strong><br />
<strong>bypass</strong> <strong>surgery</strong> after a few weeks in patients of Tehran Heart Center. Based on<br />
observations made in this study and previous lesion typing studies, we aimed to<br />
determine predictors that may be used to select the appropriate treatment plan for such<br />
patients.<br />
Methods: Between December 2003 and October 2004, thirty consecutive patients<br />
underwent carotid stenting. The mean age of the patients was 66.3 ± 8 years. All of the<br />
patients had significant <strong>coronary</strong> <strong>artery</strong> disease. Symptomatic patients with>60% stenosis<br />
and symptomatic patients with> 80% stenosis were included. A complete neurological<br />
history was taken and an examination performed on all patients by an experienced<br />
neourologist. The study protocol required that an independent neourologist not involved<br />
in the interventional procedure evaluate parients using the National Institute of Health<br />
Stroke Scale before the procedure and then 24 hours, 1 month, and 6 months after the<br />
procedure. Carotid duplex (based on the Washington criteria), magnetic resonance<br />
imaging, or computed tomographyof the head and complete diagnostic angiography,<br />
including intracranial views and assessment of the collateral circulation, were performed<br />
on all patients. Stenoses were crossed with a 0.014inch filter wire, which was placed at<br />
the site of internal carotid <strong>artery</strong> distal to the lesion. In most cases, predilation (low<br />
profile 3.5-4mm <strong>coronary</strong> balloon and low pressure) was performed before stent<br />
placement. Ballon inflations were routinely performed within the stents after placement.<br />
Continuous intravenous heparin was given during the night, and vascular sheats were<br />
removed the morning after the procedure. The clinical endpoints were major or minor<br />
stroke myocardial infarction, or death during follow up period.<br />
Results: The procedural success rate was 96.66%. For a mean follow up period of 5.6 ±<br />
3.2 months, 4 deaths occurred (17% of cases), none of which were attributed to a<br />
neurologic cause. Also 1(3%) case had a minor non fatal stroke (transient cognitive<br />
disorder). we designed a new evaluation system: anyone of the characteristics in class C<br />
is considered a predictor for events. Increased number of these predictors is associated<br />
with the risk of complications after the procedure. Also between these predictors; stenosis<br />
95%-99% and large crater ulceration of carotid lesions are more important than the<br />
others.<br />
25
Conclusion: To reduce carotid stenting complications in high risk cardiac patients and<br />
to optimize patient selection, we suggest a new evaluation system based on clinical and<br />
lesion characteristics of patients to determine the best treatment strategy.<br />
26
Predictors of the major adverse cardiac events (MACE) after<br />
percutaneous <strong>coronary</strong> intervention- a single center registry<br />
Salarifar M, Kassaian SE, Alidoosti M, Haji Zeinali AM, Paydari N and Sharafi<br />
Tehran Heart Center, Medical Sciences/University of Tehran, Tehran, Iran<br />
Abstract<br />
Objective: To propose a model for predicting the risk of MACE. MACE was defined as<br />
nonfatal MI, target vessel revascularization and cardiac death.<br />
Methods: The data of all patients undergoing PCI between March 2003 and March 2005,<br />
(n=2614) were analyzed in this prospective registry. The only exclusion criteria was dropout<br />
from the 9 month follow-up plan (n=434, 16.6%). All characteristics of the patients who had<br />
MACE (n=122, 4.7%) were compared with the others (NonMACE group). All significant<br />
factors entered in the model for multivariate analysis. Time of developing MACE (MACE<br />
time) and MACE hazard evaluated by the Cox regression.<br />
Results: Univariate ORs were revealed in the table 1. Although in univariate analysis Intraaortic<br />
balloon pump, cardiogenic shock and PCI on the left main, were strong predictors for<br />
the MACE they were not entered in the model (due to small sample size). Multivariate<br />
analysis reveals that EF lower than 40%, Unstable Angina or acute <strong>coronary</strong> syndrome and<br />
Dissection were predictors for the MACE.<br />
Median for MACE time was 5±0.49 month (SEM). Unsmoothed graph in Graph<br />
1(Hazard function) shows that the frequency of the MACE increased in the fourth and<br />
tenth month in the first year after PCI. Also It reveals that the frequency of the MACE<br />
increase in the 14 and 15 month.<br />
Conclusion: we propose that the follow up plan could cover the most dangerous time<br />
(4th, 10th, 15th month) after the PCI. So we recommend 18 month follow up plan (1, 4,<br />
9, 12, 18 and yearly after that). Our study reveals that in the current era of interventional<br />
cardiology, the best outcome achieve in the patients presenting by stable angina, having<br />
good EF and have been treated by experienced hands(to prevent dissection).<br />
27
Table 1: Univariate and multivariate analysis of the Major Adverse Cardiac Event<br />
Odds Ratio (95% Confidence Interval)<br />
Multivariate<br />
Univariate<br />
1.50(1.00-2.26)*<br />
Diabetes Mellitus
2.99(1.71-5.25) ‡<br />
0.51(0.34-0.76) †<br />
1.67(1.16-2.42) †<br />
2.01(1.07-376) *<br />
Stable Angina<br />
Unstable Angina<br />
Prior PCI<br />
1.76(0.99-3.14)<br />
3.14(1.14-8.60) *<br />
~<br />
1.80(1.15-2.83) *<br />
3.76(1.96-7.21) ‡<br />
2.77(1.46-5.24) †<br />
Multivessel Disease<br />
Primary PCI<br />
Dissection<br />
3.02(1.40-6.53) †<br />
Marked Increase in CPK 1<br />
0.61(0.38-0.97) *<br />
Right Coronary Artery Territory<br />
1.44(0.97-2.16)<br />
~<br />
Left Anterior Descending Territory<br />
~<br />
3.81(1.92-7.54) ‡<br />
1.93(0.89-4.21)<br />
1.74(1.02-2.96) *<br />
2.43(1.41-4.21) †<br />
8.56(1.56-47.19) †<br />
43.93(8.43-228.84) ‡<br />
43.93(8.43-228.84) ‡<br />
Bare Metal Stents (vs. Drug Eluting Stents)<br />
Reference Vessel Diameter ” 2.5mm<br />
Low Ejection Fraction(EF
Comparative study of success rate & complications frequency<br />
in two streptokinase trade forms:" A randomized double blind<br />
study"<br />
Salarifar M, Paydari N, Davoodi Gh, Amirzadegan AR and Biria A<br />
Tehran Heart Center, Medical Sciences/University of Tehran, Tehran, Iran<br />
Abstract<br />
Background: This study was to determine the efficacy and safety of the different trade<br />
forms of the streptokinase available in our country; Heberkinasa (heberbiotec, Havana, Cuba)<br />
and Streptase (Aventis Behring GmbH, Marburg, Germany).<br />
Methods: This study were conducted by grant of Undersecretary for Food and Drug<br />
Affairs, Ministry of Health & Medical Education. From the January 2005, the patient who<br />
met the inclusion criteria was enrolled in this randomized double blind clinical trial and<br />
allocated in one of the treatment arms; Heberkinasa(HBK) or Streptase(STP). Thrombolysis<br />
success was evaluated angiograpgically and TIMI 3 flow in the infarct-related epicardial<br />
<strong>artery</strong> was regarded as the successful <strong>coronary</strong> thrombolysis. Any complications or inhospital<br />
events (Safety) were documented on a detailed questionnaire. Clinical follow up<br />
(phone survey and mailed questionnaire) was done 30 days after thrombolysis. Successful<br />
thrombolysis and in-hospital mortality (Efficacy) were assessed in the primary end points.<br />
Secondary end point of the study (Reinfarction and cardiac death) was evaluated 1 month<br />
after thombolysis.<br />
Results: From January 2005 to January 2006, 221 patients (Age 56.9± 10.8, Men: 88.2%)<br />
were randomized, 119 were allocated in the HBK and 102 in the other group.<br />
Baseline clinical, risk factors and demographic characteristics were the same in both<br />
groups. Also there were no significant differences in the door to drug and pain to drug<br />
times. The rate of complications were the same (43.9% [HBK] vs. 45% [STP], p=NS).<br />
Angiography was done for 157(70.1 %) patients, in 9% in the first 24 hrs and in 39.8% in<br />
the first 72 Hrs after thrombolysis. Lesion morphology and<br />
Lesion / patient ratio were not significantly different (1.87[HBK] vs. 1.67[STP], p=NS).<br />
The rate of Successful thrombolysis were the same (67.5% [HBK] vs. 67.6% [STP], p=NS).<br />
Study endpoints were revealed in the table 1.<br />
Conclusion: So far, the Complication frequency and the success rate of the streptase and<br />
heberkinasa have been the same. The study will be ongoing to complete the sample size and<br />
increase the statistical power. Keywords: Streptokinase, Thrombolytic therapy,<br />
Complications, Success rate<br />
29
Study of factors affecting in-hospital mortality of patients with<br />
acute myocardial infarction<br />
Salarifar M, Darabian C, Solaymani A, Amirzadegan AR, Hamidian R and<br />
Mahmoudian M<br />
Tehran Heart Center, Medical Sciences/University of Tehran, Tehran, Iran<br />
Abstract<br />
Background: The objective of present study is to determine whether demographic,<br />
clinical and paraclinical risk factors can predict risk of In-hospital mortality of acute<br />
myocardial infarction (AMI).<br />
Methods: Using ischemic heart disease database, 1798 patients who were hospitalized<br />
for AMI were assigned to 2 groups in a retrospective cohort study: group one patients<br />
survived and group two patients died of AMI at hospitalization time.<br />
Results: Demographic findings show expired patients’ mean age was significantly<br />
higher and post- AMI mortality was significantly greater in female than male patients<br />
(p
Table1<br />
Group II Expired patients<br />
Group I Survived patients<br />
69.01 years old<br />
61.53% male ,38.46% female<br />
44.1%<br />
47.3%<br />
8%<br />
III & V<br />
51.8%<br />
29.62<br />
43.2%<br />
46.7%<br />
17.2%<br />
101.1<br />
11.7<br />
61.91 years old<br />
74.89% male ,24.61% female<br />
48.1%<br />
37.1%<br />
9.9%<br />
I & II<br />
43.3%<br />
46.1%<br />
44.8%<br />
52.5%<br />
4.3%<br />
80.67<br />
8.72<br />
Mean age<br />
Sex<br />
Dyslipidemia<br />
Diabetes mellitus<br />
Opium addiction<br />
Killip calss<br />
Hypertension<br />
LVEF<br />
Presence of Q wave<br />
ST elevation<br />
Bundle branch block<br />
mean CKMB serum<br />
concentration<br />
mean Troponin serum<br />
concentration<br />
Table 2<br />
other<br />
0,0<br />
Ant.<br />
lat<br />
15.4 %<br />
R<br />
V<br />
9.1<br />
%<br />
Ant.<br />
septal<br />
9.2%<br />
Affected region<br />
<strong>Post</strong><br />
11.1<br />
%<br />
Septal<br />
11.8%<br />
Apica<br />
l<br />
0.0<br />
La<br />
t<br />
9.1<br />
%<br />
In<br />
f<br />
6.9<br />
%<br />
Ant<br />
11.6<br />
%<br />
Female<br />
gender<br />
13.9%<br />
Male<br />
gende<br />
r<br />
7.8%<br />
Mortality (9.4%<br />
of all patients)<br />
32<br />
Risk factors for complications of delay in <strong>surgery</strong> in staged<br />
carotid stenting and <strong>coronary</strong> <strong>bypass</strong> <strong>graft</strong> <strong>surgery</strong>
Kassaian SE, Alidoosti M, Kazemi Saleh D, Haji Zeinali AM, Salarifar M, Shirani<br />
Sh, Hakki Kazazi E and Darvish S<br />
Tehran Heart Center, Medical Sciences/University of Tehran, Tehran, Iran<br />
Abstract<br />
Background: To answer the question whether the delay in <strong>coronary</strong> <strong>artery</strong> <strong>bypass</strong> <strong>graft</strong><br />
(CABG) results in adverse events, we describe our experience with planned staged carotid<br />
stenting followed by CABG in our patients.<br />
Methods: From December 2003 through February 2006, we performed 53carotid<br />
angioplasty procedures. Of these patients, 39 cases underwent carotid stenting followed by<br />
scheduled CABG but only 28 of them presented for CABG. In-hospital complications were<br />
evaluated by a neurologist .Long-term follow-up was then conducted by telephone interview<br />
for all of patients who were presented for CABG.<br />
Result: The procedural success rate was 97.4%. The mean interval from last carotid stent to<br />
CABG was 78.8±60 days (range, 8-254 days). In the interval between carotid stenting and<br />
CABG 4 deaths occurred (14.2% of cases), all of them in first week and none of which were<br />
attributed to a neurologic cause. Also 2(7.1%) case had a minor non fatal stroke. we designed<br />
a new evaluation system: anyone of the characteristics in class C, particularly stenosis 95%-<br />
99% and dense calcification is considered as a predictor for events. Increased number of<br />
these predictors in addition to age•75 and having valvular heart disease are associated with<br />
the risk of complications after the procedure.<br />
Conclusion: We suggest that if we decide for carotid intervention in patients with •4<br />
suggested predictors, especially stenosis •95% and dense calcification and/or patients who<br />
have valvular heart disease and/or age•75, the physician should closely observe the patient<br />
during the waiting period before CABG particularly in the first week after carotid stenting.<br />
Keywords: carotid stenting, CABG, complication<br />
33<br />
Angiographic profile and lesion characteristics in young<br />
patients with percutaneous <strong>coronary</strong> intervention<br />
Kassaian SE, Salarifar M, Alidoosti M, Haji Zeinali AM, Poorhosseini HR,
Pirzadeh L, Raissi Dehkordi M and Paydari N<br />
Tehran Heart Center, Medical Sciences/University of Tehran, Tehran, Iran<br />
Abstract<br />
Background: To find out the differences in baseline, angiographic, procedural and<br />
lesion characteristics in young patients ”40 years old versus old patients who underwent<br />
percutaneous <strong>coronary</strong> intervention (PCI).<br />
Methods: From April 2003 to March 2005, 138 PCI procedures were performed in 118<br />
patients aged ” 40 years and compared to 354 patients>40 years, who were randomly<br />
selected from a total of 2493 old patients as control group. Data was collected from our<br />
database.<br />
Results: 118 patients (4.5%) were 40 years old or under. Young patients were more<br />
often male (91.5% vs. 71.8%, P
Tehran Heart Center, Medical Sciences/University of Tehran, Tehran, Iran<br />
Abstract<br />
Background: PCI in diabetic patients had long been a dilemma due to high rate of<br />
restenosis. Multiple studies have shown the benefit of the use of drug eluting stents in this<br />
subgroup of patients. Our goal in the present study is to evaluate the results of PCI in<br />
diabetic patients using drug eluting stents in Iranian population.<br />
Methods: From April 2003 to March 2005, 268 patients (69 diabetic patient) underwent<br />
PCI with DES (220 Cypher and 71 Taxus) at our center. These patients made the study<br />
population. We undertook a thorough evaluation of baseline, clinical characteristics,<br />
angiographic and procedural properties. we also verified the clinical outcomes of PCI<br />
with DES in diabetic and non-diabetic subgroups.<br />
Result: There was no significant difference between the two groups regarding the<br />
baseline clinical characteristics except that the diabetics were significantly more<br />
hyperlipidemic (66.7% vs. 47% p=0.001). PCI on LAD territory was less frequent in<br />
diabetics (69% vs. 81.3% p=0.042), on the contrary PCIs on small-sized vessels<br />
(RVD
Background: Redo <strong>coronary</strong> <strong>artery</strong> <strong>bypass</strong> <strong>graft</strong> (CABG) is usually associated with high<br />
rate of complications including mortality. Many of these patients can be revascularized by<br />
PCI on their native vessels, Sapherous vein <strong>graft</strong>s (SVGS) or arterial <strong>graft</strong>s. PCI on SVG has<br />
been accompanied by high rate of procedural complications or long term restenosis. In this<br />
study we evaluated the success rate, complications and late outcomes of PCI on SVG in our<br />
patients.<br />
Methods: of 2614 consecutive patients, who underwent PCI during April 2003 to march<br />
2005, 70 (2.7%) patients had history of previous CABG and 20 of them (23 Lesion) had PCI<br />
on SVG. Based on our database we evaluated the baseline, procedural and outcomes<br />
characteristics in this group of patients.<br />
Result: They are all male. Mean age was 59.9±9.2 yrs and the period between CABG and<br />
PCI was 7.9±4.9 yrs. The most common <strong>graft</strong>s were SVG to OM (60.9%) and SVG to RCA<br />
(26.1%). 13(56.5%) patients were treated by direct stenting, 9 (39.1 %) by primary stenting<br />
and 1(4.3%) by pure only balloon angioplasty. Angiographic Success was achieved in all of<br />
them but 1 case had Non Q-wave MI after the PCI (Clinical Success Rate: 95.0%).There was<br />
not any in hospital mortality. Regarding the long-term outcome 4 patients had emergency<br />
room visit, 1 readmitted and angiography was done but no significant stenosis was revealed.<br />
Mean follow-up time was 9.5±3.1 months and of 80% patients complete their follow up plan.<br />
There was not any major adverse cardiac event in this group of patients.<br />
Conclusion: It seems that PCI on the Saphenous vein <strong>graft</strong> was safe and efficient using an<br />
appropriate patient selection and if indicated distal protecting devices.<br />
36<br />
Short- and long-term outcomes following percutaneous <strong>coronary</strong><br />
intervention in young patients<br />
Kassaian SE, Alidoosti M, Salarifar M, Haji Zeinali AM, Nematipour E, Pirzadeh L<br />
and Raissi Dehcordi M<br />
Tehran Heart Center, Medical Sciences/University of Tehran, Tehran, Iran
Abstract<br />
Background: We evaluated early and late outcomes of percutaneous <strong>coronary</strong> intervention<br />
(PCI) in patients”40 years.<br />
Methods: From April 2003 to March 2005, PCI outcomes in 118 patients ”40 years (group<br />
ǿ) was compared to 354 patients, who were randomly selected from 2493 patients >40 years<br />
(group ǿǿ) from our database.<br />
Result: Group ǿ was more often male (91.5% vs. 71.8%, P
Background: The conventional twelve-lead electrocardiogram (ECG) still is used for<br />
diagnosis of wall motion abnormality. The purpose of this study was to evaluate the<br />
relation between resting electrocardiographic abnormalities and wall motion (WM)<br />
abnormality in <strong>coronary</strong> <strong>artery</strong> disease (CAD).<br />
Methods: 6438 consecutive patients with CAD in angiography in our center over a<br />
period of two years included in this study. Electrocardiograms were reviewed for the<br />
presence of Q wave (• 2 contiguous ECG leads) and echocardiography were examined for<br />
various motion disorders (local hypokinesia, akinesia, dyskinesia and generalized<br />
hypokinesia) in patients with CAD in angiography.<br />
Result: Out of 6438 patients with CAD, 2407 had WM abnormality and 4031 patients<br />
had no WM abnormality. Among patients with CAD and wall-motion abnormality, 44%<br />
(1071) had Q waves and 66% (1336) did not have Q waves. From patients with CAD<br />
without WM abnormality, 19.5% (788) had Q waves and 80.5% (3243) did not have Q<br />
waves. So sensitivity and specificity of Q wave for the diagnosis of WM abnormality in<br />
CAD is 57% and 70%, respectively.<br />
Conclusion: Despite new methods for the diagnosis of wall-motion abnormality, the<br />
electrocardiogram is still a useful and simple method for the diagnosis of wall-motion<br />
disorders in CAD.<br />
Keywords: Wall motion abnormality, Q wave, Coronary <strong>artery</strong> disease<br />
38<br />
The prognosis of a non-Q-wave versus Q-wave myocardial<br />
infarction<br />
Sadeghian H, Sahebjam M and Mahmoodian M<br />
Tehran Heart Center, Medical Sciences/University of Tehran, Tehran, Iran<br />
Abstract
Background: Non-Q-wave myocardial infarction seems to have higher rates of<br />
complications. It is usually managed with an invasive strategy, Nevertheless, the clinical<br />
course and prognosis of this type of myocardial infarction and the best approach to its<br />
management remain controversial.<br />
Methods: From June 2003 to March 2005 data were collected from an ischemic heart<br />
disease registry enrolling 993 patients with acute non-Q-wave and 803 patients with Q-<br />
wave myocardial infarction. 49.04% of non-Q-wave and 54.4% of the patients with Q-<br />
wave myocardial infarction underwent <strong>coronary</strong> angiography within the first week after<br />
onset of a myocardial infarction.<br />
Results: The mean of patients with non-Q-wave myocardial infarction was higher<br />
(63.14±12.38 vs.61.87±12.1, P=0.029) and they were more likely to be female (P=0.013).<br />
The prevalence of single, two and three vessel disease in both group was similar<br />
(respectively P=0.65, P=0.97 and P=0.27), while the left main disease was more frequent<br />
in patients with non-Q-wave myocardial infarction (4.3% vs. 1.1, P=0.053). The<br />
prevalence of suggested treatments (percutaneous or surgical intervention and medical<br />
treatment) were similar in both groups (P=0.32). In-hospital Mortality was not<br />
statistically different between non-Q-wave and Q-wave myocardial infarction (10.3% vs.<br />
9.6%, P=0.59). Heart failure (P=0.036) and pulmonary edema were more frequent in Q-<br />
wave (P=0.043) and CVA was more frequent in non-Q-wave myocardial infarction<br />
(P=0.017).<br />
Conclusion: Patients with non-Q-wave myocardial infarction in comparison with Q-<br />
wave patients had similar angiographic features and in-hospital mortality rate and do not<br />
seem to have a worse prognosis<br />
39<br />
Normal values for ventricular synchrony measured by tissue<br />
Doppler imaging and tissue Doppler synchronization imaging<br />
in structurally normal hearts<br />
Sadeghian H, Saheb Jam M, Yamini Sharif A, Kazemisaied A, Fallah N,<br />
Goodarzynejad HR and Raissi Dehkordi M<br />
Tehran Heart Center, Medical Sciences/University of Tehran, Tehran, Iran
Abstract<br />
Background: We studied normal values for intraventricular and interventricular delay<br />
by tissue Doppler imaging (TDI) and tissue synchronization imaging (TSI).<br />
Methods: We evaluated 25 healthy adult volunteers (26.30±5.68 years, 16% male).<br />
Tissue Doppler Echocardiography was performed (system VIVID 7D, GE) using a 6-<br />
basal, 6 mid-segmental model to assess the time-to-peak systolic contraction (Ts). We<br />
also evaluated the right ventricle at basal and mid portion levels. We measured Ts both<br />
manually and with TSI.<br />
Results: Anterior basal and mid-portion had the shortest Ts and interventricular septum<br />
had the longest Ts with both methods. Correlation between manual and TSI methods was<br />
significant (p
29.25<br />
88.40<br />
200<br />
TDI: 60<br />
Anterior<br />
9.01<br />
77.28<br />
98<br />
TSI: 61<br />
midportion<br />
47.26<br />
153.60<br />
210<br />
TDI: 24<br />
Septal basal<br />
39.88<br />
141.56<br />
216<br />
TSI: 78<br />
40.89<br />
37.09<br />
161.60<br />
125.40<br />
210<br />
216<br />
TDI: 80<br />
TSI: 82<br />
Septal<br />
midportion<br />
38.10<br />
181.20<br />
230<br />
TDI: 40<br />
RV basal<br />
24.26<br />
176.04<br />
228<br />
TSI: 129<br />
52.56<br />
20.89<br />
173.60<br />
175.12<br />
260<br />
217<br />
TDI: 12<br />
TSI:129<br />
RV<br />
midportion<br />
41<br />
Discrete subvalvular aortic stenosis: severity of aortic<br />
insufficiency and rate of recurrence after <strong>surgery</strong><br />
Tehran Heart Center, Medical Sciences/University of Tehran, Tehran, Iran<br />
Abstract<br />
Background: Discrete subaortic stenosis (DSS) is a progressive condition, and it is<br />
debatable whether <strong>surgery</strong> reduces the severity of aortic insufficiency (AI). The aim of
this study was to determine the changes in the severity of aortic regurgitation and the<br />
recurrence rate of obstruction after <strong>surgery</strong> in patients with discrete subaortic stenosis.<br />
Methods: Between March 2002 and January 2006, 28 patients with a mean age of (28.9<br />
± 15.4) years were evaluated before and after <strong>surgery</strong> for DSS. Mean follow-up time was<br />
14.6 ± 10.2 months. Peak systolic gradients across the left ventricular outflow tract and<br />
severity of aortic regurgitation were evaluated by Doppler Echocardiography.<br />
Results: preoperative left ventricular outflow tract gradient of our patients were •30<br />
mmHg which decreased from a mean of 89.46 ± 41.67 to 25.23 ± 17.26 mmHg<br />
postoperatively and reached to 27.38 ± 19.02 mmHg at follow-up. The gradient remained<br />
•30 mmHg in 42.9% of patients at follow up. AI was identified in 22 (78.5%) patients<br />
preoperatively: 1+ in 13 (59.1%) patients and 2+ in 9(40.1%) patients. From 9 patients<br />
with grade 2 of AI, 2 (22.2%) remained unchanged, 4 (44.5%) had 1+, 1 (11.1%) had 4+<br />
AI (bicuspid aortic valve) and 2 (22.2%) were lost to follow-up. We had 2 recurrences of<br />
membrane after operation and 2 of our patients underwent <strong>surgery</strong> because of recurrence.<br />
Conclusion: Our results suggest that although subaortic resection may reduces the<br />
severity of AI in some patients, future studies with more cases are needed to determine<br />
whether the severity of AI decreases after membrane resection.<br />
Keywords: Subvalvular aortic stenosis, valvular heart <strong>surgery</strong><br />
42<br />
Repositioning of dislodged atrial pacing lead with a specially<br />
designed urologic basket<br />
Yamini Sharif A, Davoodi Gh and Kazemi Saeed A<br />
Tehran Heart Center, Medical Sciences/University of Tehran, Tehran, Iran<br />
Abstract<br />
Background: Lead dislodgement requiring reoperation is a complication that raises the<br />
costs of pacemaker implantation <strong>surgery</strong> while adding to patient discomfort. Migration of
a dislodged lead can cause complication such as under sensing, loss of atrial capture and<br />
loss of atrial kick in patients who need AV synchrony. Once detected, the dislodged lead<br />
should be immediately repositioned. In recent years, percutaneous transcatheter<br />
repositioning of displaced permanent pacemaker leads has been advocated before<br />
consideration of surgical repositioning. The procedure is easy and safe, allowing a<br />
reduction of the need for surgical lead revision and the associated morbidity and cost. In<br />
this report we introduce a method with specially designed urologic basket (figure 1) to<br />
solve this problem in 2 patients<br />
Methods : To perform repositioning of passive fixation atrial pacing leads , patients<br />
were brought to cath. lab in the post absorptive non-sedated state .Mullins sheath was<br />
placed around the atrial lead of pacemaker and by using the deflectable ablating<br />
catheter,the Mullins sheath was positioned over the loop of the atrial pacing lead. After<br />
the removal of the ablation catheter, the specially designed urologic basket was sent over<br />
the loop of passive fixation j-shaped atrial lead. The deflectable part of this basket was<br />
passed through the tip of Mullins sheath which had been positioned over the loop of the<br />
dislodged pacemaker lead. By deflecting the tip of basket, we made a hook around the<br />
lead. Then by pulling back the basket and Mullins sheath and some traction, the atrial<br />
lead was sent to a new position in the atrium. Immediately pacing analysis was<br />
performed, atrial pacing and sensing parameters were acceptable. By decreasing the<br />
curve and pulling back of the basket into the Mullins sheath, all devices were taken out.<br />
Results: During follow up, in one patient the lead was stable and did not move again,<br />
and in a second patient the repositioned lead dislodged again (one day after the<br />
procedure) and migrated to the previous position (SVC). Therefore, this pacemaker<br />
problem was corrected in a second operation session by the replacement of an active<br />
fixation lead.<br />
Conclusion: Percutaneous techniques could also allow us to reposition leads in a less<br />
aggressive way, maintaining adequate success and reducing the number of complications.<br />
Repositioning of displaced passive fixation atrial pacing leads with this basket could be<br />
another solution when the lead is tightly fixed to the atrial wall or SVC. When this is not<br />
feasible, surgical approach is necessary to manage the problem.<br />
43
Figure .1These figures show the specially designed urologic basket and how it makes a<br />
hook.<br />
44<br />
Radiofrequency ablation of cardiac arrhythmia using a threedimensional<br />
real-time position management and mapping<br />
system<br />
Yamini Sharif A, Kazemi Saeed A and Davoudi Gh<br />
Tehran Heart Center, Medical Sciences/University of Tehran, Tehran, Iran<br />
Abstract
Background: A recently developed three- dimensional real-time position management<br />
system (RPM) uses an ultrasound ranging technique that enables multiple distance<br />
measurements between two reference catheters and a mapping catheter each equipped<br />
with ultrasound transducers. In addition to three-dimensional representation of the<br />
catheters and ablation sites, it displays real- time movement of catheters (including the<br />
tip and shaft) .A recently released version of the system enables additional geometry<br />
reconstruction of the heart chamber and activation mapping. This study included four<br />
patients referred for radiofrequency ablation of arrhythmia.<br />
Methods: Geometry was reconstructed by tracing the endocardial contour of the<br />
respective heart chambers. Global and color coded activation maps were constructed to<br />
confirm the nature of arrhythmia and to guide ablation. Spontaneous or induced<br />
arrhythmia were AVNRT common type (n=2) and atrial tachycardia (n=2). Geometry<br />
reconstruction and mapping of arrhythmia were possible in all of them.<br />
Results: RPM-guided radiofrequency ablation was successful in 3 of 4 patients. In the<br />
patient who had atrial tachycardia very close to AV node, this system was very useful to<br />
show the location of arrhythmia. This patient was successfully ablated with no damage to<br />
AV nodal system. .Ablation procedures were successful in both patients with AVNRT,<br />
but it took a long time to insert the reference catheter into the <strong>coronary</strong> sinus and to map<br />
the arrhythmia. During follow-up, in one patient the lead was stable and did not move<br />
again, n a second patient the repositioned lead dislodged again( one day after the<br />
procedure) and migrated to the previous position(SVC), so this pacemaker problem was<br />
corrected in the second operation session by the placement of an active fixation lead.<br />
Conclusion: The new RPM system enables geometry reconstruction, and threedimensional<br />
positioning of the ablation catheters, reconstruction of the activation maps,<br />
marking of anatomic structures and reproducible tracking of multiple ablation sites. The<br />
system could be used to guide radiofrequency ablation of atrial and ventricular<br />
arrhythmia, and it is not logical and economical to use this system for arrhythmias that<br />
are easily ablated with conventional methods. In the future, we hope to solve the<br />
technical and administrative problems leading to some difficulties in using this new<br />
system.<br />
45<br />
Higher dose of heparin administration for prevention of<br />
catheter - induced thromboembolic events during cardiac<br />
catheterization & <strong>coronary</strong> angiography<br />
Yamini Sharif A, Khoshgoftar Z, Mohamadhossaini M,Sheikhrezaii F, Ghazanchai F,<br />
Nayebhosaaini M, Arab M and Ghayeghvar F<br />
Tehran Heart Center, Medical Sciences/University of Tehran, Tehran, Iran<br />
Abstract
Background: Prophylactic heparin during cardiac catheterization is recommended by<br />
some authors, but there are controversies about the recommended doses. After occurrence of<br />
a case of stroke in one of our patients during <strong>coronary</strong> angiography, we decided to evaluate<br />
the safety and efficacy of higher dose of heparin in prevention of thromboembolic events<br />
during cardiac catheterization& <strong>coronary</strong> angiography.<br />
Methods: From February 2002 to May 2005, seven hundred consecutive patients who<br />
underwent cardiac catheterization entered the study in prospective manner. Exclusion criteria<br />
were systolic blood pressure •200 mm Hg, coagulopathy, end stage renal disease, and<br />
multiple attempts to gain arterial access (> 1 arterial puncture).The intervention consisted of<br />
altering the routine dose of heparin (1000IU) to a higher dose (5000IU), in the above<br />
mentioned patients 1500IU intra introducer, the remaining in to the galipot and it was used<br />
during the procedure. Protamin sulfate was not used to neutralize heparin. All of the study<br />
population was assessed for thromboembolic as well as hemorrhagic events. Additionally in<br />
100 randomly selected subjects who received higher dose of heparin, "Compression time"<br />
was calculated and compared with a matched control group with previous dose (1000IU).<br />
Results: No hemorrhagic complication such as massive hematoma, intracranial<br />
hemorrhage, gastrointestinal or urinary tract bleeding occurred in our patients. We also did<br />
not find any thromboembolic events including stroke, renal or mesenteric emboli in our<br />
patients. More over, "compression time" was similar in both groups (6.5 ± 2 versus 6.7±2<br />
minutes).<br />
Conclusion: Higher prophylactic dose of heparin during cardiac catheterization appears to<br />
be free from the increased risk of major hemorrhagic events. More studies with larger study<br />
population are required to investigate the efficacy of this protocol in preventing<br />
thromboembolic events during cardiac catheterization & <strong>coronary</strong> angiography.<br />
46<br />
Early complications of permanent pacemaker implantation<br />
Yamini Sharif A, Kazeme Saeed A, Davoodi Gh, Abolbaghaei SM, Paydari N and<br />
Goodarzynejad HR<br />
Tehran Heart Center, Medical Sciences/University of Tehran, Tehran, Iran<br />
Abstract<br />
Background: This study was done to evaluate the incidence of intra operative and early<br />
postoperation complication (up to two months after implantation) of permanent pacemaker<br />
insertion in all patients undergoing a first implant at our center.<br />
Methods: Retrospective evaluation of all pacemaker implantation procedures performed<br />
from May 2002 to March 2006 was carried out by completion of our database form. Patients`
demographic data, medical history, details of pacemaker hardware used, and major<br />
complications were noted. Five hundred eighty-one consecutive patients underwent<br />
implantation of their first permanent pacemaker. The mean age was 68±14 years (range: 15-<br />
95) and 48.7% were male. Dual chamber units were implanted in 136 patients (23.4%) and<br />
single chamber pacemakers (VVIR) were implanted in 257 patients (44.2%).<br />
One hundred thirty-six patients received (VDDR) pacemakers (23.4%) and (VVI)<br />
pacemakers were implanted in two patients. Most implants (82.4%) were performed via right<br />
subclavian vein. The most common cause of PPM insertion was complete heart<br />
block(79.7%), followed by sick sinus syndrome in 9.3%, two to one AV Block (5.2%) and<br />
4.1% Tachy-brady syndrome.<br />
Results: Twenty four patients (4.13%) required reoperation. Ventricular or atrial lead<br />
displacement (n=19) was the most common reason for reoperation, and pacemaker pocket<br />
infection led to reoperation in 2 patients (0.34%). Pneumothorax occurred in 3 patients and<br />
was treated successfully with chest tube insertion.<br />
Conclusion: In our center, the incidence of complications following pacemaker<br />
implantation was low and compares favorably with complication rates in other centers. Lead<br />
dislodgement was the most common reason for second operation. Infection rates were low,<br />
(
<strong>surgery</strong>, and post percutaneous transvenous mitral commissurotomy (PTMC) underwent an<br />
outpatient cardiac rehabilitation (CR) program (three exercise sessions per week of 1 hour)<br />
from July 2004 to January 2006. We comprised them in three groups before and after CR:<br />
group ǿ completed <br />
10, group ǿǿ: 11 to 20, and group ǿǿǿ: 21 to 30 sessions. Also, each<br />
group was assessed in two subgroups in terms of gender. Data were collected from CR<br />
database.<br />
Results: The three groups were similar in mean age, gender, and the frequency of risk<br />
factors. There were 64.1% patients in group ǿ, 15.4% in group ǿǿ, and 18.8% in group ǿǿǿ.<br />
At baseline, consumptive calorie, and treadmill velocity were similar between all the groups,<br />
and subgroups that after CR, significantly accelerated in each group, and subgroup, but<br />
among the groups, group ǿǿǿ was the most (P
groups: Group I (n = 342) included patients < 40 years, group II (n = 765) included<br />
patients > 60 years.<br />
Results: Most of patients were male in both groups (82 Vs 60.5%). Family history of<br />
<strong>coronary</strong> <strong>artery</strong> disease, current smoking and opium addiction were more prevalent in<br />
younger patients (p < 0.001). Dyslipidemia, hypertension and diabetes mellitus were<br />
more prevalent in older patients (p < 0.001). Excluding normal angiogram, presentation<br />
of <strong>coronary</strong> <strong>artery</strong> disease in two groups was: 36% in group I and 14% in group II with<br />
ST elevation MI (p < 0.001), 8% in group I and 7% in group II with non ST elevation MI<br />
(p = 0.71), 23% in group I and 31% in group II with unstable angina (p = 0.029), 34% in<br />
group I and 48% in group II with stable angina (p < 0.001). Coronary angiography<br />
revealed more number of multivessel in older patients (62 Vs 31%; p
Results: There were no differences in mean age, gender, the frequency of risk factors<br />
between the groups. At baseline; consumptive calorie and treadmill velocity were similar in<br />
all groups (mean: 31.9, and 2.8, respectively). But after CR, calorie increased by 50.2±12.4 in<br />
group ǿ vs. 67.3±18.7 in group ǿǿ vs. 71.3±11.3 cal⁄h in group ǿǿǿ. Also, velocity improved<br />
in each group: 3.8±1 vs. 4.8±1 vs. 6.2±1.8 km⁄h, respectively, but these accelerations in<br />
calorie, and velocity were the greatest in group ǿǿǿ (P
efore and after CR.<br />
Results: Mean age, gender, and the frequency of risk factors were similar between the three<br />
groups. Before CR, these groups were similar in consumptive calorie, and treadmill velocity.<br />
After CR, consumptive calorie in group ǿ increased from 34.9±6.7 to 51±9.4 cal⁄h (P
involvement and stenosis greater than 70% were selected. Thereafter, patients were<br />
assigned to two groups: severe (70-90%) and very severe (>90%) stenosis and then<br />
correlation of ECG abnormalities with severity of <strong>coronary</strong> <strong>artery</strong> stenosis were assessed.<br />
Results: Participants include 90 female (40.7%) and 131male (59.3%) patients<br />
between25-79 at a mean age 55.05 years old. The <strong>coronary</strong> arteries that showed<br />
correlation with ECG abnormalities were left anterior descending (LAD) and left<br />
circumflex (LCX). LAD very severe stenosis (119 patients, 53.84 %) correlated<br />
significantly with inverted T in V1-V4 and AVL leads. Existence of inverted T in V1-V4<br />
and AVL leads was 53.8% and 31.1% respectively. Inverted T wave in V5-V6, inferior<br />
(II, III and AVF) and AVR was 40.3%, 6.7% and 0.0% respectively. There were 49<br />
patients (22.17%) with LAD severe stenosis which 25 patients (51%) of them presented<br />
inverted T in V1-V4 leads, but it was insignificant. There were 4 LCX severe stenosis<br />
cases (< 2%) associated with ST depression in V1-V6 leads.<br />
Conclusions: This study shows that existence of inverted T wave in V1-V6<br />
(precordial) ECG leads certainly correlates with the site of <strong>coronary</strong> <strong>artery</strong> stenosis in<br />
very severe LAD stenosis.<br />
52<br />
The association between hepatitis B surface antibody<br />
seropositivity and <strong>coronary</strong> <strong>artery</strong> disease<br />
Amirzadegan A, Davoodi Gh, Borumand MA, Raissi Dehkordi M, Goodarzynejad HR,<br />
Darabian S and Fallah N<br />
Tehran Heart Center, Medical Sciences/University of Tehran, Tehran, Iran<br />
Abstract<br />
Background: Specific infectious agents have been found to be related to the<br />
pathogenesis of <strong>coronary</strong> atherosclerosis. In this study, we assessed the possible<br />
association between angiographically-proven <strong>coronary</strong> <strong>artery</strong> disease (CAD) and<br />
Hepatitis B surface antibody (HBsAb) seropositivity.<br />
Methods: HBsAb and C - Reactive protein (CRP) were checked with Enzyme-linked<br />
immunosorbent assay and immunoturbidometry in 703 patients with no history of<br />
Hepatitis B vaccination prior to <strong>coronary</strong> angiography. Angiographic results were
eported by two cardiologists for inter-observer reliability and interpreted as significant<br />
CAD in case of •50% stenosis in •1 major <strong>coronary</strong> <strong>artery</strong> (group 1) versus normal<br />
<strong>coronary</strong> or
Results: We found 15 patients (0.35%) with segmental backflow phenomenon with a mean<br />
age of 46 years (Range: 29-61).The male to female ratio was 1.5. At 1-year's follow up, no<br />
patients presented with acute myocardial infarction and there was no mortality. But as a<br />
result of angina like chest pain, six patients were admitted to CCU in this period of time.<br />
Conclusion: Pure Segmental backflow indicates an abnormal flow in <strong>coronary</strong> arteries and<br />
can be considered as a cause of myocardial ischemia. At present the data is not sufficient to<br />
delineate the borders of this phenomenon. It should be clarified if this finding is a separate<br />
entity or sign of other pathologies such as atherosclerosis or ectasia. In addition, more time is<br />
required for better determining the prognosis of the patients with this angiographic finding.<br />
54<br />
The relationship between androgen levels in men and different<br />
stages of heart failure<br />
Davoodi Gh, Borumand MA, Amirzadegan A, Raissi Dehkordi M, Salarifar M,<br />
Haji Zeinali AM and Paydari N<br />
Abstract<br />
Background: Previous studies have shown that Congestive Heart Failure (CHF) may<br />
have correlation with low androgen levels in men. Some experts have even proposed to<br />
treat CHF with exogenous androgens. This study was conducted to compare androgen<br />
levels in patients with and without heart failure scheduled for <strong>coronary</strong> angiography.<br />
Methods: Three pooled blood samples were taken from 515 consecutive male patients<br />
before angiography. Blood samples were checked for free testosterone (fT) with Enzymelinked<br />
immunosorbent assay and total testosterone (tT) and Dehydroepiandrosterone
sulfate (DHEA-S) with Radio immunoassay. Ejection Fraction (EF) was assessed<br />
according to echocardiographic and angiographic findings. Androgen levels were<br />
compared in patients with an EF
Results: Male and female patients' mean age was 60.06 & 60.68 years, respectively.<br />
Prevalence of single vessel disease (SVD), 2VD, 3VD and Left main (LMS) lesion in<br />
males was16.7%, 21.2%, 56.7% and 5.5%, respectively. Prevalence of these lesions in<br />
females was 23.3%, 25.1%, 48.2% and 3.4%, respectively. Involvement of major<br />
diagonal (MD) (p
circumferences and the risk of metabolic syndrome in 302 men aged
dehydroepiandrosterone sulfate(DHEA-S) with radioimmunoassay, lipid profile,<br />
lipoprotein a (Lpa), and CRP were taken from 529 consecutive patients before SCA.<br />
Angiographic results were reported by two cardiologists and checked for intra- and interobserver<br />
reliability, before they were interpreted as Gensini Score , and on the base of the<br />
number of involved segments. The relations were assessed with independent sample t-<br />
tests and Chi-square.<br />
Results: 16% of the patients had single, 22% had two, and 38% had three-vessel<br />
disease. 22% had normal angiograms or minimal lesions. Significant lesions in right<br />
<strong>coronary</strong> <strong>artery</strong>, left anterior descending, and left circumflex were seen in 53%, 69% and<br />
53% of the patients, respectively. fT, tT, and DHEA-S in patients with significant CAD<br />
vs. normal individuals were 6.70±3.21pg/mL, 16.80±6.94nm/L, and 113.55±72.73µg/dL<br />
vs. 7.10±3.57pg/mL, 15.83±7.23nm/L, and 111.86±74.32µg/dL, respectively,<br />
p>0.05).There was no correlation between Gensini Score or the number of involved<br />
segments and androgen levels. However, a significant negative correlation was found<br />
between fT, and Lpa and CRP(p=0.014 and p=0.017, respectively).<br />
Conclusion: There is no significant correlation between fT, tT, DHEA-S and presence<br />
or severity of CAD. Also, no correlation was found between androgen levels and lipid<br />
profile. However, CRP and Lpa levels negatively correlate with fT concentration.<br />
Hoseini K, SadeghianS and Mahmoodian M<br />
58<br />
Parental cardiovascular disease as a risk factor for acute<br />
<strong>coronary</strong> syndromes in adult offspring<br />
Tehran Heart Center, Medical Sciences/University of Tehran, Tehran, Iran<br />
Abstract<br />
Background: Whether parental cardiovascular disease confers increased event risk<br />
independent of other risk factors remains controversial. We investigate influence of<br />
parental cardiovascular disease as an independent predictor for acute <strong>coronary</strong><br />
syndromes in offspring and importance of maternal or paternal induced risk.<br />
Methods: Data originated from single center ischemic heart disease registry and<br />
consisted of 6399 patients with established ischemic heart disease, admitted between<br />
June 2004 to March 2006.<br />
Results: 1352(21.1%) patients had a positive family history of <strong>coronary</strong> <strong>artery</strong> disease.
Among 953 patients with verified family history, father had <strong>coronary</strong> <strong>artery</strong> disease in<br />
193(17.4%), mother in 215(19.4%), brother in 257(23.1%) and sister in 118(10.6%)<br />
patients. The mean age of clinical onset of ischemic heart disease in patients with only<br />
positive family history as a risk factor was significantly lower compare with that in the<br />
others (59.21±13.21 vs. 64.58±32.84, P
positioned in lateral vein of <strong>coronary</strong> sinus, RV lead in RV apex and RA lead in the<br />
appendage of RA inserted. The patients were followed for up to 6 months; and<br />
echocardiography, 6-min walking test, EKG analysis and clinical functional class were<br />
assessed. The patients were categorized into two groups of responders and nonresponders<br />
according to their clinical and paraclinical findings. The EKGs were taken<br />
immediately, one month and 3 months after CRT.<br />
Results: In responder group 50% of LBBB patterns were switched to RBBB patterns,<br />
while this percentage was 60% in non-responders. The percentage of R>S in lead V1 was<br />
53% in responders and 28% in non-responders, respectively. There was 25% of R>S in<br />
lead aVR in the responders and 0% in non-responders. These differences were<br />
statistically significant (P
Methods: 150 patients who had referred for <strong>coronary</strong> angiography were randomized into<br />
three groups with equal populations. The first group (DP) received intramuscular injection of<br />
5 mg diazepam + 25 mg promethazine. The second (M) received 0.2 mg/kg intravenous<br />
midazolam, and the third group (P) received 2cc intravenous distilled water. Vital signs and<br />
arterial blood O2 saturation were recorded in specifically-designed questionnaires.<br />
Results: There was no significant difference in pulse rate, respiratory rate, and mean<br />
systolic blood pressure between these groups. Diastolic blood pressure decreased in all<br />
groups after angiography, which was more significant in group M (p
TG, Cholesterol, LDL and HDL were measured. Noninvasive studies for CAD performed<br />
with resting ECG, exercise stress test and echocardiography. If these tests were positive<br />
myocardial perfusion scan performed and if it was positive we proceeded to <strong>coronary</strong><br />
angiography.<br />
Results: DM was found in 5.3 %, smoking in 14.7%, hypertension in 20.6%, cholesterol<br />
> 200 mg/dl in 39.9%, TG > 200 mg/dl in 18%, LDL > 160 mg/dl in 24.6% and HDL <<br />
40 mg/dl in 32.6%. 6.4% had ECG changes and 3% echocardiographic abnormalities in<br />
favor of ischemia. ETT was positive in 7.3% (51 individuals ,36 females and 15<br />
males)and myocardial perfusion scan was positive in 2.1 % of the total study<br />
population(15 individuals ,10 males and 5 females).Coronary angiography showed<br />
stenosis of <strong>coronary</strong> lumen(50-70 % ) in 8 patients (1.1%) and stenosis of >70 % in 4<br />
patient (0.6%).Only 1 patient had severe 3VD and none had left main disease. Others<br />
had SVD (5 patients) and 2VD (6 patients).<br />
Conclusion: We found a high rate of cardiovascular risk factors in sibling and<br />
offspring of patients with premature CAD. Determination of these risk factors and proper<br />
management may be beneficial. Noninvasive tests for CAD yield low true positive results<br />
and is not recommended in this population<br />
Keywords: premature <strong>coronary</strong> <strong>artery</strong> disease, Non-invasive tests, cardiovascular risk<br />
factors<br />
62<br />
Left ventricular ejection fraction by left ventriculography<br />
before or after <strong>coronary</strong> angiography: Correlation with<br />
echocardiography<br />
Kazemi Saeed A, Salarifar M, Haji Zeinali AM, Davoodi Gh, Amirzadegan A,<br />
Yamini Sharif A and Hakki Kazazi E<br />
Tehran Heart Center, Medical Sciences/University of Tehran, Tehran, Iran<br />
Abstract<br />
Background: Measurement of global left ventricular function is important in the<br />
follow-up of cardiovascular disease and is a good prognostic indicator in cardiac<br />
situation. Detection of ejection fraction made with ventriculography after <strong>coronary</strong><br />
angiography maybe decrease ejection fraction falsely because of cardio-depressant
effects of contrast media. The purpose of this study was to evaluate the effect of the<br />
angiographic contrast medium on left ventricular ejection fraction in patients undergoing<br />
<strong>coronary</strong> angiography.<br />
Methods: We categorized the patient population in two groups: group I (n = 1027)<br />
included patients whose ejection fraction was evaluated with ventriculography before<br />
<strong>coronary</strong> angiography and group II (n = 5612) was compromised of patients whose<br />
ejection fraction was evaluated with ventriculography after <strong>coronary</strong> angiography. We<br />
calculated the difference between ejection fraction in echocardiography and<br />
ventriculography in the two groups and then compared the mean of this difference<br />
between the two groups with independent T-test.<br />
Results: Mean difference between ejection fraction in echocardiography and<br />
ventriculography was 1.06 ± 9.83% in group I and 0.8 ± 10.47% in group II (p = 0.45).<br />
Conclusion: The injection of moderate amounts of contrast in <strong>coronary</strong> angiography<br />
does not cause significant changes in ejection fraction immediately after <strong>coronary</strong><br />
angiography compared with before left ventriculography. Keywords: Left ventricular<br />
ejection fraction, Ventriculography, Echocardiography<br />
63<br />
Cardiovascular morbidity in relation to educational level in<br />
patients with chest pain presentation<br />
Yamini Sharif A, Kazemi Saeed A, Sadeghian H, Alidoosti M,. Darabian C,<br />
Sahebjam M and Mahmoodian M<br />
Abstract<br />
Background: In many industrialized countries inverse associations have been reported<br />
between socioeconomic and educational status and the prevalence of morbidity and<br />
mortality from cardiovascular disease. The aim of this study was to investigate, in a<br />
developing country, the influence of educational level on the prevalence of <strong>coronary</strong><br />
<strong>artery</strong> disease and related risk factors in patients with chest pain at the time of admission.<br />
Methods: Data originated from single center ischemic heart disease registry and<br />
consisted of 7041 patients who presented with chest pain, carried out from June 2004 to
March 2006.<br />
Results: 515(8.1%) patients had high levels of academic education as high educational<br />
level. Males were found to have a higher educational level than females (P
ooms was excluded. Successful CPR was defined as a complete improvement of the<br />
patient’s condition without any residual sequel or complication. Early results were calculated<br />
immediately after CPR, after 24 hours and at discharge and were revealed as percentage of all<br />
resuscitated patients. Regarding CPR results patients were stratified into two groups:<br />
successful and unsuccessful CPR. All factors in these groups were compared.<br />
Results: Between January 2005 and March 2006, 577 patients (320 male and 257 female,<br />
Mean age: 65.24±13.66) were resuscitated. The most important etiology of the CPR were<br />
arrhythmia (36.7%), respiratory failure (30.3%), and homodynamic instability (25.0%).<br />
Overall, success rates after resuscitation, at 24 hours and at discharge were 51.0%, 40.0% and<br />
28.3%, respectively. CPR by various etiologies had significantly different success rates<br />
which are presented in table 1. The lowest success rates were seen in the homodynamic<br />
instability [after resuscitation] and asystol or bradicardia [at 24 hours and at discharge]. Age,<br />
sex, concurrent disease and serum pH were similar between groups. As it is shown in the<br />
table 2 upper GCS levels (>8), cardiac massage duration lower than 15 minutes and CPR<br />
duration
2.78<br />
4.87<br />
1.23<br />
1.27<br />
1.85<br />
2.49<br />
0.003<br />
0.007<br />
Atropine dose < 2 mg<br />
Serum potassium lower than 6 mEq/L<br />
resuscitation (Univariate Analysis) OR: Odds Ratio ; CI: Confidence Interval<br />
Table 1: Success rates in CPR by different etiology<br />
At<br />
Discharge<br />
13.5<br />
25.6<br />
43.1<br />
12.4<br />
30.4<br />
Success Rates (%)<br />
At 24 hours After Resuscitation<br />
20.4<br />
38.2<br />
34.7<br />
52.5<br />
61.5<br />
73.1<br />
18.5<br />
40.5<br />
43.8<br />
61.0<br />
Etiology<br />
Homodynamic instability<br />
Arrhythmia<br />
VF-VT<br />
Asystol or bradycardia<br />
Respiratory failure<br />
66<br />
Early clinical result of double endarterectomy and<br />
reconstruction combined with multiple <strong>bypass</strong> <strong>graft</strong>ing for<br />
severe <strong>coronary</strong> <strong>artery</strong> disease: A single institute experience<br />
Marzban M, Karimi AA, Ahmadi SH, Movahedi N, Abbasi K, SalehiOmran A,<br />
Davoodi S and Yazdanifard P<br />
Tehran Heart Center, Medical Sciences/University of Tehran, Tehran, Iran<br />
Abstract
Background: Coronary <strong>artery</strong> endarterectomy is a valuable adjunct to conventional <strong>bypass</strong><br />
<strong>surgery</strong> when attempting to revascularize “diffuse <strong>coronary</strong> <strong>artery</strong> disease “disease <strong>coronary</strong><br />
arteries. In this study we examined the early clinical outcome of double <strong>coronary</strong><br />
endarterectomy.<br />
Methods: Between January 2002 and 2006, 10136 patients underwent <strong>coronary</strong> <strong>artery</strong><br />
<strong>bypass</strong> that 221 of whom (2.1%) required endarterectomy and 20 cases (0.2%) required<br />
double endarterectomy. There were16 men (80%), ranging in age from 44 to 80 (average 58).<br />
All of 20 patients (100%) had angina preoperatively, which was Canadian cardiovascular<br />
society (ccs) class III or IV in13 patients. The average EF was42% and 4 patients (5%) had<br />
low EF (24 h) and cardiac arrest in one patient (5%). 15 patients of 19 (78%)<br />
were followed up for a mean of 21 months. There were 2 death (13%) five months post<br />
operatively both in cardiac cause. In left 13 patients, four (30%) were in angina class I by ccs<br />
and 8 patients (61.5%) were in class II and one patient was in class III. There was no post<br />
myocardial infarction.<br />
Conclusion: Although diffuse CAD is an important risk factor of CABG, but even in these<br />
patients, CABG adjunct to <strong>coronary</strong> endarterectomy is feasible and successful in symptom<br />
relief.<br />
67<br />
Non use of left internal mammary <strong>artery</strong>: It's contributing<br />
factors<br />
Tehran Heart Center, Medical Sciences/University of Tehran, Tehran, Iran<br />
Abstract<br />
Background: In our institute, as in most centers, the left internal mammary <strong>artery</strong><br />
(LIMA) is the first choice conduit for <strong>coronary</strong> <strong>artery</strong> <strong>bypass</strong> <strong>graft</strong>ing. The purpose of this<br />
study was to investigate the frequency of non-use of lima as a <strong>bypass</strong> conduit and it’s<br />
contributing factors.<br />
Methods: A total of 11000 consecutive patients who underwent CABG (isolated or<br />
combined) from February 2002 up to 2006 were reviewed. The demographic and<br />
contributing factors to non-use of LIMA identified from the data base and operation notes<br />
of patients.
Results: 351 patients of 11000(3.2%) didn’t receive Lima for CABG, 48.7%were in the<br />
first year of hospital practice, 27.1% in second year, 14.5% in 3 year,9.4% in the last year.<br />
The mortality rate of 11000(isolated and combined CABG) was 1.2%, but in study group was<br />
10.6%. 175 patients of 351(49.9%) were women while 26% of 11000 patients were<br />
women.114 patients of 351(32.5%) had diabetes, 4.8% had urgency CABG, 9.4% had normal<br />
LAD and 8.5% had low flow and unsuitable LIMA.0.6 % had left sided arteriovenous fistula,<br />
2.3% had previous CABG, 2.6% had left ventricle anurysm, 2.8% had copd, 4.6%had<br />
osteoprotic sternum and 4.3%had poor <strong>coronary</strong> vessels.<br />
Conclusion: In comparison with most centers the frequency of LIMA usage is acceptable,<br />
as the experience increases so does use of LIMA is increasing. In some groups of patients,<br />
such as those with huge left ventricular aneurysm with LAD involvement or patients with left<br />
sided AVF or when there is unrepairable damage to LIMA, non-use of LIMA is<br />
inevitable. Nevertheless, some patients still deprive of LIMA unreasonably.<br />
68<br />
nondiabetic patients: A comparative study<br />
Ahmadi SH, Alinejad B, Karimi AA, Marzban M, Abbasi , Salehi Omran A,<br />
Davoodi Gh and Abbasi SH<br />
Tehran Heart Center, Medical Sciences/University of Tehran, Tehran, Iran<br />
Abstract<br />
Background: We evaluated the impact of diabetes mellitus on in-hospital mortality and<br />
morbidity after CABG.<br />
Methods: From February 2002 through January 2006, 9163 patients (3094 diabetic and<br />
6069 non-diabetic) underwent isolated CABG at our center. Demographic and
preoperative data and postoperative in-hospital mortality and morbidity were compared in<br />
both diabetic and non diabetic groups. Univariate and multivariate analysis were<br />
performed to compare the results.<br />
Results: Diabetic patients in comparison with non-diabetics were older (mean age 59.6y<br />
vs. 57.9y), included more women (37.6 %vs. 19.4%), had more postoperative<br />
mediastinitis (0.7%vs. 0.2 %) , renal failure (0.8% vs. 0.3%), cardiac arrest (1.1% vs.<br />
0.7%), and in-hospital mortality (1.5%vs 0.5%) (p< 0.05). We found no significant<br />
differences in left main <strong>coronary</strong> <strong>artery</strong> disease (9.8% vs. 9.6%), postoperative prolonged<br />
ventilation (1.2% vs. 0.8%), and atrial fibrillation (6.3% vs. 5.6%) between two groups<br />
(p>0.05).There were also significant differences in hospital stay (mean 8.0 vs. 7.2 days),<br />
ICU stay (mean 40.8 vs. 38.5 hours), and mean aortic cross clamp and cardiopulmonary<br />
<strong>bypass</strong> times between diabetics and non-diabetics (44.38vs 42.95 min and 74.28 vs. 71.85<br />
min respectively) (p
Results: All patients were men with a mean age of 50.2± 9 years. The major causes of<br />
renal failure were primary hypertension in 25%, diabetes mellitus in 18%, and combined<br />
of these causes in 34%. The qualities of <strong>graft</strong>s were poor in 5 patients, moderate in 2<br />
patients and good in 2. Mean preoperative ejection fraction was 40.5%±15% (range 25%<br />
to 50 %). Cardiopulmonary <strong>bypass</strong> and aortic cross-clamp times were 80.2 ± 15 and 43.8<br />
± 10 minutes respectively. Intra aortic balloon pump was used for one patient. The<br />
complications were prolonged ventilation in one patient and pricardial effusion in another<br />
one. There was not early mortality. In long-term fallow up (mean time: 2.8 years) the late<br />
mortality rate was 33.3% (3 patients). The causes were infection and renal failure in 2<br />
patients, and end stage renal failure in one.<br />
Conclusion: Coronary <strong>artery</strong> <strong>bypass</strong> <strong>graft</strong>ing could be performed in dialysis –<br />
dependent patients with acceptable perioperative morbidity and mortality risks if there is<br />
a well-organized dialysis program.<br />
70<br />
The impact of low serum triglyceride on LDL-cholesterol<br />
estimation<br />
Ahmadi SH, Boroumand MA, Dibaj SM, Tajik P and Abbasi SH<br />
Tehran Heart Center, Medical Sciences/University of Tehran, Tehran, Iran<br />
Abstract<br />
Background: Most clinical laboratories directly measure serum triglyceride, total<br />
cholesterol and HDL and indirectly calculate LDL value using the Friedewald equation. This<br />
study was done assess the effects of low serum triglyceride on LDL estimation.<br />
Methods: Between October 2002 and October 2003, in a case-control study, 115 serum
samples (group A-case) were selected from patients with triglyceride level below 100mg/dl.<br />
Another group of 115, sex and age-matched cases were also selected for comparison (group<br />
B-control) who had triglyceride levels between 150-350 mg/dl. On each sample total<br />
cholesterol, triglyceride, HDL and LDL were directly measured in duplicate by enzymatic<br />
methods. LDL-C assay was based on 2-step (homogenous) selective degradation of non-LDL<br />
lipoproteins. LDL was also calculated using Friedewald equation.<br />
Results: In group A, calculated LDL was on average 12.17 mg/dl higher than measured<br />
LDL (CI 95% = 10.34 to 14mg/dl), while in group B, calculated LDL was about 1.48 mg/dl<br />
lower than measured LDL (CI 95% = -4.21to 1.25mg/dl). Comparing the calculated and<br />
measured LDL-C levels by paired t-test in group B showed no significant difference (P =<br />
0.285), but in group A the difference was statistically significant (P < 0.001). Using this<br />
modified equation the Pearson’s correlation coefficient between the two methods approaches<br />
0.976 and the average calculated LDL is only about 0.67 mg/dl less than measured LDL (CI<br />
95% = -0.72 to 0.85mg/dl) with no significant difference between the two methods<br />
(P=0.867).<br />
Conclusion: In patients with low triglyceride and undesirably high serum cholesterol<br />
levels, LDL-C should be either directly assayed or be calculated by a modified Friedewald<br />
formula. By using linear regression modeling we proposed a modified formula. Keywords:<br />
Triglyceride, Cholesterol, LDL, HDL, Friedewald equation<br />
71<br />
Twenty –four hours in-hospital mortality predictions in<br />
<strong>coronary</strong> <strong>artery</strong> <strong>bypass</strong> <strong>graft</strong>ing <strong>surgery</strong> patients<br />
Ahmadi SH, Karimi AA, Marzban M, Movahedi N, Abbasi K, Salehi Omran A,<br />
Soleymanzadeh Ardabili M and Yazdanifard P<br />
Abstract<br />
Background: The purpose of this study was to determine the factors which can help to<br />
predict risk of mortality in the first 24 hours of <strong>coronary</strong> <strong>artery</strong> <strong>bypass</strong> <strong>graft</strong>ing (CABG)<br />
because mortality in few hours of <strong>surgery</strong> is a disastrous event for surgeon and patients<br />
family.<br />
Methods: The study population consisted of 122 in-hospital mortality case (1.2%) from
9862 patients who underwent CABG, from February 2002 to February 2006 by the same<br />
group of surgeons in a referral center. one group, 36 patients of 122(about 29.5%) who<br />
passed away during 24 hours after <strong>surgery</strong> were compared to 86 patient (70.4%) who<br />
expired after the second day up to 30 days postoperatively. A set of data was gathered<br />
from <strong>surgery</strong> database of hospital and analyzed in univariate model. In- hospital mortality<br />
was considered all expired cases during first 30 days after <strong>surgery</strong>.<br />
Results: Among studied variables, only following factors proved to be significant<br />
previous PTCA, emergent and urgent status, intra aortic balloon pump use, perfusion<br />
time, postoperative stroke and comatous state. In addition, poor <strong>coronary</strong> vessels proved<br />
to be significant in 24 hour mortality.<br />
Conclusion: It seems that influencing factors in global in-hospital mortality such as<br />
BMI, diabetes mellitus, COPD, preoperative arrhythmia , ejection fraction, history of<br />
previous CABG and resuscitation, were not significant in our study regarding the<br />
comparison of 24 hours postoperative and in-hospital mortality, although poor quality of<br />
<strong>coronary</strong> vessels was an important factor in this period of time .<br />
72<br />
Evidence for a higher mortality in women after <strong>coronary</strong><br />
<strong>artery</strong> <strong>bypass</strong> <strong>graft</strong> <strong>surgery</strong><br />
Sadeghian S, Karimi AA, Nemateepoor E, Lotfi-Tokaldany M, Soleymanzadeh<br />
Ardabili M, Sasanpoor P and Rahimi-Dehkordi N<br />
Abstract<br />
Background: Surgical outcomes have shown higher operative mortality in younger<br />
women compare with men at a similar age after Coronary Artery Bypass Graft <strong>surgery</strong><br />
(CABG). We compared multiple causes of procedural and early postoperative mortality<br />
between different age groups of men and women.<br />
Methods: 9857 patients who underwent CABG were studied between 2001 and 2006.<br />
All data were collected from the heart center data base. The mortality rate of male and
female patients was compared for a variety of risk factors. Risk-adjusted mortality rate<br />
were obtained by stepwise logistic regression.<br />
Results: There were 7304 men (mean age: 57.74±10.43 years) and 2553 women (mean<br />
age: 60.28±9.61years) in this study. The mortality rate of CABG in our center was 1.2%.<br />
Compared with men, more women had comorbidities and risk factors. In hospital<br />
mortality rate was higher in women and sex differences in mortality rate were remarkable<br />
among younger and older patients. Women 70 years of age were<br />
respectively 4.1 and 3.7 times more likely to die than men and in the other age groups<br />
women were 2.3 to 2.6 times more likely to die than men. A sex difference in diabetes<br />
was more marked among younger patients (women Vs men: OR=3.1, P
Results: The mean age of total population was 57.5r10.3 years and 64.1% of these patients<br />
were male. The prevalence of <strong>coronary</strong> <strong>artery</strong> disease (CAD) in them was 84.2%. Besides,<br />
Frequency of opium consumption was 13.4% in all patients and 19.7% in males.<br />
Notably,93.4% of opium users were male and 5.7% were female .The mean duration of<br />
opium consumption was 138.7 months and daily amounts via smoking and/or oral route<br />
varied from 0.03gram/year to 60gram/year. According to the angiographic findings,<br />
prevalence of CAD was higher in opium users (93.4% versus 82.7%, p
costs were calculated as mean direct costs multiplied by the number of patients tested.<br />
Results: Tables 1and 2 present the number of important invasive cardiac procedures and<br />
their mean charge per year in Iran and United States, respectively.<br />
Conclusion: This study is the first to estimate the costs of invasive cardiac procedures in<br />
Iran. Tables 1 and 2 show that despite the higher prevalence of <strong>coronary</strong> <strong>artery</strong> disease<br />
(CAD) in Iran as compared to that in United States, the mean amount of costs of cardiac<br />
catheterization, CABG and PTCA are 30, 16 and 10 times higher in the United States. So<br />
even after adjustment of the prevalence of CAD in these two countries, the rate of cardiac<br />
catheterization, CABG and PTCA may increase by at least 3, 4 and 9 times in the future in<br />
Iran, which could lead to at least a 60–fold increase in treatment costs. This emphasizes the<br />
need for insurance organizations to formulate the budget that<br />
must be allocated for this purpose.<br />
75<br />
Table1.Estimated direct costs of some invasive cardiac procedures per year, Iran
*Including temporary, permanent and 3 chamber<br />
**Including AICD and ICD 3 chamber ***Openheart<br />
valvuloplasty with replacement<br />
Table2.Estimated direct costs of some invasive cardiac procedures per year, USA<br />
*Including temporary, permanent and 3 chamber<br />
** Including AICD and ICD 3 chamber ***Open-heart valvuloplasty without<br />
replacement<br />
76<br />
Results of noninvasive test compared with results of<br />
angiography in young patients<br />
Sadeghian S, Hakki Kazazi E, Poorhosseini HR, Zoroofian A and Roozkari M<br />
Tehran Heart Center, Medical Sciences/University of Tehran, Tehran, Iran<br />
Abstract<br />
Background: On the basis of previous studies cardiac perfusion scan, compared with<br />
standard exercise testing, has more sensitivity and specificity especially in young women.
The purpose of present study was to compare results of these two tests with results of<br />
angiography in young adults.<br />
Methods: 1120 Consecutive patients with positive exercise test (ETT) or myocardial<br />
perfusion scan (MPS) and age < 50 years who had undergone <strong>coronary</strong> angiography over<br />
a period of two years were included in the study. We categorized these patients in two<br />
groups on the basis of sex.<br />
Results: From 204 women with positive ETT, 46% (94) and from 158 women with<br />
positive MPS 46% (73) had <strong>coronary</strong> <strong>artery</strong> disease (CAD) in angiography. Also from<br />
450 men with positive ETT, 74% (335) and from 298 men < 50 years with positive MPS<br />
74.5% (222) had CAD on angiography. After the exclusion of stenosis < 50% in <strong>coronary</strong><br />
arteries, 30% (62) of women with positive ETT, 37% (59) of women with positive MPS,<br />
65% (292) men with positive ETT and 60% (180) of men with positive MPS had CAD in<br />
angiography.<br />
Conclusion: Based on studies, previous MPS has a higher sensitivity than exercise test.<br />
However, for the diagnosis of <strong>coronary</strong> <strong>artery</strong> disease in this study, MPS led to the same<br />
results as exercise test; this may be due to an error in the accomplishment or in the report<br />
of the results.<br />
77<br />
The association between left main <strong>coronary</strong> <strong>artery</strong> disease and<br />
ischemic heart disease risk factors<br />
Darabyan C, Amirzadegan AR, Davoodi Gh, Sadeghian H, Kazemisaeid A ,<br />
Raissi Dehkordi M and Fallah N<br />
Tehran Heart Center, Medical Sciences/University of Tehran, Tehran, Iran<br />
Abstract
Background: Left main trunk disease (LMTD) is an important factor contributing to<br />
the severity of <strong>coronary</strong> <strong>artery</strong> disease (CAD) and negatively affects patients' survival.<br />
Previous studies have shown no obvious risk factor for this type of involvement. In this<br />
study, we aimed to find any association between established risk factors and LMTD.<br />
Methods: 8230 patients who had undergone selective <strong>coronary</strong> angiography (CAG)<br />
were enrolled in this study. Lipid profile, lipoprotein (a), and homocyteine were<br />
measured before <strong>coronary</strong> angiogram Risk factors for ischemic heart disease were also<br />
recorded from our angiography database. Patients were divided into three groups based<br />
on their CAG results: 1) CAD plus significant LMTD, 2) CAD without significant<br />
LMTD, and 3) normal coronaries. ANOVA and multivariate logistic regression tests<br />
were used for statistical analysis between CAD plus significant LMTD vs. the two other<br />
groups<br />
Results: Total cholesterol (P=0.03), HDL (P=0.01), LDL (P=0.04), LP (a) (P=0.01)<br />
were significantly higher in patients with LMTD versus normal <strong>coronary</strong>. Also, cigarette<br />
smoking, hypertension, diabetes mellitus, male gender and higher age (P
Background: CRP is a sensitive reactant released during tissue injury and<br />
inflammation such as ischemic events in acute <strong>coronary</strong> syndrome. We tried to evaluate<br />
the predictive value of CRP for outcome after CABG and introduce it as a risk factor for<br />
<strong>surgery</strong>.<br />
Methods: Pre-operative CRP serum level was measured in a series of 145 acute<br />
<strong>coronary</strong> syndrome Patients who underwent CABG for the first time and without any<br />
other thoracic procedure.<br />
Results: Our study consisted of 92 males and 53 females. During the in - hospital stay, 2<br />
patients ( 1.4% ) died, 3 patients ( 2.1% ) suffered bleeding while perioperative MI,<br />
mediastinitis and cerebrovascular events did not take place. Preoperative CRP correlation<br />
was statistically significant with age ( P: 0.049 ), hypercholesterolemia ( P: 0.007 ), preoperative<br />
EF ( P: 0.027 ) and parsonnet score<br />
( P: 0.000 ).<br />
Conclusion: Increased pre-operative CRP in association with other risk factors, can<br />
predict CABG outcome and operation risk in acute <strong>coronary</strong> syndrome patients.<br />
79<br />
Developing a <strong>surgery</strong> database: design and operation<br />
Abbasi K, Marzban M, Ahmadi SH,Karimi AA, Davoodi S, Salehi Omran A,<br />
Movahedi N and Soleymanzadeh M<br />
Tehran Heart Center, Medical Sciences/University of Tehran, Tehran, Iran<br />
Abstract<br />
Background: The great number of patients referring to our center leads to a great amount<br />
of data, while its classification and categorization seems to be the first priority for research<br />
and management purposes.<br />
Methods: The <strong>surgery</strong> databank in our center first developed in June 2003, and the basic
data collection form was prepared by Iranian cardiac surgeons' society. This procedure is<br />
conducted by two trained physician and a computer operator. Data collection forms are first<br />
filled up at patient’s bedside (defining risk factors and Canadian score) and then after<br />
discharge to determine their postoperative variables. This information set is then transferred<br />
to SPSS software program by the operator. 10% Of the surveyed surgical files are checked<br />
randomly to determine the probable source of fault. Cleaning of raw date is done bimonthly<br />
and a final report of <strong>surgery</strong> data bank is reported to research committee every 6 month.<br />
Conclusion: An appropriate method of transforming and computerizing data will be a<br />
great help to shorten research period and make the researcher work much easier. It is also<br />
suggested that all people involving databank (surgeons, managers and planners,<br />
Epidemiologists and statisticians) can access via an intrahospital network.<br />
80<br />
Mediastinitis after <strong>coronary</strong> <strong>artery</strong> <strong>bypass</strong> <strong>surgery</strong> (CABG),<br />
an evaluation of effect of different factors on developing<br />
mediastinitis after CABG in more than 9000 cases<br />
Tehran Heart Center, Medical Sciences/University of Tehran, Tehran, Iran<br />
Abstract<br />
Background: We aimed to evaluate the impact of different factors on developing post-<br />
CABG mediasinitis.<br />
Methods: A retrospective study was done on 9201 cases of CABG between January<br />
2002 and February 2006. The total number of the cases of sternal wound infection
(mediastinitis) was 44(about 0.5%) with mean age of 60.1 years. All the cases of<br />
mediastinitis divided into 2 parts: superficial sternal wound infection (group A-23 case)<br />
and deep sternal wound infection (group B-21 case).<br />
Results: In group 1, 74.5% were male and 25.5% female versus 47.7%male and<br />
52.3%female in group 2(mediastinitis), and this difference was significant (P=0.0001).<br />
Different factors such as BMI (Body Mass Index) and cigarette smoking and type of<br />
antibiotic prophylaxis had no significant impact on the incidence of mediastinitis as well<br />
as hypercholesterolemia, preoperative ejection fraction and peripheral vascular disease,<br />
but diabetes(59.1% versus 40.9%)and hypertension(90.9% versus 49.7%)were two<br />
significant factors in group 2 and 1 respectively. In-hospital mortality rate in CABG<br />
group 1 was 1.1% and 9.1% for mediastinitis group. There was a significant difference in<br />
rate of bleeding and reexploration in mediastinitis group in comparison with group<br />
1(13.6% vs. 1.1%).Positive sternal culture with S. aureus as a most common cause was<br />
seen in 72.1% in mediastinitis group.<br />
Conclusion: Rate of mediastinitis was about 0.5% that 0.23% were deep sternal wound<br />
infection. Mortality was high in mediastinitis group. It was shown that the risk of<br />
mediastinitis was higher in females. Furthermore, diabetes and hypertension had a<br />
significant role (P=0.0001) in the incidence of mediastinitis. It seems that there was an<br />
association between mediastinitis and reoperation for bleeding.<br />
81<br />
Comparison of short- and long-term outcomes between<br />
sirolimus eluting stents and paclitaxel eluting stents<br />
Alidoosti M, Salarifar M, Haji Zeinali AM, Kassaian E, Atashpar S and Raissi<br />
Dehkordi M<br />
Tehran Heart Center, Medical Sciences/University of Tehran, Tehran, Iran<br />
Abstract<br />
Background: Both sirolimus- and paclitaxel-eluting stents have demonstrated superior
efficacy over bare-metal stents, but recently published trials have not shown one drugeluting<br />
stent to be superior to the other. The aim of this study is to compare short- and<br />
long-term outcomes between these two groups.<br />
Methods: The data were collected from our registry for interventional cardiology. From<br />
April 2003 to September 2005, a total of 2971 patients underwent percutaneous <strong>coronary</strong><br />
intervention (PCI). Patients with primary and multivessel PCI were excluded Finally,<br />
Cypher and Taxus were used in 471 and 109 patients, respectively, but their usage has<br />
been regularly increased thereafter.<br />
Results: Patients in Cypher vs. Taxus group had more frequently presented with stable<br />
angina (50.3% vs. 34.3%, p=0.02), and less with myocardial infarction (20.3% vs.<br />
32.8%,p=0.037). Baseline characteristics such as diabetes were similar between these<br />
groups. Total occlusions and type B2/C lesions were more frequently treated with Taxus<br />
compared to Cypher(9% vs. 3%, p=0.04, 78.8% vs. 74.2%, p=0.04). The effect of<br />
confounders was fixed using stratified statistical method. Procedural and clinical success<br />
rates were not significantly different between Cypher and Taxus(100% vs. 98%, p=0.08<br />
and 97% vs. 94%, p=0.2). Intra-hospital complications were similar between these<br />
groups, too. At 9 month follow-up, cardiac mortality occurred in 2 patients (3.7%) in<br />
Taxus, but none of patients in Cypher group (p=0.056). Rate of major adverse cardiac<br />
events (MACE) at nine month follow-up was 2.9% in Cypher and 3.7% in Taxus group<br />
(p=0.7).<br />
Conclusion: There is no significant difference in procedural success rate, intra-hospital<br />
and late outcomes and major adverse cardiac events between Cypher and Taxus stenting.<br />
82<br />
Comparison of outcomes of percutaneous <strong>coronary</strong><br />
intervention on proximal versus non-proximal left anterior<br />
descending <strong>coronary</strong> <strong>artery</strong>, proximal left circumflex and<br />
proximal right <strong>coronary</strong> <strong>artery</strong><br />
Tehran Heart Center, Medical Sciences/University of Tehran, Tehran, Iran<br />
Abstract<br />
Background: Lesions in proximal left anterior descending <strong>coronary</strong> <strong>artery</strong> (LAD) may
develop more restenosis after angioplasty than stenoses in other <strong>coronary</strong> segments.<br />
Thus, we compared outcomes of percutaneous <strong>coronary</strong> intervention (PCI) on proximal<br />
LAD vs. proximal left circumflex (LCX) or right <strong>coronary</strong> <strong>artery</strong> (RCA) (study 1) and<br />
proximal versus non-proximal LAD (study 2).<br />
Methods: From 1737 patients in our database who had undergone PCI, those with<br />
multivessel and primary PCI, and total occlusion were excluded. Study 1 and 2 were<br />
conducted on 515 and 652 patients, respectively and baseline characteristics and shortand<br />
long-term outcomes were compared within groups.<br />
Results: In patients with PCI on proximal LAD vs. proximal RCA or LCX, diabetes<br />
mellitus, smoking, multivessel disease and prior PCI were less frequent(p
Mehtods: This study was conducted on 2023 patients, who had undergone 2296<br />
procedures of direct stenting or stenting with predilation between April 2003 and March<br />
2005. Patients with multivessel percutaneous <strong>coronary</strong> intervention (PCI) were included<br />
only if the procedures on attempted lesions were entirely direct or predilation type. Then,<br />
PCI outcomes were compared between Direct and Predilation groups.<br />
Results: Direct stenting was conducted on 961 patients (47.5%).Patients in Direct<br />
versus Predilation group had more frequently presented with stable angina (p
cardiac death, myocardial infarction, revascularization) of drug-eluting stents (DES) with<br />
Bare metal stents (BMS).<br />
Methods: Using our angioplasty database, 267 DES and 535 BMS patients who<br />
underwent angioplastic procedure were selected. Thereafter, success rate and adverse<br />
outcomes after 12-months follow-up were assessed.<br />
Results:Procedural success rate was significantly higher in DES group (p=0.015), while<br />
procedural complication was significantly greater in BMS group (p=0.003). In-hospital<br />
complications and mortality rate were equal in two groups. Number of patients with<br />
previous PCI procedure was significantly greater in DES group (12.3% versus 7.1%)<br />
(p=0.014) due to occurrence of more restenotic lesion. Involvement of RCA and LCX<br />
territory was more prevalent in BMS, while involvement of LAD territory was<br />
significantly more frequent in DES group (p
<strong>artery</strong> disease. However, the pattern of Lp (a) distribution in various racial and genetic<br />
groups has been found to be different. Furthermore, the association of Lp (a) and the<br />
severity of <strong>coronary</strong> <strong>artery</strong> disease in different population has not been clearly assessed.<br />
This study has been done to determine the relationship between Lp (a) and the severity of<br />
<strong>coronary</strong> <strong>artery</strong> stenosis in an Iranian population.<br />
Methods: Between July 2004 and March 2005, in Tehran Heart Center, 826 patients<br />
who had been candidates for angiography, were included. The severity of their <strong>coronary</strong><br />
<strong>artery</strong> stenosis was assessed through Gensini score. At the first part of the study, for<br />
checking interobserver reliability, 60 angiographies were reported and their Gensini<br />
scores were determined by two cardiologists. During hospitalization, Lp (a), triglyceride,<br />
cholesterol, high density lipoprotein, low density lipoprotein and quantitative C reactive<br />
protein levels were measured and their correlation with <strong>coronary</strong> <strong>artery</strong> stenosis were<br />
assessed.<br />
Results: Among 826 participants, 510(62%) patients were male and 316 (38%) were<br />
female. Coronary angiography was normal in 283(34%), while showed atherosclerosis in<br />
543(66%) patients. Mean Lp (a) levels in both normal and atherosclerotic participants<br />
showed a significant difference (P
embolism and patent foramen ovale (PFO).<br />
Methods: There were two symptomatic patients (29 and 47 years old) who underwent<br />
percutaneous transcatheter closure of PFO after at least two events of cerebral ischemia;<br />
one embolic event had occurred under antiplatelet therapy. For both patients Amplatzer<br />
PFO occluder measuring 25 mm in diameter were used. Complete occlusion by color<br />
Doppler and transesophageal contrast echocardiography investigation were achieved in<br />
both after the procedure and at 3 months follow-up after implantation. Mean fluoroscopy<br />
time was 16.7 minutes.<br />
Results: Percutaneous transcatheter closure was technically successful in both patients<br />
(100%). No residual shunt was seen in the end of procedure and at follow-up. In-hospital<br />
follow-up was uneventful. At a mean follow-up of 3 months no recurrent embolic<br />
neurological events was observed.<br />
Conclusion: Transcatheter closure of PFO with Amplatzer PFO occluder devices is a<br />
safe and effective therapy for patients with previous paradoxical embolism PFO.<br />
Percutaneous closure is associated with a high success rate, low incidence of hospital<br />
complications, and freedom of cerebral ischemic events.<br />
15 congress of the Iranian heart association, 2006, Iran<br />
87<br />
Interventional closure of patient foramen ovale with amplatzer<br />
PFO occluder in patients with paradoxical cerebral embolism<br />
Haji Zeinali AM and Ghasemi M<br />
Tehran Heart Center, Medical Sciences/University of Tehran, Tehran, Iran<br />
Abstract<br />
Background: Balloon angioplasty for coarctation of the aorta (CoA) in adults, though<br />
promising, is sometimes limited by significant residual gradient (>20 mm Hg). Few<br />
studies available have reported on use of balloon-expandable stents in such a situation.
We evaluated the use of self-expandable stents in patients with native coarctation.<br />
Methods: 5 hypertensive patients (age 16 to 27 years) with native CoA and peak<br />
systolic gradient [PSG]>40 mmHg underwent stent implantation. Balloon predilation was<br />
done and self-expandable nitinol aortic stents (optimed) were implanted in all patients.<br />
Results: Peak systolic gradient decreased from 55r15 (40 to 75) mmHg to 5r2 (3 to 7)<br />
mmHg after angioplasty. Nitinol stents were easier to deploy and conformed better to<br />
aortic anatomy compared with balloon-expandable stents. The diameter of the coarcted<br />
segment increased from 3r1 mm to 16r2 mm. There was no any complication in our<br />
series. On 3 to 6 months follow up all the implanted stents remained in their original<br />
position and none showed evidence of fracture. Significant improvement in hypertension<br />
was seen in 4 of 5 of the patients.<br />
Conclusion: Stent implantation is safe and effective in improving for CoA. Selfexpandable<br />
stents were easier to implant, adapted better to the wall of the aorta, and in<br />
most patients had similar efficacy in reducing coarctation as surgical repair.<br />
88<br />
Echocardiographic predictors of left atrial appendage<br />
contraction flow velocity<br />
Sahebjam M, Salarifar M, Davoodi Gh, Amir Zadegan A and Sadeghian H<br />
Tehran Heart Center, Medical Sciences/University of Tehran, Tehran, Iran<br />
Abstract<br />
Background: Low left atrial appendage (LAA) contraction velocity is a known<br />
important predictor of LAA thrombus formation in mitral valve stenosis (MS), but its<br />
echocardiographic predictors, especially in patients with normal sinus rhythm (NSR), are<br />
not completely established. We, therefore, designed this study to assess the
echocardiographic predictors of LAA velocity.<br />
Methods: We studied 52 (35 F, 17 M, mean age 46 yrs) consecutive patients with MS<br />
and NSR who had been referred to our echocardiography lab for transesophageal<br />
echocardiography. The patients with more than moderate Mitral regurgitation and aortic<br />
valve disease were excluded. Transthoracic and transesophageal echocardiography were<br />
performed on all cases, and we measured LAA velocity , left atrial size , mitral valve<br />
peak and mean diastolic gradient, mitral valve area(MVA) , mitral valve Wilkins score,<br />
and left ventricular ejection fraction(LVEF) .<br />
Results :The mean LAA contraction velocity ( ±SD ) was 23.3 cm/s (±10.8 ), ranging<br />
from 9.0 cm/s to 54 cm/s .The mean LA size ( ±SD) was 47.3 mm (± 7.8 ). Mean<br />
MVA (±SD) was 1.07± 0.30 cm2, and mean LVEF was 50.3. The mean mitral valve peak<br />
and mean gradient (mmHg) were 9.7 and 16.9 respectively. In our study, the most<br />
important correlation was that between LAA velocity and MVA (r = 0.56 , P value =<br />
0.000), and there was also significant negative correlation between LAA velocity and LA<br />
size (r = - 0.458 , P value = 0.01) . MVA ” 1.0 cm2 and LA size > 40 mm had sensitivity<br />
equal to 71%, 89% and specificity of 64% and 52% respectively, for determination of<br />
LAA velocity ” 30 cm/s .There was no significant correlation between the other evaluated<br />
parameters and LAA velocity.<br />
Conclusion: MVA and LA size which are measurable by transthoracic<br />
echocardiography, can be used as predictors of LAA contraction velocity in patients with<br />
MS and NSR.<br />
Keywords: Left atrial appendage, Mitral valve stenosis, Transesophageal<br />
echocardiograph<br />
Magnesium infusion and its relationship with the incidence of<br />
post <strong>coronary</strong> <strong>artery</strong> <strong>bypass</strong> <strong>graft</strong>ing arrhythmias<br />
89<br />
Najafi M, Haghighat B, Ahmadi H, Soltaninia H, Ghiasi A, Mohammadali B,<br />
Fallah N and Fayazzadeh E<br />
Tehran Heart Center, Medical Sciences/University of Tehran, Tehran, Iran<br />
Abstract
Background: Atrial and ventricular arrhythmias are among the most common<br />
complications following <strong>coronary</strong> <strong>artery</strong> <strong>bypass</strong> <strong>graft</strong>ing (CABG). Previous studies have<br />
demonstrated that serum magnesium (Mg) levels decrease following CABG, especially<br />
after cardiopulmonary <strong>bypass</strong> (CPB). In the current study, we evaluated the prophylactic<br />
effect of Mg infusion on post-CABG arrhythmias.<br />
Method: Three hundred forty five patients, candidates for isolated <strong>coronary</strong> <strong>artery</strong><br />
<strong>bypass</strong> <strong>graft</strong>ing (CABG) with normal renal function, were randomly divided into two<br />
groups. Group A (case; 48.1%) received 2 g of Mg from induction of anesthesia to<br />
cardiopulmonary <strong>bypass</strong> (CPB) at the beginning and 8 g following CPB to 24h thereafter.<br />
In group B (control; 51.9%), no supplemental Mg was administered. Mg serum levels<br />
were measured in all the patients four times (at the onset of induction, and hours 0, 24,<br />
and 48 after ICU admission). Patients were then followed for developing cardiac<br />
arrhythmias until their discharge from the hospital.<br />
Result: Seventy-nine patients (22.9%) developed post-operative arrhythmia (i.e. AF in<br />
34 [9.9%]; other supraventricular arrhythmia in 23 [6.7%]); and ventricular arrhythmias<br />
in 47 [13.6%] patients). Except for the first occasion (induction time), there were<br />
significant statistical differences in Mg serum levels in the subsequent three<br />
measurements (p
underwent isolated <strong>coronary</strong> <strong>artery</strong> <strong>bypass</strong> <strong>graft</strong>ing at our center. The patients'<br />
preoperative, operative and postoperative data were reviewed respectively. The duration<br />
of dialysis ranged from 1 to 75 months (mean 18.4 ± 12.5 months). All of the patients<br />
were on hemodialysis which was scheduled on the day before <strong>surgery</strong>, and<br />
their usual hemodialysis was carried out on the 2 nd postoperative day.<br />
Results: All the patients were men with a mean age of 50.2 ± 9 years. The major causes<br />
of renal failure were primary hypertension in 25%, diabetes mellitus in 18%, and a<br />
combination of these causes in 34%. The qualities of the <strong>graft</strong>s were poor in 5 patients,<br />
moderate in 2 patients and good in 2. Mean preoperative ejection fraction was<br />
40.5%±15% (range 25% to 50%). Cardiopulmonary <strong>bypass</strong> and aortic cross-clamp times<br />
were 80.2±15 and 43.8±10 minutes, respectively. Intra-aortic balloon pump was used for<br />
one patient. The complications were prolonged ventilation in one patient and pericardial<br />
effusion in another one. There was no early mortality. Long-term follow up (mean time:<br />
2.8 years) the late mortality rate was 33.3% (3 patients). The cases were infection and<br />
renal failure in 2 patients, and end stage renal failure in one.<br />
Conclusion: Coronary <strong>artery</strong> <strong>bypass</strong> <strong>graft</strong>ing could be performed in dialysis-dependent<br />
patients with acceptable preoperative morbidity and mortality risks if there is a wellorganized<br />
dialysis program.<br />
Keywords: Hemodialysis, <strong>coronary</strong> <strong>artery</strong> <strong>bypass</strong> <strong>graft</strong><br />
91<br />
Late outcomes in patients with uncorrected moderate mitral<br />
regurgitation at the time of isolated <strong>coronary</strong> <strong>artery</strong> <strong>bypass</strong><br />
Davoodi S, Gholami MH, Dadashi Y, Mirhosseini M, Jalalmanesh F, Javadpour J<br />
and Madani Civi M<br />
Tehran Heart Center, Medical Sciences/University of Tehran, Tehran, Iran<br />
Abstract<br />
Background: Mitral valve intervention combined with <strong>coronary</strong> <strong>artery</strong> <strong>bypass</strong> <strong>surgery</strong><br />
is inevitable in the case of severe mitral regurgitation in patients with <strong>coronary</strong> <strong>artery</strong>
disease, but the best treatment protocol for patients with a moderate degree of mitral<br />
regurgitation is under debate. We evaluated the progress of mitral regurgitation after<br />
isolated <strong>coronary</strong> <strong>artery</strong> <strong>bypass</strong> <strong>surgery</strong> in cases of ischemic mitral regurgitation.<br />
Method: The study was conducted between June 1998 and Oct 2004. Fourteen patients<br />
(85% men, with a mean age of 56 years, a mean ejection fraction of 39.3%, and a mean<br />
New York Heart Association class of 2.53) with preoperative diagnoses of moderate<br />
degree ischemic mitral regurgitation (Grade 2 mitral regurgitation on a scale of 0 to 4)<br />
and <strong>coronary</strong> <strong>artery</strong> disease underwent isolated <strong>coronary</strong> <strong>artery</strong> <strong>bypass</strong> <strong>surgery</strong>. Patients<br />
were followed up at a mean of 48 months and an echocardiographic evaluation was done<br />
to determine the progress of the mitral disease.<br />
Result: In the postoperative period the mean ejection fraction was 44.6% and the mean<br />
functional capacity of the patients was 1.31. Mitral regurgitation regressed to a mild<br />
degree in 57.1% of the patients. Grade of MR was unchanged after CABG in 5 (35.7%)<br />
patients with grade 2 ischemic MR. <strong>Post</strong> CABG-MR progression was present in 1 (7.2%)<br />
patient. No patient required subsequent mitral valve operation or other procedures in long<br />
term follow up. The 30-day operative mortality rate was 0%.<br />
Conclusion: We conclude that in patients with moderate MR isolated CABG (without<br />
mitral valve replacement or repair) suffices as it produces dramatic improvement in<br />
ejection fraction and in degree of MR with good long-term survival.<br />
Keywords: Ischemic mitral regurgitation, <strong>coronary</strong> <strong>artery</strong> <strong>bypass</strong> <strong>graft</strong>, late outcome<br />
92<br />
The adverse effects of milrinone in the elderly patients who<br />
underwent CABG<br />
Davoodi S, Mirhosseini SM, Gholami MH, Dadashi Y, Jalalmanesh F, Mehraein<br />
A, Javadpour J and Akbarnejad M<br />
Abstract<br />
Background:The phosphodiesterase inhibitors are currently available to produce both<br />
positive inotropic effects and vasodilation. Milrinone, as one of the major forms of this<br />
group of agents, increases cardiac output, while it decreases pulmonary <strong>artery</strong> pressure,<br />
pulmonary vascular resistance and systemic vascular resistance. Although milrinone is<br />
generally accepted and used to treat young patients with high pulmonary <strong>artery</strong> pressure,
using this drug in elderly patients is still under debate.<br />
Method: We studied the effect of milrinone in a group of old patients with high<br />
pulmonary <strong>artery</strong> pressure. In 5 cases who underwent CABG, intravenous milrinone was<br />
administered to overcome the raised pulmonary <strong>artery</strong> pressure. All the patients were<br />
above 65 yrs of age; they comprised 3 males and 2 females with an ejection fraction of<br />
35-65%. None of the patients had renal failure. Milrinone was started after weaning off<br />
CPB. The initial loading dose was 50 micrograms/kg given over 20 minutes, followed by<br />
a maintenance dose of 0.50 micrograms/kg/min. Hemodynamic data were recorded<br />
before and after the drug injection.<br />
Results: In response to the therapy, pulmonary <strong>artery</strong> pressure decreased, heart rate<br />
increased while severe hypotension occurred in all the cases with a mean systolic<br />
pressure of less than 65 mmHg. To increase blood pressure, electrolyte imbalances, blood<br />
gas disequilibrium and hypokalemia were assessed and corrected properly. Several<br />
medical manipulations were performed, but none of them was effective. At the last step,<br />
we discontinued milrinone, which raised the blood pressure to the normal level in all the<br />
patients, while it did not have any adverse effect on pulmonary <strong>artery</strong> pressure.<br />
Conclusion: Our data showed that although milrinone is useful in decreasing<br />
pulmonary <strong>artery</strong> pressure, hypotension induced by this drug is common, especially in the<br />
elderly group. One should keep this in mind and treat the probably observed hypotension<br />
after milrinone therapy with discontinuation of the drug. Further studies are needed to<br />
confirm these findings. Keywords: CABG, milrinone, elderly patients<br />
93<br />
Correlation between net atrioventricular compliance and<br />
pulmonary <strong>artery</strong> pressure in mitral stenosis<br />
Sahebjam M, Salarifar M, Sadeghian H and Sadeghian S<br />
Tehran Heart Center, Medical Sciences/University of Tehran, Tehran, Iran<br />
Abstract<br />
Background: There are diverse data about the impact of net atrioventricular<br />
compliance (Cn) measured by Doppler echocardiography on systolic pulmonary <strong>artery</strong><br />
pressure (PAP) in patients with mitral valve stenosis. We, therefore, planned this study to
assess the relation between Cn and PAP.<br />
Method: Thirty-six patients (24 F, 12 M, mean age: 47.8y) with mitral valve stenosis<br />
were examined by Doppler echocardiography. Our exclusion criteria were more than<br />
mild mitral regurgitation, aortic valve disease, and atrial fibrillation rhythm. Cn was<br />
calculated from the ratio of effective mitral valve area (Continuity equation) and E wave<br />
downslope (Flachskampf formula). PAP was derived from the tricuspid regurgitant jet<br />
velocity with the modified Bernoulli equation and assuming right atrial pressure base on<br />
inferior vena cava diameter and its respiratory variation.<br />
Results: Mean (±SD) mitral valve area by pressure half-time was 1.48 (±0.36) cm2, and<br />
mean gradient was 7.8±4.0 mmhg. Cn ranged from 1.8 to 12.2 (mean±SD=5.28±2.55),<br />
and PAP ranged from 27 to 80mmhg (mean±SD=43±10.7). There was a statistically<br />
important negative correlation between Cn and PAP (r=-0.367, p=0.03), but the most<br />
significant correlation in our study was that between the mean mitral valve gradient and<br />
PAP (r=784, p=0.00).<br />
Conclusion: Atrioventricular compliance, which can be non-invasively assessed, has<br />
an important correlation with PAP in mitral valve stenosis and can be useful in daily<br />
practice.<br />
Keywords: Mitral valve stenisis, Atriovantricular compliance, Pulmanary <strong>artery</strong><br />
pressure<br />
94<br />
Diabetes Mellitus Role in Impeding Prophylactic Effects of<br />
Magnesium on <strong>Post</strong>-Coronary Artery Bypass Grafting Atrial<br />
Fibrillation<br />
Najafi M and Salehi Omran A<br />
Tehran Heart Center, Medical Sciences/University of Tehran, Tehran, Iran<br />
Abstract<br />
Background: Hypomagnesaemia is a well known issue in diabetics. Recent studies have<br />
suggested promising role of supplemental magnesium (Mg) administration in preventing post<br />
surgical atrial fibrillation (AF); however, there is no evidence on differences between<br />
diabetic and non-diabetic patients in response to prophylactic administration of Mg
supplements.<br />
Methods: Thirty hundred foty-five patients (115 diabetic; 230 non-diabetic), elective<br />
candidates for isolated <strong>coronary</strong> <strong>artery</strong> <strong>bypass</strong> <strong>graft</strong>ing (CABG) with normal renal function,<br />
were randomly divided into two groups. Group A (case; 48.1%) received 2g of Mg after<br />
induction of anesthesia until cardiopulmonary <strong>bypass</strong> (CPB) onset and 8 g following CPB to<br />
24 h there after. In group B (control; 51.9%), no supplemental Mg was administered. Mg<br />
serum levels were measured in all patients four times (at the onset of induction, and hours 0,<br />
24, and 48 after ICU admission).Patients were then followed for developing AF after the end<br />
of <strong>surgery</strong> until their discharge.<br />
Results: Thirty-four patients (9.9%) developed AF of which 12 ones were in group A, and<br />
22 in group B. Of 12 patients in group A, 8 (67%) were diabetic, whereas there were just 6<br />
diabetic ones (27.3%) in group B (p=0.026). Serum Mg levels were not statistically different<br />
among groups. There was no significant difference statistically for the rate of DM in nonarrhythmic<br />
patients between the two groups (31% in group A vs. 34% in group B).<br />
Conclusions: DM has a major role in impeding prophylactic effects of Mg infusion on<br />
developing AF. This effect has no correlation with perioperative serum Mg levels. Keywords:<br />
magnesium, diabetes mellitus, <strong>coronary</strong> <strong>artery</strong> <strong>bypass</strong>, atrial fibrillation<br />
95<br />
Beta-blocker administration for preventing post-<strong>coronary</strong><br />
<strong>artery</strong> <strong>bypass</strong> <strong>graft</strong> arrhythmias: The role of diabetes mellitus<br />
Najafi M, Karimi A and Hamidian R<br />
Tehran Heart Center, Medical Sciences/University of Tehran, Tehran, Iran<br />
Abstract<br />
Background: Prophylactic effect of supplemental magnesium (Mg) and ȕ-blocker<br />
administration on atrial fibrillation (AF) is a well-known issue in <strong>coronary</strong> <strong>artery</strong><br />
<strong>bypass</strong> <strong>graft</strong> (CABG). However, there is no evidence of differences between diabetic<br />
and non-diabetic patients in response to prophylactic administration of ȕ-blocker<br />
especially in preventing ventricular arrhythmia (VA).
Methods: Three hundred forty-five patients (115 diabetic and 230 non-diabetic)<br />
candidates for isolated CABG with normal renal function sinus rhythm and positive<br />
(group A) or negative history of at least three days of ȕ-blocker consumption (group B),<br />
were randomly divided into two groups to receive 10 gr. supplemental Mg in 24 hours<br />
(case, 48.1%) or no supplementary Mg (control, 51.9%). Mg serum levels were measured<br />
in all patients 4 times (at onset of induction, hours 0, 24 and 48 after ICU admission).<br />
Then the patients were followed for developing AF and VA.<br />
Results: Forty-five patients (13.6%) (15 diabetic and 30 non-diabetic patients)<br />
developed VA. Out of 15 diabetic patients, 5 patients were in group A and 10 patients<br />
were in group B. The incidence of VA was significantly higher in group B (p
performed in our institution. The indication for off-pump <strong>surgery</strong> was renal dysfunction,<br />
in three patient advances COPD in three patient, age>80 year in one patient, sever<br />
atherosclerotic aorta in two patient. The endartrectomized vessel was left anterior<br />
descending in three patients, right <strong>coronary</strong> <strong>artery</strong> in five patients and diagonal in two<br />
patient.<br />
Results: There was no operative mortality, perioperative myocardial infarction occurred<br />
in one patient with LAD endarterectomy requiring ionotrope and intra-aortic balloon<br />
pump to recover. The mean ejection fraction before operation was 36r4. The mean<br />
ejection fraction post-op 45±8 which was significantly higher than the pre-operative<br />
value (p
from cardiopulmonary machine that were refractory to inotropic and IABP support.<br />
Methods: Between Oct 1998 and June 2004, 1450 patients underwent CABG in our<br />
center. We used Centrifugal pump in six patients (52±12 years) with acute left sided heart<br />
failure following CABG. The patients' characteristics and their risk factors for developing<br />
CAD were recorded.<br />
Results: The success rate was 30% (2 cases from 6 pt.). Four cases were not weaned<br />
from Centrifugal pump after 17±8 hours. Two patients were weaned after 21±5 hours and<br />
with good outcome. The mean preoperative left ventricular EF was 50%±10. The mean<br />
vessel involvement in these patients was 2.66 (1VD-3VD). The <strong>coronary</strong> <strong>artery</strong> Gensini<br />
score was 89±6 (p value
independent risk factor for atherosclerosis. LP (a) level in serum is genetically<br />
determined with an autosomal dominant pattern. The aim of this study was to assess the<br />
association between LP (a) and cervical carotid <strong>artery</strong> stenosis in Iranian population.<br />
Methods: Between May 2004 and January 2005, at Tehran Heart Center, 920 patients<br />
who were candidate for open heart <strong>surgery</strong> for any reason, were selected. Carotid<br />
Doppler Sonography was performed for all of these patients. Serum levels of LP (a), total<br />
cholesterol, triglyceride, High Density Lipoprotein (HDL), Low Density Lipoprotein<br />
(LDL) and LDL/HDL ratio of these patients were measured and their correlation with<br />
carotid atherosclerosis were assessed.<br />
Results: No correlation was found between high levels of LP (a) (>30 mg/dl) and<br />
carotid atherosclerosis (P>0.93). Serum levels of cholesterol (P
independent risk factor for atherosclerosis. LP (a) level in serum is genetically<br />
determined with an autosomal dominant pattern. The aim of this study was to assess the<br />
association between LP (a) and cervical carotid <strong>artery</strong> stenosis in Iraninan population.<br />
Methods: Between May 2004 and January 2005, at Tehran Heart Center, 920 patients<br />
who were candidate for open heart <strong>surgery</strong> for any reason, were selected. Carotid<br />
Doppler Sonography was performed for all of these patients. Serum levels of LP(a), total<br />
cholesterol, triglyceride, High Density Lipoprotein (HDL), Low Density Lipoprotein<br />
(LDL) and LDL/HDL ratio of these patients were measured and their correlation with<br />
carotid atherosclerosis were assessed.<br />
Results: No correlation was found between high levels of LP (a) (>30 mg/dl) and<br />
carotid atherosclerosis (P>0.93). Serum levels of cholesterol (P
type 2 who were between 31 to 78 years old and had no abnormalities of the urinary tract<br />
system were included. We defined ASB as the presence of at least 105 colony-forming<br />
units/ml of 1 or 2 bacterial species, in two separated cultures of clean voided midstream<br />
urine. All the patients were free from any symptoms of urinary tract infection(UTI). Risk<br />
factors for developing bacteriuria were assessed and compared in participants with and<br />
without bacteriuria.<br />
Results: In this study, the prevalence of ASB was 10.9% among diabetic women. E-coli<br />
was the most prevalent microorganism responsible for positive urine cultures. Most of the<br />
isolated microorganisms had resistant to Co-trimoxazole, Nalidixic acid and<br />
Ciprofloxacin. Pyuria (p
infarction. The aim of this study was to assess the prognostic value of quantitative CRP<br />
(Q-CRP) for predicting intra-hospital MI in patients with unstable angina.<br />
Methods: This cohort study was done between December 2003 & June 2004 in Tehran<br />
Heart Center. 121 patients with unstable angina were studied. The exclusion criteria for<br />
this study were: cases with acute MI of less than 1 month duration, finding of left<br />
Bundle Branch Block on EKG and cases with any kind of inflammation, infection,<br />
trauma or acute rheumatic fever. Q-CRP of these patients was measured, and 10 mg/l<br />
considered as a cut off point value for Q-CRP. Patients were divided into two groups<br />
according to their Q-CRP values. One group with Q-CRP >= 10 mg/l (n=68) and the<br />
other group with Q-CRP 10 mg/l and in 1 (1.8%) case of patients with<br />
CRP 0.38).<br />
Conclusion: Considering analyzed results in this study, although there is no<br />
significant correlation between Q-CRP level and MI development, in places in which<br />
there are no facilities to assess the specific laboratory tests for MI, Q-CRP can be used<br />
as a risk stratification module in unstable angina patients.<br />
104<br />
Predictive factors of the cardiopulmonary resuscitation results<br />
Najafi M<br />
Tehran Heart Center, Medical Sciences/University of Tehran, Tehran, Iran<br />
Abstract<br />
Background: Cardiopulmonary resuscitation (CPR) is one of the most important,<br />
lifesaving and unfortunately disappointing components of the standard hospital cares. Former<br />
studies reveal that the CPR success rate (at discharge) was nearly 14%.This study was<br />
designed to evaluate the predictive factors of the CPR results.<br />
Methods: This study was performed on Tehran Heart Center Registry–CPR database
(THCR-CPR) which contains demographical, clinical, procedural and in hospital data for<br />
each resuscitated patient in Tehran Heart Center. CPR in the operating rooms or<br />
postoperative intensive care units was excluded. Successful CPR was defined as a complete<br />
improvement of the patient’s condition without any residual sequel or complication.<br />
Regarding CPR results patients were stratified in two groups: successful and unsuccessful<br />
CPR. All factors in these two groups were compared.<br />
Results: Between January 21, 2004 and June 22, 2004 193 patients (107 male and 86<br />
female, Mean age: 65.11±13.34) were resuscitated. The most important causes of the CPR<br />
were arrhythmia (35.2%), respiratory failure (34.1%), and homodynamic instability (26.7%).<br />
Success rate after resuscitation, at 24 hours and at discharge were 48.7%, 33.8% and 25.5%,<br />
respectively. CABG candidates, patients with unstable angina, patients who had serum<br />
potassium lower than 6 mEq/dl, ventricular fibrillation as starting arrhythmia, CPR or cardiac<br />
massage duration lower than 15 minutes, epinephrine dose lower than 3 mg and higher GCS<br />
levels had significantly better results. On the contrary, cerebrovascular accident, asystol and<br />
need for epinephrine usage in the CPR were significantly higher in the unsuccessful group.<br />
Age, sex, concurrent disease, CPR reason, and serum pH were similar between groups. CPR<br />
and shock delay although were lower in the successful group, were not significantly different.<br />
Conclusion: Our results are comparable with the former studies. Further studies and more<br />
sample size required to determine other predictive factors of the successful CPR.<br />
105<br />
<strong>Post</strong> <strong>coronary</strong> <strong>artery</strong> <strong>bypass</strong> <strong>graft</strong> <strong>surgery</strong> (CABG) atrial<br />
fibrillation: evaluating predisposing and preventive factors<br />
Najafi M, Kamangari A, Haghighat B and Fallah N<br />
Tehran Heart Center, Medical Sciences/University of Tehran, Tehran, Iran<br />
Abstract<br />
Background: <strong>Post</strong> operative arrhythmia are among common complications of CABG<br />
<strong>surgery</strong> and Atrial Fibrillation (AF) is the most important of them. Studies show variable<br />
and different predisposing factors and different studies are evaluating preventive factors.
This study evaluates the role of amiodarone and Magnesium (Mg) administration in<br />
preventing AF.<br />
Methods: CABG candidates with normal sinus rhythm were divided into 4 groups:<br />
1. 1. No Mg. administration<br />
2. 2. With Mg. administration<br />
3. 3. Only amiodarone (300 mg) administration.<br />
4. 4. Mg and amiodarone administration. Other interfering factors were also<br />
evaluated including: sex, age, preoperative Mg blood level, serum creatinine level,<br />
congestive heart failure (CHF), obstructive lung disease, right <strong>coronary</strong> <strong>artery</strong><br />
obstruction, pericarditis, duration of aortic cross clamp and total dosage of Mg<br />
administration.<br />
Results: 822 cases (581 male , 241 female) with a mean age of 60.9 (9.5), mean<br />
creatinine of 1.2 mg/dl, mean aortic cross clamp duration of 49.8 minutes and mean<br />
blood Mg level of 2.3 were evaluated. 107 out of 727 (14.7%) cases developed AF. AF<br />
was statistically related to age (P
Methods: One hundred cases were divided into two groups. In FT group, fentanyl<br />
(0.05-0.15 Pg/kg/min) and Propofol (10-50 Pg/kg/min) infusions were started since<br />
induction time. Atracurium infusion started one hour later, no bolus drug was<br />
administered during operation. Muscle relaxants were neutralized at the end of <strong>surgery</strong>.<br />
Fentanyl infusion continued up to 12 hours post <strong>surgery</strong>. The above two groups were<br />
evaluated for time of alertness and extubation in ICU, total analgesic dosage administered<br />
during 24 hours post operation, ABG and SpO2 pre-and post-extubation. Inclusion and<br />
exclusion criteria for FT method as well as extubation criteria were explained to the ICU,<br />
staff.<br />
Results: Time period between ICU admition and alertness was significantly different in<br />
FT (1.3 hour) and control group (3.3 hours) (P
2002-2005, of which 209 elderly patients were selected. We reviewed their records to<br />
evaluate the effectiveness of CABG and assess their outcomes after <strong>surgery</strong>.<br />
Results: 72.4% of patients were male and 25.8% were female. Left main lesions were<br />
markedly higher than younger patients (18.5% vs. 16%). The rate of postoperative<br />
complications was 15.7% vs. 10%, which showed significant difference [cardiac: AF<br />
rhythm (11.4% vs. 6.5%) & cardiac arrest (3.3% vs. 0.9%), non cardiac: pneumonia (1%<br />
vs. 0.1%), renal failure multisystem failure (1% vs. 0.1%)]. Elderly people also had<br />
considerable longer stay in ICU hospital (49 hrs vs. 33 & 8.9 days vs. 7.4). <strong>Post</strong>operative<br />
ventilation time between two group was noticeably different (13 hr vs. 9 hr). The use of<br />
intra aortic balloon pump was more common in the elderly (4.8% vs 2.1%). In hospital<br />
mortality was 4.8% in old group and readmission was more common in older patients.<br />
Conclusion: Regarding to high rate of complications, trace changes in quality of life in<br />
elderly group limited financial sources and prolonged waiting list for CABG it is wise to<br />
select old patients properly to achieve acceptable outcomes after CABG.<br />
108<br />
Various surgical approaches to complex aortic arch aneurysim,<br />
a single institute experience<br />
Abbasi K, Marzban M, Ahmadi SH, Davoodi S, Movahedi N, Salehi Omran<br />
A, Madani Civi M and Rahnama Azar A<br />
Abstract<br />
Background: Aneurysms of the aortic arch are usually a manifestation of more<br />
diffuse aortic disease involving either the ascending or descending aorta or both. These<br />
aneurysms are a dillence for a surgeon because deciding whether or not to resect an arch<br />
aneurysm involves careful assessment of both the liked hood of rupture and the
operative risk in each individual, balancing one against another.<br />
Methods: In 120 cases with ascending aortic aneurysms (acute or chronic) referred to<br />
our institute; 15 patients had involvement of arch, 8 ones with a complex disorder;<br />
following procedures were scheduled:<br />
1) A-54-year-old man presented with acute limb ischemia underwent a femmo- femoral<br />
<strong>bypass</strong> in another center and then referred to our institute as a case of acute aortic<br />
dissection and managed by aortic hemiarch replacement but about 24h after operation<br />
develops cerebral ischemia; CVA (re dissection) and expired. 2) A-62y-old man<br />
presented with sub-acute aortic dissection (12 days before)<br />
underwent total arch replacement with insertion of innominate <strong>artery</strong><br />
on tube <strong>graft</strong>s separate buttons 3) A-32y-old marfan patient with acute<br />
aortic dissection and acute AI underwent hemiarch replacement<br />
(uneventful recovery)<br />
4) A 68 y old women a case of aortic archaneurysm underwent supra <strong>coronary</strong> root<br />
and total arch replacement complicated by prolonged ventilatory support (72hr) but<br />
uneventful recovery<br />
5) A-22y-old man with chronic dissection underwent Bental operation with arch vessel<br />
implantation and left carotid to left subclavin <strong>bypass</strong> had uneventful recovery (type of<br />
cerebral perfusion: retrograde)<br />
6) A-65y-old man case of acute type dissection underwent Bentall operation and<br />
arch vessel implantationassending aorta to brachiocephalic <strong>bypass</strong>; patient expired due<br />
to ATN<br />
7) A-64y-old man case of choronic dissection and 3 vesel disease underwent aortic valve<br />
preservation, supra<strong>coronary</strong> <strong>graft</strong>s, excision of arch bifurcated <strong>graft</strong>s of brachiocephalic<br />
and carotid <strong>artery</strong> and CABG (antegrade cerebral perfusion) complicated by prolonged<br />
ventilatory support (72h) but uneventful recovery. 8) A-32-y old man a case of acute<br />
dissection underwent bental procedure and <strong>graft</strong><br />
of brachiocephalic <strong>artery</strong> and uneventful recovery.<br />
Results:The postoperative course was uneventful in 4 patients, two patients had a<br />
prolonged ventilation time and two patients of our study group were expired, one (case2)<br />
109<br />
because of re dissection and cerebrovascular accident and other (case6) because of<br />
developing acute tubular necrosis. Hypothermic circulatory arrest in all of patients was<br />
below 45 minute.<br />
Conclusion: Aortic arch aneurysm is a cumbersome and difficult situation needs to a<br />
good decision making and expert hands. Results of this experience could be comparable<br />
with other institute results; this may be due to using deep hypothermia (15c) good<br />
myocardial protection and individualized techniques. One of the major postoperative<br />
morbidities is cerebrovascular accident should be managed with good preservation of<br />
cerebral perfusion and fortunately none of our patients experience these type s of<br />
complications. At last to have better results we recommend to limit the time of<br />
hypothermic circulatory arrest and using deep hypothermi and individualized every<br />
patient in different aspects as methods of cerebral perfusion and operative techniques.
110<br />
Have diabetes worson the outcome of CABG<br />
Tehran Heart Center, Medical Sciences/University of Tehran, Tehran, Iran<br />
Abstract<br />
Background: Diabetes is commonly regarded as a risk factor for mortality and<br />
morbidity after <strong>coronary</strong> <strong>artery</strong> <strong>bypass</strong> <strong>graft</strong>ing.<br />
Methods: In 5795 consecutive patients underwent isolated <strong>coronary</strong> <strong>artery</strong> <strong>bypass</strong><br />
<strong>surgery</strong> in our institute, impact of diabetes on mortality and morbidity was investigated.<br />
Two thousands and seventy four (2071) patients of these had diabetes (mean<br />
age=58.9±9.08). In this article we study the impact of many factors such as age, sex,
BMI, unstable angina, smoking, previous MI cerebral vascular disease, renal dysfunction,<br />
respiratory disease, significant left main stenosis, ejection fraction, emergent <strong>surgery</strong><br />
along with diabetes on in hospital mortality and post operative morbidity and to control<br />
for differences in patient characteristics we used a multivariate logistic regression model<br />
(SPSS ver. 11.0)<br />
Results: In this study there was a significant difference in age (diabetic mean<br />
age=58.9±9.08, non diabetic mean age=57.9±9.95), number of diseased vessels (in<br />
diabetic=3.7±0.51, in non diabetic= 3.6 ±0.58), aortic cross clamp time (in diabetic=<br />
42.3±16.63 min, non diabetic= 67.2±25.94) and number of vein <strong>graft</strong>s but not arterial<br />
ones (diabetic=2.6±0.89, non diabetic= 2.4± 0.94). In hospital mortality was significantly<br />
higher for diabetic patients (in diabetic=2.4%, in non diabetic=1.1% with p value
patients after <strong>coronary</strong> <strong>artery</strong> <strong>bypass</strong> <strong>surgery</strong> and in USA annually more than 70000<br />
patients,underwent <strong>coronary</strong> <strong>artery</strong> <strong>bypass</strong> <strong>graft</strong>ing (CABG) experience such a problems<br />
during their postoperative period. Mild moderate depression is another complication<br />
affects 1/3 of patients after CABG.<br />
Methods: 45 patients with conventional <strong>bypass</strong> and 45 patients with off pump <strong>bypass</strong><br />
were included in this study and we assessed the incidence of depression 5 days before<br />
and 4 days after CABG in both groups (with standard beck depression inventory test). To<br />
control for differences in patient characteristics we try to select patients with higher<br />
matched risk factors (age, sex, smoking…).<br />
Results: There was not any significant difference in time of <strong>surgery</strong>; time of extubation<br />
and history of depression. But the number of <strong>graft</strong>s had significant difference between<br />
two groups. Coma, seizure and cerebrovascular accident were not seen in our patients<br />
after <strong>surgery</strong>. The incidence of depression in conventional group was meaningfully<br />
higher than off pump group (p value=0.04) and also incidence of memory deficit was<br />
higher in conventional group but no significant difference was seen (p value= 0.3).<br />
Conclusion: Although non of the patients of this study experience neurologic<br />
complications but it seems that neurologic morbidities be lower in off pump CABG.<br />
Based on the founding of this study we can conclude that depression was lower in off<br />
pump method than conventional one.<br />
112<br />
In vitro effects of cardioplegia on saphenous vein <strong>graft</strong>s<br />
during CABG<br />
Ahmadi SH, Soleimani M, Daliri M, Dehpour HR, Sanatkar, Karimi AA, Abbasi<br />
K, Kaviani S, Piryaee A, Fayaz-Zadeh and Madani-Civi M<br />
Abstract<br />
Background: Administration of cardioplegia into vein <strong>graft</strong> is an establish method to<br />
ensure cardioplegia distribution beyond <strong>coronary</strong> <strong>artery</strong> stenosis. The aim of this study<br />
was to examine the influence of potassium concentration in cardioplegia on structure and
function of saphenous vein.<br />
Methods: 10 specimens of saphenous vein <strong>graft</strong> from 10 patients during CABG were<br />
used. A part of each specimen served as control: the others were assigned to test groups.<br />
All test groups of specimens exposed to solution supplemented with 5, 20, mmol/1 KCL<br />
for at least 1 hour. A part of each specimen was sent to laboratory for tissue culture.<br />
Endothelial cell viability, calcium mobilization and NO generation were determined by<br />
using specific florescence marker. Another part of each specimen of vein <strong>graft</strong>s was<br />
studied by scanning electron microscopy. The last part of each specimen was evaluated<br />
for function and vasomotor responses.<br />
Results: Structural disorder and dysfunction of vein <strong>graft</strong> due to expose to cardioplegia<br />
will be discussed in the future.<br />
Conclusion: Intravenous cardioplegic administration can contribute to early and late<br />
thrombosis. So, complete evaluation of vein <strong>graft</strong> after exposure to cardioplegia can<br />
provide new insights into cardioprotection during aorto-<strong>coronary</strong> <strong>bypass</strong> <strong>surgery</strong>.<br />
113<br />
Outcomes and long term survival for patients undergoing<br />
mitral valve repair versus replacement concomitant <strong>coronary</strong><br />
<strong>bypass</strong><br />
Tehran Heart Center, Medical Sciences/University of Tehran, Tehran, Iran<br />
Abstract<br />
Background: In moderate to severe mitral regurgitation (MR) and <strong>coronary</strong> <strong>artery</strong><br />
disease (CAD), use of mitral valve repair (MV repair) vs replacement (MVR) in the time<br />
of CABG is controversial. To determine success rate and durability of mitral valve repair<br />
vs replacement concomitant with CABG in this group of patients.
Methods: From March 2002 to February 2005, 88 consecutive patients (mean age<br />
63.00±8.08 years, mean ejection fraction 44.80±10.89%parsonnet score 20.70±8.82) with<br />
CAD and moderate to severe MR (2 to4+) and CAD underwent CABG plus MVR or MV<br />
repair, 78.4% had post operative echocardiography, 47.7% had follow up<br />
echocardiography and 93.2% had post operative or follow up echocardiography, intra<br />
operative TEE was performed for 19(21%) patients, mean time of follow up was 8±4<br />
months.<br />
Results: 48.9% of patients underwent CABG plus MVR and 51.1% CABG plus MV<br />
repair, early mortality was (8%) 7 patients, all in MV repair group, but difference of<br />
mortality between MVR and MV repair group was not statistically significant p=0.114,<br />
late mortality was 3.4% (3 patients). MR was ischemic in 61% (with persistent wall<br />
motion abnormality) and ischemic in 23. Mortality was not related to preoperative<br />
ejection fraction, severity and mechanism of MR, or post operative MR, p=0.59, 0.49,<br />
0.41, 0.18, but mortality was higher in patients with more severe LV systolic dysfunction<br />
after CABG (EF 33% vs 40% p=0.04). in MV repair group, 39.8% had no MR, 33% mild<br />
MR, 13.6% moderate MR, 5.7% moderately severe and 1.1% severe MR (2 patients<br />
underwent reopration one because of severe MS and another because of severe MR.<br />
overall 72.8% had no or mild MR and 27.2% had moderate to severe MR, success of<br />
repair was not related to preoperative ejection fraction, severity and mechanism of MR<br />
and mechanism of mitral valve repair. 44.9±10.6 vs 41 25±12.9% p=0.38 p=0.6 p=0.9,<br />
p=0.59). We performed intraoperative TEE for 12 patients in MV repair group, severity<br />
of MR in intraoperative TEE had exact correlation with postoperative and follow up<br />
echocardiography. 20% had both follow up and postoperative echocardiography, MR<br />
severity was unchanged in follow up p=0.5.<br />
Conclusion: Early and late mortality was not difference between MVR vs MV repair<br />
group concomitant CABG. Durability of MV repair in MR and CAD in mid term is<br />
acceptable and repair is successful in most patients, so mitral valve repair may be<br />
preferred if technically possible.<br />
114<br />
Moderate nonorganic mitral regurgitataion and <strong>coronary</strong><br />
disease: treatment by <strong>coronary</strong> <strong>bypass</strong> alone<br />
Tehran Heart Center, Medical Sciences/University of Tehran, Tehran, Iran<br />
Abstract<br />
Background: In cases of moderate (2+ or 3+ on a scale of 0 to 4+) mitral regurgitation<br />
(MR) and <strong>coronary</strong> <strong>artery</strong> disease operative strategy continues to be debated between<br />
<strong>coronary</strong> <strong>artery</strong> <strong>bypass</strong> <strong>graft</strong>ing alone (CABG) or concomitant valve repair. To clarify the<br />
optimal management of these patients we evaluated the mid term result of isolated CABG
on moderate MR without organic mitral valve disease.<br />
Methods: From March 2002 to February 2005, 40 consecutive patients (57.5% male,<br />
mean age 62.45 years, mean ejection fraction 43.81%, mean Parsonnet score 19.58) with<br />
<strong>coronary</strong> <strong>artery</strong> disease and moderate MR without leaflet prolapse or rheumatism or other<br />
organic mitral valve disease underwent CABG alone 31 (77.5%) patients had either post<br />
operative or follow up transthoracic echocardiography with mean time of follow up<br />
10.82±8.12 months.<br />
Results: MR was ischemic in 25 (62.5%) patients (with persistent wall motion<br />
abnormality) and without significant etiology in 15 (37.5%) patients. Overall mortality<br />
was 7 (25.9%), 2(5)% early or in hospital and 5/30 (16.6%)late, mortality was not<br />
different between ischemic and non ischemic MR group, p=0.99. Also it was not related<br />
preoperative ejection fraction and severity of MR, 0.48, 0.62. considering postoperative<br />
and follow up transthorasic echocardiography, 16.1% had moderately severe MR , 29%<br />
had moderate MR, 29% mild MR and 25.8% no MR. p=0.000. Overall 54.8% had no or<br />
mild MR and 45.2% had moderate to severe MR. Ischemic MR, preoperative ejection<br />
fraction and LV systolic and diastolic dimensions had no significant effect on resolution<br />
of MR, p=0.46, 0.09, 0.79, 0.70.<br />
Conclusion: Although CABG alone for <strong>coronary</strong> <strong>artery</strong> disease accompanying<br />
moderate nonorganic MR reduces MR severity significantly, but many patients left with<br />
moderate or moderately severe MR. So a pre operative diagnosis of moderate nonorganic<br />
MR may warrant concomitant mitral repair.<br />
Mid-Term follow up of sixty patients with implantable<br />
cardiovertor defibrillator<br />
YaminisharifA, Kazemisaeid.A, Davoudi.G, Sadegian.S, Moughaddam.M ,<br />
Goodarzynejad H and Paydari.N<br />
115<br />
Tehran Heart Center, Medical Sciences/University of Tehran, Tehran, Iran<br />
Abstract<br />
Background: This study assessed the results of ICD implantation in 60 patients with<br />
different etiology, age, ejection fraction and different venous access.
Method: From May 2002 to July 2005, 60 ICDs were implanted in 60 patients who<br />
need to have ICD for secondary or primary prevention (Except MADITII inclusion<br />
criteria). Their age were between (16 to 79y) mean 51±16y (13% over 70 years). Follow<br />
up period was between (1 month to 38 months) mean 18±7m. 75% of patients were<br />
male.EF in 22% of patients was t %50 ,30-50% in 41%,
not respond to conventional analgesics. This study evaluates the effect of low dose<br />
ketamine (NMDA receptor inhibitor) infusion in controlling post CABG pain of opium<br />
addicts.<br />
Methods: We administered 100g/kg ketamine to 25 opium addicted CABG candidates<br />
after induction of anesthesia and before surgical incision. We continued ketamine<br />
infusion (2g/kg/min) for 48 hours after extubation. 25 controlled cases received placebo<br />
with the same pattern as ketamine. We recorded pain severity at rest and deep inspiration<br />
by VAS score in 6 equal intervals up to 48 hours after extubation. Besides, we recorded<br />
analgesic dosage during and after <strong>surgery</strong> up to 48 hours.<br />
Results: Sedation score was not high in either group. Although total analgesic dosage<br />
during <strong>surgery</strong> was lower in ketamine group (14.6 vs 20 mg), there was no significant<br />
difference between two groups. Although total dosage and number of analgesic and<br />
opium consumption in ICU was not different significantly, VAS score both in rest and<br />
deep inspiration in all intervals except 6 hour after extubation was higher in control group<br />
compared to ketamine group (p
demonstrated that cardiopulmonary <strong>bypass</strong> itself, results in reduced serum magnesium<br />
level. In this study, we wanted to evaluate the effect of total blood magnesium level<br />
(TMG) on preventing perioperative arrhythmias by routine regimens of 2-4 grams<br />
supplemental magnesium (SMG).<br />
Methods: TMG was measured in patients who were scheduled for CABG on 3<br />
occasions [just before anesthesia, just after entering intensive care unit (ICU)<br />
postoperatively and on the first morning after operation]. Patients were evaluated for<br />
primary cardiac rhythm and other variables that could have an influence on magnesium<br />
level (serum creatinine, urine output in operating room and diuretic therapy). SMG was<br />
also recorded in operating room and ICU. Then the patients were evaluated for the rate<br />
and kind of arrhythmia through next 3 days.<br />
Results: Mean TMG level in 174 cases was 2.2 (0.5), 2.6 (0.6) and 2.4 (0.6) mg/dl on<br />
three occasions respectively. Mean SMG was 2.5 (1.2) grams. 47 out of 157 patients<br />
developed post-operative arrhythmia (%30) [AF* (%6.4), Non-AF SVA** (%14.6) and<br />
Ventricular arrhythmia (%16.6)]. Mean serum creatinine level and urine output were 1.2<br />
mg/dl and 1800ml respectively. Although there was a significant difference between<br />
TMG on three occasions (P
Abstract<br />
Background: Experimental studies suggest that autologous bone marrow stem cell<br />
transplantation (AC 133+) in patients with myocardial infarction (MI) may improve<br />
cardiac function. The aim of this study was to assess feasibility, safety of this therapy and<br />
cardiac performance as well.<br />
Methods:Between June 2004- June 2005, 21 patients with history of acute myocardial<br />
infarction within 3 months who were candidate for <strong>coronary</strong> <strong>artery</strong> <strong>bypass</strong> <strong>graft</strong>ing<br />
(CABG), were entered in our study. The patients randomly divided to two groups: control<br />
group (n=8, CABG alone) and case group (n=13, CABG with intramyocardial injection<br />
of autologus AC133+ bone marrow stem cell in the infracted border zone). For all<br />
patients we have done dobutamine stress echo (DSE) and thallium scan before CABG<br />
and 3 months after CABG to determine perfusion and viability of the heart.<br />
Results:There were no significant differences between demographic factors of two<br />
groups. Left ventricular ejection fraction (LVEF) improved from 31.25% to 46.25% in<br />
case group (EF improvement in control group less than 10%, P
<strong>artery</strong> harvesting regarding arterial flow, vessel wall operative time, economic aspects<br />
and complications.<br />
Methods: Forty four consecutive patients undergoing <strong>coronary</strong> <strong>artery</strong> <strong>bypass</strong> and<br />
candidate for radial <strong>artery</strong> harvesting were randomized to two groups. In the first group,<br />
harvesting was done by sharp dissection (n=22) and in the second group by<br />
electrocautery as a vascular pedicle.<br />
Radial <strong>artery</strong> flow was measured before and after papaverin injection to its lumen.<br />
Specimens were examined by two special staining and immunohistochemistry to assess<br />
the vessel wall integrity.<br />
Results: Arterial flow was higher in group two (p=0.033) morphologic analysis showed<br />
full integrity of endothelium and no major arterial damage. Immunohistochemical<br />
staining demonstrated an extremely high degree of endothelial integrity in both groups.<br />
Operative time was shorter in group two (P=0.0001) The number of used clips was lesser<br />
in group two No special major complication was noted from radial <strong>artery</strong> harvesting in<br />
two groups.<br />
Conclusion: Elecrrocautery dissection for radial <strong>artery</strong> harvesting is a fact, safe and<br />
reliable technique compared with sharp dissection.<br />
123<br />
Seven-year follow-up of <strong>coronary</strong> <strong>artery</strong> <strong>surgery</strong> in young<br />
adults (
the 40 years old and evaluated mid-term results of CABGs in this group of patients, this<br />
study was done.<br />
Methods: Between July 1997 and March 2003, a total of 54 patients under the age of 40<br />
years at the time of <strong>surgery</strong>, operated for <strong>coronary</strong> <strong>artery</strong> disease. Gender, family history,<br />
cigarette smoking, opium addiction, diabetes, hypertension, hyperlipidemia, angina class,<br />
number of diseased vessels, ejection fraction (EF), prior MI and cardiac arrest were<br />
studied. The mean age was 35. The average EF was 36.8% (20-55%). Patients were<br />
followed for seven years.<br />
Results: Ninety three percent of these patients were male. Smoking (92%), positive<br />
family history for CAD (83%), hyperlipidemia (70%) opium addiction (39%) and<br />
diabetes (31%) were more prevalent in this study compared with patients older than 40<br />
years whereas the occurrence of hypertension (9%) was lower (P
Background: The aim of this study is to evaluate the appropriation between the size of<br />
prosthetic Aortic valve and body surface area in patients with AVR because of AS.<br />
Prosthetic Aortic valve replacement in a small aortic root raises concern about its<br />
hemodynamic effect.<br />
Methods: 12 AVR patients were evaluated with exercise stress echocardiography, peak<br />
gradient, effective orifice area and valve index were evaluated at rest and peak exercise.<br />
Results: Two patients had ideal hemodynamic results (peak gradient, Mean gradient 22<br />
appropriate, valve index > 1 cm/m at rest and exercise) (group AI).<br />
Five patients had intermediate hemodynamic results (good peak and mean gradient and<br />
valve index > 1 cm/m at rest but peak gradient, MG and or VI < 1 cm/m at peak exercise)<br />
(group A II).Five patients had inappropriate hemodynamic results at rest (PG, MG<br />
elevated and / or valve index < 1 cm2/m2).prosthetic Aortic valve size / BSA = 14/48 AI,<br />
12/53 AII, 12/22 B. The difference between group AI and AII was significant, but not<br />
meaningful statistically, (P = 0.08). The difference between group AI and B was<br />
meaningful statistically, (P = 0.05).<br />
Conclusion: For ideal hemodynamic results, we can consider Aortic root enlargement<br />
in small aortic roots with large BSA. BSA: body surface area PG: peak gradient MG:<br />
mean gradient :Valve Indexeffective orifice area BSA<br />
Absence of beneficial effect of autotransfusion combined with<br />
tranexamic acid on post cardiopulmonary <strong>bypass</strong> bleeding<br />
125<br />
Mehr-Aein A, Davoodi S and Madani-Civi M<br />
Department of anesthesiology , shariati hospital, Tehran University, Tehran Heart Center, Iran Tehran<br />
University of Medical Sciences. National Iranian oil company central hospital, Tehran, Iran<br />
Abstract
Background: The aim of this study was to assess the effects of intraoperative<br />
autotransfusion combined with tranexamic acid on post-operative bleeding and need for<br />
allogeneic transfusion.<br />
Methods: In a prospective, double blinded, randomized trial, 350 patients undergoing<br />
conventional CABG allocated into two groups:<br />
.Group1= 175 patients received tranexamic acid, 15mg/kg before the injection of<br />
heparin and 15mg/kg after protamin injection. .<br />
Group2= 175 patients received 30 mg/kg tranexamic acid and 2 units autologous blood.<br />
<strong>Post</strong>operative bleeding allogenic transfusions and complications were recorded.<br />
Results: The intraoperative and postoperative bleeding was 600±125 ml in group1 and<br />
620±150 ml in group2 (p=0.7). The rates of transfused patients in group 1&2 were 67%<br />
and 72% (P
Background: Several studies showed that elevated plasma homocysteine level is a risk<br />
factor for <strong>coronary</strong> <strong>artery</strong> disease. A common mutation C677T of<br />
methylenetetrahydrofolate reductase (MTHFR) gene is reported to be associated with<br />
decreased enzyme activity and increased blood homocysteine level.<br />
Methods: This study was to analyze the frequency of this mutation in relation to blood<br />
homocysteine level in 100 patients with CAD compared to the 100 normal controls.<br />
Results: Higher prevalence of the C677T mutation as well as elevated level in blood<br />
homocysteine were observed in Iranian CAD cases compared to the normal control. The<br />
C677T MTHFR common mutation was significantly linked to the CAD, supported by a P<br />
value
Abstract<br />
Background: Retrosternal and pericardial adhesions formation after cardiac <strong>surgery</strong><br />
make a repeat sternotomy, time consuming and dangerous, with high risk of iatrogenic<br />
trauma to heart, aorta, innominate vessels and <strong>graft</strong>s. So we decided to find another<br />
substitute for pericard other than the ordinary ones in use, with the advantage of lower<br />
cost but good results.<br />
Methods: Thirty sheep, 35-45 kg were used in this study and categorized into two<br />
groups including test group and control group. In group one (n=18) pericardium was<br />
excised and the LTS (laser treated silicone) membrane implanted as a pericardial<br />
substitute. In control group (n=12) the pericardium was excised without LTS membrane<br />
implantation. During follow up ranging from 3-24 months, sheep were observed for any<br />
clinical sign of post operation problems. Reoperation was done in all animals of test and<br />
control groups to evaluate adhesions formation.<br />
Results: In the control group dense adhesions were observed, while in the study group<br />
adhesions formation were reduced at all sites covered by LTS membrane and no infection<br />
or other complications were observed.<br />
Conclusion: The LTS membrane is safe and efficacious in the reduction of pericardial<br />
adhesions formation and might be used in patients undergoing cardiac <strong>surgery</strong> and may<br />
need reoperation, and due to it's lower costs it may replace other substitute such as PTFE.<br />
128<br />
Preparation of chistosan derived from shrimp’s shell of<br />
Persian gulf as a blood hemostasis agent<br />
Mirzadeh H, Yaghobi N, Amanpour S, Ahmadi SH, Ziabakhsh Tabary Sh,<br />
Mohagheghi MA and Hormozi F<br />
Iran Polymer Institute Cancer Institute, Tehran University of medical sciences Mazandaran University of<br />
medical sciences<br />
Abstract
Background: Hemostasis especially in heparinized patients has always been a problem<br />
and a large number of products has been introduced to make it easier. The purpose of this<br />
experiment was to evaluate the effectiveness and safety of PGC (Percian Gulf Chistosan)<br />
as a hemostasis agent with surgical application.<br />
Methods: Chitin used in this experiment was extracted from Persian Gulf shrimp' s<br />
shell according to Kifune et al. Method. Eighteen adult female mixed breed sheep<br />
(weight range: 40-50kg) were used in this study, an oblique incision was made at the<br />
anterior border of sternocleidomastoid muscle, carried directly down to the carotid sheat,<br />
three holes were punctured in carotid <strong>artery</strong> and led to jet bleeding. Bleeding time from<br />
the holes was assessed in different conditions: after manual compression with or without<br />
using PGC (and in heparinized and non heparinized animals).<br />
Results: Using PGC had significant reduction in manual compression time of the<br />
carotid <strong>artery</strong> in comparison with the control. It's mechanism of hemostasis seems to be<br />
independent from classic coagulation cascade because it works also in heparinized<br />
animals.<br />
Conclusion: There is significant reduction in manual compression time form bleeding<br />
site when PGC is used. It has a good hemostatic effect that is independent from classic<br />
coagulation cascade. The optimization and a better formulation of PGC for hemostatic<br />
purpose require further studies.<br />
129<br />
Evaluation of cardiac adhesions after pericardial substitution<br />
by laser treated silicone (LTS) membrane.<br />
Amanpour S, Mirzadeh H, Ahmadi SH and Mirkhani SH<br />
Tehran Heart Center, Medical Sciences/University of Tehran, Tehran, Iran Iran polymer and petrochemical<br />
institute, Tehran, Iran<br />
Abstract
Background: Reoperative median sternotomy may result in cardiac rupture due to<br />
severe adhesion between heart and surrounding tissues. To avoid this type of adhesion<br />
LTS membrane was developed and evaluated in animal models as a pericardial substitute.<br />
Methods: In this study 24 sheep were used. After general anesthesia chest was opened<br />
as in human, pencardium was excised and LTS membranes implanted in 14 sheep. 10<br />
sheep were used as a control group and the same surgical procedure was carried out<br />
without LTS membrane. According to a defined timetable between 1-27 months, the<br />
chest reopened and adhesion formation was evaluated both for LTS membranes and<br />
control groups.<br />
Results: As a substitute LTS membrane showed no adhesion to the posterior surface of<br />
the chest wall. Total adhesion scores were also statistically significant (P
Background: The clinical significance of mammary side branches is still controversial.<br />
This study was designed to show the potential phenomena in two different situations of<br />
distal resistance to mammary flow.<br />
Methods: Mammary <strong>artery</strong> flow measurement was done in four different situations<br />
(with and without distal resistance producing by partial occlusion of it's lumen by clip<br />
with patent or occluded side branch) in 31 patients undergoing elective CABG at end of<br />
harvesting by ejection of blood to a syringe.<br />
Results: There was significant difference (p
Abstract<br />
Background: In cases of moderate mitral regurgitation and <strong>coronary</strong> <strong>artery</strong> disease<br />
operative strategy continues to be debated between <strong>coronary</strong> <strong>artery</strong> <strong>bypass</strong> <strong>graft</strong>ing alone<br />
and concomitant valve replacement or repair.<br />
Method: From March 2002 to June 2004 20 consecutive patients mean age 63.30 ± 8.16<br />
years were treated for moderate mitral regurgitation and <strong>coronary</strong> <strong>artery</strong> disease with<br />
CABG alone, mean EF was 47.22± 14.16 and Parsonet score was 12.55± 9.40 Follow up<br />
ranged from<br />
Results: MR reduced from 1.61± 0.92 but difference was not statistically significant.<br />
(PV=0.12) EF reached from 47.22±14.16 to 48.61±9.6 post operatively difference was<br />
not statistically significant also. In hospital mortality was a and late mortality was 10% (2<br />
patients)<br />
Conclusion: Severity of MR in most patients with moderate ischemic MR reduce with<br />
CABG alone, but even moderate ischemic MR include high risk patients with high late<br />
mortality for CABG alone.<br />
132<br />
Chronic total occlusion of left main <strong>coronary</strong> <strong>artery</strong>: a case<br />
series<br />
Marzban M, Mandegar MH, Karimi A, Salarifar M, Amirzadegan A, Ahmadi H,<br />
Abbasi K, Movahedi N, Davoodi S and Abbasi SH<br />
Tehran Heart Center, Medical Sciences/University of Tehran, Tehran, Iran
Abstract<br />
Background: Acute occlusion of left main <strong>coronary</strong> <strong>artery</strong> as a complication of cardiac<br />
catheterization is a well-known clinical entity; but few reports exist about chronic total<br />
occlusion, its incidence and management.<br />
Methods: From 2000 to 2003, 10 patients with chronic total occlusion of left main<br />
<strong>coronary</strong> <strong>artery</strong> underwent <strong>coronary</strong> revascularization with conventional technique<br />
(cardiopulmonary <strong>bypass</strong> and combined antegrade with retrograde cardioplegia delivery<br />
technique). Patients were followed regularly.<br />
Results: No mortality, no major morbidity except one episode of postoperative bleeding<br />
requiring re-exploration were seen. At mean follow up of 30 months, all patients were in<br />
NYHA class I.<br />
Conclusion: Total occlusion of left main <strong>coronary</strong> <strong>artery</strong> is not as rare as literature<br />
review suggests and can be managed as other patients with left main stenosis.<br />
133<br />
Results of CABG concomitant with mitral valve replacement<br />
versus repair in patients with moderate to severe mitral<br />
regurgitation accompanying <strong>coronary</strong> <strong>artery</strong> disease<br />
Sadeghian H, Karimi AA, Ahmadi H, Salarifar M, Darabian C, Davoodi S, Abbasi K,<br />
Haji Zeinali A, Amirzadeghan A and Majd M<br />
Tehran Heart Center, Medical Sciences/University of Tehran, Tehran, Iran
Abstract<br />
Background: We studied outcome of <strong>surgery</strong> in patients with moderate to severe mitral<br />
regurgitation (MR) suffering from <strong>coronary</strong> <strong>artery</strong> disease (CAD), undergone mitral valve<br />
replacement (MVR) vs. mitral valve (MV repair) accompanying <strong>coronary</strong> <strong>artery</strong> <strong>bypass</strong><br />
<strong>graft</strong>ing(CABG).<br />
Methods: From March 2002 to January 2004, 40 consecutive patients (mean age:<br />
59/7±8/9years) undergone CABG plus MVR or MV repair. From 40 patients, 18(45%) were<br />
in NYHA functional class lll or IV, 36(90%) of them had MR grade III. The mean follow-up<br />
time was 7/7±5/9 months.<br />
Results: The mitral valve was replaced in 16 (group A) and repaired in 24 (group B)<br />
concomitant with CABG. Risk for CABG was similar in both groups according to Parsonnet<br />
scorer. 1) Early mortality was similar in both groups (0 in group A, 3 in group B, 7/5%,<br />
p=0.26), late mortality also had no significant difference between two groups(1 in group A, 0<br />
in group B , p=0.9). Multivariate analysis identified poor coronaries as a risk factor for early<br />
death (p=0.004). Pulmonary hypertension had a trend for increased mortality (p=0.12), but<br />
recent unstable angina, low ejection fraction (EF) and history of pulmonary edema had no<br />
influence. 2) In group A, EF decreased from mean 51.87±10.14 to 44.37± 8.3% after <strong>surgery</strong><br />
(p=0.002), in group B no significant change in EF occurred (from 43.42± 11 to 43.7± 13%,<br />
p=0.86).<br />
Conclusion: in patients with moderate to severe MR accompanying CAD, mortality was<br />
similar in MVR vs. MV repair plus CABG, but EF significantly decreased after MVR, thus<br />
according to this study there is a trend for MV repair concomitant with CABG in patients<br />
with significant MR accompanying CAD, but we need more studies for definite conclusion.<br />
134<br />
Effects of oral Pentoxifylline in cardiopulmonary <strong>bypass</strong><br />
surgeries<br />
Abbasi K, Karimi A, Ahmadi H, Davoodi S, Movahedi N, Marzban M and<br />
Khamne'ian S<br />
Tehran Heart Center, Medical Sciences/University of Tehran, Tehran, Iran
Abstract<br />
Background: The aim of the presented study was to evaluate the preservation effect of<br />
the Pentoxifylline on enzymatic raise after the cardiopulmonary <strong>bypass</strong> <strong>surgery</strong>.<br />
Methods: 60 patients undergoing cardiopulmonary <strong>bypass</strong> surgeries in Tehran Heart<br />
Center in1381-82 were entered in a prospective placebo controlled clinical trial and<br />
randomly divided to control (placebo) and case (oral Pentoxifyliin 400mg tds<br />
preoperative and 400mg bd in early postoperative period) groups. Plasma concentration<br />
of creatine phosphokinase (CK), creatine phosphokinase MB (CK-MB) and lactate<br />
dehydrogenase (LDH) were recorded immediately, 4, 6 and 24 hours after the<br />
cardiopulmonary <strong>bypass</strong> and preoperative ejection fraction were measured.<br />
Results: There were no significant difference between demographic factors (age and<br />
gender) and operation duration and ejection fraction in control and case groups (51.50 vs.<br />
54.80 yr; 63.64 vs. 70% male and 192.23 vs. 176.38 min. and 40.50% vs. 48.80<br />
respectively. CK means in immediately, 4, 6 and 24 hours after operation were<br />
significantly higher in control group (156.6 vs. 131.02 and 921.10 vs. 343.43 and 316.70<br />
vs. 287.30 IU/L; respectively p
Abstract<br />
Background: This study was undertaken to evaluate of risk factors for CAD in patients<br />
< 40 years old<br />
Method: Among 2269 patients undergoing CABG operation. A total of 86 patients were<br />
40 years old. (group<br />
2) gender, family history, smoking, diabetes, hypertension, hyperlipidemia, functional<br />
class, number of disease vessels, Ejection fraction, prior MI were studied and we<br />
compared CAD risk factors between 2 groups.<br />
Results: From 86 patients who were
Abstract<br />
Background: The role of preoperative screening for carotid <strong>artery</strong> stenosis in patients<br />
who underwent cardiac surgical procedures is not clearly established. This retrospective<br />
study was designed to determine the prevalence of carotid disease in this population and<br />
to identify preoperative risk factors for carotid <strong>artery</strong> stenosis.<br />
Methods: During a 13-month interval 2677 patients of a consecutive series of patients<br />
55 years of age and older who underwent carotid <strong>artery</strong> <strong>bypass</strong> <strong>graft</strong>ing were evaluated<br />
before operation with carotid duplex ultrasonography.<br />
Results: The prevalence of disease was 2.6% for significant stenosis (significant<br />
stenosis was defined as 60% or greater narrowing of intraluminal diameter due to<br />
Washington University criteria). The major risk factors were male gender (61.4%),<br />
hypercholesterolemia (50%), HTN (61.4%), familial history of CAD and smoking did not<br />
show significant relation with carotid <strong>artery</strong> stenosis. Carotid endarterectomy combined<br />
with CABG was performed on 16 patients; all operative and postoperative variables were<br />
collected and analyzed. For 33 patients did not been performed any carotid intervention<br />
in combination with CABG and in short-term follow-up we didn’t detect any major<br />
complication such as stroke and 30-day mortality in these 33 cases.<br />
Conclusion: This study showed that prevalence of carotid stenosis in CAD patients of<br />
our society is less than western studies (2.6% vs. 5.9%): so we can organize a specific<br />
scoring for preoperative carotid evaluation.<br />
137<br />
Analysis of effective factors on mortality of CABG patients in<br />
hospital<br />
Sadeghian S, Salarifar M, Karimi A, Marzban M, Abbasi K, Ahmadi H, Movahed<br />
N, Davoodi S, Paydari N and Padeghan M.
Tehran Heart Center, Medical Sciences/University of Tehran, Tehran, Iran<br />
Abstract<br />
Background: More than 30.000 CABG surgeries are performed in Iran annually. The<br />
main goal of performing CABG <strong>surgery</strong> is to control disease symptoms and to increase<br />
the patients' life expectancy; therefore, analyzing the rate of mortality and the effective<br />
factors can affect the decision we make about performing CABG.<br />
Methods: In order to analyze these factors in Iranian patients the files of all the patients<br />
from March 2002 to March 2004 from the viewpoint of their personal data disease and<br />
the risk factors were analyzed.<br />
Results: During this period the total number of patients who underwent CABG <strong>surgery</strong><br />
was 5475 patients with an average age of 58 years old of whom 24% were 65-75 years<br />
old and 76% were male. Seventy patients have passed away during this period which<br />
shows a mortality of 1.3%. The mortality in emergency surgeries was 2.4% and in<br />
elective surgeries was 1.2%. The risk of this <strong>surgery</strong> in both sexes increases after the age<br />
of 65, but this increase is higher in men (1.8 times against 1.4). After the age of 75 this<br />
risk in men multiplies by<br />
4.3. in general, the risk of the <strong>surgery</strong> in women was twice as much as men (p=0.001).<br />
Emergency <strong>surgery</strong> multiplies the risk by 1.9 (p=0.001). Carotid arterial stenosis and<br />
heart valve <strong>surgery</strong> multiply the risk by 3 and 8, respectively (p=0.001). there is a relation<br />
between EF and mortality rate of the <strong>surgery</strong> (p=0.001), so that for an EF of less<br />
than30%, the risk of the <strong>surgery</strong> multiplies by 2.4 and for an EF range of 30-50% the risk<br />
multiplies by 1.9. Among atherosclerotic risk factors only a relation between the risk of<br />
this <strong>surgery</strong> and diabetes mellitus (p=0.02) and hypertension (p=0.07) has been proved<br />
which multiply the mortality rate of the <strong>surgery</strong> by 1.6 and 1.5, respectively. For those<br />
patients who are addicted to smoking cigarettes, the age of disease appearance and the<br />
life expectancy are five years less than that of other patients.<br />
Conclusion: The results indicate that the age of CAD appearance in Iran is eight years<br />
less than that of America and the increase in risk of the <strong>surgery</strong> except left main <strong>coronary</strong><br />
<strong>artery</strong> <strong>surgery</strong> is similar to other studies but the rate of this increase is different.<br />
138<br />
Long term evaluation of laser-treated silicone (LTC)<br />
membrane as a pericardial substitute: An experimental study<br />
Ahmadi H, Mirzadeh H, Amanpour S, Rabbani Sh, Mohagheghi MA and<br />
Mirkhani H<br />
Tehran Heart Center, Medical Sciences/University of Tehran, Tehran, Iran
Abstract<br />
Background: Evaluation of efficacy and safety of LTC membrane as a new<br />
pericardial substitute in sheep model.<br />
Methods: 30 ewes (35-45 kg) were used and categorized into two groups including test<br />
group and control group. In group one (n=18) pericardium was excised and the LTC<br />
membrane implanted as a pericardial substitute. In control group (n=12) the pericardium<br />
was excised without LTC membrane implantation. During follow up ranging from 3-24<br />
months, sheep were observed for any clinical sign of post operation problems.<br />
Reoperations were done in all animals of test and control group to evaluate adhesions<br />
formation.<br />
Results: In the control group dense adhesions were observed, while in the study group<br />
adhesions formation was reduced at all sites covered by LTC membrane and no infection<br />
or other complications were observed.<br />
Conclusions: The LTC membranes were safe and efficacious in the reduction of<br />
pericardial adhesions formation and might be used in patient undergoing cardiac <strong>surgery</strong><br />
and may need re-operation. Key words: cardiac <strong>surgery</strong>, pericardial adhesions, sheep,<br />
silicone.<br />
139<br />
Autologus bone marrow stem cell transplantation for<br />
myocardial regeneration<br />
Ahmadi H, Baharvand H, Soleymani A, Kamangari A, Ashtiani K, Salarifar M,<br />
Sadeghian H, Emami, Ardekani JM and Madani Civi M<br />
Tehran Heart Center, Medical Sciences/University of Tehran, Tehran, Iran
Abstract<br />
Background: To assess the therapeutic effect safety and feasibility of this method in<br />
patients with myocardial infarction.<br />
Method: 4 patients with history of acute myocardial infarction within 3 months<br />
underwent <strong>coronary</strong> <strong>artery</strong> <strong>bypass</strong> <strong>graft</strong>ing. Autologus AC 133+ bone marrow stem cells<br />
were injected intra-myocardially in the infracted border zone at the time of <strong>surgery</strong>. In<br />
nest four weeks we are going to schedule cell transplantation in six cases.<br />
Results: Global and regional left ventricular function would be evaluated by stress<br />
echocardiography. Ischemia and viability of target area of myocardium were evaluated by<br />
thallium scan. Final results would be reported after 3-4 months.<br />
Conclusion: We believe that implantation of AC133+ bone marrow stem cell into the<br />
heart is safe and might induce cell regeneration with angiogenesis in infracted areas thus<br />
improving function and perfusion of the myocardium.<br />
140<br />
Rest and Stress echocardiographic evaluation of patients with<br />
AVR for estimation of mismatch between effective area and<br />
body surface area<br />
Sadeghian H, Kamangari A, Marzban M, Mandegar MH, Karimi AA, Davoodi S ,<br />
Salarifar M, Ahmadi SH, Abbasi SH and Madani Civi M
Tehran Heart Center, Medical Sciences/University of Tehran, Tehran, Iran<br />
Abstract<br />
Background: The aim of this study is to evaluate the appropriation between the size of<br />
prosthetic Aortic valve and body surface area in patients with AVR because of AS.<br />
Prosthetic Aortic valve replacement in a small aortic root raises concern about its<br />
hemodynamic effect.<br />
Methods: 12 AVR patients were evaluated with exercise stress echocardiography, peak<br />
gradient, effective orifice area and valve index were evaluated at rest and peak exercise.<br />
Results: Two patients had ideal hemodynamic results (peak gradient, Mean gradient<br />
appropriate, valve index > 1 cm 2 /m 2 at rest and exercise) (group AI).<br />
Five patients had intermediate hemodynamic results (good peak and mean gradient and<br />
valve index > 1 cm 2 /m 2 at rest but peak gradient, MG and or VI < 1 cm/m at peak<br />
exercise) (group A II).Five patients had inappropriate hemodynamic results at rest (PG,<br />
MG elevated and / or valve index < 1 cm 2 /m 2 ).prosthetic Aortic valve size / BSA = 14/48<br />
AI, 12/53 AII, 12/22 B. The difference between group AI and AII was significant, but not<br />
meaningful statistically, (P = 0.08). The difference between group AI and B was<br />
meaningful statistically, (P = 0.05).<br />
Conclusion: For ideal hemodynamic results, we can consider Aortic root enlargement in<br />
small aortic roots with large BSA. BSA: body surface area PG: peak gradient MG: mean<br />
gradient :Valve Indexe ffective orifice area<br />
BSA<br />
141<br />
Relation between age and sex of CABG patients and kind and<br />
number of risk factors<br />
Sadeghian S, Darabian C, Haji Zeinali AM, Karimi A, Amirzadegan A, Marzban<br />
M, Abbasi K and Hanafizadeh B<br />
Tehran Heart Center, Medical Sciences/University of Tehran, Tehran, Iran
Abstract<br />
Background: Regarding the importance of knowledge of the risk factors (RF) in<br />
preventing atherosclerosis the rate of risk factors was studied in CABG patients at<br />
different ages based on their sex.<br />
Methods: A questionnaire including the age, sex, and risk factors of the disease was<br />
designed for all CABG patients who have been hospitalized in the past 11 months (from<br />
23 Aug 2003 to 19 may 2004).these questionnaires were filled out after bedside<br />
interviews and lab tests. Meanwhile, the same questionnaire was filled out for the patients<br />
who had normal angiographies as the control group.<br />
Results: Out of 2734 CABG patients, 79% were men and 21% were women. The<br />
women had an average age of 60 years and the men had an average of 57.9 years. The<br />
highest rate of RF in the men under 45 years old was cigarette smoking (63.5% control<br />
group: 17.4%), hypercholesterolemia (49.6% control group: 7%) and positive FH (49.4%,<br />
control group: 26.1%). The highest rate of RF in the women under 45 years old was<br />
hypercholesterolemia (55.6%, control group: 11.1), diabetes mellitus (48.9%, control<br />
group: 3.4%), and positive FH (48.9%, control group: 37.9%). In comparison with the<br />
control group, the highest increase in the rate of RF in this group was seen in women with<br />
diabetes mellitus which can indicate the importance of diabetes mellitus in this age group.<br />
The highest rate of RF in the men 45-55 age group was cigarette smoking (58.3%, control<br />
group: 27.7%), in 55-56 age group was cigarette smoking (45.3%, control group: 43.5%),<br />
and in 65-75 age group was diabetes mellitus (35.2%, control group: 16.7%). The highest<br />
rate of RF in the women of 45-55age group was hypercholesterolemia (62.3%, control<br />
group: 28%), in 55-56 age group was hypercholesterolemia (63.6%, control group:<br />
56.3%), and in 65-75 age group was hypercholesterolemia (596%, control group: 44.4%).<br />
The largest number of risk factors was 2 for men under 65 years old and 1 for men over<br />
65 years old. In women the largest number of risk factors was 2 in all age groups.<br />
Conclusion: In general in men the rate of risk factors of cigarette smoking, positive<br />
FH, and hypercholesterolemia decrease as their age increases, but the rate of diabetes<br />
mellitus increases as their age increases. The rate of HTN in men increases till the age of<br />
65 and then decreases. In women the rate of positive FH decreases till the age of 75, but<br />
there was no meaningful statistical relation between "cigarette, DM,<br />
hypercholesterolemia, and HTN risk factors" and different age groups.<br />
142<br />
Early results and 12 months follow up of PTMC<br />
Salarifar M, Sadeghian H, Kazemi Saleh D, Kassaian E, Haji Zeinali A, Alidoosti<br />
M, Sobh Bidarai and Paydari N<br />
Tehran Heart Center, Medical Sciences/University of Tehran, Tehran, Iran
Abstract<br />
Background: Percutaneous transvenous mitral commissurotomy (PTMC) is now the<br />
treatment of choice for selected patients with symptomatic mitral stenosis (MS) with<br />
mitral valve area (MVA)
Abstract<br />
Background: Regarding the higher danger of left main <strong>coronary</strong> arterial disease<br />
(LMD) in comparison with other kinds of <strong>coronary</strong> <strong>artery</strong> disease (CAD), the study of the<br />
rate of this disease in the total CAD patients and their ages and sex may probably help us<br />
to diagnose these patients earlier.<br />
Methods: A questionnaire was filled out for all patients who were candidates for CABG<br />
during a period of six months (from 23 Sep 2003 to 19 Apr 2004) after bedside<br />
interviews, lab tests, and angiography.<br />
Results: Out of 1465 CAD patients, 136 patients (7.2%) had more than 50% left main<br />
<strong>coronary</strong> stenosis (79.7% male and 20.3% female). This shows no statistically<br />
meaningful difference between both sexes in comparison with the total number of each<br />
sex. From the view point of the patients' ages, the most common age for development of<br />
this disease was 55-65 which is the same as CAD. In four age groups, classified from<br />
under 45 to 75 years, the rate of the disease in men was 8.3%, 24%, 34% and 28%<br />
respectively, while in women the rate was 0%, 21%, 39% and 32%. Regarding the age of<br />
CAD development, there was no meaningful difference. From the viewpoint of the<br />
number of risk factors (RF), 14.2% of men had no risk factors, 26.4% had one risk factor,<br />
43.4% two risk factors, 9.4% three risk factors, 4.7% four risk factors and 1.9% five risk<br />
factors, which shows a meaningful difference in comparison with the number of risk<br />
factors in CAD patients of 45-55 age group. 7.1% of the women had no risk factors, 25%<br />
had one risk factor, 49.5% two risk factors, 17.9 % three risk factors, 3.6% four risk<br />
factors, and 0% five risk factors, which shows no meaningful difference in comparison<br />
with the number of risk factors in CAD patients. There was a meaningful difference, from<br />
the viewpoint of the rate of RF, between LMD patients and the total number of the<br />
patients.<br />
Conclusion: The prevalence of LMD in our patients is almost similar to that of other<br />
communities and some factors such as having two risk factors, age group of 55-65,<br />
cigarette smoking for men, and DM for women, increases the probability of LMD<br />
development.<br />
144<br />
Effect of antioxidants on reducing the damaging effect of<br />
cardiopulmonary <strong>bypass</strong>: a clinical study<br />
Marzban M, Mandegar MH, Abbasi K and Hanafizadeh B<br />
Tehran Heart Center, Medical Sciences/University of Tehran, Tehran, Iran
Abstract<br />
Background: Damaging effects of CPB on different organs is a well-known clinical<br />
entity. To reduce these effects some antioxidant agents have introduced, such as<br />
allopurinol, vitamin E and vitamin C. This study was designed to show the potential<br />
benefit of these agents on heart and lung <strong>bypass</strong> patients.<br />
Method: 96 consecutive candidates for elective CABG were divided into two groups.<br />
The study group received allopurinol (1500mg orally in 3 divided doses), vitamin C (3g<br />
in two divided doses) and vitamin E (600mg) on the day before operation. Control group<br />
received placebo. Following indices were recorded: demographic data, EF, CPB time,<br />
cross-clamp time, ICU stay, hospital stay, IABP use, inotrope use, serial EKG, serum<br />
cardiac enzymes, PaO2, PAO2, alveoloatrial O2 difference and intubation time.<br />
Results: There was a significant difference in indices of myocardial damage (EKG and<br />
serum enzymes) between the two groups ( p
Abstract<br />
Background: Previous studies have suggested that cardiac resynchronization achived<br />
through atrial-synchronized pacing produces clinical benefits in patients with heart failure<br />
who have an intraventricualr and interventricular conduction delay. We performed CRT<br />
in patients with severe heart failure in our center.<br />
Methods: Between July 2003 and May 2004 twelve patients (11males and 1 female<br />
with average age of 58±13.2 years) with severe symptoms of heart failure associated with<br />
ejection fraction of 30% or less and QRS interval 136 msec or more underwent CRT. To<br />
evaluate progress in our patient conditions we used ECG, echocardiography and<br />
exertional test, before and after the procedure. Mean follow up period was 169±108 days.<br />
MRI was performed for nine patients before CRT implantation.<br />
Results: 10 patients experienced an improvement in functional class and exertion time<br />
in exertional test. Echocardiography showed decreased LV size and (MR grading). One<br />
patient had no clinical progress and is a candidate for cardiac transplantation. In nine<br />
patients MRI showed asynchron wall and septal movement. Among 3 patients without<br />
MRI report, one case died shortly after cardiac transplantation due to transplant rejection.<br />
Conclusion: Cardiac Resynchronization results in significant clinical improvement in<br />
patients who have severe heart failure with an intraventricular and interventricular<br />
conduction delay. In addition; MRI guided patient selection could help to achieve more<br />
benefactions for the patients.<br />
146<br />
High-dose heparin to prevent deep venous thrombosis in slow<br />
pathway ablation<br />
Yamini Sharif A, Moghddam M, Kazemi-Saeed A and Lotfi-Tokaldany M
Tehran Heart Center, Medical Sciences/University of Tehran, Tehran, Iran Dr. Shariati Hospital, Medical<br />
Sciences/University of Tehran, Tehran, Iran<br />
Abstract<br />
Background: Deep Venous Thrombosis (DVT) is a rare complication of slow pathway<br />
ablation (SPA). We decided to increase the dosage and duration of heparin administration<br />
to prevent complication.<br />
Methods: Between 1995 and 2002, we recorded 2 cases of DVT in 148 patients who<br />
underwent SPA for atrioventricular nodal reentrant tachycardia (AVNRT).<br />
Anticoagulation consisted of 5000 units of heparin IV bolus, followed by 1000 units/hour<br />
up to the end of the procedure. Mean patient age was 46.9±13.4 years. Average procedure<br />
time was 2.8±1.4. After the 2 cases of DVT, we decided to increase the initial IV heparin<br />
dosage to 10,000 units in adults and continue heparin at 1000 units/hour for 24 hours. 92<br />
patients (mean age of 48.8±13.4 years) underwent SPA with the new anticoagulation<br />
regimen. Average procedure and fluoroscopy times were 60±10 and 10±3 minuets,<br />
respectively. Mean hospitalization period was 3.3±0.8 days and duration of follow up<br />
was 265±128 days.<br />
Results: No bleeding events or DVT occurred in the patients who received high-dose<br />
heparin.<br />
Conclusion: Increasing the dosage and the duration of heparin prevented DVT in out<br />
patients, without any additional risk of bleeding.<br />
147<br />
How Safe or Feasible is <strong>Post</strong> CABG PCI<br />
Kazemi Saleh D, Haji Zeinali A, Kassaian E, Salarifar M, Alidoosti M, Paydari<br />
N and Madani Civi M<br />
Tehran Heart Center, Medical Sciences/University of Tehran, Tehran, Iran
Abstract<br />
Background: Redo-CABG is usually associated with more complications and<br />
mortality so, feasibility and safety of PCI in this group of patients is important.<br />
This study was performed to evaluate success rate, complications and late outcomes of<br />
PCI in patients with history of previous CABG and comparing the results with patients<br />
with no history of previous CABG.<br />
Methods: Analysis of data of 1376 consecutive patients who underwent PCI from April<br />
2003 to March 2004 revealed that38 of these patients had history of previous CABG.<br />
We analyzed and compared the rate of mortality, early complications, success rate and<br />
MACE during follow up between these two groups (group A=Previous history of<br />
CABG, group B= No history of CABG).<br />
Results: Success rate in two group was (97.2% in group A and 98.6 % group in B,<br />
P = NS). The rate of mortality was also similar (0 % in group A, 1.2 % in group B,<br />
P = NS). The rate of re-PCI or redo CABGs was also the same in two groups (7.7 %<br />
group A vs. 2 % group B, P= NS) and (0 % group A vs. 2.5 % group B, p = NS),<br />
respectively. The rate of MACE during follow up (9.64 mo ± 2.4) was 8.3 % in group A<br />
vs.6.6 % in group B (P = NS).<br />
Conclusion: There are no significant differences regarding mortality, early<br />
complications, success rate and MACE rate during follow up between PCI patients with<br />
or without history of previous CABGs.<br />
148<br />
A report of first fractional flow reserve (FFR) measurements<br />
in Iran<br />
Kassaian E, Salarifar M, Alidoosti M, Haji zeinali AM, Kazemi Saleh D, Majd<br />
Ardakani J, Abbasi H and Padegan M<br />
Tehran Heart Center, Medical Sciences/University of Tehran, Tehran, Iran
Abstract<br />
Background: Coronary <strong>artery</strong> stenosis of moderate severity is often a challenge for<br />
decision making and planning an appropriate management. Furthermore waiting for non<br />
invasive testing such as SPECT in patients admitted for acute chest pain is often time<br />
consuming and prolongs hospital stay. FFR which can be derived easily from the ratio of<br />
the mean distal <strong>coronary</strong> <strong>artery</strong> pressure to the aortic pressure during maximal<br />
vasodilation is useful for making clinical decisions concerning patients with ambiguous<br />
clinical symptoms and moderate <strong>coronary</strong> stenosis as determined angiographically.<br />
Methods: According to a specific protocol during the year 2004 we are going to<br />
measure FFR in patients with moderate stenosis. In this study we want to compare the<br />
results of FFR with SPECT and to know if measuring FFR can change the therapeutic<br />
plans of these patients.<br />
Results: For the first 5 patients (mean age 57.8) for whom FFR has been measured 7<br />
<strong>coronary</strong> arteries were evaluated. Of these patients 2 of them had FFR
diameter of the culprit <strong>coronary</strong> <strong>artery</strong> influences the outcome of an attempted<br />
percutaneous <strong>coronary</strong> intervention (PCI) in the current era of interventional cardiology.<br />
Methods: A total of 1344 patients undergoing PCI were divided into groups with<br />
reference diameter”2.5 mm (n=305) and>2.5 (n=1039). Success and in-hospital and 9-<br />
month major adverse cardiac events (death, myocardial infarction and target vessel<br />
revascularization) rates between both groups were compared.<br />
Results: Patients with lesions in small vessel were more frequency female (36% vs.<br />
27%; p= 0.006), diabetic (30% vs. 21%; p=0.005), had multi-vessel involvement (45%<br />
vs. 15%; p
Background: Atrial fibrillation (AF) is a frequent arrhythmia among the cardiac<br />
patients and because of increased risk of thromboembolism in this arrhythmia<br />
discrimination of effective risk factors in producing left atrial (LA) thrombosis is<br />
clinically important. Lipoprotein (a) [LP (a)] has similar structure as plasminogen, so<br />
when it is high can be a risk for prevention of fibrinolysis (thrombogenesis).<br />
Methods: This study is a case control among the chronic AF patients mostly with mitral<br />
stenosis. LA thrombus had been confirmed by transthoracic and transesophageal<br />
echocardiography.<br />
Results: 50 patients mostly with mitral stenosis had been studied half of them had LA<br />
thrombosis (patient group) and half of them had no LA thrombosis (control group). All of<br />
them had chronic AF. Between sex and LA gradient and existence of LA thrombus was<br />
no significant correlation. In the control group © age was 45±11y in contrast to patient<br />
group (p) where it was 57±9y. LA size was 49±5mm ( c ) and 56±9mm (p) La blood<br />
velocity was 12±2 cm/sec ( c) and 5±3 cm/sec (p) LP(a) concentration was 30±6.7 mg/dl<br />
( c) and 55±2.75 mg/dl (p). Significant correlation (p
Back ground: Coronary <strong>artery</strong> disease is the treating cause of mortality at present.<br />
So, understanding the different factors while affect this disease can help for better<br />
prevention of CAD.<br />
Methods: From February 2003 to December 2003, the blood group and Rh of 2026<br />
patients with documented <strong>coronary</strong> <strong>artery</strong> disease who underwent <strong>coronary</strong> <strong>artery</strong><br />
<strong>bypass</strong> <strong>surgery</strong>, was preoperatively determined in a routine laboratory test.<br />
The frequency of each blood group and Rh in the study group was compared with<br />
frequency of blood groups and Rh in Iranian general population that has been already<br />
published by Blood Transfusion Organization of Iran. Also in each group of patients with<br />
different blood group the frequency of main risk factor for CAD, (HIP, HTN, NIDDM,<br />
smoking) was assessed to evaluate any correlation between blood group and known risk<br />
factor with CAD.<br />
Result: The frequency of blood groups( A,B,AB, O)of these patients were as follow:<br />
A=650(32.1%), B=503(24.8%), AB=153(7.5%), O=720(35.6%) and 1830(90.5%) of<br />
them were Rh positive while 193(9.5%) were Rh negative. In evaluation of the frequency<br />
each blood group and Rh in the study group versus Iranian general population no<br />
significant difference was detected. In CAD patient with different blood groups, no<br />
significant difference was detected. In CAD patient with different blood groups, no<br />
significant difference was detected in frequency of risk factors.<br />
With considering of age the frequency of each blood group was similar in patients under<br />
and above 45 years old.<br />
Conclusion: There is no correlation between different blood groups and Rh and<br />
development of CAD. Also the frequency of main risk factors is equal in patients with<br />
different blood groups. Blood groups have no effect in development of premature CAD.<br />
152<br />
Stem cell transplantation in patients with acute myocardial<br />
infarction; a single center registry<br />
Salarifar M, Kassaian E, Kazemi Saleh D, Alidoosti M, Haji Zeinali A,<br />
Sadeghian H, Ghavamzadeh A, Ali Moghadam K, Majd Ardakani J and Hakki<br />
kazazi E<br />
Tehran Heart Center, Medical Sciences/University of Tehran, Tehran, Iran
Abstract<br />
Background: Many clinical and experimental studies reveal that blood derived or bone<br />
marrow derived progenitor cells could beneficially affect post infarction remodeling. We<br />
have designed a study protocol to evaluate the effects of these cells in conjunction with<br />
TUMS hematologic research center. The main purpose of this study is to examine if<br />
intra<strong>coronary</strong> transplantation of autologous hematopoietic bone marrow derived<br />
progenitor cells could improve patients ejection fraction and extent of viable tissue.<br />
Methods: from July to October 2004; 12 patients with reperfused recent (within 30<br />
days) AMI will be included in the study to received intra<strong>coronary</strong> infusion of bone<br />
marrow derived autologus hematopoeitic stem cells into the infracted related <strong>artery</strong>.<br />
Ventricular EF, regional wall motion and extent of non viable tissue are measured at base<br />
line and 3 months after the procedure using stress echocardioghraphy, myocardial<br />
perfusion scan and dobutamine stress echocardioghraphy. Also the procedure and in<br />
hospital reactions and complications will be measured.<br />
Results: primary stenting was done in our first 35 years old patient with recent<br />
anteroseptal MI with 95% stenosis of the proximal LAD and EF=30%. 8x 10 16<br />
hematopoeitic stem cells were injected with over the wire balloon technique. We are<br />
going to present the results of the short term follow up of these patients in December<br />
2004.<br />
153<br />
Short term results of renal <strong>artery</strong> angioplasty (stenting) on<br />
blood pressure and serum creatinine<br />
Haji Zeinali A, Kazemi Saleh D, Salarifar M, Kassaian E, Alidoosti M, and Hakki<br />
kazazi E<br />
Tehran Heart Center, Medical Sciences/University of Tehran, Tehran, Iran<br />
Abstract<br />
Back ground: Angioplasty and stenting are a good alternative treatment for renal<br />
<strong>artery</strong> stenosis (RAS), which have the advantage of avoiding general anesthesia and the
discomforts of <strong>surgery</strong>. Prevalence of atherosclerotic RAS in old hypertensive CAD<br />
patients in high and angioplasty of significant RAS helps in the management of both<br />
HTN and CAD symptoms. This report is a summary of the primary results of our cases<br />
from 2002.<br />
Methods:21 renal angioplasties (18 patients) were done (mean age 58±14 years old) in<br />
11 males and 7 females.17 of them were hypertensive, 6 diabetic, 9 had renal dysfunction<br />
(Cr>1.5) and associated CAD were seen in 12 patients. All of them had stenosis•70%<br />
with 9 right RAS, 6 leftand 3 bilateral RAS. Five stenoses were ostial, 3 had 99%<br />
stenosis and 2 were total occlusions. 17 angioplasties were done from the right or left<br />
femoral <strong>artery</strong> and one brachial approach. The stents were 14 Herculink, 3 Bridge, 3<br />
express vascular and 1 S7. Predilation was done in 7 and direct stenting in 11 cases. <strong>Post</strong>dilation<br />
was done in 7 cases.<br />
Results: In 12 renal stenting procedures with mean stenosis 85%±15, success rate was<br />
100%. Major procedural complications (death, MI, emergency <strong>surgery</strong>) were zero. Minor<br />
femoral <strong>artery</strong> complications were seen in two cases. Elevation of serum creatinine was<br />
seen in the first day because of dye in all patients and decreasing serum Cr in 6 of 9<br />
uremic patients took place from the third day. One patient needed dialysis because of<br />
symptomatic uremia. A decrease in BP took place from the first day in 12 of 17 patients.<br />
In 4 months of follow up, there was one mortality because of underlying CHF and CRF.<br />
No case of MI, CVA and repeat admission was seen. From 17 hypertensive patients, 2<br />
had no HTN and 10 had mild HTN with minimal drug treatment and 5 had no change in<br />
drug consumption. From 9 uremic patients, serum Cr was increased in one, unchanged in<br />
2, and decreased in 6 patients (60%).<br />
Conclusion: renal <strong>artery</strong> angioplasty (stenting) is a safe alternative for <strong>surgery</strong>.<br />
Primary success rate without major complications was near 100% and the effect on BP<br />
and serum Cr in follow up is significant.<br />
Outcome of primary percutaneous <strong>coronary</strong> intervention in<br />
acute my cordial infarction.<br />
Alidoosti M, Salarifar M, Haji Zeinali A, Kassaian E, Kojouri J, Kazemi Saleh<br />
D, Soleimani A, Hakki Kazazi E and Dariyani Saeed K.<br />
154<br />
Tehran Heart Center, Medical Sciences/University of Tehran, Tehran, Iran<br />
Abstract<br />
Background: There is increasing evidence that primary PCI, when carried out by
experienced interventional cardiologist in high volume angiography laboratory is superior<br />
to thrombolytic therapy especially in high risk patients (hemodynamic instability, large<br />
anterior myocardial infarction, elderly & diabetics).<br />
Method: we established the protocol of primary PCI in patients with ST segment<br />
elevation MI (especially high risk cases) admitted within 12 hours of onset of symptoms,<br />
if balloon dilatation could be performed within 90 minutes of admission (day time).<br />
Results: 33 cases (21-80 year old, mean age 53±12) of primary PCI were performed<br />
between April 2003 and March 2004. Two thirds were accomplished within 4 hours of<br />
symptoms onset. Six (18%) of patients were in cardiogenic shock (two were transferred<br />
to cath lab under CPR). Target vessels were; LAD (n=21), RCA (n=9), LCX (n=2) & left<br />
main (n=1). In seven patients, a second critically stenotic vessel was also approached<br />
additionally (five diagonals, one LAD, one LCX ). Our procedural strategy was: primary<br />
stenting (n=22), provisional stenting (n=6), direct stenting (n=1) &pure only balloon<br />
angioplasty (n=3). Intra-aortic balloon was inserted in six patients. protection device was<br />
used in two. Angiographic success was achieved in all patients. Major complications in<br />
follow up period {3-14 months; mean :7 months} were; death (n=5) mostly in shock<br />
group (80%), but in non shock group mortality was 4% (1/25), non fatal MI (n=1) &<br />
target lesion revascularization (n=1) due to subacute thrombus also occurred. Patients<br />
with adverse outcome had significantly (p=0.006) lower systolic pressures (90±20mmHg)<br />
relative to those with favorite outcomes (129±28 mmHg). Moreover, patients with<br />
adverse outcomes had significantly lower ejection fraction<br />
(22.5 % vs. 53%).<br />
Conclusion: These encouraging results particularly in non-shock group are<br />
comparable with the other reports and persuade us to perform more primary PCI in high<br />
risk patients.<br />
Comparing success rate complications and late outcome in<br />
<strong>coronary</strong> intervention for total and non total occlusion<br />
Kazemi Saleh D, Kassaian E, Haji Zeinali A, Salarifar M, Alidoosti M, Sobh<br />
bidari P and Fallah N<br />
155<br />
Tehran Heart Center, Medical Sciences/University of Tehran, Tehran, Iran<br />
Abstract
Background: PCI in <strong>coronary</strong> total occlusion is a complex procedure with lower<br />
success rate and more complications compared to non total occlusion. In this study, we<br />
compared success rate complications and late outcomes in <strong>coronary</strong> intervention for total<br />
and non total occlusion.<br />
Methods: The data of 1344 consecutive patients who underwent <strong>coronary</strong> intervention<br />
during April 2003 to March 2004 were analyzed. 175 cases were total occlusion<br />
interventions (TOI) comparing to 1169 cases of non total occlusion interventions (NTOI).<br />
All the confounding variables were adjusted.<br />
Results: Success rate was (94.3% in TOI vs. 99.1% NTOI p
Background: To perform slow pathway ablation, multiple catheters (usually 4-5) are<br />
often inserted percutaneously. In this study it is hypothesized that it is safe and feasible to<br />
perform both diagnostic and therapeutic treatment for AV Nodal re-entrant Tachycardia<br />
(AVNRT) using 2-catheter inserted via the right femoral vein alone.<br />
Methods: Eighty consecutive patients (14 males and 66 females, mean age of 49.4±11<br />
years) with AVNRT underwent Radiofrequency (RF) ablation with the minimally<br />
invasive strategy as the initial approach. Both the diagnostic electrophysiologic study and<br />
catheters ablation were performed as a combined procedure in all patients. A mean of<br />
3±3 (Rang 1-10) RF applications were required for successful ablation. Procedure and<br />
fluoroscopy times were 60±10 minutes and 10±3 minutes, respectively.<br />
Results: For all patients (except one patient with dextrocardia and corrected<br />
transposition) undergoing the procedure, the 2 catheters approach could be employed<br />
successfully. Two patients had Wenkebach AV block which after a few days was<br />
changed to first degree AV block.<br />
Recurrence occurred in 3 patients. Two patients were treated in the second and the<br />
third underwent a third ablation session. The success rate and recurrence rate was<br />
similar to conventional methods.<br />
Conclusion: Two-catheter approach could be considered as initial strategy for patient<br />
undergoing ablation for AVNRT.<br />
Relation between the number of involved <strong>coronary</strong> arteries in<br />
patients and the kind and multiplicity of risk factors<br />
157<br />
Sadeghian S, Haji Zeinali AM, Salarifar M, Kazemi Saeed A, Yamini Sharif A,<br />
Sadeghian H and Hanafizadeh B<br />
Tehran Heart Center, Medical Sciences/University of Tehran, Tehran, Iran<br />
Abstract
Background: Regarding the proved effect of risk factors (RF) in development of CAD<br />
the relations between each of them singly and along with other risk factors and the<br />
patients involved <strong>coronary</strong> <strong>artery</strong> were analyzed in order to determine whether the effects<br />
of risk factors in development of multi vessel disease are similar or different.<br />
Methods: All the patients who were recognized as CAD patients through angiographies<br />
during a period of six months (from 23 September 2003 to 19 April 2004) were studied<br />
from the view point of the anatomy of their <strong>coronary</strong> arteries and the prevalence of risk<br />
factors.<br />
Results: Out of 1645 CAD patients 4% had MVD and 74% 3VD. The most common<br />
age group for this disease in all the three kinds in both sexes was 55-65 and the average<br />
for the disease was 58 years. In men there were meaningful relation between the patients<br />
involved <strong>coronary</strong> arteries and cigarette smoking (p=0.001) diabetes mellitus (p=0.001)<br />
positive family history (p=0.002) and risk factors multiplicity (p=0.001) and in women<br />
there were meaningful relations between the patients involved <strong>coronary</strong> arteries and<br />
hypercholesterolemia (p=0.002) diabetes mellitus (p=0.001) risk factors multiplicity<br />
(p=0.014) but for other risk factors there was no meaningful relation.<br />
Conclusion: This study indicates that different kinds of risk factors have different<br />
effects on the number of the patients involved <strong>coronary</strong> arteries in both sexes. Risk<br />
factors multiplicity and diabetes mellitus in both sexes were effective on development of<br />
multi vessel <strong>coronary</strong> <strong>artery</strong> disease. In men cigarette smoking and family history were<br />
effective in this regard and in women hypercholesterolemia was effective; but in other<br />
risk factors this effect was not proved.<br />
158<br />
Angiographic findings in 401 very premture CADpatients<br />
(age
in very premature patients (age
Abstract<br />
Background: Injection of thrombolytics is still the most common treatment of acute<br />
myocardial infarction. Regarding the consumption of specific kinds of them in our<br />
country and inadequacy of these effective substances in some reports, this study has been<br />
designed.<br />
Methods: 110 acute MI patients who received thrombolytic treatment in first 12 hours<br />
and their angiography was done till 20 days after receiving treatment were selected, and<br />
the highest "TIMI 2 flow" was regarded as patency. For 49% of the patients, the drug was<br />
injected in the first two hours and in 39% of them it was injected in the first 2-6 hours.<br />
Results: 73 patients underwent angiography during the first ten days and had a patency<br />
of 61% in the involved <strong>artery</strong>, and the remaining 37 ones underwent angiography during<br />
the second 10 days and had a patency of 50%. The average of patency in 20 days was<br />
55%. The rate of patency had no relations with the period of drug injection up to 6 hours<br />
(P=0.09), the location of MI, or the involved arteries (P=0.09). Comparing two groups of<br />
the patients with patent and occluded arteries, there was no obvious difference between<br />
ST elevation changes, but enzymatic changes in 12 hours and 24 hours had obvious<br />
difference (P=0.02). EF of both groups had obvious difference and it was 5% higher for<br />
the patent group (P=0.03).<br />
Conclusion: Comparing the results with five similar studies indicates that the patency<br />
rate in the first 10 days was 9% less than that of the similar treated patients and 5% more<br />
than that of non-treated patients. Patency rate for all the patients in the first 20 days<br />
was16% less than that of the similar treated patients and was not different from that of the<br />
patients who did not receive thrombolytic treatment. With regard to EF and enzymes, we<br />
can conclude that this drug is effective but not as much as those in other studies.<br />
160<br />
Short term results of carotid <strong>artery</strong> stenting: A single center<br />
registry<br />
Kassaian E, Kazemi Saleh D, Alidoosti M, Haji Zeinali A, Salarifar M, Kojoori J,<br />
Gheini M, Shirani Sh, Hakki kazazi E and Abbasi E.<br />
Tehran Heart Center, Medical Sciences/University of Tehran, Tehran, Iran
Abstract<br />
Back ground: Angioplasty and stenting are alternative treatments for carotid <strong>artery</strong><br />
stenosis which have the advantage of avoiding general anaesthesia, cranial never injury<br />
and the discomforts of <strong>surgery</strong>. Although there are several years of experience in western<br />
countries, it is still a new therapeutic modality in Iran. Therefore we started a carotid<br />
stenting program in our center since December 2003. This is a summary of the<br />
preliminary report of our first 18 patients.<br />
Methods: From December 2003 to July 2004, 18 consecutive patients were treated by<br />
angioplasty and stenting (12 males and 6 females with mean age of 64.88± 8.53 years):<br />
two patients were symptomatic with more than 60% stenosis; 16 patients were<br />
asymptomatic with more than 80% stenosis who had high risk <strong>coronary</strong> anatomies (6 left<br />
main and all multi-vessel <strong>coronary</strong> lesions) and were CABG candidates. All patients were<br />
evaluated by a neurologist pre- and post-procedure and had at least a baseline brain MRI<br />
or CT scan prior to the procedure. In all cases self-expandable stents (Acculink in 12 and<br />
wall stent in 6) and distal protective devices (Accunet in 12 and filter wire EZ in 6) were<br />
used in the left (n=7) or right (n=11) internal carotid <strong>artery</strong>. Follow-up period ranged<br />
from 1 to 6 months (mean 3.1± 2 months).<br />
Results: The procedural success rate was 100%. Mean carotid <strong>artery</strong> stenosis was<br />
85.18% ± 9.37% before and 10.2%± 3.5% after the procedure. After stent deployment,<br />
control cerebral angiogram was normal in all patients. Neurologic assessment showed no<br />
transient neurological deficit, minor or major stroke during the procedure, predischarge<br />
and during the follow-up. Three cases died of unrelated causes during the first month of<br />
follow-up. One of them died in the CCU after three days with pulmonary edema and<br />
cardiogenic shock, another death was one day after CABG (8 days after the procedure)<br />
with bradycardia and electromechanical dissociation, and the third was 5 days after<br />
discharge with hypoglycemia and MI.<br />
Conclusion: Carotid stenting is a safe and feasible method in patients who are high risk<br />
for surgical carotid endarterectomy.<br />
161<br />
Comparing background and confounding factors in the<br />
MACE and non-MACE patients; late outcome assessment of<br />
PCI<br />
Salarifar M, Alidoosti M, Kazemi Saleh D, Haji Zeinali A, Kassaian E, Dariyani<br />
Saeed K, Fallah N and Paydari N<br />
Tehran Heart Center, Medical Sciences/University of Tehran, Tehran, Iran
Abstract<br />
Background: PCI is a common choice for revascularization of CAD patients. But still<br />
there is debate about long-term results of PCI. Forty percent restenosis in angioplasty and<br />
25-30% restenosis in stenting with bare stents has been reported. However by using the<br />
new generation of stents, the restenosis rate has decreased significantly.<br />
Methods: So far 534 consecutive patients, who underwent PCI from April 2003 to<br />
September 2003, were followed based on the follow-up clinic data, filing room data and<br />
phone survey. Based on the late outcome data, patients were divided into 2 groups. Group<br />
A; MACE group and group B; non MACE group. We compared the early rates including<br />
risk factors, procedural and device success, complications and procedural details in these<br />
groups. All confounding variables were adjusted.<br />
Results: The MACE rate in the patients who completed the follow up period (mean,<br />
10.2± 1.6) was 6.3%. MACE group consisted of 7 MI (29.2%), 9 CABG (37.5%), 8 Re-<br />
PCI (33.3%), 7 TVR , 5 TLR and 4 mortalities. Age and gender distribution of patients in<br />
A and B groups was the same. Also there was no statistically meaningful difference in the<br />
frequency of risk factors. Success rate in the two groups was significantly different<br />
(91.7% group A vs. 98.5% group B; p value
Abstract<br />
Background: Outcome studies of conventional balloon angioplasty have established<br />
increased in-hospital and 1-year mortality in patients with left ventricular dysfunction. It<br />
is unclear whether recent practice innovation, including stents and adjunctive<br />
pharmacotherapy, have made percutaneous <strong>coronary</strong> intervention (PCI) safer and more<br />
effective in patients with LV dysfunction.<br />
Methods: We evaluated the influence of LV ejection fraction (EF) on in-hospital and 9<br />
months outcomes in 1,344 patients within our dynamic registry. Patients with acute<br />
myocardial infarction were excluded. The remaining were divided into two categories:<br />
group 1, EF”40% (n=193), group 2, EF>40% (n=1151). We determined success rate and<br />
the frequency of individual and composite adverse events (death/ myocardial infarction<br />
(MI)/ target vessel revascularization) at discharge and 9 months.<br />
Results: Mean EF in the groups with EF40 was 35±6% and 56±6 %(<br />
success rate 97% vs. 98%) and in-hospital adverse events did not differ between groups<br />
(zero vs. 1%). The composite end point of death /MI/ target vessel revascularization after<br />
9 months was not significantly different, although it occurred more frequently in group 1<br />
patients (8.8% vs. 4.6%).<br />
Conclusion: It seems recent improvement in devices (especially stents) and adjunctive<br />
pharmacotherapy in peri-procedural and follow-up periods results in more successful<br />
complete revascularization in patients with LV dysfunction and clinical outcomes are<br />
almost similar with other patients undergoing PCI.<br />
163<br />
American or European based bare stent: which one is<br />
preferred<br />
Kassaian E, Haji Zeinali A, Salarifar M, Kazemi Saleh D, Alidoosti M, Abbasi<br />
SH and Paydari N<br />
Tehran Heart Center, Medical Sciences/University of Tehran, Tehran, Iran
Abstarct<br />
Background: The role of <strong>coronary</strong> stents in reducing early and long term<br />
complications of percutaneaus <strong>coronary</strong> intervention has been evaluated in multiple<br />
studies. Different types of stents with several brand names are frequently used in our<br />
country. We compared the effects of expensive drug-eluting stents, relatively expensive<br />
FDA-approved American bare stents and cheaper European products (with CE mark of<br />
approval).<br />
Methods: The data of 1197 consecutive patients with 1542 stents who underwent PCI<br />
from April 2003 to march 2004 were analyzed (drug-eluting stents (DES) [Cypher,<br />
Taxus], 5.6% , American-based bare stents [Driver, S660, S7, Biodivysio, Cordis,<br />
Express, Penta, Tetra, Zeta, Jomed], 75.9% and European-based bare stents<br />
[AMG,Coroflex, Genius, Occam, Phytis, Sorin, Tron], 18.5% of all cases). All the<br />
confounding variables were adjusted.<br />
Results: Successful deployment was equal for the groups (99%). There were more<br />
patients with NQWMI in DES patients (3% vs. 1.1% and 0.5% in DES, American-based<br />
and European-based stents consecutively; p=0.05). Regarding long-term results<br />
(including MACE, TVR and TLR), there were significantly less complications in DES<br />
group. Importantly there was no significant difference between American and European<br />
stents regarding all short and long-term outcomes. Conclusion: Although there are some<br />
technical problems with their use, European-based stents have equal efficacy and<br />
complication rate compared to American-based bare stents.<br />
164<br />
Short and long-term results after multivessel PCI<br />
Kassaian E, Kazemi Saleh D, Alidoosti M, Salarifar M, Haji Zeinali A, Paydari N<br />
and Hakki Kazzazi E<br />
Tehran Heart Center, Medical Sciences/University of Tehran, Tehran, Iran<br />
Abstract
Background: The present study evaluated clinical outcomes in patients after multivessel<br />
PCI.<br />
Methods: Of 1374 consecutive patients who had undergone PCI from April 2003 to<br />
March 2004; 796 patients (58%) had angiographic evidence of multi-vessel CAD and 211<br />
patients (21%) underwent multi-vessel PCI. All of these patients underwent PCI in at<br />
least 2 vessels at the same session. In 61% of the vessels, at least one stent was deployed<br />
(in contrast to 89% in single-vessel PCI).<br />
After considering the effects of confounding factors; short and long term results of<br />
patients with multi-vessel PCI were compared to those of single vessel PCI.<br />
Results: Procedural success was high (98.6%); there were no significant differences in<br />
short-term complications( NQMI, CABG, death) between patients with multi- and single<br />
vessel PCI. Multi-vessel PCI patients had higher rate of 9 months MI (4.2% vs. 1.4%<br />
p=0.05). Mace (death, MI and repeat revascularization), TVR and TLR rates were 8.6%.<br />
3% and 2.8% consecutively in multi-vessel PCI patients (no difference with data of<br />
single-vessel PCI cases).<br />
Conclusion: In patients undergoing multi-vessel PCI, short and long term results are<br />
favorable in carefully selected patients.<br />
Short and long term outcome after PCI in patients with acute<br />
165<br />
<strong>coronary</strong> syndrome<br />
Kassaian E, Haji Zeinali A, Salarifar M, Kazemi Saleh D, Alidoosti M, Paydari N<br />
and Padegan M<br />
Tehran Heart Center, Medical Sciences/University of Tehran, Tehran, Iran
Abstract<br />
Background: PCI has been successfully applied in patients with acute <strong>coronary</strong><br />
syndrome (ACS) to carefully selected patients. This is a report of acute (in hospital)<br />
results and 9 months follow up data in patients with acute <strong>coronary</strong> syndrome (recentwithin<br />
the last 2 weeks-ST elevation myocardial infarction (MI), non-ST elevation MI or<br />
unstable angina) who underwent PCI at our center from April 2003 till March 2004.<br />
Methods: Success rate; early (in hospital) complications and 9 months MACE (death,<br />
MI and repeat revascularization), TVR and TLR were analyzed in 200 cases with ACS<br />
(14.6% of all PCI cases) and were compared to data of other patients. Primary PCI cases<br />
were excluded from the study.<br />
Results: Success rate was about 98.5% in both groups. The rate of in-hospital NQMI<br />
amounted to 3% in ACS and 0.9% in other patients (p=0.01). There was only 1 predischarge<br />
death in ACS group. Other acute complications were rare (0.5%) and equal.<br />
During a 9-month follow-up period, there was more MACE rate in acute <strong>coronary</strong><br />
syndrome group (10% vs. 6%, p=0.05) which was mostly due to more death rate (3.4%<br />
vs. 0.7%, p=0.02), and there was a trend towards more cases with repeat<br />
revascularization, TVR and TLR in the ACS group.<br />
Conclusion: Although the short and long-term results after PCI of ACS patients are<br />
within safe limits, there are still more complications in this high-risk group.<br />
Are there any differences in mortality, complications and late<br />
outcomes of PCI in patients with different educational levels<br />
Kazemi Saleh D, salarifar M, Kassaian E, Haji zeinali A, Alidoosti M, Abbasi<br />
SH and Jalali Roodsary M<br />
166<br />
Tehran Heart Center, Medical Sciences/University of Tehran, Tehran, Iran
Abstract<br />
Background: The knowledge of patients about their disease and its necessary care is<br />
dependent on their level of education and this knowledge may affect outcomes of PCI.<br />
This study was performed to compare the incidence of risk factors, early complications,<br />
mortality, success rate and late outcomes in PCI patients with different educational levels.<br />
Methods: The data of 1029 consecutive patients who underwent PCI during April 2003<br />
to March 2004 period were analyzed regarding their educational level in three groups.<br />
Group A with educational level zero, group B with educational level under high school<br />
diploma and group C with educational level above diploma.<br />
Results: 25% of our patients (n=257) were in group A, 60.5% (n=623) in group B and<br />
14.5% (n=149) in group C. The rate of cigarette smoking was significantly different in<br />
the three groups (7.8% group A, 21.2% group B, 16.1% group C, p=0.000). Incidence of<br />
HTN was significantly higher in group A vs. group C (43% vs. 21.5%, p=0.000). Positive<br />
family history of CAD was significantly higher in group C vs. group A (30.9% vs.<br />
16.35%). There were no significant differences regarding success rate and early<br />
complications between all three groups. There was no mortality during hospitalization.<br />
Although the rate of MACE was highest in group A and B (6.8% group A, 5.5% group B,<br />
2% group C, p=ns) but statistically these differences were not significant.<br />
Conclusion: There is no differences regarding mortality, success rate, complication and<br />
MACE during follow up between patients with different educational levels who<br />
underwent PCI.<br />
167<br />
Biopump as a temporary assist device for postcardiotomy<br />
heart failure<br />
Davoodi S, Madani Civi M and Abbasi SH<br />
Tehran Heart Center, Medical Sciences/University of Tehran, Tehran, Iran
Abstract<br />
Background: Ventricular assist devices (VAD) have become an important therapeutic<br />
tool to manage the patients with post-cardiotomy heart failure. We evaluated biopump as<br />
a circulatory support for bridge to recovery in the setting of difficult weaning from<br />
cardiopulmonary machine that were refractory to inotropic and IABP support.<br />
Methods: Between Oct 1998 and June 2004, 1450 patients underwent CABG in our<br />
center. There were 24 cases that required high dose inotropes or IABP for weaning from<br />
CPB machine in the operating room. We used biopump in six patients (52±12 years) with<br />
acute left-sided heart failure following CABG. The patients' characteristics and their risk<br />
factors for developing CAD were recorded.<br />
Results: The success rate was 30% (2 cases from 6pts). Four cases were not weaned<br />
from the biopump after 17±8 hours. Two patients were weaned after 21± 5 hours and<br />
with good outcome. The mean preoperative left ventricular EF was 50%±10. The mean<br />
vessel involvement in these patients was 2.66 (IVD-3VD). The <strong>coronary</strong> <strong>artery</strong> Gensini<br />
score was 89±6 (P value
Background: The number of CABGs is increasing in our country. In spite of this, little<br />
data exists about the risk factors influencing the in-hospital mortality in Iranian patients;<br />
in addition, the effect of body mass index (BMI) on mortality is still in controversial<br />
issue.<br />
Methods: This is a cross-sectional study on 1258 patients who underwent isolated<br />
CABG in our center between 2002 and 2004. The patients were divided in 3 groups: nonobese<br />
(BMI
cigarette smoking). The rate of the patients without the risk factors in our CAD patients<br />
was not known; therefore, this study has been done in order to analyze the percentage of<br />
CAD patients without risk factors out of the whole CAD patients.<br />
Methods: The risk factors in the patients, who were hospitalized to undergo CABG<br />
since July 2003, were studied after interviews and lab tests, and the following results<br />
have been concluded.<br />
Results: Out of 2734 patients, 256 patients (9.3%) had none of the atherosclerosis risk<br />
factors. 81.2% of these patients were men and 18.8% were women, which shows no<br />
meaningful difference between them and the patients who had risk factors. The most<br />
common age of the patients who did not have the risk factors was 65-75 which is 10<br />
years higher than that of the patients who had risk factors (55-65). The prevalence of<br />
the disease in the patients without risk factors and the patients who had risk factors,<br />
based on their age group, were as follows:<br />
Age groups Patients without RF Patients having RF<br />
There were no meaningful differences between the patients who had risk factors and the<br />
ones who did not have the risk factors from the viewpoint of the rate of SVD, 2VD, 3VD,<br />
and even LMD.<br />
Conclusion: In comparison with other studies, the rate of our patients who did not<br />
have risk factors (9.3%) was lower. These patients were distributed in all the age groups,<br />
but the rate increased as their age increased. The rate of patients, with various kinds of<br />
<strong>coronary</strong> <strong>artery</strong> disease, including SVD, 2VD, 3VD, and even left main <strong>coronary</strong> <strong>artery</strong>,<br />
who did not have risk factors, was similar to the rate of the diseases itself.<br />
170<br />
Developmental ultrastructure of mouse embryonic stem cell<br />
derived cardiomyocytes in vitro<br />
Baharvand H, Rohani R, Pyriaie A and Taei A<br />
Tehran Heart Center, Medical Sciences/University of Tehran, Tehran, Iran<br />
Abstract
Background: Stem cell biology has been the subject of much recent discussion.<br />
Embryonic stem cells, derived from the inner cell mass of the blastocyst-stage early<br />
mammalian embryos are expected to become a powerful tool for future regenerative<br />
medicine and developmental biology due to their capacity of self-renewal and<br />
pluripotency. In the present study, developmental ultrastructure of mouse embryonic stem<br />
cells-derived cardiomyocyte was assessed.<br />
Methods: Cardiomyocytes were derived from a newly established murine ES line<br />
derived from a C57B1/6 strain mouse embryo. Cardiomyocytes of 3, 7, 14 and 21 days<br />
after plating (day 7) were processed for immunhistochemistry and transmission electron<br />
microscopy (TEM).<br />
Results: While in 7+21d cardiomyocytes showed all sarcomeric components such as A-<br />
and I-band, Z line, H-band and also M-band, T-Tubule, endoplasmic reticulum and<br />
intercalated discs were present, in early stages (7+3d, 7+7d and 7+14) a few primary<br />
characteristics of subcellular structures found.<br />
Conclusion: Embryonic stem cell provide a good model for cardiomyocyte<br />
development and may use for cell therapy in future.<br />
171<br />
Dose routine magnesium administration prevent perioperative<br />
<strong>coronary</strong> <strong>artery</strong> <strong>bypass</strong> <strong>graft</strong> <strong>surgery</strong> arrhythimas<br />
Najafi M and Haghighat B<br />
Tehran Heart Center, Medical Sciences/University of Tehran, Tehran, Iran<br />
Abstract
Background: Atrial and ventricular arrhythmias are among the most common<br />
complication after <strong>coronary</strong> <strong>artery</strong> <strong>bypass</strong> <strong>graft</strong> (CABG) <strong>surgery</strong>. Previous studies<br />
demonstrated that cardiopulmonary <strong>bypass</strong> itself, results in reduced serum magnesium<br />
level. In this study, we wanted to evaluate the effect of total blood magnesium level<br />
(TMG) on preventing peri-operative arrhythmias by routine regimens of 2-4 gram<br />
supplemental mangnesium (SMG).<br />
Methods: TMG was measured in patients who were scheduled for CABG on 3<br />
occasions [just before anesthesia, just after entering to intensive care unit (ICU)<br />
postoperatively and on the first morning after operation]. Patients were evaluated for<br />
primary cardiac rhythm (97cases) and other variables that could have an influence on<br />
magnesium level (serum creatinine, urine output in operating room and diuretic therapy).<br />
SMG was also recorded in operating room and ICU. Then the patients were evaluated for<br />
the rate of arrhythmia.<br />
Results: Mean TMG level in 160 cases was 2.2, 2.6 and 2 mg/dl on three occasions<br />
respectively. Mean SMG was 2.5 grams. 27 of 97 patients developed post-operative<br />
arrhythmia [AF* (7cases), PAC** (12cases) and PVC*** (16cases)]. Mean serum<br />
creatinine level and urine output were 1.2 mg/dl and 1800 ml respectively. Although<br />
there was a significant difference between TMG on the first and second occasion which<br />
were both in the normal range (P
cardiopulmonary <strong>bypass</strong> (CPB) during <strong>coronary</strong> <strong>artery</strong> <strong>bypass</strong> <strong>graft</strong> (CABG) <strong>surgery</strong>.<br />
Furosemide therapy is regarded as a way of preventing renal compromise due to CPB.<br />
Previous studies have variable results. This study is to determine whether it is necessary<br />
to administer furosemide and if it is what are the best timing and the least amount that<br />
work best.<br />
Methods: Candidates for CABG were divided into 4 groups. 51 patients were oliguric<br />
(U/O*0.2). Group3, had clearly the least U/O before CPB (P
POUR HOSEINI 34-75-77<br />
HAJI ZEINALI 25-27-33-34-35-36-37-38-54-55-61-63-82-83-84-85-87-88-134-<br />
142-143-148-149-150-153-154-155-156-158-159-160-161-162-<br />
163-164-165-166-167-170-174<br />
HOSEINI 59-75<br />
HAGHIGHAT 4-23-24-65-90-105-106-107-117-118-172-173<br />
KHATAMI 70-91<br />
DARABIAN 31-53-56-64-134-142-152-160<br />
DARIANI 19-20<br />
DAVOODI ,S 7-8-67-68-79-80-81-92-93-99-100-101-102-105-108-109-111-112-<br />
115-124-125-126-127-131-132-133-134-135-136-137-138-141-<br />
144-168<br />
DAVOODI .GH 10-11-17-22-29-36-38-43-45-47-49-53-54-55-56-57-58-60-61-63-<br />
69-74-76-86-89-116-164-152-157-159-160-170-174<br />
RABBANI 12-14-128-139<br />
SALARIFAR 25-27-29-31-33-34-35-36-37-54-55-56-62-63-74-82-83-84-85-89-<br />
94-103-104-114-115-131-132-133-134-138-140-143-144-148-149-<br />
150-152-153-154-155-156-158-160-161-162-163-164-165-166-<br />
167-170-174<br />
SOTUDEH<br />
14<br />
SOLEMANI 8-13-14-15-31-48-49-50-51-52-56-65-113-140-155<br />
SHIRANI 33-101-102-137-146-161<br />
SHIRZAD 15<br />
SAHEB JAM 14-15-17-38-39-40-57-64-89-94<br />
SADEGHIAN .H 3-13-17-38-39-40-42-58-64-76-87-89-94-114-115-119-125-132-<br />
134-140-141-143-144-153-158-175<br />
SADEGHIAN .S 10-11-14-17-59-65-73-74-75-77-94-105-114-115-116-132-138-<br />
142-144-152-157-158-159-160-170<br />
SALEHI 3-4-5-7-67-68-69-72-79-0 -81-95-99-109-111-112-119-175<br />
OMRAN<br />
ZOROFIAN 75-77-89<br />
ABBASI .H 7-8-22-25-35-38-42-69-70-71-86-91-99-100-101-102-103-104-<br />
108-124-127-131-133-136-137-149-164-167-168<br />
ABBASI .K 7-8-10-14-15-67-68-69-72-79-80-81-99-109-111-112-113-123-<br />
131-132-133-134-135-136-137-138-142-145<br />
KAZEMISAEID 10-11-17-40-43-45-47-54-56-58-60-61-63-64-76-116-147-151-<br />
157-158<br />
KAZEMI<br />
SALEH<br />
25-33-36-143-148-149-150-153-154-155-156-161-162-163-164-<br />
165-166-167-<br />
KAZEMEINI 62<br />
KASSAEIAN 25-27-33-34-36-37-57-82-83-84-85-103-143-148-149-150-153-<br />
154-155-156-161-162-163-164-165-166-167<br />
KARIMI 7-8-14-15-42-65-67-68-69-70-72-73-74-79-80-81-91-96-99-101-<br />
102-105-108-111-112-113-114-115-123-125-131-132-133-134-
135-136-137-138-141-142-144-175<br />
ALIDOOSTI 25-27-33-34-35-36-37-57-64-82-83-84-85-143-148-149-150-153-<br />
154-155-156-159-161-162-163-164-165-166-167<br />
MARZBAN 3-7-8-13-14-15-36-67-68-69-70-72-79-80-81-91-99-101-102-108-<br />
109-111-112-114-119-123-125-131-132-133-135-136-138-141-<br />
142-144-145-169<br />
MAJD<br />
3-13-42-119-134-140-149-153<br />
ARDAKANI<br />
MOVAHEDI 7-8-14-67-68-70-72-79-80-81-91-99-109-111- 112-123-131-132-<br />
133-135-136-137-138<br />
MIRHOSENI 6-92-93<br />
NEJATIAN 48-50-51<br />
NAJAFI 4-5-8-15-23-24-65-90-95-96-105-106-107-117-118-172-173-176<br />
NEMATI POOR 37-73-74-75<br />
YAMINI 10-11-17-40-43-45-47-54-56-58-60-60-63-64-76-116-146-147-<br />
SHARIF<br />
151-157-158
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