[Show abstract][Hide abstract] ABSTRACT: We describe a simple technique for aortic root replacement in destructive prosthetic aortic valve endocarditis wherein the fragile aortic annulus tissue is not suitable for suture placement. Therefore, we first reconstructed the intervalvular part with a nontreated pericardial patch and then implanted the aortic composite graft on the aortic root through the roof of the left atrium and reconstructed the defect thus made with another pericardial patch. No complication was seen at 6-month follow up.
The Annals of thoracic surgery 01/2014; 97(1):347-9. · 3.45 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: The aim of this study was to determine the impact of manifest accessory pathway on left ventricle (LV) twist physiology in Wolff-Parkinson-White (WPW) patients. Although this issue was addressed in 1 study based on speckle tracking method, there was no comparative study with a different technique. We planned to use velocity vector imaging (VVI) to find out how much an accessory pathway can affect LV twist mechanics.
Thirty patients were enrolled regarding inclusion and exclusion criteria. Two serial comprehensive transthoracic echocardiography evaluations were performed before and after radiofrequency catheter ablation (RFCA) within 24 hours. Stored cine loops were analyzed using VVI technique and LV twist and related parameters were extracted.
Comparing pre- and post-RFCA data, no significant changes were observed in LV systolic and diastolic dimensions, LV ejection fraction (LVEF), and Doppler and tissue Doppler-related parameters. VVI study revealed remarkable rise in peak LV apical rotation (10.3º ± 3.0º to 13.8º ± 3.6º, P < 0.001) and basal rotation (-6.0 ± 1.8º to -7.7 ± 1.8º, P < 0.001) after RFCA. Subsequently LV twist showed a surge from 14.7º ± 3.9º to 20.2º ± 4.4º (P < 0.001). LV untwisting rate changed significantly from -96 ± 67 to -149.0 ± 47.5°/sec (P < 0.001) and apical-basal rotation delay showed a remarkable decline after RFCA (106 ± 81 vs. 42.8 ± 26.0 msec, P < 0.001).
Accessory pathways have a major impact on LV twist mechanics.
[Show abstract][Hide abstract] ABSTRACT: To improve cellular cardiomyoplasty efficacy after myocardial infarction (MI), we postulated that combining mesenchymal stem cells (MSCs) transplantation with anti-apoptotic and angiogenic effects of erythropoietin (EPO) and vascular endothelial growth factor (VEGF) may provide better prognosis in an infarcted heart.48 rats, underwent left anterior descending artery ligation, were divided into eight groups and treated as follows: Group1: MSC+ EPO+VEGF, Group2: MSC+EPO, Group3: MSC+VEGF, Group4: MSC, Group5: EPO+VEGF, Group6: EPO, Group7: VEGF and Group8: Control. After MI induction, EPO and VEGF were injected subcutaneously at the dose of 3000U/kg and 3µg/kg respectively. MSCs were transplanted one week after MI. In the fourteenth and sixteenth days after infarction, EPO was injected again. Echocardiography demonstrated that all treatments improved left ventricular function significantly (before vs. after treatment) but in control group ejection fraction deteriorated over the 2-months period. Percent of ejection fraction recovery in all treatment groups were significantly greater than control (P<0.05).Compared with the control group, all treatments attenuated cell death in peri-infarct areas significantly, except groups 6 and 7.Vascular density of all treatment groups were more than control group but this superiority was statistically significant only in group1 (P<0.01). All of our treatments had beneficial effects to some extent but MSC transplantation combined with EPO and VEGF administration resulted in superior therapeutic outcome in enhancing cell survival and neovascularization.
European journal of pharmacology 07/2013; · 2.59 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: Tetralogy of Fallot (TOF) is the most common form of cyanotic congenital heart disease. Today, we are faced with an increasing number of patients with residual pulmonary regurgitation (PR) late after TOF repair. The right ventricular (RV) volumes and function are among the most important factors influencing clinical decision-making. Cardiac magnetic resonance (CMR) is the gold standard method for the quantitative assessment of the RV function; it is, however, expensive for routine clinical follow-up and sometimes is contraindicated. We sought to evaluate the RV systolic function via CMR and compare it with Doppler-derived strain(S) and strain rate (SR) imaging in patients with repaired TOF.
In an observational cross-sectional study, 70 patients (22 women, mean age=22±4.9 years) late after TOF repair with severe PR were evaluated. Peak systolic strain and SR in the basal, mid, and apical segments of RV free wall (RVFW) were measured and compared with the RV function measured in the short-axis cine MR. Associations between RVEF and S/SR, investigated by ordinal logistic regression models.
Significant association was observed between RV function and mean S of all the three segments of the RVFW segments [OR (CI95%): 1.17 (1.05-1.31)]. Association between RV function and mean SR of all the three segments of the RVFW segments was borderline significant [OR (CI95%): 1.7 (0.97-2.93)].
There was a significant correlation between the Doppler-derived mean strain of RVFW and the RV function measured by CMR in adults late after TOF repair. These quantitative methods improved the assessment of the RV function and served as an additional method to follow up patients with contraindications to CMR.
Anadolu kardiyoloji dergisi: AKD = the Anatolian journal of cardiology 07/2013; · 0.72 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: Noninvasive techniques for the localization of the accessory pathways (APs) might help guide mapping procedures and ablation techniques. We sought to examine the diagnostic accuracy of strain imaging for the localization of the APs in Wolff-Parkinson-White syndrome.
We prospectively studied 25 patients (mean age = 32 ± 17 years, 58.3% men) with evidence of pre-excitation on electrocardiography (ECG). Electromechanical interval was defined as the time difference between the onset of delta wave and the onset of regional myocardial contraction. Time differences between the onset of delta wave (δ) and the onset of regional myocardial contraction (δ-So), peak systolic motion (δ-Sm), regional strain (δ-ε), peak strain (δ-εp), and peak strain rate (δ-SRp) were measured.
There was a significant difference between time to onset of delta wave to onset of peak systolic motion (mean ± SD) in the AP location (A) and normal segments (B) versus that in the normal volunteers (C) [A: (57.08 ± 23.88 msec) vs. B: (75.20 ± 14.75) vs. C: (72.9 0 ± 11.16); p value (A vs. B) = 0.004 and p value (A vs. C) = 0.18] and [A: (49.17 ± 35.79) vs. B: (67.60 ± 14.51) vs. C: (67.40 ± 6.06 msec); p value (A vs. B) < 0.001 and p value (A vs. C) = 0.12, respectively].
Our study showed that strain imaging parameters [(δ-So) and (δ-Strain)] are superior to the ECG in the localization of the APs (84% vs. 76%).
The journal of Tehran Heart Center. 04/2013; 8(2):65-9.
[Show abstract][Hide abstract] ABSTRACT: Complexity of some congenital heart diseases sometimes necessitates a combination of interventional procedures and surgery, amongst which intraoperative stent implantation is one of the most common. We herein report a successful hybrid procedure in a cyanotic adult patient who had undergone no procedure in childhood. The patient was a 24-year-old cyanotic male (oxygen saturation in the room air was 65%) who presented with dyspnea. According to echocardiography, catheterization, and cardiac magnetic resonance imaging data, the patient was amenable to the Fontan surgery. However, because of significant left pulmonary stenosis and his age, he first underwent a hybrid procedure (Glenn shunt and left pulmonary artery [LPA] stenting). After the procedure, oxygen saturation rose to 83%. At six months' follow-up of the patient, exercise capacity and cyanosis had improved significantly, with O2 saturation having reached near 85% by pulse oximetry.
The journal of Tehran Heart Center. 01/2013; 8(1):58-60.
[Show abstract][Hide abstract] ABSTRACT: A 39-year-old woman was hospitalized in our center due to chest and left shoulder pain. Having a history of tamponade and tuberculosis, she was under treatment for the previous two months. Echocardiography, chest CT and MRI documented intramyocardial and pericardial hydatid cyst which was later confirmed by further pathological studies. Later, the cyst was removed surgically.
Journal of cardiovascular and thoracic research. 01/2013; 5(4):175-178.
[Show abstract][Hide abstract] ABSTRACT: BACKGROUND: Percutaneous balloon mitral valvuloplasty is the preferred therapeutic strategy in patients with mitral stenosis, but it has shortcomings in a subset of patients. HYPOTHESIS: A new method of balloon sizing through echocardiographic measurement of the intercommissural diameter would be safe and effective and lead to better outcomes. METHODS: Eighty-six mitral-stenosis patients were randomly assigned to undergo balloon mitral valvuloplasty either with height-based balloon reference sizing (HBRS group, n = 43) or with balloons sized by the echocardiographic measurement of intercommissural diameter (EBRS group, n = 43). Postprocedural mitral valve area (MVA) and severity of mitral regurgitation (MR) were assessed via echocardiography and ventriculography. Intention-to-treat approach was applied for the statistical analysis. RESULTS: Baseline characteristics were not different between the groups. The mean of the estimated balloon reference sizes was significantly higher in the HBRS patients than in the EBRS group (26.4 ± 0.92 mm, 95% confidence interval [CI]: 26.2-26.6 vs 24.5 ± 1.03 mm, 95% CI: 24.2-24.7, respectively; P = 0.006). Final MVAs were significantly larger in the EBRS group (1.5 ± 0.2 cm(2), 95% CI: 1.46-1.59 vs 1.4 ± 0.2 cm(2), 95% CI: 1.35-1.47, respectively; P = 0.01). The occurrence of new or aggravated MR was significantly lower in the EBRS group as assessed both by echocardiography (P = 0.04) and ventriculography (P = 0.05). Mitral regurgitation was aggravated in 13 (29.3%) patients in the HBRS group and in 5 (11.5%) patients in the EBRS group. CONCLUSIONS: Percutaneous balloon mitral valvuloplasty via the Inoue technique using balloons sized by the echocardiographic measurement of the maximal commissural diameter is an effective and safe method that might lead to an acceptable increase in the MVA and significant decrease in the rate and severity of iatrogenic MR. The results of this work were orally presented in part at EuroPCR, Paris, France, May 17-20, 2011. The authors have no funding, financial relationships, or conflicts of interest to disclose.
[Show abstract][Hide abstract] ABSTRACT: A 29 year old woman with NYHA functional class II and large secundum type atrial septal defect (ASD) underwent successfully percutaneous ASD closure with Figula ASD occluder (no. 30) without any peri-procedural complication. After 2 days she underwent transthoracic echocardiography and a large hypo-echoic mass was seen on left atrial side of implanted device in multiple views, suggestive of thrombosis or echocardiographic beam width artifact? A diagnostic enigma!
The international journal of cardiovascular imaging 02/2012; · 2.15 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: We introduce a 28-year-old woman with Thalassemia major whose clinical assessment, including two-dimensional Doppler echocardiography demonstrated severe left ventricular hypertrophy with severe biventricular enlargement and systolic dysfunction as well as severe diastolic dysfunction. We hereby address these issues from an echocardiographic point of view.
Journal of cardiovascular and thoracic research. 01/2012; 4(2):57-9.
[Show abstract][Hide abstract] ABSTRACT: Apical Hypertrophic Cardiomyopathy is an uncommon condition constituting 1% -2% of the cases with Hypertrophic Cardiomyopathy (HCM) diagnosis. We interestingly report two patients with apical hypertrophic cardiomyopathy in association with significant pulmonary artery hypertension without any other underlying reason for pulmonary hypertension. The patients were assessed by echocardiography, cardiac catheterization and pulmonary function parameters study.
Journal of cardiovascular and thoracic research. 01/2012; 4(3):87-8.
[Show abstract][Hide abstract] ABSTRACT: Partial anomalous pulmonary venous connection (PAPVC) is a very rare congenital heart disease where one or more of the pulmonary veins are connected to the venous circulation. Although initially suspected with inexplicable right ventricular enlargement on transthoracic echocardiography, other modalities such as transesophageal echocardiography, CT angiography or cardiac Magnetic resonance (CMR) imaging are able to diagnosis the anatomical abnormalities. We present a 29-year-old female with moderate right ventricular enlargement and isolated right upper and middle pulmonary vein anomalous return to superior vena cava.
Journal of cardiovascular and thoracic research. 01/2012; 4(4):123-4.