Mashhad University of Medical SciencesJournal of Cardio-Thoracic Medicine2345-24474320160901Effects of Nicorandil on the Clinical and Laboratory Outcomes of Unstable Angina Patients after Coronary Angioplasty465467742210.22038/jctm.2016.7422ENHoma FalsoleimanCariodiologist, Cardiovascular Research Center,Ghaem Hospital,Faculty Of Medicine,Mashhad Univrersity of Medical Sciences,Mashhad,IranMashalla Dehghani DashtabiCariodiologist, Cardiovascular Research Center,Ghaem Hospital,Faculty of Medicine,Mashhad Univrersity of Medical Sciences, Mashhad,IranMohsen MouhebatiCariodiologist, Cardiovascular Research Center,Ghaem Hospital,Faculty of Medicine,Mashhad Univrersity of Medical Sciences,Mashhad,Iran0000-0002-1813-1995Mostafa DastaniCariodiologist ,Ghaem Hospital, Faculty of Medicine,Mashhad Univrersity of Medical Sciences,Mashhad,IranAtooshe RohaniCariodiologist,Cardiovascular Research Center, School of Medicine, Mashhad University of Medical Sciences, Mashhad, IranNeda PartoviCariodiologist,Cardiovascular Research Center, School of Medicine, Mashhad University of Medical Sciences, Mashhad, IranJournal Article20160523<strong>Introduction:</strong> Ischemic preconditioning mediated by potassium channels is a physiological protective mechanism, . It is hypothesized that Nicorandil, which is a potassium channel activator, could protect the heart via preconditioning. <br/><strong>Materials and Methods:</strong>This clinical trial was conducted on 162 patients undergoing percutaneous coronary intervention (PCI) in Quem hospital, from Jan2013 to Jan 2014,patients divided into two groups. The first group received standard treatment plus Nicorandil (10 mg, twice daily) for three days before and after angioplasty. The second group received standard treatment after PCI. <br/><strong>Results:</strong> Cardiac enzyme levels were significantly lower in the Nicorandil group at 6 and 12 hours after angioplasty,(p value=0.001) while no significant differences were observed in the symptoms and four-month prognosis of the study groups(p value=0.8). <br/><strong>Conclusion:</strong>It is recommended that a randomized clinical trial be conducted for the close evaluation of the effects of Nicorandil on unstable angina patients.Mashhad University of Medical SciencesJournal of Cardio-Thoracic Medicine2345-24474320160901Enneagram Personality System as an Effective Model in Prediction of Risk of Cardiovascular Diseases: A Case-Control Study468473740310.22038/jctm.2016.7403ENSaeid KomasiMaster of Clinical Psychology, Social Development and Health Promotion Research Center, Kermanshah University of Medical Sciences. Kermanshah, IranAli SoroushMD, Ph.D, Lifestyle Modification Research Center, Imam Reza Hospital, Kermanshah University of Medical Sciences, Kermanshah, IranNasrin NazeieMaster of Clinical Psychology, Lifestyle Modification Research Center, Imam Reza Hospital, Kermanshah University of Medical Sciences, Kermanshah, IranMozhgan SaeidiPh.D. Student of Psychology, Cardiac Rehabilitation Center, Imam Ali Hospital, Kermanshah University of Medical Sciences. Kermanshah, IranAli ZakieiPh.D. Student of Psychology, Social Development and Health Promotion Research Center, Kermanshah University of Medical Sciences, Kermanshah, IranJournal Article20160630<strong>Introduction: </strong>Studies on behavioral patterns and personality traits play a critical role in the prediction of healthy or unhealthy behaviors and identification of high-risk individuals for cardiovascular diseases (CVDs) in order to implement preventive strategies. This study aimed to compare personality types in individuals with and without CVD based on the enneagram of personality. <br/><strong>Materials and Methods: </strong>This case-control study was conducted on 96 gender-matched participants (48 CVD patients and 48 healthy subjects).Data were collected using the Riso-Hudson Enneagram Type Indicator (RHETI). Data analysis was performed in SPSS V.20 using MANOVA, Chi-square, and T-test. <br/><strong>Results: </strong>After adjustment for age and gender there is a significant difference between two groups (and male) in term of personality types one and five. In CVD patients, score of personality type one (F(1,94)=9.476) (P=0.003) was significantly higher, while score of personality type five was significantly lower (F(1,94)=6.231) (P=0.014), compared to healthy subjects. However, this significant difference was only observed in the score of personality type one in female patients (F(1,66)=4.382) (P=0.04). <br/><strong>Conclusion: </strong>Identifying healthy personality type one individuals before CVD development, providing necessary training on the potential risk factors of CVDs, and implementation of preventive strategies (e.g., anger management skills) could lead to positive outcomes for the society and healthcare system. It is recommended that further investigation be conducted in this regard. Mashhad University of Medical SciencesJournal of Cardio-Thoracic Medicine2345-24474320160901Exogenous Fibrinogen Pertains Beneficial Effects in Managing Post-Cardiac Surgery Bleeding: A Randomized Clinical Trial474479741910.22038/jctm.2016.7419ENMohammad EsmaeelzadehAnesthesiologist, Department Of Anesthesiology and Critical Care, Mashhad University of Medical Sciences, Mashhad, IranShahram AminiAnesthesiologist, Cardiac Anesthesia Research Center, Mashhad University of Medical Sciences, Mashhad, IranGhasem SoltaniAnesthesiologist, Department of Anesthesiology and Critical Care, Mashhad University Of Medical Sciences, Mashhad, Iran0000-0003-2043-1564Mohammad Abbasi TashniziCardiac Surgeon, Cardio-Thoracic Surgery & Transplant Research Center, Emam Reza hospital, Faculty of medicine, Mashhad University of Medical Sciences, Mashhad, Iran.0000-0002-3695-1030Mathias AzamiCardiac Surgeon, Department Of Cardiac Surgery, Kurdestan University Of Medical Sciences, Kordestan, IranJournal Article20160222<strong>Introduction:</strong> Post cardiac surgery hemorrhagic syndromes, potentialized by implementing cardiopulmonary bypass, leads to increased hazards of blood products transfusion and pertains serious impacts on immediate patients outcome. <br />The objective of this clinical trial was to investigate the efficiency of exogenous fibrinogen to control hemorrhagic syndromes following cardiac surgery in the intensive care unit. <br /><strong>Materials and Methods:</strong> Eighty patients undergoing open heart surgery at Imam Reza Hospital, Mashhad, Iran with blood drainage more than 200 ml per hour were randomly divided to receive either fibrinogen 2 grams or placebo. The patients were investigated for amount of blood drainage, units of required blood product, length of stay in intensive care unit (ICU), and mortality. <br /><strong>Results</strong>: The first early 3-hours drainage (443.97±169.98 vs 606.66±235.93ml; p value =0.001) and total first 24 hours drainage (1025.30 ml and 1377.60 ml; p value: 0.041) showed significant difference in favor of fibrinogen receiving group. The fibrinogen group required significantly lesser units of red blood cells, and fresh frozen plasma (FFP) (1.62 and 2.55) compared to placebo group (2.74 and 3.21) (p values: 0.010 and 0.032). Platelets units requirement did not reach significant difference between the groups. ICU length of stay was shorter in fibrinogen group (2.82 days versus 4.02 days; p value 0.045), while mechanical ventilation time did not significantly differ among the two groups. In addition, there was a trend towards decreased early mortality in fibrinogen receiving group (7.5% versus 17.5 % ; p value = 0.02). <br /><strong>Conclusion:</strong> Administration of low dose of fibrinogen in patients with postoperative bleeding can reduce ongoing and total blood drainage, transfusion of blood products, ICU length and early mortality.Mashhad University of Medical SciencesJournal of Cardio-Thoracic Medicine2345-24474320160901Early Clinical Outcomes and Mortality of Coronary Endarterectomy in the Left Anterior Descending Artery: A Single-Center Experience480483741810.22038/jctm.2016.7418ENHamid HoseinikhahCardiac Surgeon, Faculty of Medicine, Mashhad University of Medical Sciences, Atherosclerosis Prevention Research Center, Imam Reza Hospital. Iran0000-0003-1812-9200Mohammad Abbassi TeshnisiCardiac Surgeon, Department of cardiac surgery, Cardio-Thoracic Surgery & Transplant Research Center, Emam Reza hospital, Faculty of medicine, Mashhad University of Medical Sciences, Mashhad, Iran.
.0000-0002-3695-1030Ahmadreza ZarifianMedical Student, Student Research Committee, Faculty of Medicine, Mashhad University of Medical Sciences, Mashhad, IranYasamin MoeinipourMedical Student, Faculty of Medicine, Mashhad University of Medical Sciences, IranAliasghar MoeinipourCardiac Surgeon, Atherosclerosis Prevention Research Center, cardiac surgery Imam Reza Hospital, Mashhad University of Medical Sciences,0000-0002-4208-800XJournal Article20160124<strong>Introduction</strong>: Although coronary endarterectomy is not an ideal procedure, it is the only available option for cardiac surgeons in some patients with diffuse coronary artery disease. Based on the majority of conducted studies, the results of coronary endarterectomy (including survival, graft patency, and recurrence of the symptoms of myocardial ischemia) are less prevalent than standard coronary artery bypass grafting. Generally, the left anterior descending artery (LAD) is the most commonly involved artery in coronary endarterectomy. The aim of this study was evaluate clinical and early results of Endarterectomy of LAD artery. <br/><strong>Materials & Methods</strong>: In total, 30 cases of coronary endarterectomy of the LAD were studied from January 2015 until January 2016.this is a retrospective study that Endarterectomy procedure was performed in Imamreza hospital of Mashhad university of medical sciences. <br/><strong>Results</strong>: The mean age of the subjects was 63±4.5 years (range: 45-78 years). As the findings revealed, eighteen patients were male (60%), and the mean ejection fraction index was 43±5.1 (range: 15-60). Also, prior history of myocardial infarction was documented in 8 (26%) patients. The mortality rate among patients was estimated at 6.6% (n=2). In total, 12 (40%) and 7 (23%) patients required high-dose inotropic support and intra-aortic balloon pump, respectively. Risk of preoperative myocardial infarction was observed in 5 (16.5%) cases, and 3 (10%) patients required re-exploration due to significant hemorrhage. <br/><strong>Conclusion</strong>: If coronary endarterectomy of the LAD is performed by experienced cardiac surgeons, favorable outcomes can be obtained.Mashhad University of Medical SciencesJournal of Cardio-Thoracic Medicine2345-24474320160901Double Valve Replacement (Mitral and Aortic) for Rheumatic Heart Disease: A 20-year experience with 300 patients.484489742710.22038/jctm.2016.7427ENPrashant MishraCardiovascular and Thoracic Surgeon, Department of CVTS, LTMMC and GH, Sion, Mumbai, IndiaHarsh SethResident of Cardiovascular and Thoracic Surgeon, Department of CVTS, LTMMC and GH, Sion, Mumbai, India.0000-0002-0700-5782Jayant KhandekarCardiovascular and Thoracic Surgeon, Department of CVTS, LTMMC and GH, Sion, Mumbai, India.Chandan MohapatraResident of Cardiovascular and Thoracic Surgeon, Department of CVTS, LTMMC and GH, Sion, Mumbai, India0000-0002-3163-6488Ganesh AmmannayaResident of Cardiovascular and Thoracic Surgeon, Department of CVTS, LTMMC and GH, Sion, Mumbai, IndiaChaitanya RautCardiovascular And Thoracic Surgeon, Department Of CVTS, LTMMC And GH, Sion, Mumbai, India.0000000191743114Jaskaran SainiResident of Cardiovascular and Thoracic Surgeon, Department of CVTS, LTMMC and GH, Sion, Mumbai, IndiaVaibhav ShahResident of Cardiovascular and Thoracic Surgeon, Department of CVTS, LTMMC and GH, Sion, Mumbai, India0000-0001-6724-2942Journal Article20160731<strong>Introduction:</strong> Rheumatic heart disease still remains one of the leading causes of congestive heart failure and death owing to valvular pathologies, in developing countries. Valve replacement still remains the treatment of choice in such patients.The aim of this study wasto analyze the postoperative outcome of double valve replacement (Mitral and Aortic ) in patients of rheumatic heart disease. <br/><strong>Materials and Methods</strong>: Between 1988 and 2008, 300 patients of rheumatic heart disease underwent double (Mitral and Aortic) valve replacement with Starr Edwards valve or St Jude mechanical valve prosthesis were implanted. These patients were studied retrospectively for preoperative data and postoperative outcome including causes of early and late deaths and the data was analyzed statistically. <br/><strong>Results:</strong> The 30-day hospital death rate was 11.3% andlate death occurred in 11.6%. Anticoagulant regimen was followed to maintain the target pro-thrombin time at 1.5 times the control value. The actuarial survival (exclusive of hospital mortality) was 92.4%, 84.6%, and 84.4%, per year at 5, 10, and 20 years, respectively <br/><strong>Conclusions:</strong> In view of the acknowledged advantageof superior durability, increased thromboresistance in our patient population, and its cost effectiveness the Starr-Edwards ball valve or St. Jude valve is the mechanical prosthesis of choice for advanced combined valvular disease. The low-intensity anticoagulant regimen has offered suffcient protection against thromboembolism as well as hemorrhage.Mashhad University of Medical SciencesJournal of Cardio-Thoracic Medicine2345-24474320160901Successful Repair of Type a Aortic Dissection in a Term Pregnancy: A Case Report490492742410.22038/jctm.2016.7424ENKambiz AlizadehCardiac Surgeon, Faculty of Medicine, Mashhad University of Medical Sciences,Mashhad,IranMasoomeh TabariAnaesthesiologist, Faculty of Medicine, Mashhad University of Medical Sciences,Mashhad,Iran0000-0000-0000-0000Maliheh Hasanzadeh MofradGynecologist, Faculty of Medicine, Mashhad University of Medical Sciences,Mashhad,IranShima SheybaniAnaesthesiologist, Faculty of Medicine, Mashhad University of Medical Sciences,Mashhad,Iran0000-0002-0808-9084Journal Article20160211Stanford type A acute aortic dissection (AAD) is a very rare complication, with potentially lethal consequences in pregnancy. In fact, pregnancy has been regularly associated with the possibility of aortic. dissection in almost half of young women. Herein, we present the case of a 38-year-old woman in her 37<sup>th</sup> week of pregnancy. The patient’s medical history was indicative of G4L2Ab1(4 gestaitions,2 lives, 1 abortion). She developed persistent chronic pain in the neck, chest, and back, without nausea or vomiting while waking in the morning. The computed tomography angiogram was indicative of AAD. The medical decision was to perform a combination of cesarean section under general anesthesia and median sternotomy for the open aortic valve. The term newborn showed an Apgar score of 9-10. The coronary arteries were preserved and the valve was repaired at commissural positions. Dacron supracoronary tube graft was attached to the aortic anastomotic site and subsequently to the aortic arch. The patient was discharged on day three after surgery with a good general condition. Moreover, the results indicated that she and one of her brothers suffered from Marfan syndrome.Mashhad University of Medical SciencesJournal of Cardio-Thoracic Medicine2345-24474320160901Coronary Artery Spasm During Dobutamine Stress Echocardiography: A Case Report493495742510.22038/jctm.2016.7425ENHoorak PoorzandCardiologist, Atherosclerosis Prevention Research Center, Imam Reza Hospital, Faculty of Medicine, Mashhad University of Medical Sciences, Mashhad, Iran0000-0002-0764-6563Ali EshraghiInterventionist, Atherosclerosis Prevention Research Center, Imam Reza Hospital, Faculty of Medicine, Mashhad University of Medical Sciences, Mashhad, Iran0000-0002-3642-3553Ali AzariCardiac Surgeon, Cardiovascular Research Center, Ghaem Hospital, School of Medicine, Mashhad University of Medical Sciences, Mashhad, IranResearch Center, Ghaem Hospital, School of Medicine, Mashhad University of Medical Sciences, Mashhad, IranLeila BigdeluCardiologist, Atherosclerosis Prevention Research Center, Imam Reza Hospital, Faculty of Medicine, Mashhad University of Medical Sciences, Mashhad, IranSheida GolmohammadzadehInterventionist, Razavi Hospital, Mashhad, IranJournal Article20151113Dobutamine stress echocardiography (DSE) has been widely used as a diagnostic and prognostic modality in the management of stress. DSE is associated with limited complications and adverse effects on the health of patients. In this case report, we described a 42-year-old female patient with dobutamine-induced coronary artery spasm with history of exertional dyspnea, which had deteriorated recently. No risk factors of coronary artery disease were observed in the patient, and she had previous non-diagnostic exercise tolerance test. DSE was performed on the patient, and at the end of the infusion rate of 30 mcg/min, retrosternal pain was detected. Standard 12-lead electrocardiogram was indicative of ST segment elevation in inferior leads. Moreover, echocardiographic imaging of the patient revealed concomitant akinesia in the right coronary artery. On the other hand, subsequent coronary angiograms showed only mild coronary atherosclerosis.Mashhad University of Medical SciencesJournal of Cardio-Thoracic Medicine2345-24474320160901Esophageal Diverticula496496742310.22038/jctm.2016.7423ENReza AfghaniThoracic Surgeon,Department of Surgery,5Azar Hospital,Golestan University of Medical Sciences,Gorgan,Iran0000-0002-5984-481XAbdolreza FazelFellowship of Oncologic Surgery,5Azar Hospital,Golestan University of Medical Science,Gorgan,Iran.Mohammad RezaHashempourResident of General Surgery, 5Azar Hospital,Golestan University of Medical Science,Gorgan,Iran.Nooruddin MortazaviResident of General Surgery, 5Azar Hospital,Golestan University of Medical Science,Gorgan,Iran.Journal Article20160204Herein, we present the case of a 45-year-old woman with pulsion and midesophageal diverticula, who had complaints of dysphagia and regurgitation. Diagnosis was confirmed by endoscopy and barium swallow. The patient underwent right posterolateral thoracotomy with excision of diverticula and repair of the muscular layer along the site of diverticula. Five days following the operation, barium swallow with the passage of the contrast material through distal esophagus showed no diverticula. After five months, the patient remained asymptomatic.