ORIGINAL_ARTICLE
Effects of Nicorandil on the Clinical and Laboratory Outcomes of Unstable Angina Patients after Coronary Angioplasty
Introduction: 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. Materials and Methods: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. Results: 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). Conclusion:It is recommended that a randomized clinical trial be conducted for the close evaluation of the effects of Nicorandil on unstable angina patients.
https://jctm.mums.ac.ir/article_7422_51b82300b4babed2041dc45c8f26c106.pdf
2016-09-01
465
467
10.22038/jctm.2016.7422
Angioplasty
Nicorandil
Preconditioning
Homa
Falsoleiman
falsoleimanh@mums.ac.ir
1
Cariodiologist, Cardiovascular Research Center,Ghaem Hospital,Faculty Of Medicine,Mashhad Univrersity of Medical Sciences,Mashhad,Iran
AUTHOR
Mashalla
Dehghani Dashtabi
dehghanim@mums.ac.ir
2
Cariodiologist, Cardiovascular Research Center,Ghaem Hospital,Faculty of Medicine,Mashhad Univrersity of Medical Sciences, Mashhad,Iran
AUTHOR
Mohsen
Mouhebati
mouhebatim@mums.ac.ir
3
Cariodiologist, Cardiovascular Research Center,Ghaem Hospital,Faculty of Medicine,Mashhad Univrersity of Medical Sciences,Mashhad,Iran
AUTHOR
Mostafa
Dastani
dastanim@mums.ac.ir
4
Cariodiologist ,Ghaem Hospital, Faculty of Medicine,Mashhad Univrersity of Medical Sciences,Mashhad,Iran
AUTHOR
Atooshe
Rohani
rohania@mums.ac.ir
5
Cariodiologist,Cardiovascular Research Center, School of Medicine, Mashhad University of Medical Sciences, Mashhad, Iran
LEAD_AUTHOR
Neda
Partovi
partovin89@yahoo.com
6
Cariodiologist,Cardiovascular Research Center, School of Medicine, Mashhad University of Medical Sciences, Mashhad, Iran
AUTHOR
1- Keith AAF, Philippe GS, Kim AE, Shaun GG, Frederick Jr AA, Christopher BG, Marcus DF, Andrzej B, Ann Q, Joel MG, GRACE Investigators. Decline in rates of death and heart failure in acute coronary syndromes, 1999—2006. JAMA2007;297:1892-900.
1
2. Sakata Y, Kodama K, Komamura K, Lim YJ, Ishikura F, Hirayama A, et al. Salutary effect of adjunctive intracoronary nicorandil administration on restoration of myocardial blood flow and functional improvement in patients with acute myocardial infarction. Am Heart J 1997; 133: 616 – 621.
2
3. Kawai Y, Hisamatsu K, Matsubara H, Dan K, Akagi S, Miyaji K, et al. Intravenous administration of nicorandil immediately before percutaneous coronary intervention can prevent slow coronary flow phenomenon. Eur Heart J 2009; 30: 765 – 772.
3
4. Ishii H, Ichimiya S, Kanashiro M, Amano T, Imai K, Murohara T,et al. Impact of a single intravenous administration of nicorandil before reperfusion in patients with ST-segment-elevation myocar-dial infarction. Circulation 2005; 112: 1284 – 1288.
4
5. Ito H, Taniyama Y, Iwakura K, Nishikawa N, Masuyama T, Kuzuya T, et al. Intravenous nicorandil can preserve microvascular integrity and myocardial viability in patients with reperfused anterior wall myocardial infarction. J Am Coll Cardiol 1999; 33: 654 – 660.
5
6. Iwakura K, Ito H, Okamura A, Koyama Y, Date M, Higuchi Y, et al. Nicorandil treatment in patients with acute myocardial infarc-tion: A meta-analysis. Circ J 2009; 73: 925 – 931.
6
7-Stone GW, Peterson MA, Lansky AJ, Dangas G, Mehran R, Leon MB. Impact of normalized myocardial perfusion after successful angioplasty in acute myocardial infarction. J Am Coll Cardiol 2002;39: 591 – 597.
7
8-Gibson CM, Cannon CP, Daley WL, Dodge Jr JT, Alexander B, Marble SJ, et al. TIMI frame count: A quantitative method of assessing coronary artery flow. Circulation 1996; 93: 879 – 888.
8
9- Donald E. Cutlip, Richard E. Kuntz, Cardiac Enzyme Elevation After Successful Percutaneous Coronary Intervention Is Not an Independent Predictor of Adverse Outcomes. Circulation. 2005; 112: 916-923
9
10- Belsey J, Savelieva I, Mugelli A, Camm AJ. Relative efficacy of antianginal drugs used as add-on therapy in patients with stable angina: A systematic review and meta-analysis. Eur J Prev Cardiol. 2015 Jul;22(7):837-48.
10
11- Hirohata A, Yamamoto K, Hirose E, Kobayashi Y, Takafuji H, Sano F, Matsumoto K, et al. Nicorandil prevents microvascular dysfunction resulting from PCI in patients with stable angina pectoris: a randomised study. EuroIntervention. 2014 Jan 22;9(9):1050-6.
11
12-Hiroshi Ito, Yoshiaki Taniyama, Katsuomi Iwakura, Nagahiro Nishikawa, Tohru Masuyama, et al. Intravenous nicorandil can preserve microvascular integrity and myocardial viability in patients with reperfused anterior wall myocardial infarction. J Am Coll Cardiol. 1999;33(3):654-660.
12
13- IONA Study Group. Effect of nicorandil on coronary events in patients with stable angina: the impact of nicorandil in angina(IONA) randomized trial. Lancet 2002;359:1269—75.
13
14-Kasama S, Toyama T, Sumino H, Kumakura H, Takayama Y,Ichikawa S, et al. Long-term nicorandil therapy improves car-diac sympathetic nerve activity after reperfusion therapy inpatients with first acute myocardial infarction. J Nucl Med2007;48:1676-82.
14
ORIGINAL_ARTICLE
Enneagram Personality System as an Effective Model in Prediction of Risk of Cardiovascular Diseases: A Case-Control Study
Introduction: 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. Materials and Methods: 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. Results: 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). Conclusion: 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.
https://jctm.mums.ac.ir/article_7403_b90b8f8b76bb47575ef92417f02fd32c.pdf
2016-09-01
468
473
10.22038/jctm.2016.7403
Cardiovascular Disease
Enneagram System
Personality Types
Iranian Population
Saeid
Komasi
s_komasi63@yahoo.com
1
Master of Clinical Psychology, Social Development and Health Promotion Research Center, Kermanshah University of Medical Sciences. Kermanshah, Iran
AUTHOR
Ali
Soroush
ali.soroush.mhr@gmail.com
2
MD, Ph.D, Lifestyle Modification Research Center, Imam Reza Hospital, Kermanshah University of Medical Sciences, Kermanshah, Iran
AUTHOR
Nasrin
Nazeie
nazee.narin@yahoo.com
3
Master of Clinical Psychology, Lifestyle Modification Research Center, Imam Reza Hospital, Kermanshah University of Medical Sciences, Kermanshah, Iran
AUTHOR
Mozhgan
Saeidi
m_saeidi20@yahoo.com
4
Ph.D. Student of Psychology, Cardiac Rehabilitation Center, Imam Ali Hospital, Kermanshah University of Medical Sciences. Kermanshah, Iran
LEAD_AUTHOR
Ali
Zakiei
ali.zakiei@gmail.com
5
Ph.D. Student of Psychology, Social Development and Health Promotion Research Center, Kermanshah University of Medical Sciences, Kermanshah, Iran
AUTHOR
Saeidi M, Komasi S, Soroush A, Zakiei A, Shakeri J. Gender differences in patients' beliefs about biological, environmental, behavioral, and psychological risk factors in a cardiac rehabilitation program. J Cardio Thoracic Med. 2014; 2:215‐20.
1
Jones J, Buckley JP, Furze G, Doherty P, Speck L, Connolly S, et al. The BACPR standards and core components for cardiovascular disease prevention and rehabilitation 2012. 2nd ed. London: British Association for Cardiovascular Prevention and Rehabilitation; 2012. P. 1-22.
2
Komasi S, Saeidi M. Aging is an important cause for a lack of understanding of the main risk factor in cardiac rehabilitation patients. Thrita. 2015; 4:e32751.
3
Saeidi M, Soroush A, Komasi S, Moemeni K, Heydarpour B. Attitudes toward cardiovascular disease risk factors among patients referred to a cardiac rehabilitation center: importance of psychological attitudes. Shiraz E-Med J. 2015; 16:e22281.
4
Karami J, Komasi S, Maesoomi M, Saeidi M. Comparing the effects of two methods of relaxation and interpersonal cognitive problem solving (ICPS) on decreasing anxiety and depression in cardiac rehabilitation patients. J Urmia Univ Med Sci. 2014; 25:298-308.
5
Jokela M, Pulkki-Raback L, Elovainio M, Kivimaki M. Personality traits as risk factors for stroke and coronary heart disease mortality: pooled analysis of three cohort studies. J Behav Med. 2014; 37:881-9.
6
Suls J, Bunde J. Anger, anxiety, and depression as risk factors for cardiovascular disease: the problems and implications of overlapping affective dispositions. Psychol Bull. 2005; 131:260-300.
7
Khoosfi H, Monirpoor N, Birashk B, Peighambari M. A comparative study of personality factors, stressful life events, and social support in coronary heart patients and non-patients. Contemp Psychol. 2007; 2:41-8.
8
Mosavi SM, Namazi SH, Lotfian AA. Personality and coronary heart diseases. Med J Hormozgan Univ. 2005; 9:109-12.
9
Hamid N. Relationship between stress, hardiness and coronary heart disease. Jundishapur Sci Med J. 2007; 6:219-25.
10
Shipley BA, Weiss A, Der G, Taylor MD, Deary IJ. Neuroticism, extraversion, and mortality in the UK health and lifestyle survey: a 21-year prospective cohort study. Psychosom Med. 2007; 69:923-31.
11
Hur Y, Lee KH. Analysis of medical students' enneagram personality types, stress, and developmental level. Korean J Med Educ. 2011; 23:175-84.
12
Lee JS, Yoon JA, Do KJ. Effectiveness of enneagram group counseling for self-identification and depression in nursing college students. J Korean Acad Nurs. 2013; 43:649-57.
13
Riso DR, Hudson R. Discovering your personality type: the essential introduction to the Enneagram. Boston: Houghton Mifflin Harcourt; 2003.
14
Palmer H. The enneagram: understanding yourself and the others in your life. San Francisco, CA: Harper Collins; 1991.
15
Riso DR, Hudson R. Understanding the enneagram: the practical guide to personality types. Boston: Houghton Mifflin Harcourt; 2000.
16
Newgent RA, Parr PE, Newman I, Higgins KK. The riso-hudson enneagram type indicator: estimates of reliability and validity. Measurem Evalu Counsel Dev. 2004; 36:226–37.
17
Hoseinian S, Azimipour P, Karami A, Yazdi SM, Keshavaz G. Study of the psychometrical features of Enneagram personality types. Q J Career Organizat Counsel. 2012; 4:125-44.
18
Cao X, Wong EM, Chow Choi K, Cheng L, Ying Chair S. Interventions for cardiovascular patients with type D personality: a systematic review. Worldviews Evid Based Nurs.
19
2016. 13:314-23.Lapid-Bogda G. Bringing out the best in yourself at work: how to use the enneagram system for success. New York: McGraw-Hill; 2004. P. 32-42.
20
Lapid-Bogda G. Bringing out the best in everyone you coach: use the Enneagram system for Exceptional Results. New York: McGraw-Hill; 2010. P. 43-121.
21
Chida Y, Steptoe A. The association of anger and hostility with future coronary heart disease: a meta-analytic review of prospective evidence. J Am Coll Cardiol. 2009; 53:936-46.
22
Krantz DS, Olson MB, Francis JL, Phankao C, Bairey Merz CN, Sopko G, et al. Anger, hostility, and cardiac symptoms in women with suspected coronary artery disease: the Women's Ischemia Syndrome Evaluation (WISE) Study. J Womens Health. 2006; 15:1214-23.
23
Komasi S. The effectiveness of Enneagram personality types training in decreasing couple burnout in couples seeking divorce. Kermanshah: Welfare Organization; 2014. P. 75-6.
24
Aparicio MD, Moreno-Rosset C, Díaz MD, Ramírez–Uclés I. Gender differences in affect, emotional maladjustment and adaptive resources in infertile couples: a positive approach. Ann Clin Health Psychol. 2009; 5:39-46.
25
ORIGINAL_ARTICLE
Exogenous Fibrinogen Pertains Beneficial Effects in Managing Post-Cardiac Surgery Bleeding: A Randomized Clinical Trial
Introduction: 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. 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. Materials and Methods: 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. Results: 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). Conclusion: 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.
https://jctm.mums.ac.ir/article_7419_08b7a2c879e5c9fde0713d15f9ce8d85.pdf
2016-09-01
474
479
10.22038/jctm.2016.7419
Cardiac Surgery
Fibrinogen
Postoperative Bleeding
Mohammad
Esmaeelzadeh
esmaeelzadeh@gmail.com
1
Anesthesiologist, Department Of Anesthesiology and Critical Care, Mashhad University of Medical Sciences, Mashhad, Iran
AUTHOR
Shahram
Amini
aminish@mums.ac.ir
2
Anesthesiologist, Cardiac Anesthesia Research Center, Mashhad University of Medical Sciences, Mashhad, Iran
LEAD_AUTHOR
Ghasem
Soltani
soltanigh@mums.ac.ir
3
Anesthesiologist, Department of Anesthesiology and Critical Care, Mashhad University Of Medical Sciences, Mashhad, Iran
AUTHOR
Mohammad
Abbasi Tashnizi
abbasim@mums.ac.ir
4
Cardiac Surgeon, Cardio-Thoracic Surgery & Transplant Research Center, Emam Reza hospital, Faculty of medicine, Mashhad University of Medical Sciences, Mashhad, Iran.
AUTHOR
Mathias
Azami
drazami@gmail.com
5
Cardiac Surgeon, Department Of Cardiac Surgery, Kurdestan University Of Medical Sciences, Kordestan, Iran
AUTHOR
1.Woodman RC, Harker LA. Bleeding complications associated with cardiopulmonary bypass. Blood. 1990;76:1680-97
1
2. Görlinger K, Shore-Lesserson L, Dirkmann D, Hanke AA, Rahe-Meyer N, Tanaka KA.Management of hemorrhage in cardiothoracic surgery. J Cardiothorac Vasc Anesth.2013; 27:S20-34.
2
3. Biancari F, Mikkola R, Heikkinen J, Lahtinen J, Airaksinen KEJ, Juvonen T. Estimating the risk of complications related to re-exploration for bleeding after adult cardiac surgery: a systematic review and meta-analysis. Eur J Cardiothorac Surg. 2012; 41: 50–55
3
4. Tanaka KA, Egan K, Szlam F, Ogawa S, Roback JD, Sreeram G, et al. Transfusion and hematologic variables after fibrinogen or platelet transfusion in valve replacement surgery: preliminary data of purified lyophilized human fibrinogen concentrate versus conventional transfusion. Transfusion. 2014 ; 54:109-18
4
5. Görlinger K, Dirkmann D, Hanke AA. Potential value of transfusion protocols incardiac surgery. Curr Opin Anaesthesiol. 2013 ;26 :230-43.
5
6.Sadeghi M, Atefyekta R, Azimaraghi O, Marashi SM, Aghajani Y,Ghadimi F, et al.A randomized, double blind trial of prophylactic fibrinogen to reduce bleeding in cardiac surgery. Braz J Anesthesiol. 2014 ;64:253-7
6
7. Karlsson M, Ternström L, Hyllner M, Baghaei F, Skrtic S, Jeppsson A.Prophylactic fibrinogen infusion in cardiac surgery patients: effects on biomarkers of coagulation, fibrinolysis, and platelet function. Clin Appl Thromb Hemost. 2011 ; 17:396-404.
7
8. Rahe-Meyer N, Solomon C, Hanke A, Schmidt DS, Knoerzer D, Hochleitner G, et al. Effects of fibrinogen concentrate as first-line therapy during major aortic replacement surgery: a randomized, placebo-controlled trial. Anesthesiology. 2013 ;118:40-50.
8
9. Rahe-Meyer N. Fibrinogen concentrate in the treatment of severe bleeding after aortic aneurysm graft surgery. Thromb Res. 2011;128 :S17-9.
9
10. Ferraris VA, Brown JR, George J. Despotis GJ, Hammon JW, Reece B, et al.
10
2011 Update to The Society of Thoracic Surgeons and the Society of Cardiovascular Anesthesiologists Blood Conservation Clinical Practice Guidelines. Ann Thorac Surg 2011;91:944–82
11
11. Kristensen KL, Rauer LJ, Mortensen PE, Kjeldsen BJ. Reoperation for bleeding in cardiac surgery. Interactive CardioVascular and Thoracic Surgery.2012; 14: 709–71
12
12. Karkouti K, Callum J, Crowther MA, McCluskey SA, Pendergrast J, Tait G, et al. The relationship between fibrinogen levels after cardiopulmonary bypass and large volume red cell transfusion in cardiac surgery: an observational study. Anesth Analg. 2013; 117:14-22.
13
13 Galas FR, de Almeida JP, Fukushima JT, Vincent JL, Osawa EA, Zeferino S, et al . Hemostatic effects of fibrinogen concentrate compared with cryoprecipitate in children after cardiac surgery: a randomized pilot trial. J Thorac Cardiovasc Surg. 2014 ;148:1647-55
14
14. Faraoni D, Willems A, Savan V, Demanet H, De Ville A, Van der Linden P. Plasma fibrinogen concentration is correlated with postoperative blood loss in children undergoing cardiac surgery. A retrospective review. Eur J Anaesthesiol. 2014;31:317-26
15
15. Pillai RC, Fraser JF, Ziegenfuss M, Bhaskar B. Influence of circulating levels of fibrinogen and perioperative coagulation parameters on predicting postoperative blood loss in cardiac surgery: a prospective observational study. J Card Surg. 2014 ;29:189-95
16
16. Gielen C, Dekkers O, Stijnen T, Schoones J, Brand A, Klautz R, et al. The effects of pre- and postoperative fibrinogen levels on blood loss after cardiac surgery: a systematic review and meta-analysis. Interact Cardiovasc Thorac Surg. 2014 ;18:292-8.
17
17. Ranucci M(1), Jeppsson A, Baryshnikova E. Pre-operative fibrinogen supplementation in cardiac surgery patients: an evaluation of different trigger values. Acta Anaesthesiol Scand. 2015 ;59:427-33
18
18. Kindo M, Hoang Minh T, Gerelli S, Perrier S, Meyer N, Schaeffer M, et al. Plasma fibrinogen level on admission to the intensive care unit is a powerful predictor of postoperative bleeding after cardiac surgery with cardiopulmonary bypass. Thromb Res. 2014 ;134:360-8.
19
19. Fassl J, Lurati Buse G, Filipovic M, Reuthebuch O, Hampl K, Seeberger MD, et al.Perioperative administration of fibrinogen does not increase adverse cardiac and thromboembolic events after cardiac surgery. Br J Anaesth. 2015 ;114:225-34
20
20. Stanzel R, Henderson M, O'Blenes S. Prophylactic fibrinogen administration during complex congenital cardiac surgery leading to thrombosis of a patient's brachial artery and the cardiopulmonary bypass circuit: a case report. Perfusion. 2013 ;29:369-372.
21
21. Bilecen S, Peelen LM, Kalkman CJ, Spanjersberg AJ, Moons KG, Nierich AP.Fibrinogen concentrate therapy in complex cardiac surgery. J Cardiothorac Vasc Anesth. 2013 ;27:12-17
22
22. Theusinger OM, Stein P, Levy JH. Point of care and factor concentrate-based coagulation algorithms. Transfus Med Hemother. 2015 ;42:115-21.
23
23. TEG®- or ROTEM®-based individualized goal-directed coagulation algorithms: don’t wait - act now!.Crit Care. 2014 ;18:637.
24
24. Ghavidel AA, Toutounchi Z, Shahandashti FJ, Mirmesdagh Y. Rotational thromboelastometry in prediction of bleeding after cardiac surgery. Asian Cardiovasc Thorac Ann. 2015 ;23:525-9.
25
ORIGINAL_ARTICLE
Early Clinical Outcomes and Mortality of Coronary Endarterectomy in the Left Anterior Descending Artery: A Single-Center Experience
Introduction: 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. Materials & Methods: 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. Results: 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. Conclusion: If coronary endarterectomy of the LAD is performed by experienced cardiac surgeons, favorable outcomes can be obtained.
https://jctm.mums.ac.ir/article_7418_2f07e32cbf28434ee344ee96465b5cde.pdf
2016-09-01
480
483
10.22038/jctm.2016.7418
CABG
Coronary Endarterectomy
Left Anterior Descending Artery
Hamid
Hoseinikhah
hoseinikhahh@mums.ac.ir
1
Cardiac Surgeon, Faculty of Medicine, Mashhad University of Medical Sciences, Atherosclerosis Prevention Research Center, Imam Reza Hospital. Iran
AUTHOR
Mohammad
Abbassi Teshnisi
abbasim@mums.ac.ir
2
Cardiac Surgeon, Department of cardiac surgery, Cardio-Thoracic Surgery & Transplant Research Center, Emam Reza hospital, Faculty of medicine, Mashhad University of Medical Sciences, Mashhad, Iran.
.
AUTHOR
Ahmadreza
Zarifian
zarifianar891@mums.ac.ir
3
Medical Student, Student Research Committee, Faculty of Medicine, Mashhad University of Medical Sciences, Mashhad, Iran
AUTHOR
Yasamin
Moeinipour
yasaminmp@yahoo.com
4
Medical Student, Faculty of Medicine, Mashhad University of Medical Sciences, Iran
AUTHOR
Aliasghar
Moeinipour
moinipoora1@mums.ac.ir
5
Cardiac Surgeon, Atherosclerosis Prevention Research Center, cardiac surgery Imam Reza Hospital, Mashhad University of Medical Sciences,
LEAD_AUTHOR
1. Abid AR, Farogh A, Naqshband MS, Akhtar RP, Khan JS. Hospital outcome of coronary artery bypass grafting and coronary endarterectomy.Asian Cardiovasc Thorac Ann. 2009; 17:59–63
1
2. Akchurin RS, Brand I, Barskova T. Assessment of efficacy of endarterectomy of coronary arteries. Khirurgiia. 2003; 10:21–24.
2
3. Erdil N, Cetin L, Kucuker S, Demirkilic U, Sener E, Tatar H.. Closed endarterectomy for diffuse right coronary artery disease: early results with angiographic controls. J Card Surg. 2002; 17:261–266.
3
4. Fukui T, Takanashi S, Hosoda Y. Long segmental reconstruction of diffusely diseased left anterior descending coronary artery with left internal thoracic artery with or without endarterectomy. Ann Thorac Surg. 2005; 80:2098–2105.
4
5. Authors/Task Force MWindecker S, Kolh P, et al. 2014 ESC/ EACTS guidelines on myocardial revascularization: The task force on myocardial revascularization of the European Society of Cardiol- ogy (ESC) and the European Association for Cardio-Thoracic Surgery (EACTS) developed with the special contribution of the European Association of Percutaneous Cardiovascular Interventions (EAPCI) Eur Heart J. 2014; 35:2541–2619.
5
6. Yoo JS, Kim JB, Jung SH, Choo SJ, Chung CH, Lee JW. Coronary artery bypass grafting in patients with left ventricular dysfunction: predictors of long-term survival and impact of surgical strategies. Int J Cardiol. 2013; 168:53 16–5322.
6
7. Soylu E, Harling L, Ashrafian H, Casula R, Kokotsakis J, Athanasiou T. Adjunct coronary endarter- ectomy increases myocardial infarction and early mortality after coronary artery bypass grafting: a meta-analysis. Interact Cardiovasc Thorac Surg. 2014; 19:462–473.
7
8. irivella S, Gielchinsky I, Parsonnet V. Results of coronary artery endarterectomy and coronary artery bypass grafting for diffuse coronary artery disease. Ann Thorac Surg.2005; 80:1738–1744.
8
9. Silberman S, Dzigivker I, Merin O, Shapira N, Deeb M, Bitran D. Does coronary endarter- ectomy increase the risk of coronary bypass? J Card Surg. 2002;17:267–271.
9
10. Tiruvoipati R, Loubani M, Lencioni M, Ghosh S, Jones PW, Patel RL. Coronary endarter- ectomy: impact on morbidity and mortality when combined with coronary artery bypass surgery. Ann Thorac Surg. 2005; 79:1999– 2003
10
11. Fukui T, Tabata M, Taguri M, Manabe S, Morita S, Takanashi S. Extensive reconstruction of the left anterior descending coronary artery with an internal thoracic artery graft. Ann Thorac Surg. 2011; 91:445–451.
11
12. Kato Y, Shibata T, Takanashi S, Fukui T, Ito A, Shimizu Y. Results of long segmental reconstruction of left anterior descending artery using left internal thoracic artery. Ann Thorac Surg. 2012;93:1195–1200
12
13. Qiu Z, Chen X, Jiang Y, Wang L, Xu M, Huang F, et al. Comparison of off-pump and on- pump coronary endarterectomy for patients with diffusely diseased coronary arteries: early and midterm outcome. J Cardiothorac Surg. 2014;9:186
13
14. Naseri E, Sevinc M, Erk MK. Comparison of off-pump and conventional coronary endarterectomy. Heart Surg Forum. 2003;6:216–219
14
15. Hussain I, Ghaffar A, Shahbaz A, Sami W, Muhammad A, Seher N,. In hospital outcome of patients undergoing coronary endarterectomy: comparison between off-pump vs on pump CABG. J Ayub Med Coll Abbottabad. 2008;20:31–37.
15
16. Bonetti PO, Lerman LO, Lerman A. Endothelial dysfunction: a marker of atherosclerotic risk. Arterioscler Thromb Vasc Biol. 2003; 23:168–175
16
ORIGINAL_ARTICLE
Double Valve Replacement (Mitral and Aortic) for Rheumatic Heart Disease: A 20-year experience with 300 patients.
Introduction: 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. Materials and Methods: 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. Results: 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 Conclusions: 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.
https://jctm.mums.ac.ir/article_7427_98fc588687609a69774f6a6c558b029d.pdf
2016-09-01
484
489
10.22038/jctm.2016.7427
Double Valve Replacement
Rheumatic Heart Disease
Starr Edwards Valve
St. Jude Valve
Prashant
Mishra
drprashantmishra100@yahoo.co.in
1
Cardiovascular and Thoracic Surgeon, Department of CVTS, LTMMC and GH, Sion, Mumbai, India
AUTHOR
Harsh
Seth
seth.harsh@gmail.com
2
Resident of Cardiovascular and Thoracic Surgeon, Department of CVTS, LTMMC and GH, Sion, Mumbai, India.
LEAD_AUTHOR
Jayant
Khandekar
harsh_h@hotmail.com
3
Cardiovascular and Thoracic Surgeon, Department of CVTS, LTMMC and GH, Sion, Mumbai, India.
AUTHOR
Chandan
Mohapatra
bapun39@gmail.com
4
Resident of Cardiovascular and Thoracic Surgeon, Department of CVTS, LTMMC and GH, Sion, Mumbai, India
AUTHOR
Ganesh
Ammannaya
doc.ammannaya@gmail.com
5
Resident of Cardiovascular and Thoracic Surgeon, Department of CVTS, LTMMC and GH, Sion, Mumbai, India
AUTHOR
Chaitanya
Raut
drrautchaitanya@gmail.com
6
Cardiovascular And Thoracic Surgeon, Department Of CVTS, LTMMC And GH, Sion, Mumbai, India.
AUTHOR
Jaskaran
Saini
drjaskaransinghsaini@gmail.com
7
Resident of Cardiovascular and Thoracic Surgeon, Department of CVTS, LTMMC and GH, Sion, Mumbai, India
AUTHOR
Vaibhav
Shah
vaibhavshah126@gmail.com
8
Resident of Cardiovascular and Thoracic Surgeon, Department of CVTS, LTMMC and GH, Sion, Mumbai, India
AUTHOR
1. Robbins S L, Cotran R S. The Heart. Kumar V, Abbas A K, Fausto N. Pathologic basis of disease. 7th ed Philadelphia: Saunders; 2006. P,592-594.
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2. Kaplan M, Bolande R, Rakita L, Blair J. Presence of Bound Immunoglobulins and Complement in the Myocardium in Acute Rheumatic Fever. New England Journal of Medicine. 1964;271(13):637-645.
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3. Grover FL, Hammermeister KE, Burchfiel C. Initial report of the Veterans Administration preoperative risk assessment study for cardiac surgery. Ann ThoracSurg 1990; 50:12-28.
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4.Christakis GT, Weisel RD, David TE, Salerno TA, Ivanov J.Predictors of operative survival of valve replacement.Circulation 1988;78 (Suppl. I):25–34.
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5. Milano A, Bortolotti U, Mazucco A, Guerra F, Magni A, Gallucci V. Aortic valve replacement with the Hancock standard, Björk-Shiley and Lillehei-Kaster prostheses. A comparison based on follow-up from 1±15 years. J ThoracCardiovascSurg 1989;98:37-47.
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6. Duncan J M, Cooley D A, Livesay J J, Ott D A, Reul G A, Walker W E, etal. The St. Jude Medical Valve: Early Clinical Results in 253 Patients.Tex Heart Inst J. 1983 March; 10(1): 11–16.
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8. Edmunds L, Clark R, Cohn L, Grunkemeier G, Miller D, Weisel R. Guidelines for Reporting Morbidity and Mortality after Cardiac Valvular Operations. Asian Cardiovascular and Thoracic Annals. 1996;4(2):126-129.
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9. Brown P, Roberts C, McIntosh C, Swain J, Clark R. Relation between choice of prostheses and late outcome in double-valve replacement. The Annals of Thoracic Surgery. 1993;55(3):631-640.
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10. Emery RW, Palmquist WE, Metther E, Nicoloff DM; A new cardiac valve prosthesis: in vitro results.Trans Am Soc Artif Intern Organs. 24 1978:550-556.
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11. Bortolotti U, Milano A, Testolin L, Tursi V, Mazzucco A, Gallucci V. Influence of type of prosthesis on late results after combined mitral-aortic valve replacement. The Annals of Thoracic Surgery. 1991;52(1):84-91.
11
12. Litmathe J, Boeken U, Kurt M, Feindt P, Gams E. Predictive Risk Factors in Double-Valve Replacement (AVR and MVR) Compared to Isolated Aortic Valve Replacement. The Thoracic and Cardiovascular Surgeon. 2006;54(7):459-463.
12
13. Teoh KH, Christakis GT, Weisel RD, Tong CP, Mickleborough LL, Scully HE, et al. The Determinants of Mortality and Morbidity after Multiple-Valve Operations. The Annals of Thoracic Surgery. 1987;43(4):353-358.
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14. Karp RB, Cyrus RJ, Blackstone EH, Kirklin JW, Kouchoukos NT, Pacifico AD. The Björk-Shiley valve: intermediate-term follow-up. J Thorac Cardiovasc Surg.1981 Apr;81(4):602–614.
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15. Bernal J, Rabasa J, Gutierrez-Garcia F, Morales C, Nistal J, Revuelta J. The CarboMedics Valve: Experience With 1,049 Implants. The Annals of Thoracic Surgery. 1998;65(1):137-143.
15
16. Taylor K. The United Kingdom Heart Valve Registry: the first 10 years. Heart. 1997;77(4):295-296.
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17. Malouf J, Enriquez-Sarano M, Pellikka P, Oh J, Bailey K, Chandrasekaran K et al. Severe pulmonary hypertension in patients with severe aortic valve stenosis: clinical profile and prognostic implications. Journal of the American College of Cardiology. 2002;40(4):789-795.
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18. Galloway A, Grossi E, Baumann F et al. Multiple valve operation for advanced valvular heart disease: Results and risk factors in 513 patients. Journal of the American College of Cardiology. 1992;19(4):725-732.
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19. Talwar S, Jayanthkumar H, Kumar A. Chordal preservation during mitral valve replacement: basis, techniques and results. Indian J Thorac Cardiovasc Surg. 2005;21(1):45-52.
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20. Kopf GS, Hammond GL, Geha AS, Elefteriades J, Hashim SW. Long-term performance of the St. Jude Medical valve: low incidence of thromboembolism and hemorrhagic complications with modest doses of warfarin. Circulation. 1987 Sep;76(3 Pt 2):III132-6
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21. Iyer KS, Reddy KS, Rao IM, Bhatia ML, Gopinath N, Venugopal P. Valve replacement in children under 20 years of age. Experience with Björk-Shiley valve. J ThoracCardiovascSurg 1984;88:217-24.
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22. Salazar, E., Zajarias, A., Gutierrez, N., Iturbe, I. The problem of cardiac valve prosthesis anticoagulants and pregnancy. Circulation. 1984;70:69–77.
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23. Corcos T, Gandjbakch I, Pavie A, et al. Long term results of valve replacement with Starr-Edwards silicone ball valve prosthesis. Circulation 1987;71(Suppl 4):446.
23
24. Armenti F, Stephenson LW, Edmunds LH Jr. Simultaneous implantation of St. Jude medical aortic and mitral prostheses. J ThoracCardiovascSurg 1987;94:733-9.
24
25. Sethia B, Turner MA, Lewis S, Rodger RA, Bain WH. Fourteen years experience with the Björk-Shiley tilting disc prosthesis. J ThoracCardiovasc Surg 1986;91:350-361.
25
26.Dhasmana JP, Blackstone EH, Kirklin JW, Kouchoukos NT. Factors associated with periprosthetic leakage following pri-mary mitral valve replacement with special consideration of the suture technique. Ann ThoracSurg 1983;35:170-178.
26
ORIGINAL_ARTICLE
Successful Repair of Type a Aortic Dissection in a Term Pregnancy: A Case Report
Stanford 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 37th 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.
https://jctm.mums.ac.ir/article_7424_e7d4a06977d89e46602b9e67445d8e0c.pdf
2016-09-01
490
492
10.22038/jctm.2016.7424
Aortic Surgery
Type A Aortic Dissection
pregnancy
Kambiz
Alizadeh
alizadehk@mums.ac.ir
1
Cardiac Surgeon, Faculty of Medicine, Mashhad University of Medical Sciences,Mashhad,Iran
AUTHOR
Masoomeh
Tabari
tabarim@mums.ac.ir
2
Anaesthesiologist, Faculty of Medicine, Mashhad University of Medical Sciences,Mashhad,Iran
AUTHOR
Maliheh
Hasanzadeh Mofrad
hasanzadehm@mums.ac.ir
3
Gynecologist, Faculty of Medicine, Mashhad University of Medical Sciences,Mashhad,Iran
AUTHOR
Shima
Sheybani
sheybanish@mums.ac.ir
4
Anaesthesiologist, Faculty of Medicine, Mashhad University of Medical Sciences,Mashhad,Iran
LEAD_AUTHOR
Manalo-Estrella P, Barker AE.Histopathologic findings in human aortic media associated with pregnancy. Archives of Pathology 1967;83: 336-341.
1
Konishi Y, Tatsuta N,Kumuda K, Minami K. Dissecting aneurism during pregnancy and the puerperium.Japanese Circulation Journal 1980;44:726-733.
2
M. Shihata, V. Pretorius, R.Mac Arthur, “Repair of an type A aortic dissection combined with an emergency cesarean section in a pregnant woman,” Interactive Cardiovascular and Thoracic Surgery, 2008 vol. 7, no. 5, pp. 938–940,
3
Pitt MP, Bonser RS. The natural history of thoracic aortic aneurysm disease: an overview. J Card Surg 1997; 12: 270–8
4
Cunningham GF, Leveno JK, Bloon LS, Sponf YC,et al.Williams obstetrics.24th edition. MC Graw Hill Companies Inc. 2014 Volume 2;49:992
5
Thalmann M1, Sodeck GH, Domanovits H, Grassberger M, Loewe C, Grimm M.et al.Acute type A aortic dissection and pregnancy: a population-based study Eur J Cardiothorac Surg. 2011 ;39:e159-63
6
Immer FF, Bansi AG, Immer-Bansi AS, McDougall J, Zehr KJ, Schaff HV, et al. Aortic dissection in pregnancy: analysis of risk factors and outcome. Ann Thorac Surg
7
Nienaber CA, Fattori R, Mehta RH, Richartz BM, Evangelista A, Petzsch M, et al. Gender-related differences in acute aortic dissection. Circulation. 2004;109:3014–3021.
8
Kim TE, Smith DD. Thoracic aortic dissection in an 18-year-old woman with no risk factors. J Emerg Med. 2010;38:e41–e44.
9
M. P. I. Pitt and R. S. Bonser, The natural history of thoracic aortic aneurysm disease: an overview,” J Cardiothorac Surg, 1997 vol. 12, no. 2, pp. 270–278,.
10
Chen K1, Varon J, Wenker OC, Judge DK, Fromm RE Jr, Sternbach GL. Acute thoracic aortic dissection: the basics. J Emerg Med. 1997;15:859–867.
11
Cheitlin MD, Armstrong WF, Aurigemma GP et al. ACC/AHA/ ASE 2003 guideline update for the clinical application of echocardiography: a report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines (ACC/AHA/ASE Committee to Update the 1997 Guidelines for the Clinical Application of Echocardiography). American College of Cardiology website. Available at: www. acc.org/clinical/guidelines/echo/index.pdf
12
ZeegbregtsCJ, Schepens MA, Hameeteman TM, Morshuis WJ, and de la Rivi`ere AB, “Acute aortic dissection complicating pregnancy,” Ann Thorac Surg, 1997 vol. 64, pp. 1345–1348,.
13
Kinney-Ham L, H. Bryant Nguyen, Steele R, L. Walters E. Acute Aortic Dissection in Third Trimester Pregnancy without Risk Factors. West J Emerg Med. 2011;12:571–574.
14
Kohli E, Jwayyed SH, Giorgio G, Bhalla MC. Acute Type A Aortic Dissection in a 36-Week Pregnant Patient. Hindawi Publishing Corporation Case Reports in Emergency Medicine Volume 2013, Article ID 390670, 3 pages http://dx.doi.org/10.1155/2013/390670.
15
ORIGINAL_ARTICLE
Coronary Artery Spasm During Dobutamine Stress Echocardiography: A Case Report
Dobutamine 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.
https://jctm.mums.ac.ir/article_7425_f0e79ad70d6404bdfb4325ff050293f3.pdf
2016-09-01
493
495
10.22038/jctm.2016.7425
Coronary Spasm
Dobutamine
Stress Echocardiography
Hoorak
Poorzand
poorzandh@mums.ac.ir
1
Cardiologist, Atherosclerosis Prevention Research Center, Imam Reza Hospital, Faculty of Medicine, Mashhad University of Medical Sciences, Mashhad, Iran
AUTHOR
Ali
Eshraghi
eshraghia@mums.ac.ir
2
Interventionist, Atherosclerosis Prevention Research Center, Imam Reza Hospital, Faculty of Medicine, Mashhad University of Medical Sciences, Mashhad, Iran
AUTHOR
Ali
Azari
azaria@mums.ac.ir
3
Cardiac 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, Iran
AUTHOR
Leila
Bigdelu
bigdelul@mums.ac.ir
4
Cardiologist, Atherosclerosis Prevention Research Center, Imam Reza Hospital, Faculty of Medicine, Mashhad University of Medical Sciences, Mashhad, Iran
LEAD_AUTHOR
Sheida
Golmohammadzadeh
golmohammadzade@gmail.com
5
Interventionist, Razavi Hospital, Mashhad, Iran
AUTHOR
1. Rosado PRB, Gil MA, Campos Filho O. Coronary Spasm during the Dobutamine Stress Echocardiography. Arq Bras Cardiol. 2014;27(2):97-100.
1
2. Geleijnse ML, Krenning BJ, Nemes A, van Dalen BM, Soliman OI, Folkert J, et al. Incidence, pathophysiology, and treatment of complications during dobutamine-atropine stress echocardiography. Circulation. 2010;121(15):1756-67.
2
3. Mansencal N, El Hajjaji I, El Mahmoud R, Digne F, Dubourg O. Prevalence of coronary artery spasm during dobutamine stress echocardiography. The American journal of cardiology. 2012;109(6):800-4.
3
4. Kawano H, Ogawa H. Endothelial function and coronary spastic angina. Internal medicine. 2005;44(2):91-9.
4
5. Yasue H. PAthophysiology and treatment of coronary arterial spasm. Chest. 1980;78(1_Supplement):216-23.
5
6. Álvarez L, Zamorano J, Mataix L, Almeria C, Moreno R, Rodrigo JL. Coronary spasm after administration of propranolol during dobutamine stress echocardiography. Revista Española de Cardiología. 2002;55(07):778-81.
6
7. Tio RA, Van Gelder IC, Boonstra PW, Crijns H. Myocardial bridging in a survivor of sudden cardiac near-death: role of intracoronary doppler flow measurements and angiography during dobutamine stress in the clinical evaluation. Heart. 1997;77(3):280-2.
7
8. Kawano H, Fujii H, Motoyama T, Kugiyama K, Ogawa H, Yasue H. Myocardial ischemia due to coronary artery spasm during dobutamine stress echocardiography. The American journal of cardiology. 2000;85(1):26-30.
8
ORIGINAL_ARTICLE
Esophageal Diverticula
Herein, 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.
https://jctm.mums.ac.ir/article_7423_5711ec253bfeba298c05d073511e2697.pdf
2016-09-01
496
496
10.22038/jctm.2016.7423
Dysphagia
Esophageal Diverticula
Endoscopy
Thoracotomy
Reza
Afghani
af_med75@yahoo.com
1
Thoracic Surgeon,Department of Surgery,5Azar Hospital,Golestan University of Medical Sciences,Gorgan,Iran
LEAD_AUTHOR
Abdolreza
Fazel
fazelabdolreza@gmail.com
2
Fellowship of Oncologic Surgery,5Azar Hospital,Golestan University of Medical Science,Gorgan,Iran.
AUTHOR
Mohammad
Hashempour
hashempourm@yahoo.com
3
Resident of General Surgery, 5Azar Hospital,Golestan University of Medical Science,Gorgan,Iran.
AUTHOR
Nooruddin
Mortazavi
noor625@yahoo.com
4
Resident of General Surgery, 5Azar Hospital,Golestan University of Medical Science,Gorgan,Iran.
AUTHOR