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  Journal of Cardio-Thoracic Medicine
  [2 followers]  Follow
  This is an Open Access Journal Open Access journal
   ISSN (Print) 2345-2447 - ISSN (Online) 2322-5750
   Published by Mashhad University of Medical Sciences Homepage  [11 journals]
  • Enlarged Right Atrium Falsely Interpreted as a Mediastinal Mass: A Case

    • Abstract: Right atrial dilation due to left heart disease is a common complication among adults. The present review aimed to describe a case of massively dilated right atrium in a female patient presenting with valvular heart disease and no atrial fibrillation. The results of chest X-ray revealed a large opacity filling the lower right hemithorax, falsely interpreted as a mediastinal mass. During the transesophageal echocardiography, severe enlargement of the right atrium was detected, and open mitral and tricuspid valve replacements were performed successfully.
      PubDate: Mon, 31 Aug 2015 19:30:00 +010
  • Mediastinal Neuroendocrine Carcinoma of Unknown Origin Presenting with
           Superior Vena Cava ...

    • Abstract: Primary neuroendocrine carcinoma (NEC) of the mediastinum is a rare type of carcinoma. According to the literature, only five cases of this condition have been reported so far. In this paper, we present a rare case of mediastinal NEC of unknown primary site. The patient was a 34-year-old man with mediastinal NEC, who presented with chronic dry cough and a right-sided mediastinal mass one year prior to hospital admission (winter 1391). His condition was confirmed by cervical lymph node biopsy. The patient refused to undergo chemotherapy treatment. During the hospital admission, the patient presented with severe dyspnea and signs of superior vena cava syndrome. Contrast-enhanced CT scan of the chest revealed a large heterogeneous mass extended from the right superior mediastinum to the right lung base with the encasement of the superior vena cava. After radiotherapy, the patient′s symptoms subsided and he underwent etoposide and cisplatin chemotherapy. After a 20-month patient follow-up, the subject remained alive and symptom-free.
      PubDate: Mon, 31 Aug 2015 19:30:00 +010
  • Prediction of Changes in Left Ventricular Ejection Fraction after Off-Pump
           Coronary Artery ...

    • Abstract: Introduction: Left ventricular ejection fraction (LVEF) is considered to be the single most important prognostic factor in patients with previous myocardial infarction. LVEF is not improved in all patients after coronary artery bypass grafting (CABG). This study aimed to assess the possibility of LVEF changes after CABG using myocardial perfusion single-photon emission computed tomography (SPECT). Materials and Methods: Overall, 48 patients with confirmed coronary artery disease and mean LVEF of 30.2% (±4.7) were studied. Echocardiography, as well as gated myocardial perfusion SPECT after injection of Tc-99m-methoxy-isobutyl-isonitrile was performed on all the patients at rest. Myocardial uptake was evaluated in 17 myocardial segments and was compared with age and gender matched normal data pool. The risks and benefits of CABG were explained to all the patients and 16 cases (15 male and 1 female) with the mean age of 61.1 years (±10.8) accepted to undergo off-pump CABG. All the patients were followed-up for at least six months and echocardiography and myocardial perfusion GSPECT Patients had a mean LVEF of 31.1% (±3.5), which increased to 34.5% (±3.6) after surgery (P<0.001). Delta LVEF was defined as ΔLVEF=LVEF (before CABG) - LVEF (after CABG). ΔLVEF was within the range of 0-8% with the mean of 3.4% (±2.5). The number of non-viable myocardial segments  of patients with ΔLVEF ≥ 5% was not significantly different from that of patients with smaller changes. Using Quark Publishing System (QPS) software and 17 segment models, myocardial perfusion was estimated for all segments, and the mean global uptake was defined by adding the mean uptake in all segments, divided by 17. The mean global uptake was 53.1 in our patients. Regression analysis revealed that ΔLVEF after CABG can be predicted reliably using the following formula: ΔLVEF= -33.8 + (0.77 × mean global uptake) (P<0.01). Conclusion: Our study showed that change of LVEF after CABG can be predicted reliably using mean global uptake in preoperative myocardial perfusion SPECT at rest.
      PubDate: Mon, 31 Aug 2015 19:30:00 +010
  • Optimal Stent Expansion by Stent Balloon Multiple Inflation at Nominal
           Pressure in Resistant ...

    • Abstract: Introduction: This study aimed to evaluate the effects of four-time inflation of the stent balloon at nominal pressure on optimal stent expansion in resistant lesions. Materials and Methods: This interventional study was conducted on 39 patients with coronary artery lesions, in whom zotarolimus-eluting stents (N=20), paclitaxel-eluting stents (N=11) and other stents (N=8) were deployed four times at nominal inflation pressure and increased inflation times (5, 15, 30 and 45 seconds). After the deployments, enhanced stent visualization imaging technique (IC stent) was used to assess stent placement and artery expansion. Results: In this study, early success rate was estimated at 79.5% using the enhanced stent visualization imaging technique. In addition, major adverse cardiac event (MACE) was determined at 2.6%. Also, conventional methods resulted in lower success rate and higher MACE in resistant lesions. Conclusion: According to the results of this study, four-time stent balloon inflation at nominal pressure could allow adequate stent expansion in resistant lesions leading to lower MACE.
      PubDate: Mon, 31 Aug 2015 19:30:00 +010
  • The Role of Pyloromyotomy on Gastric Drainage in Esophagectomy and Gastric
           Pull-up Procedures: ...

    • Abstract: Introduction: Gastric drainage disorder is one of the complications of gastric pull-up and esophagectomy after surgery which might lead to esophageal cancer and benign strictures. The aim of this study was to determine the role of pyloromyotomy on gastric drainage. Materials and Methods: In this prospective randomized controlled clinical trial study, we studied 51 patients in two matched groups from July 2008 to August 2010 in ImamRezaHospital, Tabriz,Iran. Twenty-seven patients in group one had no pyloromyotomy and 24 patients in group two had pyloromyotomy after transhiatal esophagectomy and gastric pull-up procedure. The outcomes were measured as the incidence of gastric outlet compromise which was diagnosed 12 months after esophagectomy and gastric pull-up. Regurgitation, fullness, respiratory distress, coughing and, clinical delayed gastric emptying were observed and compared in two groups by radioisotope gastric emptying scanning. Results: A total number of 51 patients, 19 (37.25%) male and 32 (62.75%) female were studied in this research. The overall incidence of delayed gastric emptying was 19 /51 (37.25%). Pyloromyotomy did not reduce the incidence of delayed gastric emptying. There was no statistically significant difference in the length of hospital stay in study groups (group 1= 11 days versus 12 days in group 2, P=0.41). There was no statistical difference in anastomotic leak or anastomotic stricture (P= 0.72). Mortality was two (one patient, 3.7%, in group 1 and one patient, 4.2%, in group 2). The incidences of regurgitation and increased gastric emptying were not statistically different in two groups. Conclusion: Pyloromyotomy could not reduce the incidence of delayed gastric emptying after transhiatal esophagectomy, and vagotomy.
      PubDate: Mon, 31 Aug 2015 19:30:00 +010
  • Chronic Asthma and Gastro-Esophageal Reflux Disease: The Treatment

    • Abstract: Gastro-esophageal reflux disease (GERD) regularly occurs when stomach acid moves up from the stomach into the esophagus. GERD might be associated with chronic asthma symptoms such as coughing and breathlessness. According to several studies on children and adults, GERD is proven to have a close relationship with asthma.  Medication treatment via proton-pump inhibitors (PPIs), such as Omeprazole, H2 receptor blockers (Ranitidine), and other antireflux medications, is appropriate for ameliorating GERD and asthma. Moreover, surgery is another useful approach to GERD and asthma treatment. In this regard, Nissen fundoplication (laparoscopic) is a principal surgery method. Medical and surgical antireflux therapies are recognized as effective methods in the treatment of GERD-associated asthma. Our  review included studies that evaluated treatment of GERD-associated asthma. These studies accentuated the critical role of acid reflux suppression in relieving the patients suffering from a difficult to control asthma.
      PubDate: Mon, 31 Aug 2015 19:30:00 +010
  • The Association between B-type Natriuretic Peptide Family and Successful
           Percutaneous ...

    • Abstract: B-type natriuretic peptide (BNP) level is known to increase in patients with rheumatic mitral stenosis. In this systematic review, we aimed to discuss the possible association between plasma BNP level and the success rate of percutaneous transvenous mitral commissurotomy. PubMed and Scopus databases were searched systematically, using the following key terms: “B-type natriuretic peptide” OR “BNP” AND “percutaneous transvenous mitral commissurotomy” OR “percutaneous transluminal mitral commissurotomy” OR “PTMC” OR “percutaneous balloon mitral valvotomy” OR “PBMV”. The title, keywords and abstract of relevant articles were searched thoroughly. Among 27 articles found in these databases, 18 studies were excluded during different stages of article selection, based on the inclusion and exclusion criteria. A total of 333 patients were evaluated in the selected studies. Overall, 75 and 191 cases were male and female, respectively. Sex ratio was not specified in two studies, evaluating a total of 67 patients. The obtained results showed that BNP level may decrease after a successful PTMC. Furthermore, post-operative plasma levels of BNP and N-terminal proBNP could be considered as predictors of the success rate of PTMC. Based on the results reported in the evaluated articles, there may be an association between post-operative plasma levels of BNP family and the success rate of PTMC.
      PubDate: Mon, 31 Aug 2015 19:30:00 +010
  • An Investigation of Safety and Efficacy of Intravenous Paracetamol in Pain
           Management Following ...

    • Abstract: Introduction: Optimum pain management immediately after surgeries can lower the possibility of pain syndrome and its following consequences. Opioids are amongst the analgesics used for postoperative pain control; however, their application can bring about several adverse effects. In this study, all the published articles regarding efficacy of paracetamol in post-cardiac surgery pain management were systematically reviewed. Materials and Methods: Pubmed and Scopus were searched for relevant articles. The employed search strategy was as follows: (paracetamol OR acetaminophen OR propacetamol) AND (pain OR analgesia) AND coronary. All the English-language articles (with no time restriction), investigating the effectiveness of acetaminophen in comparison with other analgesics or placebo, were included in the study. All the articles examining the efficacy of paracetamol in combination with other analgesics were excluded from the search results. Results: On the whole, our electronic search retrieved 192 articles from PubMed and 365 articles from Scopus. After screening the titles, abstracts, and full texts of the search results, only 5 English-language articles met our inclusion criteria. Conclusion: Although paracetamol demonstrated considerable efficacy in minimizing application of post-operative opioids, its strength in soothing post-operative pain is not significantly different from opioids. Further, conducting randomized-controlled-trials with large sample size are necessary to accurately reveal the efficacy of paracetamol in curtailing application of opioids in post cardiac surgeries.
      PubDate: Mon, 31 Aug 2015 19:30:00 +010
  • The Six-minute Walk Test (6MWT) for the Evaluation of Pulmonary Diseases

    • Abstract: The six-minute walk test (6MWT) is a well-tolerated test which reflects daily activities and can be easily used in clinical practice. The 6MWT provides information about functional capacity, response to therapy and prognosis across a range of chronic cardiopulmonary conditions. Moreover, the 6MWT is sensitive to the common therapies used for chronic obstructive pulmonary disease, such as pulmonary rehabilitation with supplemental oxygen, long-term use of inhaled corticosteroids and lung volume reduction surgery. Several studies have investigated the role of 6MWT in the evaluation of pulmonary disease and cardiac disorders. This article aimed to review the significance of 6MWT in pulmonary disease
      PubDate: Sun, 31 May 2015 19:30:00 +010
  • Delayed Presentation of Traumatic Diaphragmatic Hernia: The Evaluation of
           Surgical Treatment Results

    • Abstract: Introduction: Diaphragmatic hernia could be caused by congenital disorders, blunt trauma or penetrating injuries. The diagnosis of traumatic diaphragmatic hernia is normally neglected during the first presentation leading to late complications and considerably increased mortality and morbidity among the patients. Materials and Methods: In this retrospective, descriptive study, we reviewed the medical records of patients presented with traumatic diaphragmatic hernia who had undergone surgical operations between 1982-2015 in Ghaem Hospital and Omid Hospital affiliated to Mashhad University of Medical Sciences, Iran. The studied variables included age, gender, clinical symptoms, location of hernia, involved organs, type of imaging modalities, surgical techniques, length of hospital stay, mortality rate and surgical complications. Results: In this study, 38 patients were diagnosed with traumatic diaphragmatic hernia consisting of 28 men and 10 women. In total, 79% and 21% of the patients suffered from penetrating trauma and blunt trauma, respectively. In addition, left-sided, right-sided and bilateral hernias were present in 33%, 4% and 1% of the patients, respectively. The most frequently herniated organ was the stomach, and the most common clinical symptoms were abdominal pain (84%) and dyspnea (53%). Initially, chest radiographs were performed on all the patients, and thoracotomy was performed to repair diaphragmatic tears in all the cases (100%). In this study, 3 patients had previously undergone Hartmann’s operation for gangrenous herniated colon, and devolvulation of gastric volvulus had also been performed on 3 patients. The main post-operative complications were reported to be pneumonia and respiratory insufficiency (2 cases), and the mean length of hospital stay was 6 days (5-8 days) which was longer (1-2 months) in patients with gangrenous bowel (3 patients). Furthermore, no mortality was reported during the course of hospitalization in these patients. Conclusion: According to the results of this study, patients presented with blunt or penetrating traumas to the upper abdomen or lower chest require urgent attention as to immediately rule out diaphragmatic hernia in order to prevent later complications and mortality and morbidity among these patients.
      PubDate: Sun, 31 May 2015 19:30:00 +010
  • Spirometric Parameters: Hemodialysis Compared to Peritoneal Dialysis

    • Abstract: Introduction: Renal failure affects the mechanical and the ventilatory function of the lungs. A few studies have evaluated the ventilatory and pulmonary function in dialysis patients. The present study aimed to compare pulmonary function test (PFT) results in patients undergoing Hemodialysis (HD) and Peritoneal Dialysis (PD). Materials and Methods: We conducted a cross-sectional study on 50  patients with hemodialysis (HD) and 50 cases with PD who  underwent PFT in Ghaem and Imam Reza hospital, mashhad, Iran from November 2010 to july 2012. Spirometric parameters including forced expiratory volume in 1s (FEV1), FEV1/forced vital capacity (FVC), forced expiratory flow 25-75% (FEF) and peak expiratory flow (PEF) were compared between the two groups of patients. Results: Approximately 68% of the HD patients, 66% of the PD patients, and 67% of all the studied cases showed a normal spirometric pattern. Moreover, there were no significant differences between the two groups considering the mean of the aforementioned spirometric parameters(restrictive ,obstructive pattern) (P=0.969). However, an insignificant inverse correlation was observed between the duration of dialysis with FEV1 (r=0.381, P=0.008), FVC (r=-0.298, P=0.04), FEF 25-75% (r=0.43, P=0.003), PEF (r= 0.349, P=0.02) and FEV1/FVC (r=-0.363, P=0.01,) in the HD patients and between the patients’ age with FEV1/FVC (r=0.03, P=0.02) in the PD patients. Conclusion: This study showed no significant difference in pulmonary function in hemo and peritoneal dialysis,so according this result ,both of the dialysis had the same affect on the lung function.
      PubDate: Sun, 31 May 2015 19:30:00 +010
  • Expression of Epidermal Growth Factor Receptor and the association with
           Demographic and ...

    • Abstract: Introduction: Growth, proliferation, survival, and differentiation are the prominent characteristics of cells, which are affected by cancer. Epidermal growth factor receptor (EGFR) plays a pivotal role in the effective control of these features. Given the significance of EGFR signaling pathway in non-small cell lung cancer (NSCLC), EGFR expression is influential on these cell characteristics. In this paper, we studied EGFR expression and its association with demographic factors, clinicopathological features, and prognosis of NSCLC patients. Materials and Methods: In this retrospective cohort study which was done during 2009-12 at Ghaem Hospital, Mashhad, Iran. EGFR expression was evaluated in 96 patients with formalin-fixed, paraffin-embedded NSCLC tissues (43 adenocarcinomas, 48 squamous-cell carcinomas, and 5 large-cell carcinomas) using immunohistochemistry (IHC). Data analysis was performed by SPSS version 20.0. Results: Out of 96 specimens, approximately 53% were classified as positive for EGFR expression. The study group consisted of 68% (N=65) male and 32% (N=31) female subjects, with the mean age of 61.1±9.03 years. There was no difference between EGFR-positive and EGFR-negative patients in terms of the overall survival rate (P=0.49). In addition, no association was observed between tumor histology and EGFR expression (P=0.08), while EGFR-positive adenocarcinoma (N=28, 29%) was more prevalent compared to other subtypes of NSCLC. Moreover, there were no differences between tumor subtypes and the overall survival rate of the patients (P=0.21), and no association was found between EGFR expression and the patients’ demographic factors (e.g. age and gender). Conclusion: The results of this study indicated that EGFR expression could not be a prognostic marker in NSCLC patients; however, it seems that using standardized IHC scoring is likely to yield more reliable data in this regard.
      PubDate: Sun, 31 May 2015 19:30:00 +010
  • The Diagnostic Value of End-tidal Carbon Dioxide (EtCO2) and Alveolar Dead
           Space (AVDS) in ...

    • Abstract: Introduction: Capnography, is an easy, fast and practical method which its application in the diagnosis of Pulmonary Thromboendarterectomy (PTE) has recently been studied. This study aimed to assess the diagnostic value of end-tidal CO2 (ETCO2) and the alveolar dead space (AVDS) in the diagnosis of patients suspected to PTE who have been referred to the emergency department. Materials and Methods: This cross-sectional study was conducted during one year in the emergency department of Ghaem Hospital on patients with suspected PTE who scored less than 4 for the Wells’ criteria during the initial evaluation. After excluding other differential diagnoses, all patients underwent CTPA to confirm PTE. Following that, arterial blood gas sampling, ETCO2 and AVDS were requested for all the patients based on capnography. Data analysis was performed using descriptive statistical tests in SPSS software version 11.5. The sensitivity, specificity, and positive and negative predictive values of AVDS and ETCO2 were measured based on CT pulmonary angiography (CTPA) results. Results: The study was performed on 78 patients (mean age of 47.08± 15.6 years, 43 males/35 females) suspected to PTE. According to the results of CTPA, 37 patients did not develop PTE while 41 patients were with PTE. There was no significant difference between the two groups in terms of age and gender (P=0.999), while a statistically significant difference was found between the mean values of ETCO2 and AVDS between the two groups (P<0.001). The best cut-off points for PTE diagnosis were 0.17 (based on AVDS, with sensitivity and specificity of 78.0% and 56.8%, respectively), and 26.5 (based on ETCO2, with sensitivity and specificity of 67.6% and 75.6%, respectively). In addition, the negative predictive values for AVDS and ETCO2 were estimated as 70.0% and 71.43%, respectively. Conclusion: According to the results of this study, capnography could be effective to promptly rule out PTE in emergency situations. Given its negative predictive value to rule out PTE, ETCO2 is considered as the most valid criterion among capnography parameters.
      PubDate: Sun, 31 May 2015 19:30:00 +010
  • The Effects of Pantoprazole on the Treatment of Palpitation in Patients
           with Gastro esophageal ...

    • Abstract: Introduction: Atrial arrhythmia is a common complication in patients with Gastro esophageal reflux disease (GERD). The treatment of palpitation is relatively problematic in these patients, especially if there is not enough evidence of cardiovascular or systemic diseases. The esophagus is in close proximity to the left atrium posterior wall. Hypothetically, locally released cytokines from esophageal injuries could stimulate the left atrium and produce premature atrial contractions. In this study we aimed to evaluate the effects of pantoprazole on palpitation in patients with reflux palpitation. Materials and Methods: This study was conducted on patients presented with palpitation and symptom of GERD from January 2014 to June 2014 in the General Clinic of Imam Reza Hospital. In order to establish the precise effects of pantoprazole on the treatment of palpitation in GERD patients, pantoprazole was added to the beta-blockers during treatment, and the patients were followed-up for one month. Results: In total, 10 patients within the age range of 21-35 years with a history of palpitation were enrolled in this study. The mean age of the subjects was 25 years, and the study group consisted of 6 men and 4 women. After a one-month follow-up, a significant reduction was observed in the palpitation of these patients (P<0.001). Conclusion: According to the results of this study, addition of pantoprazole to the treatment of palpitation was effective in patients with a history of GERD. Therefore, pantoprazole could be used as an effective adjunctive treatment for palpitation.
      PubDate: Sun, 31 May 2015 19:30:00 +010
  • The Improvement of the Atrial Flutter Rhythm upon the Removal of the
           Infected Permanent ...

    • Abstract: Pacemaker infection has multiple risk factors. Its presentation is most often similar to infected endocarditis and the diagnosis is made through studying blood cultures. Transesophageal echocardiography can confirm the diagnosis. The most common microorganisms are staphylococcus speciesis. As a matter of fact, complete pacemaker removal appears to be the only definite treatment. We presented a case of infected pacemaker lead which was firstly referred with fever and nephritic syndrome. She had intermittent atrial flutterrhythm. Therefore, a total infected pacemaker system was removed under cardiopulmonary bypass support. Yet, the lead was firmly attached to the septal leaflet of tricuspid valve while leaflet repair was needed. As a result, atrial flutter rhythm was converted into sinus rhythm after an incidental interruption of the macroreentrant circuit in the process of the tricuspid leaflet surgery.
      PubDate: Sun, 31 May 2015 19:30:00 +010
  • Tricuspid Valve Endocarditis in an Intravenous Drug Abuser: A Case Report

    • Abstract: Recently, there have been more reports of cardiac valve infections due to the increasing number of intravenous (IV) drug abusers and chronic renal failure patients. Among cardiac valves, tricuspid valve is most commonly affected in the course of endocarditis. Appropriate management of these patients is a challenging and controversial issue in the field of cardiac surgery. Treatment options in such cases include IV antibiotics, surgical excision alone, and surgical excision with the re-implantation of prosthetic valve. In this study, we present a case of tricuspid valve endocarditis (TVE), confirmed by echocardiography, in a young IV drug abuser. Tricuspid valve replacement was performed by using a biological prosthesis with remarkable results in the early and long-term follow-up of the patient.
      PubDate: Sun, 31 May 2015 19:30:00 +010
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