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Journal of Cardio-Thoracic Medicine
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  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  [14 journals]
  • Early Effectiveness of Noninvasive Positive Pressure Ventilation on Right
           Ventricular Function ...

    • Abstract: Introduction: Noninvasive positive pressure ventilation (NIPPV) has become an integral tool in the management of acute hypercapnic respiratory failure (AHRF) in chronic obstructive pulmonary disease (COPD). This study was performed to evaluate the early effects of NIPPV on pulmonary artery pressure (PAP), serum N-terminal pro BNP (NT-proBNP), and ventilatory parameters in the COPD patients with AHRF. Materials & Methods: This quasi-experimental study was conducted on 20 COPD patients with AHRF. The participants received the standard treatment in addition to NIPPV. There was no contraindication for NIPPV. Arterial blood gas analysis, Doppler echocardiography (for measuring PAP), and plasma NT-proBNP measurements were performed before and after NIPPV. Results: According to the results, the mean age of the participants was 54.57±15.43 years. Furthermore, the mean pressures of carbon dioxide (PCO2), NT-proBNP levels, and PAP were 72.33±13.96 mmHg, 4333.90±6542.20 pg/ml, and 47.5±6.38 mmHg, respectively. After one week of NIPPV, there were statistically significant differences among the mean pH, PaCO2, PAP, and NT-proBNP (P<0.001, P=0.003, P<0.001, and P<0.001, respectively). Conclusion: As the findings of the present study indicated, the application of NIPPV in the COPD patients with AHRF can not only improve arterial blood pH and carbon dioxide tension, but also instantly decrease NT-proBNP levels and PAP.
      PubDate: Wed, 31 May 2017 19:30:00 +010
  • The Lipid Profile Parameter in Chronic Obstructive Pulmonary Disease
           Patients and Correlation ...

    • Abstract: Introduction: More than 90% of the deaths caused by chronic obstructive pulmonary disease (COPD) occur in the low- and middle -income countries. The main aim of this study was to investigate the lipid profile levels in COPD patients and examine the correlation of total cholesterol, triglycerides, low-density lipoproteins, high density lipoproteins, and LDL/HDL risk ratio with COPD stages that are developed by the global initiative for chronic obstructive lung disease (GOLD) Materials & Methods: A total of 100 COPD patients including 25 COPD non-smokers were enrolled in this study. The diagnosis of COPD was carried out by using the spirometry following the GOLD guidelines (post-bronchodilator forced expiratory volume (FEV1)/forced vital capacity (FVC) ratio < 70% predicted). Accordingly, the patients were divided into four groups based on the severity of their disease in accordance with the GOLD guidelines, including mild COPD (stage I, FEV1 ≥ 80% predicted), moderate COPD (stage II, 50% ≤ FEV1 < 80% predicted), severe COPD (stage III, 30% ≤ FEV1 < 50% predicted), and very severe COPD (stage IV, FEV1 < 30% predicted). The fasting blood samples of lipid profile were collected. The four COPD groups were compared using the ANOVA test. Results: According to the results, the majority 53 patients (53%) were in age group 40 to 60 years with mean age of 60.46 +/-11.56. Most of the patients had moderate to severe airflow obstruction (GOLD stages II and III). The severity of COPD had no significant correlation with the triglycerides, LDL, HDL, and LDL/HDL risk ratio. The mean total cholesterol levels in the stages I and IV were 151.92±32.82 and 128.50 ±21.46 mg/dL, respectively, which was statistically significant (P=0.04). Conclusion: The present study indicates that there was no significant correlation between various lipid profile parameters and severity of COPD.
      PubDate: Wed, 31 May 2017 19:30:00 +010
  • Comparison the Outcomes of Open Thoracotomy and Minimally Invasive
           Thoracoscopic Esophagectomy ...

    • Abstract: Introduction: Surgery is the first therapeutic option for esophageal cancer. There is controversy over the selection of the best surgical approach. Regarding this, the present study aimed to compare the minimally invasive and open esophagectomy in terms of their short-term outcomes and preoperative complications. Materials & Methods: This randomized clinical trial was conducted on 61 patients in Ghaem Hospital, Mashhad, Iran, within 2011-2013. The patients were assigned into two groups based on the type of therapeutic approach they received. The minimally invasive esophagectomy (MIE) and open esophagectomy (OE) groups consisted of 31 and 30 patients, respectively. For the purpose of the study, we collected such data as age, gender, site of lesion, bleeding, duration of surgery, rate of switch to open approach, post-operative morbidity, duration of hospital stay, and mortality rate. Results: According to the results of the study, 60.7% of the participants were male. The mean age of the patients was 62.39±11.91 years. There was no significant difference between the two groups regarding the site of lesion (P=0.014) and stage of tumor (P=0.108). No significant difference was observed between the MIE and OE groups in terms of the blood transfusion (P=0.981). Considering the complications, there was one case of fistula in the MIE group; furthermore, one and two cases of wound infection and pleural effusions were observed in the OE group, respectively. There were no significant differences between the two groups in terms of the post-operative complications, namely fistula, pleural effusions, and wound infection (P=0.492, P=0.238, and P=0.492, respectively). The MIE group had longer operation time (P≤0.001). There was one patient in the MIE group converted to open approach. The duration of hospitalization was significantly longer in the OE group, and there was no mortality. Conclusion: As the findings of the present study demonstrated, the MIE outcomes were comparable with those of the OE with improved short-term outcomes.
      PubDate: Wed, 31 May 2017 19:30:00 +010
  • Urgent Surgical Intervention for Embolized Cardiac Occluder Devices: A
           Case Series

    • Abstract: Introduction: In this study, we sought to illustrate our experience in urgent surgical management for embolized cardiac septal occlude devices resulting from trans-catheter closure of atrial septal defect and ventricular septal defect. Mathrials and Methods: We retrospectively reviewed four patients aged 2–10 years who underwent urgent surgery due to cardiac septal occluder embolization between December 2015 and December 2016. Congenital defects were atrial septal defect (n=2) and ventricular septal defect (VSD) (n=2). Risk factors for device embolization and the need for urgent surgical retrieval/definitive management techniques for embolized device removal are discussed. Results: Removal of embolized devices was performed in all the cases. Inevitably, in three patients the primary defect was closed, while in one case of VSD the device was removed without closing the defect. All the operations were completed successfully and no hospital mortality or morbidity was encountered. Conclusions: Although closure of left to right shunting defects by percutaneous occluder devices has several advantages, device embolization is still a major complication. If embolized device retrieval fails with percutaneous intervention attempts, surgical management is the only method to remove embolized devices. In this circumstance, to provide an uneventful perioperative course, urgent management strategies should be well planned.
      PubDate: Wed, 31 May 2017 19:30:00 +010
  • A Case Report of Recurrent Rheumatic Fever: Considerations and Comments

    • Abstract: Rheumatic fever (RF) is a prevalent healthcare problem in the developing countries. Recurrence of this disorder is often observed in childhood and adolescence. RF can mimic the presentations of infective endocarditis, and clinicians are not really familiar with this issue. Herein, we present a case of recurrent acute rheumatic fever in a patient suspicious of acute bacterial endocarditis due to her previous RF. Finally, she was definitively diagnosed and underwent valvular replacement surgery and received prophylaxis antibiotics besides regular follow-up
      PubDate: Wed, 31 May 2017 19:30:00 +010
  • High-risk Coronary Artery Bypass Grafting and Mitral Valve Replacement in
           a HIV Positive Patient

    • Abstract: Certain subsets of high-risk mitral valve patients are not suitable candidates for transcatheter therapies. The objective of this report is to present a young patient with combined mitral valve and coronary artery disease to illustrate these challenges.In this report, we present a 47-year-old man with longstanding HIV infection who was referred with severe mitral regurgitation (MR) and profound cardiomyopathy to highlight the importance of decision-making and perioperative management.A 47-year-old HIV positive man with New York Heart Association class IV congestive heart failure was found to have severe MR (mixed Carpentier Type I and IIIB pathologies). The last viral load titer of the patient was undetectable. Cardiac catheterization revealed a chronic total occlusion of the middle of left anterior descending artery, ostial obtuse marginal and 70% posterior descending artery lesion, as well as severe pulmonary hypertension (PAP of 70/30 (mean: 43)), and a pulmonary vascular resistance of 4.6 Woods units. Preoperative cardiac magnetic resonance imaging showed left ventricular ejection fraction of 20%, right ventricular ejection fraction of 30%, nonviable circumflex distribution and scattered viability in the anterior and inferior cardiac walls. He underwent a high-risk coronary artery blood grafting plus mitral valve (MV) replacement (with intra-aortic balloon pump support). The postoperative course was complicated by gastrointestinal bleeding requiring transfusion, aspiration pneumonitis, atrial flutter and difficile colitis. However, the patient recovered appropriately, and remained asymptomatic and healthy in three months follow-up postoperatively. Application of transcatheter MV or device-assisted therapies for high-risk patients with severe MR might be limited due to financial, medical or social situations. In these instances, high-risk mitral valve surgery may still be the choice treatment in the selected patients.
      PubDate: Wed, 31 May 2017 19:30:00 +010
  • The Five Years Survival after Surgery of Primary Tracheal Squamous Cell
           Carcinoma: A Case ...

    • Abstract: Unlike the primary tracheal tumors, squamous cell carcinoma of trachea is common, especially in smokers. This type of tumor has a low rate of survival and it is diagnosed too late on account of late presentation of its signs. The treatment of choice is surgical removal followed by adjuvant radiotherapy; Primary radiotherapy is the appropriate treatment in inoperable cases. In this study, we present the case with a long history of smoking, who was suffering from cough and dyspnea for a long time. During diagnostic evaluations a vegetated tumor was observed about 5 centimeters below the vocal cords. Pathologists reported the tumor as a squamous cell carcinoma, and the patient underwent an operation for resection of involved trachea. Through presenting this patient, we aimed to draw attention to this uncommon malignancy and recommend considering it as a probable diagnosis when evaluating a patient with treatment-resistant respiratory symptoms
      PubDate: Wed, 31 May 2017 19:30:00 +010
  • Individual Psychosexual Counseling Is One of the Educational Necessities
           for Cardiac ...

    • Abstract: Letter to Editor
      PubDate: Wed, 31 May 2017 19:30:00 +010
  • Right-sided Infective Endocarditis with Multiple Large Vegetations in a
           Case of Ventricular ...

    • Abstract: Herein, we present the case of a 10-year-old child suffering from right-sided infective endocarditis with ventricular septal defect. Echocardiography revealed multiple rare large vegetations on the pulmonary valve extending into pulmonary artery along with a large vegetation over the septal leaflet of tricuspid valve
      PubDate: Fri, 19 May 2017 19:30:00 +010
  • Upper Extremity Ischemia Complicating Ulcerative Plaque in Descending

    • Abstract: A 54-year-old female patient was presented with upper extremity ischemia. Further investigation revealed ulcerated atherosclerosis plaque in aorta with intramural hematoma and clot formation. The subject underwent a successful surgical resection of mass with the assistance of cardiopulmonary bypass and total circulatory arrest.
      PubDate: Tue, 28 Feb 2017 20:30:00 +010
  • Recurrent Venous Thromboembolism as the Initial Clinical Presentation of
           Gastric Cancer: A Case ...

    • Abstract: Pulmonary thromboembolism (PTE) is a clinically critical disease misdiagnosis or delayed diagnosis of which can lead to increased rate of mortality (1). For prevention of recurrence of PTE, recognition of its risk factors or underlying diseases is of great importance. PTE is common in patients with cancer and has high morbidity and mortality rates. Although cancer is a lethal condition, PTE accelerates death in these patients (2, 3). In the current study, we reported the case of a 50-year-old male presenting with dyspnea, pleuritic chest pain, and non-massive hemoptysis indicating pulmonary embolism. Anticoagulant therapy was initiated, but after 12 days of treatment, new deep vein thromboses in the left upper and right lower limbs were diagnosed. However, no specific risk factors or laboratory abnormalities were detected. History of weight loss during the recent months encouraged further investigation for ruling out malignancy, which led to diagnosis of gastric adenocarcinoma in upper endoscopy that was pathologically confirmed. He did not have any complaints of gastrointestinal disorders.
      PubDate: Tue, 28 Feb 2017 20:30:00 +010
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