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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]
  • Urgent Surgical Intervention for Embolized Cardiac Occluder Devices: A
           Case Series

    • Abstract: Introduction: In this study , we sought to analyze 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 childhood patient group. Mathrials and Methods: We retrospectively reviewed 4 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), ventricular septal defect (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 done in all cases. Inevitably, three of them were closed to the primary defect except one case of VSD case only device removed without closing the defect. All 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 a lot of 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
  • Individual Psychosexual Counseling Is One of the Cardiac Rehabilitation
           Necessities for Iranian ...

    • Abstract: Dear Editor Cardiovascular diseases (CVDs) are debilitating conditions with long-term physical and psycho-logical consequences (1). After a cardiac event or procedure, the patient encounters several problems, two of the most important of which are psychosexual dysfunction and difficulty in resuming sexual activity (2-4). The World Health Organization (WHO) defines sexual health as a state of physical, emotional, psychological, and social well-being related to sexual interaction and sexuality (2). Resuming sexual activity is a common concern among patients, such that in nearly half of patients resuming sexual activity is associated with fear (5). In the developed countries, despite cultural constraints and shame, numerous cardiac patients frequently request information on how to resume sexual activity (2). However, the evidence suggests that information on sexual issues is not easily available to patients, which can lead to misper-ceptions among patients on how to resume sexual activity (2, 6). According to the available evidence, 37-76% of cardiac patients experience changes in their sexual activity, only in 42% of whom these issues are raised with the treating physician (7, 8). However, in the developing countries, only 11% of patients receive information about sexual life after a cardiac event (7) and Iran is no exception in this regard. Barriers to sexual activity include lack of need for patients by health professionals, lack of experience of care providers, time constraints, linguistic and cultural barriers, as well as fear and shame (6). After cardiac event or procedures, doubt about resuming sexual activity, fear of sudden death during sexual intercourse, inadequate knowledge about when and how to resume sexual activity, as well as sexual anxiety and depression are the main obstacles cardiac patients face (9, 10). Based on the repeated recommendations of professionals and researchers on this issue, psychosexual counseling and rehabilitation is one of the educational needs of this group of patients (2, 3, 6, 8, 11), and the focus of sexual counseling strategies should be on assuaging patients' anxiety and the healthy resumption of sexual activity (3). Counseling and psychosexual education can be presented to patients in the form of verbal (face to face counseling), written (books and pamphlets), and visual (photos and videos) information (2, 6). The content of sexual education and psych-osexual counseling with a focus on psychosocial homework, including cognitive behavioral therapy and social support, can be effective in reducing patient anxiety and problems (6). In addition, in relation to delivery format of psychosexual counseling to cardiac patients, various approaches were proposed and it seems that culture plays an important role in choosing the appropriate format. Based on pair, group, or one-on-one teaching methods and seminars despite being used in different parts of the world (2, 6), it seems that one-on-one approach is more appropriate for the Iranian culture. Our experience in Kermanshah center of cardiac rehabilitation showed that patients do not welcome pair and group meetings and they generally refuse to participate in meetings and ask their questions. However, creating a private and safe environment with a same-sex counselor can facilitate participation of patients. Given that the sexual problems of men and women, and consequently, their needs are different (4), content of interventions should be defined according to the needs of each sex. Therefore, we recommend providing one-on-one psychosexual counseling, as one of the educational requirements of patients, in cardiac rehabilitation centers of Iran.
      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
  • Comparison of the outcomes of open thoracotomy versus minimally invasive
           thoracoscopic ...

    • Abstract: Introduction:First treatment for esophageal cancer is surgery. There is controversy in selecting the best surgical approach. In current study we have compared Minimal invasive and open esophagectomy in short-term results and preoperative complications.Materials and Methods:We performed a clinical trial between years 2011-2013. 61 patients underwent Minimal invasive esophagectomy (MIE) or open esophagectomy surgery (OE). Variables were age, sex, site of lesion, bleeding, duration of surgery, rate of switch to open approach, post surgical morbidity, duration of hospitalization and mortality.Results:61 patients (M/F: 60.7% / 39.3%) participated in this study. The mean age was 62.39±11.91 years. There was no significant difference between site of lesion and stage of tumor. Considering blood transfusion there was no difference between two groups. We found 1 fistula in MIE group and 2 pleural effusions and 1 wound infection in open group. There was no significant difference between two groups in post operative complications. Duration of operation took more times in MIE group. There was 1 patient in MIE group that convert to open approach. Duration of hospitalization was significantly longer in open group. We had no mortality.Conclusion:Our findings showed the MIE result is comparable with OE and improve short-term outcomes.
      PubDate: Sun, 30 Apr 2017 19:30:00 +010
  • Determination of The Relationship Between Severity of Obstructive Sleep
           Apnea And Chronic ...

    • Abstract: Introduction: Chronic obstructive pulmonary disease (COPD) patients are at increased risk of sleep-disorders. The concomitant occurrence of COPD and obstructive sleep apnea hypopnea syndrome (OSAHS) is named overlap syndrome. This study aimed to evaluate the severity of OSAHS in overlap syndrome patients.Materials & Methods: This cross-sectional study was conducted on adult patients with forced expiratory volume in 1 second (FEV1%)/forced vital capacityResults: Forty patients (62.5% male) with mean age of 59.7±8.3 years participated in the study. Severity of obstructive sleep apnea was low, moderate, and severe in 23 (57.5%), 14 (35%), and 3 (7.5%) cases, respectively and there was no statistical relation between OSAHS and FEV1% (P=0.55).Conclusion: This study showed that there was no significant correlation between apnea–hypopnea index and FEV1% predicted in overlap syndrome patients.
      PubDate: Tue, 28 Feb 2017 20:30:00 +010
  • Frequency of Acute Kidney Injury in Patients Treated With Normal Saline
           after Off-Pump Coronary ...

    • Abstract: Introduction: Acute kidney injury (AKI) is a common postoperative complication of cardiac surgery, which is associated with an increased risk of morbidity and mortality. This study investigated the frequency of postoperative AKI in low risk adult patients undergoing off-pump coronary artery bypass grafting (CABG).Materials & Methods: All consecutive adult patients of American Society of Anesthesiologists (ASA) class II and III, who were transferred to the post-operative cardiac surgery ICU after off-pump CABG and were low risk for AKI from October 2013 to September 2014 at Emam Reza Hospital, Mashhad, Iran were enrolled in this prospective cohort study at a teaching hospital. The patients were explored for AKI development, based on risk-injury-failure-loss- end stage kidney disease (RIFLE) and acute kidney injury network (AKIN) criteria, frequency of metabolic acidosis, hypernatremia, hyperchloremia, and length of stay in ICU.Results: According to the results of the present study, 479 patients with the mean age of 60.8±10.75 yrs were included. AKI occurred in 22 (4.4%) and23 (4.8%) patients, based on both the RIFLE and AKIN criteria, respectively with the highest rate of AKI, reported on the third and fourth post-operative days. Additionally, hyperchloremia and hypernatremia were observed in 71 (14.8%) and 76 (15.9%) patients, respectively. Only one case of mortality occurred during the study. Metabolic acidosis was reported in 112 (23.4%) patients with a high anion gap in 60 (12.5%) cases.Conclusion: The current study demonstrated that hypernatremia and metabolic acidosis but not AKI are frequently seen in patients receiving normal saline following off pump CABG with low risk for AKI.
      PubDate: Tue, 28 Feb 2017 20:30:00 +010
  • Video-assisted Thoracoscopic Surgery Versus Axillary Thoracotomy in
           Primary Spontaneous Pneumothorax

    • Abstract: Introduction: Video-assisted thoracic surgery (VATS) is now commonly used for primary spontaneous pneumothorax. In the present study we compared the outcomes of this technique with those obtained by conventional thoracotomy.Material and Methods: In this cross-sectional stud, forty patients were enrolled into two groups: VATS (n=20) and thoracotomy (n=20). In both groups the blebs were resected and pleural abrasion was performed with putting a mesh on the apical surface of the parietal pleura, finalized by patchy pleurectomy and mechanical abrasion with gas. Two groups were appropriately matched for age, gender, side of bleb, indication for surgery, and the smoking habits. As outcome measures, the conversion from VATS to thoracotomy and the early complications including wound infection, air leakage and intraoperative bleeding were assessed. After discharge, follow up schedule included visits at one, three, six months and one year post-operation to evaluate the recurrence rate.Results: Mean age of these forty patients (34 males and 6 females) was 28.4±8.74 years. There was no conversion from VATS to thoracotomy group. The complications, including prolonged air leakage and wound infection, were seen in three patients of each group (totally 6 patients) (P=0.712). One patient in VATS group experienced the recurrence (P=0.235). Average admission time was 5±0.79 days in the VATS and 5.65±0.81 days in the thoracotomy group (P=0.043), duration of surgery in the open thoracotomy and VATS groups were 76±5.52 and 48.35±4.35 min, respectively (P<0.001) and intra-operative bleeding in the open thoracotomy and VATS groups were 127.5±10.69 and 112.5±8.5 mL, respectively (P<0.001) these three factors were significantly less in the VATS group.Conclusion: VATS seems to be superior to thoracotomy, when it is indicated due to the recurrence or other reasons, because in spite of the similar therapeutic efficacy and recurrence rate, VATS is associated with less tissue damage and shorter hospital stay.
      PubDate: Tue, 28 Feb 2017 20:30:00 +010
  • Avoidance of Dialysis in an End-Stage Renal Disease Patient Status-post
           Off-pump Coronary ...

    • Abstract: Certain benefits are clearly associated with the use of off-pump coronary artery bypass grafting (CABG) as compared with the on-pump CABG. The superiority is more evident in patients with multiple co morbidities including renal failure.We reviewed the medical records of a 67-year-old male with a past medical history that was significant for multiple cardiovascular diseases and new-onset end-stage renal disease. The case was suffering from dyspnea and work-up was suggestive of non-ST elevation myocardial infarction and congestive heart failure.During the hospital course, he developed end-stage renal disease requiring hemodialysis. Further cardiac evaluation presented three-vessel coronary artery disease. The patient underwent off-pump CABG. Post-operatively, the patient had minimal complications and did not receive hemodialysis for 53 days.Off-pump CABG has evident short-term benefits for patients with the end-stage renal disease requiring dialysis, including possible improvement in cardiac function and avoidance of hemodialysis
      PubDate: Tue, 28 Feb 2017 20:30:00 +010
  • Intracardiac Ifection at the Tip of Hemodialysis Catheter: Life
           threatening Morbidity

    • Abstract: Endocarditis and intracardiac infection have been increased recently especially in dialysis dependent renal failure patients. This is usually intractable infection to broad spectrum Antibiotic therapy and in most cases surgical intervention was necessary. We have presented 45 years old man with intracardiac infection at the tip of dialysis catheter that after catheter removal intracardiac infection was removed.
      PubDate: Tue, 28 Feb 2017 20:30:00 +010
  • Malignant Fibrous Histiocytoma of the Lung: A Case Report

    • Abstract: Malignant Fibrous Histiocytoma (MFH) is the most common soft-tissue sarcoma which predominantly surfaces in the retro-peritoneum and extremity. MFH of lung is a very rare condition. The diagnosis is essentially through histologic examination. However, the invasion of the chest wall or other organs might help establish the malignant nature.We report a case of a 77-year-old man who had been presented with a history of dyspnea and non-massive hemoptysis. Computed Tomography (CT) scan of the chest showed a lobulated mass which had developed into the hilum of the lung. Furthermore, the inferior pulmonary artery was invaded. Thus, the final histological diagnosis confirmed MFH. The patient underwent a left pneumonectomy along with the dissection of the regional lymph nodes. Although lung MFH is rather an uncommon condition, it must be taken into consideration in differentiating between the types of lung tumor. What can be concluded is that complete surgical resection is the essential approach.
      PubDate: Tue, 28 Feb 2017 20:30:00 +010
  • Idiopathic Exudative Hydropneumothorax and Spontaneous Pneumomediastinum
           in a Young Iranian ...

    • Abstract: Hydropneumothorax denotes concurrent presence of pneumothorax and hydrothorax in the pleural space, which can be a fatal situation. In this study, we presented the case of a 35-year-old male with history of progressive pleuritic chest pain 30 days before admission with idiopathic hydropneumothorax and spontaneous pneumomediastinum
      PubDate: Tue, 28 Feb 2017 20:30:00 +010
  • Three Different Imaging Modalities of a Patient with the Aortic

    • Abstract: The patient was a 19 year-old woman with the diagnosis of resistant hypertension, although she was under treatment of three classes of anti-hypertensive drugs (beta blocker, angiotensin receptor blocker, diuretic) for more than one year. In physical examination there was only a significant difference between the systolic blood pressure of upper and lower extremities (200 vs. 120 mmHg), without any other remarkable finding. Three different imaging modalities (echocardiography (Figure 1), CT angiography (Figure 2), conventional aortography (Figure 3) confirmed the aortic coarctation at 30 mm after left subclavian artery origin, with the 3.5-4 mm diameter of the narrowest segment. She underwent implantation of a self-expanding aortic stent and therefore the systolic pressure gradient decreased from 90 to 15 mmHg. After three months, her blood pressure was stable on 110/80 mmHg, while she received only metoprolol 25 mg twice daily and follow-up echocardiography showed 15-20 mmHg pressure gradient through the stent.
      PubDate: Tue, 28 Feb 2017 20:30:00 +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
  • A case report of recurrent rheumatic fever in older young female:
           considerations and comments

    • Abstract: Rheumatic fever (RF) is a prevalent healthcare problem in developing countries. Recurrence of this disorder often can be seen in older young and children and is not frequent in older age. RF can mimic the presentations of infective endocarditis and clinicians is not really familiar with this issue. We showed a case of recurrent acute rheumatic fever in a patient was suspicious to acute bacterial endocarditis due to her previous RF. She finally was definitively diagnosed and underwent valvular replacement surgery and received prophylaxis antibiotic beside regular follow up.
      PubDate: Sun, 05 Feb 2017 20:30:00 +010
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