Opium is a plant with euphoria effect. People from some parts of the world traditionally use opium for cardioprotective effects. We did a systematic review to assess the effect of opium on coronary artery disease (CAD). A systematic database search was conducted in PubMed, Web of Science, Google Scholar, Cochrane library, Scopus, and SID from their onset up to June 2016. The quality of the studies was assessed with a standardized scoring system. Articles assessing the effect of opium consumption as orally or smoked were included in this review. Outcome was defined as age on CAD disease, risk of CAD, and morbidity from CAD. Poor methodological studies, animal studies, and studies on cardiovascular risk factors or serum markers were excluded from the review. Three case–control, three cohort, and eight cross-sectional studies were included in this systematic review. The age at the occurrence of myocardial infarction, coronary bypass surgery, and percutaneous intervention in opium users was signifi cantly lower than that of nonusers. Odds ratio of opium consumption for CAD ranged from 1.3 to 3.8 in different studies. Hazard ratio of opium consumption for ischemic heart disease was 1.90 (1.57–2.29) with modification by sex, ethnicity, education level, marital status, residential place, and cigarette smoking. We concluded, in spite of the traditional belief, that the current evidence did not support the protective effect of opium on CAD. Future well-designed studies concerning probable confounders in Iran and other similar parts of world are required.

Background: The impact of prosthesis-patient mismatch (PPM) on early and late outcomes after aortic valve replacement (AVR) remains controversial. In this study, we aimed to investigate the patient and surgery-related factors leading to various severities of PPM following AVR. Methods: Ninety-six patients who had undergone AVR with a prosthetic valve between 2001 and 2013 and later found to have PPM were enrolled. PPM was defined as the indexed effective orifice area (iEOA) of the aortic prosthesis to be ≤0.8 cm²/m². PPM was considered to be of moderate or severe degrees if the iEOA was between 0.66 and 0.85 cm²/m² or ≤0.65 cm²/m², respectively. Results: The mean age of patients was 26 ± 15 years, and 51% of patients were female. Sixteen patients (15.2%) had mild PPM, 40 patients (38.1%) had moderate PPM, and 40 patients (38.1%) had severe PPM. The majority of our patients had surgery due to congenital causes. Prosthetic valve size and preoperative left ventricular outflow tract diameter were factors statistically related to PPM in the three groups (P < 0.05). There was only one death that was in severe PPM group due to severe heart failure. Conclusion: PPM is a substantial yet underrated clinical entity in patients undergoing prosthetic valve replacement surgery. Patients with smaller body surface areas, surgery at earlier age, and underlying congenital heart disease are more commonly prone to the development of PPM. As our center is referral for the patients affected with congenital aortic valve disease, mindful scheduling and performance of the aortic valve replacement surgery in this patient population is highly recommended.

Background: Patients with congenital heart defects that have single functional ventricle undergo Fontan surgery. After the surgery, patients will develop reduced capacity for physical activity and exercise. Phosphodiesterase inhibitor drugs have vasodilatory effects and can decrease blood flow resistance. Thereby, they can help to improve the exercise capacity of patients. The aim of this study was to assess the effect of tadalafil on exercise capacity in these patients. Materials and Methods: In this before and after interventional study, 16 patients who had undergone Fontan operation were treated with tadalafil (10 mg daily for 2 weeks and then 10 mg every 12 h for 6 months). Demographic data, heart disease morphology, pulse oximetry, blood pressure (BP), functional class, age at the time of surgery, and the surgery type were collected. Pulmonary function and exercise capacity were assessed by 6-min walk test and VO₂ max (maximal oxygen consumption). Results: Mean distance based on 6-min walk test increased from 418.75 m to 439.06 m (P = 0.004). Mean maximal oxygen consumption increased from 0.84 L/min to 1.07 L/min (P < 0.001). Furthermore, preexercise test oxygen saturation increased from 89% to 90.94% (P = 0.02). No significant change was observed regarding other variables. Conclusion: Tadalafil was found to be effective in improving exercise capacity of the patients with a previous history of Fontan surgery. However, tadalafil had no significant effect on systolic or diastolic BP and heart rate.

Background: There is evidence that oxidative stress can be considered as a critical event in the development of atherosclerotic complications. In this study, we aimed to assay the values of prooxidant-antioxidant balance (PAB) in patients with coronary artery disease (CAD), as a cardiovascular risk factor, and its relationship with some clinical, biochemical, and anthropometric parameters was examined. Materials and Methods: In a case–control study, forty CAD patients and forty age and body mass index (BMI)-matched healthy controls hospitalized in the cardiology section of Imam Ali hospital of Zahedan, Iran, were enrolled. The levels of serum lipid profile, C-reactive protein (CRP), blood pressure, BMI, and waist circumference (WC) were evaluated. The values of PAB were also assayed simultaneously by photometric method, using 3, 3′, 5, 5′-tetramethylbenzidine and its cation, used as an indicator of redox. Results: PAB was found to be significantly higher in CAD patients (P < 0.05) as compared with control group. The obese patients had higher values than nonobese patients and controls (P < 0.05). In CAD patients, a significant positive correlation was demonstrated between WC (r = 0.56, P = 0.05), high-sensitivity-CRP (r = 0.65, P = 0.04), cholesterol (r = 0.36, P = 0.052), and triglyceride (r = 0.29, P = 0.055) with PAB. Conclusion: The study shows that the PAB assay in conjunction with other risk factors can be used as an independent prognostic predictor of CAD, particularly in patients who need antioxidant therapy.

Background: Along with advances in end-stage heart failure (HF) treatments, such as heart transplantation (HTx) and ventricular assist devices as destination therapy, there is an increasing need to define scoring systems for selecting the most suitable candidates for these interventions. Furthermore, constraints in donor number necessitate the precise evaluation of patients before candidacy for HTx. Methods: We enrolled eighty patients with severe symptomatic HF, left ventricular ejection fraction <30%, and New York Heart Association Functional Class III–IV. All patients underwent right heart catheterization for hemodynamic assessment and were followed for 18 months. We defined cSVO2 as the ratio of right atrial pressure (RAP) to mixed venous saturation. Results: During follow-up, 13 patients died, 7 patients underwent HTx, and 36 patients were hospitalized with signs and symptoms of HF. Among hemodynamic parameters, RAP and cSVO₂had strongest association with prognosis and clinical worsening. Conclusion: Defining predictors of clinical worsening has great importance in HF. The current study showed cSVO₂as a strong predictor of clinical worsening in end-stage HF.

Background: Coronary artery ectasia (CAE) is an uncommon but known finding in coronary angiography. We compared the neutrophil to lymphocyte ratio in patients with sole CAE and coronary artery disease (CAD) patients as well as normal coronary individuals who presented to our center. Methods: In this case-control study, we compared patients with lone coronary ectasia with two other groups: patients with CAD and normal coronary individuals. Demographic and clinical data of the ectatic patients were retrieved from the databank of our center and all variables, particularly neutrophil to lymphocyte ratio compared between the study groups. Results: A total of 233 patients with coronary ectasia met our criteria and were compared to 433 stenotic CAD patients and 466 normal coronary individuals. The neutrophil to lymphocyte ratio was significantly lower in the normal coronary individuals (P < 0.001). However, there was no significant difference between the coronary ectasia group and the CAD group. This difference was significantly lower in the normal coronary group (P < 0.001), while no difference was observed between the ectasia and the CAD group (P = 0.127). Conclusion: Higher neutrophil to lymphocyte ratio was present in patients with CAE and CAD patients than the normal coronary individuals.

Objectives: The study aimed to assess the efficacy of a psychosexual education program (PSEP) on the psychological dimensions of sexual function and its quality in cardiac rehabilitation (CR) patients. Methods: In this randomized clinical trial, 43 male patients undergoing coronary artery bypass graft were selected randomly and then divided into case (n = 23) or control groups (n = 20). The research instruments consist of multidimensional sexual questionnaire and Sexual Quality of Life Questionnaire. Levin's PSEP (two 1-hour sessions) is presented as an intervention program. Data were analyzed through multivariate analysis of covariance to control the baseline scores. Results: Approximately 84% of patients (cases: 87% and controls: 80%) completed the final assessment. The results indicated that PSEP is significantly effective in the enhancement of sexual assertiveness (P = 0.034) and reduction of fear about intercourse (P = 0.007). There were no significant differences between two groups in other variables (P > 0.05). Conclusion: The results of the study indicated that PSEP is effective in the promotion of sexual assertiveness and fear of intercourse among CR patients. As the resumption of sexual function is one of the most important components in the psychosocial improvement of patients, it seems that this intervention should be included as a priority among educational programs in Iranian CRs.

Background: Sternotomy for coronary artery bypass surgery operation is associated with neuropathic pain, hypertension, tachycardia, agitation, and several other complications. In severe cases, the neuropathic pain may result in arrhythmia which is an important concern in cardiopulmonary bypass surgeries. Premedication for reducing the risk of hemodynamic instability, neuropathic pain, and other adverse associated consequences is very important. Objectives: We Scrutinized the effects of dexmedetomidine intravenous infusions on hemodynamic parameters and postsurgical pain in coronary artery bypass patients. Patients and Methods: A total of 60 coronary artery bypass surgery patients were recruited and were randomly allocated into two groups. 31 patients received placebo, and 29 received 1 μg/kg of dexmedetomidine 10 min before anesthesia and then 0.4 μg/kg/h of dexmedetomidine until the end of the operation. Heart rate, blood pressure, and postsurgical pain score according to the numerical rating scale were measured and recorded after recovery from anesthesia. Results: Blood pressure significantly decreased after bolus administration of dexmedetomidine which remained lower at the end of screening in most of the times. No remarkable adverse effects were observed, and its consumption was associated with significant reduction in the postsurgical pain scores as measured in 2, 4, and 6 h after surgery as well as the time of extubation. Conclusions: Infusion with 1 μg/kg of dexmedetomidine 10 min before anesthesia and 0.4 μg/kg/h of dexmedetomidine from the time of sternum closure until the extubation time appears to be effective for the maintenance of hemodynamics in coronary artery bypass surgery without remarkable adverse outcomes.

Background: Secundum atrial septal defects (ASD2) are one of the most common congenital disorders in children which includes about 10%–20% of congenital heart defects. In recent years, closure of secundum ASD percutaneously has been proposed to reduce mortality, morbidity, and become the standard method in both pediatric and young adults. The aim of this study was to determine the right ventricular (RV) function by strain and strain rate echocardiography parameters in children who underwent surgically versus percutaneous ASD2 device closure. Methods: In this cohort study, all children underwent ASD2 treatment from May 2014 to April 2016 were enrolled in this study. Echocardiography was performed 24 h after transcatheter closure and 3 days after surgical closure. MyLab 60 echo machine (Esoate, Florance, Italy) equipped with a multi-frequency 5 MHz transducer was used, and all echocardiographic data were collected by same pediatric cardiologist. All demographic characteristics and echocardiography indices were compared using SPSS version 18 between two groups. Results: Thirty-six patients (63.2%) were treated by the transcatheter closure and 21 (36.8%) underwent surgery. Longitudinal RV strain (S), longitudinal RV strain rate (S^'), and early diastolic longitudinal RV strain rate (E') were improved significantly in device patients in comparison with surgical patients (P < 0.001). There were no significant differences between RV longitudinal dimension and Mid RV size change after procedures in two groups (P > 0.05). However, tricuspid valve annular diameter was significantly decreased in patients who underwent ASD percutaneous device closure in comparison with a surgical group (P = 0.004). Conclusion: The results of this study showed that percutaneous ASD2 device closure will results in better RV function in comparison to surgical closure

Introduction: Previous single- and multi-center studies done in predominantly metropolitan areas have shown transcatheter aortic valve replacement (TAVR) to be a safe and effective treatment modality for patients of advanced age with severe aortic stenosis. However, it is unknown whether similar patient cohorts from rural areas have similar outcomes or if these initial studies are not representative of the experience in more rural areas. Setting: This is a single-center health-care system in a predominantly rural area. Methods: A retrospective chart review case–control study of 339 consecutive patients who underwent a TAVR for severe aortic stenosis at Sanford Health in Fargo, ND, was performed to determine if advanced age (>80 years of age) at the time of TAVR affects short- and long-term outcomes. Results: Despite higher predicted baseline surgical risk,s predominantly rural patients of advanced age had no significant difference in overall survival at 1-month (93% vs. 97%, P = 0.228), 6-month (88% vs. 90%, P = 0.695), 1-year (79% vs. 82%, P = 0.611), or 2-year (63% vs. 60%, P = 0.731) post-TAVR versus younger patients from the same geographical area. Patients of advanced age also had no significant difference in periprocedural or echocardiographic outcomes out to 1-year post-TAVR. Conclusion: This study from a predominantly rural area gives evidence to suggest that there is no association between extreme age (>80 years of age) and decreased overall survival. In addition, high baseline Society of Thoracic Surgeons and European System for Cardiac Operative Risk Evaluation predicted risk was not suggestive of worse outcomes in patients of advanced age. This study gives reassurance of the safety of TAVR in patients of advanced age in rural areas.

A 21-year-old girl with congenital aneurysm of the left atrial appendage represented with recent-onset palpitation and exertional dyspnea. The diagnosis was established by transthoracic and transesophageal echocardiography and chest multislice computed tomography scan. Surgical excision of the aneurysm and repair of the neck were done under extracorporal circulation and left ventricular function (ejection fraction = 50%) improved with mild mitral regurgitation.