Background: Development of fibrinous pericarditis after pericardiotomy is a well-recognized reaction. Within a few post-operative days, the inflammated surface of pericardium begins to fuse to the overlying sternum. Objectives: Our aim was to assess the prevalence, risk factors, time course and therapy response of pericardial effusion (PE) after cardiac surgeries in children. Patients and Methods: PE occurrence was assessed prospectively in 486 children who underwent cardiac surgery for congenital heart diseases by serial echocardiography. Clinical manifestations were observed and response to different therapies was analyzed. Results: The prevalence of PE was about 10% for all cardiac surgeries. Symptoms were exclusively seen in patients who had moderate to large effusions. The mean onset of pericardial effusion was 11 (± 8) days after surgery procedure, with 87 % (42 of 48) of cases being diagnosed on or before day 13 after operation. The prevalence of effusion after Fontan-type procedures and AVSD repair (29 %, 5 of 17 for both) was significantly higher than other types of cardiac surgeries. Aspirin administration was effective in 77 % and prednisone in 90 % of the cases. Conclusions: PE may be developed as late as weeks after cardiac surgeries. PE after palliative cardiac surgeries is not uncommon. Low doses of aspirin and corticosteroids are usually effective for treating this complication.

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Background: In its Constitution of 1948, WHO defined health as “a state of complete physical, mental, and social well-being, and not merely the absence of disease and infirmity” . In 1994, the Agency for Health Care Policy and Research published clinical practice guidelines recommending providers to routinely evaluate patients' HRQoL (Health Related Quality of Life) and use their assessment to modify and guide patient care. Objectives: to create a valid, sensitive, disease-specific Persian health status quality of life questionnaire for patients with chronic heart failure in Iran. Materials and Methods: Considering the existing relevant inventories and scientific literature, the authors designed the first draft of questionnaire which was modified and validated, using expert opinions and finalized in a session of expert panel. The questionnaire was processed among 130 patients with heart failure. Construct validity evaluated by principle component factor analysis, and promax method was used for factor rotation. MacNew quality of life questionnaire was selected to assess convergence validity, and the agreements were measured in 60 patients. Discriminant validity was also assessed. Thirty patients were followed for 3 months and responsiveness of questionnaire was measured. Cronbach's alpha, item analysis, and Intra-class correlation coefficients (ICCs) were used to investigate reliability of questionnaire. SPSS 15 for Windows was applied for statistical analysis. Results: Principle component factor analysis revealed 4 main components. Sub-group analysis suggested that IHF-QoL questionnaire demonstrated an acceptable discriminant validity. High conformity between this inventory and MacNew questionnaire revealed an appropriate convergence validity. Cronbach's alpha (α) for the overall questionnaire was equal to 0.922. Intra-class correlation coefficients (ICCs) for all components were significant (from. 708 to. 883; all P values < 0.001). Patients fallow-up revealed an acceptable responsiveness of our questionnaire. Conclusions: IHF-QoL questionnaire is a valid and reliable inventory. It can be applied in daily clinical practice and in the clinical research context.

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Background: Atrial fibrillation (AF) after coronary artery bypass graft (CABG) is a common complication with potentially higher risk of adverse outcome and prolonged hospital stay. Objective: To determine the impact of postoperative AF (POAF) on long-term outcome in a large cohort of patients who underwent CABG. Patients and Methods: We conducted an observational cohort study of 989 patients who underwent isolated CABG with more than 5-year follow-up. Patient divided in two groups: patients with and without POAF. Results: In this study, atrial fibrillation developed after CABG in 156 patients (15.8%). Patients with POAF were generally older (P = 0.001) and presented more often with comorbidities including congestive heart failure (P = 0.001), hypertension (P = 0.001), peripheral vascular disease (P = 0.001), hyperlipidemia (P = 0.009), and renal failure (P = 0.001). Five-year mortality was observed in 23 (2.3%) patients. Patients with POAF had higher five-year mortality rate than those without POAF. Multivariate logistic analysis showed that AF after surgery has a strong effect on mortality (HR, 3.3; 95% CI, 0.04-10.8, P = 0.04) and morbidity rates (HR, 4.0; 95% CI, 2.35-6.96, P = 0.001). Conclusions: Postoperative atrial fibrillation strongly predicts higher long-term mortality and morbidity following coronary artery bypass graft.

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Transcatheter Aortic Valve Implantation (TAVI) is a new therapeutic option for patients with severe aortic stenosis with unacceptable surgical risk for conventional aortic valve surgery. A Bicuspid Aortic Valve (BAV) is the most common congenital cardiac disorder (1% of the population) and currently is considered exclusion criteria for TAVI, because it predicts an increased risk of adverse aortic events as incomplete sealing, severe paravalvular regurgitation, or dislocation due to more frequent elliptic shape and asymmetric calcifications in BAV annulus. Only few cases have been published in recent literature, so in this case report we illustrate our experience and management of TAVI in a BAV, with excellent outcomes and no late complications at 1 year follow-up. We believe that currently the presence of a BAV might not be considered an absolute contraindication for TAVI, because although there is no sufficient data for assess the safety or efficacy of TAVI in BAV, this case report shows that it could be performed safely in selected patients with unacceptable surgical risk after an extensive preoperative evaluation, avoiding this procedure in patients with bad prognostic factors as huge and heavy calcifications, asymmetric valves, elliptic annulus or small distance from leaflets to coronary ostia. Each case must be individualized, being alert at follow-up because the risk of late complications.

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We present a very rare case of partially unroofed coronary sinus without persistent left superior vena cava in a 74 years old female with a history of hypertension, severe myxomatous bileaflet mitral valve prolapse with severe eccentric mitral regurgitation which was diagnosed during cardiac surgery.

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Background: Many previous studies have investigated the influence of gender on coronary artery bypass grafting surgery (CABG) outcomes. Despite the great volume of reports on this issue, it is still not clear whether it is the gender of the patient or pre-existing comorbid conditions that is the best predictor for the different outcomes seen between men and women. Multiple studies have shown that women are at higher risk of postoperative complications than men, particularly in the perioperative period. Objectives: The goal of this study was to determine whether sex differences exist in preoperative variables between men and women, and to evaluate the effect of gender on short-term mortality and morbidity after CABG in an Iranian population. Patients and Methods: Data were collected prospectively from 690 consecutive patients (495 men and 195 women) who underwent isolated CABG. Preoperative, intraoperative, and postoperative variables, major complications and death were compared between the male and female patients until hospital discharge using multivariate analysis. Results: Women were older (P = 0.020), had more diabetes (P = 0.0001), more obesity (P = 0.010), a higher New York Heart Association functional class (P = 0.030), and there was less use of arterial grafts (P = 0.016). Men had more tobacco smokers (P = 0.0001) and lower preoperative ejection fractions (EF) (P = 0.030). After surgery, women had a higher incidence of respiratory complications (P = 0.003), higher creatine kinase (CK) – MB levels (P = 0.0001), and higher inotropic support requirements (P = 0.030). They also had a higher incidence of decreased postoperative EF versus preoperative values (P = 0.020). The length of ICU stay, incidence of return to ICU and postoperative death, were similar between men and women. Nevertheless, after adjusting for age and diabetes, female gender was still independently associated with higher morbidity in patients over 50 years of age. Conclusions: Women had more risk factors, comorbidities, and postoperative complications. Women older than 50 years of age were at a higher risk of postoperative complications than men. This difference decreased with younger age. In-hospital mortality rates were not influenced by sex, as there was no difference found between the two groups (2.5% women vs. 2.2% men; P > 0.05).

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