A 66- year-old male presented with recurrent syncope and ventricular fibrillation arrest twenty years ago, for which an implantable cardioverter defibrillator was inserted. Electrocardiography showed a Type 1 Brugada pattern. He fulfilled the diagnostic criteria for definite Brugada syndrome, according to the Shanghai Score System, proposed in 2016. Flecainide challenge test was positive, and genetic analysis revealed an A1427S missense mutation in the SCN5A gene. Magnetic resonance imaging showed right ventricular wall thinning but no additional abnormalities that would suggest a diagnosis of arrhythmogenic right ventricular dysplasia. Examination of the international classification of disease (ICD) records revealed several instances of arrhythmias, including one episode of supraventricular tachycardia (SVT), and four episodes of ventricular tachycardia (VT). In response, the patient was placed on chronic quinidine treatment at a dose of 200mgtwice a day, after which no further episodes of arrhythmias were observed. This illustrates that sodium channel mutation can cause both Brugada syndrome and structural abnormalities in the right ventricle.

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Background: Patients undergoing heart surgery experience different levels of anxiety that may affect their recovery. Objectives: As it is essential to use low-cost and non-invasive methods for these patients, wedecided to assess the effect of an Islamic praise (Zikr) on patients' anxiety after coronary artery bypass graft (CABG) surgery. Methods: In this trial, 80 hospitalized patients, who underwent CABG surgery at Busheher Bentolhoda Hospital, Iran, were randomly allocated to intervention (n = 40) and control (n = 40) groups. We asked patients in the intervention group to recite Hazrate Zahra's praises while they received routine care, and in the control group patients received only routine care. In both groups, anxiety was assessed at three consecutive days before and immediately after the intervention. Data was collected by demographic and clinical checklist and hospital anxiety depression scale (HADS). Results: There was no significant difference between patients' anxiety of both groups before the intervention (P > 0.05), while after the intervention a significant difference was seen in anxiety between patients, who had recited the praise and those who had not, on all three days (P≤0.001). Also, in the intervention group, before and after the recitation, a significant difference was seen during three days (for three days P ≤ 0.001), but no significant difference was indicated before and after the intervention in the control group (P = 0.423, P = 0.541 and P = 0.621, respectively). Conclusions: Recitation of Hazrate Zahra's praises was effective on patients' anxiety reduction after CABG surgery among Shia Muslims.

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Background: Considering the importance of knowledge about anatomical variations in the left atrium (LA) and its nearby structures for clinical decision-making and the lack of pertinent studies on Iranian patients, this study was conducted to determine the prevalence of LA diverticula and accessory appendages and the origins of the sinoatrial (SA) nodal artery in patients with atrial fibrillation. Methods: In this observational cross-sectional study, 45 consecutive patients with atrial fibrillation undergoing preprocedural computed tomography angiography were enrolled. The prevalence rates of LA diverticula and accessory appendages and the origins of the SA nodal artery were determined and compared according to the patients' age and gender. Results: The origin of the SA nodal artery was R1 (medial to right auricle) in 30 patients (66.7%), L1 (medial to left auricle) in 11 patients (24.4%), and both R1 and L1 in 1 patient. The origin in the remaining 3 subjects was L2 (posterior to auricle), L3 (posterior to left atrium), and R2 (posterior to right atrium). The prevalence rates of LA diverticula and accessory appendages were 48.9% and 17.8%, respectively. Diverticula were seen in 34.8% and 63.6% of the patients younger and older than 50 years, respectively (P = 0.050). Also, accessory appendages were present in 30.4% and 4.5% of the patients younger and older than 50 years, respectively (P = 0.047). There was no significant association for age (P > 0.05). Conclusions: The findings of the present study show that the main supplying artery of the SA nodal artery was R1 from the right coronary artery. The prevalence rates of LA diverticula and accessory appendages were higher than those reported previously.

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Introduction: In practical settings of endovascular treatment,wesometimes encounter difficulties in treating lesions with massive thrombi, which may cause distal thromboembolism. Case Presentation: We encountered a case of severe critical limb ischemia involving in-stent iliac occlusion with massive thrombi. We had to overcome the critical issue of how to treat the massive thrombi in the iliac artery while avoiding thromboembolism. Therefore, we devised a very simple but possibly very useful protection system without any special devices based on the concept of the Optimo^® balloon-tipped occlusion catheter. Conclusions: Although various endovascular treatment (EVT) devices and techniques have since been developed, little tips and tricks during EVT procedures are sometimes markedly useful.

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Background: Atrial fibrillation (AF) is one of the most common complications occurring after cardiac surgeries. The incidence of post-operative AF is increasing continuously over the past decades and it is associated with lengthened hospital stay and risk of stroke. Objectives: This study was designed to examine the relationship between coronary artery involvement and the occurrence of AF after coronary artery bypass graft (CABG). Methods: This prospective observational study was to assess the relationship between the coronary artery involvement and the occurrence of post CABG surgery AF. Patients with chronic and paroxysmal AF before surgery were excluded. All patients had a complete evaluation by echocardiography, electrocardiography, and laboratory testing. The patients were monitored for 3 days after surgery and any tachycardia monitored as AF was noted. Patients were also divided into two groups of having post-operative AF and not having AF. Coronary artery involvement was defined using the Rentrop system. The coronary arteries were divided into 14 segments for better understanding of the lesions. Results: In this study 232 patients were selected, from which 106 patients had AF and 126 patients had sinus rhythm. The results of the present study confirmed that the older patients had a more frequent occurrence of AF after CABG (P < 0.001). There was no significant relationship between the right coronary artery (RCA) lesion and the development of AF after CABG. Proximal left anterior descending (LAD) artery lesion was associated with a higher occurrence of AF after CABG (P = 0.022). Patients with single vessel or two-vessel coronary artery disease had a more frequent occurrence of AF after CABG versus those with three vessel disease (P = 0.021). Conclusions: Although age has been the most important predictor for occurrence of AF after CABG in the past and present studies, there are many other variables affecting its occurrence. Out of the variables evaluated in this study, higher PAP, proximal LAD lesion, higher levels of BNP, and D dimer as well as single vessel and two vessel coronary artery diseases were noted to significantly predict a higher occurrence of AF after CABG.

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Background: It seems that more cardinal steps can be taken towards constraining cardiovascular diseases (CVD) through the identification of relevant factors and predictors of behaviors associated with cardiac health. Objectives: The present study is aimed to investigate the health literacy of cardiovascular diseases (CVD), personality traits, perception of cardiovascular disease risk and their relationships with controlling behaviors associated with cardiac health through playing self-efficient intervention roles. Methods: The statistical population of the present study consisted of residents of Kermanshah, Iran in 2015. Additionally, due to the possibility of sample attrition and uncooperative subjects during the study, a total sample of 800 subjects was selected using cluster sampling. After data collection, they were analyzed using structural equation modeling (SEM). Results: The results demonstrated that there were significant correlations between personality traits and controlling the risk factors of cardiovascular diseases. Similarly, significant correlations were found between controlling the risk factors of cardiovascular diseases and self-efficacy, health literacy of cardiovascular diseases (CVD) and perception of cardiovascular diseases. Further, the results showed that controlling behaviors associated with cardiac health had the greatest direct effects on the path of perception of cardiovascular diseases. Conclusions: It can be concluded that neuroticism, impulsive sensation seeking and hostility result in risky behaviors of cardiovascular diseases (CVD) when self-efficacy is low and the cardiovascular disease (CVD) risk factors are controlled through health literacy and perception of cardiovascular diseases when self-efficacy is high.

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Introduction: In percutaneous coronary intervention (PCI) with a retrograde approach, successful guide wire passage through the collateral channels is indispensable. However, success of the procedure depends on the quality of collateral channels, and vascular tortuosity is one of the most common obstacles for successful guidewire passage. Case Presentation: Herein, we present a case of PCI with retrograde approach for chronic total occlusion at the ostium of the left anterior descending coronary artery. A highly tortuous morphology of the right posterior descending artery (PDA) and septal channels bifurcating from the right PDA with marked angulations were recognized in angiographic images from multiple directions. We could advance a guidewire to the optimal route of the septal collateral channel with guidance provided by these images and successfully completed all PCI procedures. Conclusions: To pass a guidewire through collateral arteries in PCI with a retrograde approach, careful inspection of angiographic images for thoroughly understanding the optimal route through the collateral vasculature is of great significance.

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Introduction: Congenital portosystemic shunts constitute a rare disorder in childhood with a wide spectrum of symptoms and signs, one of which may be cyanosis. Case Presentation: We describe for the first time in Iran a 9-year-old boy with a portacaval shunt presenting with cyanosis. He was diagnosed, managed, and treated successfully. The postoperative period was complicated by portal vein thrombosis, which wasgradually resolved with appropriate treatment. Conclusions: Cyanosis is one of the hallmarks of cardiopulmonary disease; however, as was the case in our patient, a secondary cause of pulmonary disease should be considered. The portacaval shunt is a rare but important cause of cyanosis and should be considered in all patients in whom cyanosis is unexplained.

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Introduction: Pseudoaneurysm formation is a rare complication. If this condition remains untreated, it can lead to morbidity and mortality. Pseudoaneurysmcan be a consequence of iatrogenic trauma, vasculitis, infection, and sometimes it forms spontaneously. This condition was treated by surgery in the past. However, nowadays an interventional procedure is mentioned as an alternative for surgical treatment. Case Presentation: Here, wereport an unusual case of Wegener's granulomatosis complicated by pseudoaneurysmof the left sinus of Valsalva causing complete collapse of the left main coronary artery. The pseudoaneurysm was closed percutaneously using a membranous device. This study presented a patient with the rare large artery involvement inWegener's granulomatosis and tried to repair that without surgery. Long-term follow-up demonstrated that the procedures were successful.

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Background: Postoperative bleeding of more than 10% of circulating blood volume (CBV) within the first six hours after a cardiac surgery with cardiopulmonary bypass (CBS) is one of the most frequent complications associated with postoperative morbidity and mortality in children. Objectives: This study aimedto identify specific risk factors for the development of this complication in a subpopulation of Mexican pediatric patients. Methods: A nested case-control study was conducted at a tertiary level pediatric intensive care unit (PICU) of Mexico City. Cases were those children who developed bleeding of more than 10% of circulating blood volume (CBV) within the first six hours after the surgery and controls were all those children who did not presented this complication. Bivariate and logistic regression analyses were performed. A P-value less than 0.05 was considered as statistically significant. Results: Results showed that 33% (n = 21) of included children developed significant bleeding in the first six hours after the cardiac surgery. The main risk factors for developing this complication were the cyanotic congenital heart disease (P < 0.01), bypass time exceeding 90 minutes (P < 0.01), aortic clamping time > 60 minutes (P = 0.01), intraoperative bleeding volume (P = 0.04), and an initial activated clotting time > 140 seconds (P < 0.01). Conclusions: An important proportion of patients developed postoperative significant bleeding. Risk factors identified in the present study could help to identify and close monitor a subgroup of children at high risk for the development of this complication.

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Spontaneous coronary artery dissection (SCAD) is non-iatrogenic longitudinal separation of the coronary arterial walls, generating true and false lumens. Although it wasknownas a disease of the young females without cardiovascular risk factors, recent evidences have revealed that SCAD can also be seen in older patients having traditional risk factors for ather-osclerosis. In this report, we present a 50-year-old female patient with theSCADof left anterior descending artery (LAD) leading to anteriormyocardial infarction, ten days previously and persisting angina. She was successfully treated using intravascular ultrasound (IVUS) by stenting dissected segment. She has done well since then, and stent patency was demonstrated with coronary computed angiography (CTA) at the fifth-year follow up.

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