We describe an interesting fluoroscopic calcification of the aortic knuckle assuming a reverse “C” shape in an atherosclerotic aorta in a 42-year-old male presenting with anterior wall ST-elevation myocardial infarction with dyslipidemia. Although calcification of the aortic knuckle and dilatation of the aorta is a common phenomenon in the elderly population, otherwise known as the “unfolding of aorta,” we observed this interesting pattern of calcification in a middle-aged person in an atherosclerotic aorta with calcification. The patient had double-vessel coronary artery disease with chronic total occlusion in the left anterior descending coronary artery and significant stenosis in the mid-segment of the right coronary artery, which we revascularized with drug-eluting stents and achieved TIMI III flow. Although calcium sign or C sign is described in aortic dissection and it is not specific to it, we observed this interesting pattern of calcification in a middle-aged person in the atherosclerotic aorta with dyslipidemia.

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Myocarditis with preserved ejection fraction (MCpEF) is a subgroup of myocarditis with normal or near-normal left ventricular systolic function. Its prevalence has been reported to be low, and there are limited data about the diagnostic strategy, management, and outcome. Initial manifestation of myocarditis can be new-onset heart failure, acute coronary syndrome-like presentation, life-threatening arrhythmia, or even sudden cardiac death. Echocardiography with two-dimensional speckle-tracking mode and cardiac magnetic resonance imaging have pivotal roles in diagnosis and management of the disease. The present study is based on a research on “myocarditis preserved ejection fraction (EF)” or “ myocarditis with normal EF” mainly in PubMed, Google Scholar, and Embase databases. The search focused on the aspects of the disease which is not usually mentioned clearly. In contrast to the myocarditis as a general concept, the total number of clinical studies or case reports in the context of myocarditis with preserved EF is really low. Most treatment strategies have been based on the patient's initial presentation, and there are not enough clinical trials or long-term follow-up studies to confirm the most accurate diagnostic and therapeutic approach. In conclusion, although MCpEF has been known as a subgroup of myocarditis with specific clinical and imaging features, there are still a lot of questions about the diagnosis, management strategy, and patient prognosis which require further studies to be investigated.

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Background: Mitral valve replacement procedure has increased in the Iran over the last years. For optimization of the results, as the other procedure, it needs statistical evaluation of the results, and then a system for the prediction of outcome. Hence, in this study, we generate a machine learning (ML)-based model to predict in-hospital mortality after isolated mitral valve replacement (IMVR). Materials and Methods: The patients who underwent IMVR from February 2005 to August 2016 were identified in a single tertiary heart hospital. Data were retrospectively gathered including baseline characteristics, echocardiographic and surgical features, and patient's outcome. Prediction models for in-hospital mortality were obtained using five supervised ML classifiers including: logistic regression (LR), linear discriminant analysis (LDA), support-vector machine (SVM), K-nearest neighbors (KNN), and multilayer perceptron (MLP). Results: A total of 1200 IMVRs were analyzed in our study. The study population was randomly divided into a training set (n = 840) and a testing set (n = 360). The overall in-hospital mortality was 4.2%. LR model had the best discrimination for 22 variables in predicting mortality after IMVR, with area under the receiver-operating curve (AUC), specificity, and sensitivity of 0.68, 0.73, and 0.58, respectively. A LDA model had an (AUC) of 0.73, compared to 0.56 for SVM, 0.51 for KNN, and 0.5 for MLP. Conclusions: We developed a robust ML-derived model to predict in-hospital mortality in patients undergoing IMVR. This model is promising for decision-making and deserves further clinical validation.

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Radiofrequency ablation of concealed posteroseptal accessory pathway (AP) and differentiating the right posteroseptal from the left is a challenge for electrophysiologists. Considering different electrophysiological characteristics of posteroseptal AP can help to predict the successful ablation site. We report on a 45-year-old man with simultaneous orthodromic reentrant tachycardia and atrioventricular nodal reentrant tachycardia, both of which were successfully ablated in the right posteroseptal area at the site of the slow pathway. The arrhythmia with both right bundle branch block (RBBB) and left bundle branch block (LBBB) aberrant conduction was observed during our study. The ventriculoatrial (VA) interval increased approximately 25 ms when arrhythmia was conducted with LBBB aberrancy, while it did not change during the RBBB aberrancy. This finding is diagnostic for orthodromic reciprocating tachycardia using a left-sided AP rather than right. However, other parameters, such as delta VA interval and sharp/blunt feature in the proximal coronary sinus electrogram, indicated that the AP is located on the right posteroseptal area.

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Background: Iran is one of the countries hit hard and early by the corona virus disease 2019 (COVID-19) outbreak. Interventions for congenital and structural heart disease came to a halt in the initial part the year 2020, however as the pandemic seemed no closer to an end there was a mandate for elective catheterization procedures to be slowly and cautiously resumed. Aims and Objectives: In the present report we discuss the challenges we faced and the experiences earned as a cardiovascular tertiary center in the field of adult congenital and structural interventions in the COVID era. Material and Methods: Adult congenital and structural interventions were resumed in May 2020 with implementing strict screening protocols regulated by our institutional COVID committee. Patients were closely monitored for developing COVID-19 symptoms in hospital and two weeks following discharge. Results: In the regular review performed by the COVID committee there was no increase in new cases of the disease related to the interventional procedures and related admission. Conclusion: As the fate of pandemic remains unforeseeable, structural and congenital interventions need to be resumed in a sustainable fashion and with an instituted system of patient protection. The workflow might slow down during disease peaks with a catch-up in more stable disease periods.

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A 64-year-old woman admitted to our hospital (a tertiary care center) with symptoms of chest pain and dyspnea of functional class 2. Coronary angiography showed no stenosis, but injection of right coronary artery (RCA) showed suspicious shadow around the vessel. Computed tomographic angiography was done for further evaluation of probable iatrogenic aortic dissection, and incidental tumor was found encasing RCA proximal anterior to its origin of aorta. Magnetic resonance imaging suggested lymphangioma as the most probable cause (based on the tissue characterization criteria). According to benign nature of the tumor, follow-up by imaging was recommended.

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