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   2018| January-March  | Volume 7 | Issue 1  
    Online since February 26, 2018

 
 
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REVIEW ARTICLE
Black Pleural Effusion
Surya S Palakuru, Praveen Vijhani, Sujith V Cherian
January-March 2018, 7(1):1-4
DOI:10.4103/rcm.rcm_24_17  
Pleural effusions are common in clinical practice. In general, the diagnostic approach starts with thoracentesis. Serous (yellow) and blood tinged (reddish) pleural effusions are the most common types of pleural fluid at thoracentesis. Black colored pleural effusions are an extremely rare entity and knowledge regarding this entity is limited to case reports. A thorough systemic search on PubMed database was done looking at all reported cases of black pleural effusion. Broadly, dividing black pleural effusion based on etiology, the causes are as follows: (1) infectious – especially fungal – Aspergillus niger, Rhizopus oryzae, (2) malignancy -metastatic melanoma and primary lung cancers, (3) pancreaticopleural fistula, and (4) miscellaneous causes-including crack cocaine use, rheumatoid pleurisy, and charcoal containing empyema. Treatment of these effusions involves treatment of the underlying cause. Black pleural effusions are very rare entities with a limited differential, which the treating clinician should consider when encountered in clinical practice.
  5,817 320 2
ORIGINAL ARTICLES
Acute Complications in Cardiac Electrophysiology Procedures: A Prospective Study in a High-volume Tertiary Heart Center
Ali Vasheghani-Farahani, Akbar Shafiee, Mohammadali Akbarzadeh, Negar Bahrololoumi-Bafruee, Abolfath Alizadeh-Diz, Zahra Emkanjoo, Amirfarjam Fazelifar, Hooman Bakhshandeh, Majid Haghjoo
January-March 2018, 7(1):20-25
DOI:10.4103/rcm.rcm_34_17  
Background: Several complications can occur during electrophysiology (EP) study and radiofrequency catheter ablation (RFCA). In this study, we aimed to determine the frequency and types of complications following EP study and RF ablation in a tertiary cardiovascular center. Methods: Between September 2012 and December 2012, patients undergoing RF ablation and EP studies were prospectively enrolled. Demographic and clinical data of the patients, as well as the underlying arrhythmia and indication for EP study, were recorded. Complications occurring during the procedure and admission period were documented. Results: A total of 382 procedures were performed in 357 patients with the mean age of 47 ± 18 years within the study period. The most common arrhythmia was atrioventricular nodal reentrant tachycardia (26.4%). Major complication happened in 10 (2.6%) procedures while minor complications occurred in 36 (9.4%) procedures. Tamponade was the most common major complication (n = 3 [0.7%]), and pericardial effusion was the most common minor complication (n = 19 [4.9%]). Patients with complication were significantly younger and had a lower ejection fraction (P = 0.003 and P = 0.02, respectively). Conclusion: The complications observed in this study are comparable to previous reports, and EP study and RFCA can be considered as safe procedures.
  5,225 381 -
The Effect of Negative Pressure Applied on Chest Tubes in the Amount of Pleural Effusions in Postcoronary Artery Bypass Grafting Patients
Ali Sadeghpour Tabaie, Rasoul Azarfarin, Bahador Baharestani, Shariar Mali, Sepehr Sadeghpour Tabaei
January-March 2018, 7(1):10-14
DOI:10.4103/rcm.rcm_20_17  
Background: Application of negative pressure on chest tubes is one of the most common methods for management of chest tubes drainage after cardio-thoracic surgeries. However, the effect of this measure on long-term outcome of these patients and especially on postoperative pleural effusions is not thoroughly evaluated. For this reason, we designed a clinical randomized trial for the evaluation of the effect of negative pressure application on early and late pleural effusions after coronary artery bypass grafting (CABG) operations. Methods: A total of 440 patients entered in this study and divided into two groups: 220 patients, their chest tubes managed by application of −10–−20 cmH2O negative pressure (negative pressure drainage group) and those who managed conventionally by simple under-water seal method (control group, n = 220). Evaluation for pleural effusion performed by signs and symptoms and chest X-rays at 3rd and 7th postoperative days and for those became symptomatic after 30th day of operation. Results: The occurrence of moderate and massive effusions at 3rd and 7th days after operation was the same in both groups. The most striking difference was in patients' required pleural tap or chest tube insertion, late after surgery due to pleural effusion. This was significantly more common in patients in control group (P < 0.001). Conclusion: Negative pressure application on chest tubes after CABG surgery is a safe and effective method for decreasing the occurrence of late pleural effusion.
  3,804 298 -
Supraclavicular versus Infraclavicular Subclavian Vein Catheterization in Coronary Artery Bypass Graft Surgery
Masoud Tarbiat, Afshin Farhanchi, Maryam Davoudi, Maryam Farhadian
January-March 2018, 7(1):5-9
DOI:10.4103/rcm.rcm_26_17  
Background: Percutaneous central vein catheterization is one of the most invasive procedures commonly performed by anesthesiologists during cardiac surgery. Objectives: The aim of this study was to investigate the complications of supraclavicular (SC) versus infraclavicular (IC) approaches for subclavian vein catheterization during coronary artery bypass graft surgery. Materials and Methods: Between October 2014 and June 2015, this prospective, randomized clinical trial was performed in 280 patients. The patients were randomly cannulated by SC or IC approach. The success and complication rates were compared for the two approaches. The outcome of this study was analyzed using SPSS software and through Chi-square test. Results: In the first attempt of catheterization, the success rate in SC (78.6%) group was lower than IC (94.3%) group (P = 0.0001). The overall success rate in two attempts were 136 (97.1%) in the IC approach and 132 (94.3%) in the SC approach (P = 0.238). In 12 (4.3%) patients, subclavian catheterizations were failed after two attempts in both approaches. In 28 (10%) patients, hematoma at puncture site occurred, 1 (0.7%) in IC approach, and 27 (19.3%) in SC approach (P = 0.0001). The differences in other complications on two approaches were statistically insignificant. Conclusions: Compared with the SC approach, the IC approach resulted in fewer hematomas at puncture sites. The incidence of overall cannulation failure and other complications were similar on both approaches.
  2,934 302 3
The Effect of Intracoronary Infusion of Bone Marrow-derived Mononuclear Cells on Clinical Outcome and Cardiac Function in Chronic Heart Failure Patients: An Uncontrolled Study
Ahmad Amin, Ata Firouzi, Arezoo Mohamadifar, Nasim Naderi, Behshid Ghadrdoost, Hoda Madani, Nasser Aghdami
January-March 2018, 7(1):26-30
DOI:10.4103/rcm.rcm_38_17  
Objective: To evaluate the effect of bone marrow-derived mononuclear cells (BM-MNCs) on clinical outcome and cardiac function in chronic heart failure (HF). Methods: An uncontrolled, open-label trial was performed on symptomatic patients (New York Heart Association [NYHA] Functional Classification II–IV) receiving maximal medical therapy for at least 2 months, with a left ventricular (LV) ejection fraction <25%. Patients were divided into ischemic and nonischemic subgroups. All patients underwent BM aspiration, isolation of BM-MNCs using a standardized system, and intracoronary infusion of BM-MNCs. Primary endpoints assessed in 36 months were changes in (1) LV systolic function and LV end-diastolic diameter by echocardiography and (2) clinical improvement. Secondary measures included other echocardiography measures and major adverse cardiac events and HF hospitalization. Phenotypic and functional analyses of the cell product were performed by the Royan Institute for stem Cell Biology and Technology laboratory. Results: We enrolled 58 patients in our study. There was a significant improvement to exercise and functional capacity (evaluated by NYHA classification and 6-min walking distance) with both groups (for all P < 0.001). A significant decline in serum N-terminal Prohormone of Brain Natriuretic Peptide(NT- ProBNP) was observed in ischemic group (P = 0.01), but it was not statistically significant in nonischemic group. No significant changes were found in LV systolic and diastolic function, right ventricular size and function, severity of Mitral and Tricuspid regurgitation and pulmonary arterial pressure. There was minimal decrease in LV end-diastolic diameter which was statistically significant in ischemic and nonischemic group (P = 0.008 and P = 0.01 accordingly). Our study revealed a remarkably safe profile for BM-MNC infusion. Conclusion: It seems that intracoronary infusion of bone marrow-derived mononuclear stem cells is a safe treatment for patients with advanced HF and further studies need to address the best type of cell, route of administration, and criteria for patient selection.
  1,807 714 -
Comparison of Enoxaparin versus Heparin among Patients Undergoing Elective Coronary Angiography via Radial Artery Access
Reza Kiani, Mohammad Javad Alemzadeh-Ansari, Vahid Feghhi, Ata Firouzi, Hamid Reza Sanati, Ali Zahedmehr, Farshad Shakerian, Ahmad Shakeri, Reza Beheshti Namdar, Mohammad Reza Baay, Amir Mikailvand, Sayyed Shahrokh Taghavi
January-March 2018, 7(1):15-19
DOI:10.4103/rcm.rcm_15_17  
Background: Radial artery occlusion (RAO) is one of the few postprocedural complications of transradial approach (TRA) which may be symptomatic in some cases. The aim of this study was to investigate the safety and efficacy of enoxaparin compared with unfractionated heparin (UFH) for preventing RAO among patients who underwent elective diagnostic coronary artery angiography (CAG) via TRA. Patients and Methods: This randomized clinical trial study was conducted on patients who underwent TRA for elective diagnostic CAG. Then, the patients included were randomly divided into 2 groups. A group received 0.75 mg enoxaparin intravenously and the second group received 70–100 IU/Kg UFH single-bolus dose intravenously. During 24 h after the procedure and 3 months later, all the participants were monitored for the occurrence of RAO, access hematoma, periprocedural myocardial infarction, stroke, and death. Results: From 189 patients with mean age of 52.52 ± 6.23 years old, 95 patients received UFH (70–100 IU/kg), and the other group (n = 94) received enoxaparin after radial sheath insertion. After 24 h, decrease in radial pulse was observed in 17.6% patient (14.9% in UFH group and 20.2% in enoxaparin group) and only one patient had absent radial pulse in UFH group. There were no significant differences between UFH group compared with enoxaparin group in the reduction of the radial pulse that examined with reverse Allen test (P = 0.359). Furthermore, other complications did not differ significantly between the two groups. Conclusion: This study demonstrates that intravenous enoxaparin administration compared with intravenous UFH during diagnostic CAG via TRA is a safe and effective strategy for preventing RAO at 24 h after the procedure.
  2,142 254 -
Network Mining Indicated the Triglycerides as the Most Related Clinical Relevance to Age-related Transcriptional Changes in the Aorta
Fereshteh Izadi
January-March 2018, 7(1):35-42
DOI:10.4103/rcm.rcm_14_17  
Background: Aging is believed to be one of the main causes of cardiovascular diseases. The incidence of cardiovascular dysfunctions has increased substantially over the past few years. However, our understanding of molecular mechanisms of age-related vascular disorders remains somehow unclear, and an effective treatment has not been developed. A biological network is a collection of interactions between molecular regulators and their targets in cells governing gene expression level that is usually built by employing omics data, facilitating the inference of molecular basis of complex diseases. Materials and Methods: GSE50833 series containing aorta samples of 6-month-old mice (n = 6) and 20-month-old mice (n = 6) obtained from Janvier labs (Saint Berthevin, France) were downloaded from Gene Expression Omnibus database and the verified Agilent probe IDs were subjected to build a weighted gene coexpression network by a bioinformatics tool known as Weighted Gene Coexpression Network Analysis. We then conducted a network-driven integrative analysis to find significant modules and underlying pathways. Results: The unique genes extracted from normalized gene expression values were parsed into six modules. Among the incorporated clinical traits, the most significant module was associated with triglycerides enriched in biological terms, including proteolysis, blood circulation, and circulatory system process. Moreover, Enpp5, Fez1, Kif1a, F3, H2-Q7, and Pa × 8 were taken as putative hallmark molecules by further screening. Conclusion: the main goal of this analysis was the prioritization of genes that likely play a role in the pathogenesis of vascular diseases. We attempted to provide a system understanding of the potential connections among these genes.
  1,791 169 -
CASE REPORTS
Ventricular Arrhythmia and Left Ventricular Dysfunction: A Rare Manifestation of Adrenal Adenoma
Mohammad Javad Alemzadeh-Ansari, Zahra Emkanjoo, Bahram Mohebbi, Hamid Reza Pouraliakbar
January-March 2018, 7(1):46-48
DOI:10.4103/rcm.rcm_16_17  
Primary aldosteronism is characterized by hypertension, suppressed plasma renin activity, increased aldosterone excretion, and hypokalemia with metabolic alkalosis. Ventricular arrhythmia is an uncommon finding. We report the case of a 46-year-old female who was referred to our center due to uncontrolled ventricular arrhythmia. The past medical history was positive for hypertension. On admission, echocardiography showed severe left ventricular (LV) dysfunction. Blood examination revealed severe hypokalemia. She had been diagnosed with acute coronary syndrome and decompensated heart failure elsewhere and was given diuretics. A diagnosis of primary aldosteronism due to adrenal adenoma was made according to laboratory findings and imaging modalities. The prompt management of bradycardia and correction of hypokalemia, along with surgical resection of adrenal adenoma, resulted in control of arrhythmias and improvement in LV function.
  1,661 165 -
ORIGINAL ARTICLES
The Results of a 2-year Experience in Pediatric Heart Transplant in Rajaie Cardiovascular Medical and Research Center
Mohammad Mahdavi, Golnar Morataz Hejri, Hooman Bakhshandeh, Ahmad Amin, Ali Sadeghpour Tabaei, Maziar Gholampour Dehaki, Saeid Hosseini, Zeai Totonchi, Bahador Baharestani
January-March 2018, 7(1):31-34
DOI:10.4103/rcm.rcm_36_17  
Introduction: Heart transplantation is the ultimate treatment method for many infants and children with the diagnosis of cardiomyopathy or final stages of congenital heart failure. Purpose: This report provides the results of children's heart transplantation in Shahid Rajaie Heart Center during a 2-year period. Methods: Studying retrospective information of heart-transplanted children between 2012 and 2015. Results: Nineteen cases of pediatric heart transplantation were performed between 2012 and 2015 on children aged between 16 months and 14 years with an average age of 10 months. Among these, 14 (73.7%) cases were male and 5 (26.3%) cases were female. Among heart-transplanted cases, 10 (52.6%) cases were diagnosed with idiopathic dilated cardiomyopathy, 1 (5.3%) case was diagnosed with myocarditis, 7 (36.8%) cases were diagnosed with left ventricular (LV) noncompaction, and 1 (5.3%) case was diagnosed with myocarditis and LV noncompaction. After the heart transplantation, two cases suffered from pericardial effusion, three cases suffered from renal failure, three cases suffered from the right heart failure, three cases received extracorporeal membrane oxygenation, one case suffered from hypersensitivity to mycophenolate mofetil, and one case suffered from polyradiculopathy. Conclusion: Our short-term experience shows good results with low mortality rates and controlled complications of heart transplantation. Although we are in the early stages and are going through experiences, we expect to get better results given that there is an increase in the number of donors alongside improvements in immunosuppressive treatments and appropriate antibiotics.
  1,543 193 1
CASE REPORTS
Pseudo-Premature Ventricular Complex Can Herald Device Malfunction
Amir Farjam Fazelifar, Mona Heidarali, Majid Haghjoo
January-March 2018, 7(1):43-45
DOI:10.4103/rcm.rcm_11_17  
The increasing number of complex functions in implantable devices demands for an increased ability to recognize these features during patient monitoring and assessment. New device algorithm and lead structures are embryonic concerning device implantation; hence, we should familiarize ourselves and become alert of different types of device malfunction. Although it is unreasonable to expect to know the exact details of all algorithms, the numerous most often encountered should be discussed. This case highlights a novel device malfunction and its management in a 76-year-old male after coronary artery bypass grafts.
  1,447 140 -
LETTER TO EDITOR
Perceived Nonpsychological Etiologies of Cardiovascular Diseases are Unable to Predict Heart Risk Perception
Ali Soroush, Mozhgan Saeidi, Saeid Komasi
January-March 2018, 7(1):49-50
DOI:10.4103/rcm.rcm_3_17  
  1,340 152 2