Cardiac tuberculoma of the right atrium.

We report a patient with a large mass in the right atrium with tricuspid valve involvement resulting in significant stenosis, which was a tuberculoma without active pulmonary disease. Cardiac tuberculoma is rare and usually involves the pericardium. Myocardial involvement is a very rare occurrence.

Global and regional left ventricular function improvement following successful percutaneous coronary intervention in patients with ischemic left ventricular dysfunction.

This study assessed changes in global and regional systolic left ventricular function after successful percutaneous recanalization of coronary artery occlusions. A consecutive series of 110 patients with mean+/-SD age of 53.6+/-9.1 years, in whom a complete angiographic evaluation was available before angioplasty, underwent successful percutaneous recanalization of significant occlusions of coronary arteries. Left ventricular ejection fraction and wall motion score index were assessed by echocardiography at baseline, and 1, and 6 months after recanalization. Left ventricular ejection fraction increased from a mean+/-SD of 40.7+/-4.52% at baseline to 50+/-8.3% after one month (P<0.001) and to 50.9+/-8.5% after 6 months. There was no significant difference between left ventricular ejection fraction at the end of the first and the sixth month of treatment (P = NS). The wall motion score index decreased from 1.3+/-0.2 at baseline to 1.1+/-0.2 after one month (P<0.01). There was no significant difference between 1 and 6 months results. Six-month follow-up of all patients showed significant improvement in both angina severity and NYHA class. The restoration of coronary potency of occluded coronary arteries by successful percutaneous recanalization is associated with significant improvement in regional and global left ventricular function and clinical outcome.

Immediate results of percutaneous trans-luminal mitral commissurotomy in pregnant women with severe mitral stenosis.

BACKGROUND: Valvular heart diseases and mainly rheumatic heart diseases complicate about 1% of pregnancies. During pregnancy physiological hemodynamic changes of the circulation are the main cause of mitral stenosis (MS) decompensation. Prior to introduction of percutaneous mitral balloon commissuroplasty (PTMC), surgical comissurotomy was the preferred method of treatment in patients with refractory symptoms. PTMC is an established non-surgical treatment of rheumatic mitral stenosis. The study aimed to assess the safety and efficacy of PTMC in pregnant women with severs mitral stenosis. MATERIAL AND METHOD: Thirty three consecutive patients undergoing PTMC during pregnancy enrolled in this prospective study. Mitral valve area (MVA), transmitral valve gradient (MVG), and severity of mitral regurgitation (MR) were assessed before and 24 hour after the procedure by transthoracic and transesophageal echocardiography. Mitral valve morphology was evaluated before the procedure using Wilkin's criteria. Patient followed for one month and neonates monitored for weight and height and adverse effect of radiation. RESULT: Mitral valve area increased from 0.83 ± 0.13 cm(2) to 1.38 ± 0.29 cm(2) (P = 0.007). Mean gradient of mitral valve decreased from 15.5 ± 7.4 mmHg to 2.3 ± 2.3 mmHg (P = <0.001). Pulmonary artery pressure decreased from 65.24 ± 17.9 to 50.45 ± 15.33 (P = 0.012). No maternal death, abortion, intrauterine growth restriction was observed and only one stillbirth occurred. CONCLUSION: PTMC in pregnant women has favorable outcome and no harmful effect on children noted.

Gender specific variations in the description, intensity and location of angina pectoris: a cross-sectional study.

BACKGROUND: Some research suggests that men and women may experience Angina Pectoris (AP) differently. More research is needed to characterize AP symptoms by gender and to familiarize health care providers with them, to enable proper education, diagnostic evaluation and timely management. OBJECTIVE: This study examines gender differences in the description, intensity and location of AP in patients with CHD. DESIGN: A cross-sectional study was performed to compare AP patients according to gender. SETTINGS: This study was performed on patients residing in Tehran, who were being treated in a hospital and were admitted to cardiac units. PARTICIPANTS: Five hundred patients with AP were selected. The participants were patients with AP who were diagnosed with CHD based on documented results from an angiography. METHOD: Outpatients who were admitted to the cardiac units were screened. Informed consent was obtained from all study participants, who then completed the Iranian version of the AP characteristics questionnaire. RESULTS: Women were significantly more likely to feel pain in the left arm and hand, odds ratio 1.5 (95% CI=1.0-2.1, P=0.04), left scapula, odds ratio 2.3 (95% CI=1.6-3.5, P<0.001), and neck, odds ratio 2.8 (95% CI=1.9-4.1, P<0.0001), while controlling for demographic and clinical factors. Women were significantly more likely to choose the possible pain descriptors for describing their AP and reported significantly greater intensity than men for all the pain descriptors. Significantly higher scores for sensory, affective, total and NRS (Numeric Rating Scale) scores were observed in women (P<0.001). Multiple linear regression analyses revealed that gender remained a statistically significant predictor of pain scores and NRS, while controlling for demographic and clinical factors. CONCLUSION: Women and men differ with respect to description, intensity and location of AP. Educating the general public and informing health care providers about gender variation in AP may help to decrease delays in seeking medical care.