Aortic dilation in adults with repaired tetralogy of Fallot: a single-centre study.

BACKGROUND: Tetralogy of Fallot is the most prevalent cyanotic CHD. With the advent of advanced surgical methods, the majority of tetralogy of Fallot patients reach adulthood. However, many need re-intervention for the residual anomalies including residual right ventricular outflow obstruction, pulmonary regurgitation, residual ventricular septal defects, and progressive aortic dilatation. Aortic dilation could lead to aortic regurgitation or dissection requiring surgical correction. In the current study, we aimed to determine the prevalence and outcomes of aortic root dilatation in adults with repaired tetralogy of Fallot in our tertiary care centre. METHODS: In this retrospective study, 730 consecutive patients with history of repaired tetralogy of Fallot were included. Aortic diameter at the level of annulus, the sinus of Valsalva, sinotubular junction, and the ascending aorta as measured by echocardiography were evaluated. Prevalence of outcomes necessitating re-intervention including aortic regurgitation and dissection were recorded. RESULTS: The mean size of annulus, sinus of Valsalva, sinotubular-junction, and ascending aorta in the latest available echocardiography of patients were 2.4+/-0.4 cm, 3.3+/-0.5 cm, 2.9+/-0.5cm, and 3.2+/-0.5cm, respectively. Prevalence of dilatation of sinus of Valsalva, dilation of Ascending aorta, sinotubular-junction, and aortic annulus was 28.7%, 21%, 8.3%, and 1 %, respectively. Five patients had severe aortic regurgitation (0.6%) and underwent surgical repair. One of these patients presented with acute aortic dissection. CONCLUSION: Aortic dilation is common in tetralogy of Fallot but prevalence of redo surgery for aortic dilation, regurgitation, and adverse events including acute dissection is low.

Cardiac remodeling after atrial septal defects device closure.

BACKGROUND: Trans-catheter device closure of secundum type atrial septal defects (ASDs) has now become the treatment of choice. Device closure affects the hemodynamics and function of the heart. In the current study, we investigated the remodeling of the heart as assessed by advanced echocardiographic parameters following successful device closure. METHODS: A prospective cohort study was conducted and 45 patients who were eligible for ASD device closure were evaluated for volumetric, functional, Doppler, strain, and strain rate data of left and right atrium and ventricle pre-procedural and 48 h post-procedure RESULTS: In a prospective cohort study 45 patients who were eligible for ASD device closure; atrial and ventricular volumetric, functional, Doppler, strain, and strain rate data were recorded and compared pre-procedurally and 48 h post-procedure.We found significant changes in the left ventricular (LV) end diastolic volume index (p-value = .03), right ventricular (RV) diameter (p-value = <.001), left atrial (LA) volume index (p-value = .05), right atrial (RA) volume index (p-value = .001), and right and left sided E/e' ratio with a p-value of .001 and .004, respectively. Our findings showed a significant reduction in the strains of the right and left atria and the right ventricular free wall after ASD device closure. LV global longitudinal strain decreased after the procedure but did not reach statistical significance. CONCLUSION: ASD patients have impaired global strains compared to normal defined ranges. LA, RA, and RV strains show significant reduction after device closure. Decline in LA function following closure was greater in those with larger ASDs. In adult patients undergoing the procedure, abnormal LA function is a clinically relevant issue demanding pre and post- procedural precautions and treatment.

Transhepatic device closure of large atrial septal defect.

Transcatheter closure of secundum-type atrial septal defects has become the treatment of choice in the majority of cases. Femoral venous access is the standard rout for device implantation. Anatomic abnormalities of venous system including interrupted inferior caval vein with azygous continuation can make the percutaneous procedure more complicated. In such instances, alternative methods of transjugular or transhepatic approach or surgical repair should be considered. We present the case of a 50-year-old male with secundum-type atrial septal defect and a rare form of segmental interruption of inferior caval vein and describe successful atrial septal defect closure through transfemoral approach.

Successful thoracic endovascular aortic repair for post-coarctoplasty aneurysm.

BACKGROUND: Aortic coarctation is currently treated by both surgical and transcatheter methods. Patients can present with late complication of prior surgical repair including recoarctation and aneurysm formation. There are limited reports on safety and efficacy of thoracic endovascular aortic repair methods (TEVAR) in post-coarctation repair patients. CASE PRESENTATION: We report an adult patient with aortic aneurysm formation following surgical coarctoplasty successfully treated with transcatheter TEVAR method obviating the need for open heart surgery. CONCLUSION: Endovascular repair of aneurysms in post-coarctoplasty patients is a promising method and should be considered in those with suitable anatomy based on prior imaging.

Congenital atresia of left main coronary artery.

Congenital atresia of the left main coronary artery is a very rare form of coronary anomalies with poor clinical outcomes if left untreated. Patients require surgical correction by coronary bypass grafting after diagnosis. Here we report a case of congenital left main atresia in a 36 years old woman who had previous heart surgery with this anomaly having gone undetected.

Catheter intervention for abnormal pulmonary venous drainage.

Transcatheter interventions for congenital heart anomalies are constantly improving. Although correction of anomalous pulmonary venous connection is routinely achieved through surgery, there are rare instances where the abnormal pulmonary vein has dual connections to both left atrium and the major systemic veins. Under these circumstances catheter based treatment might become a feasible option. We report a case of dual supply vertical vein connected to left upper pulmonary vein and innominate vein which was successfully obstructed by an occluder device leading to improvements in patient's condition.

Coronary slow flow: Benign or ominous?

OBJECTIVE: Coronary slow flow phenomenon has been arbitrarily defined as delayed coronary blood flow in the absence of obstructive coronary artery disease. The present study sought to investigate the clinical features, natural history, and outcomes of affected patients. METHODS: In this prospective cross-sectional study, 217 consecutive patients who had undergone coronary angiography and showed features of coronary slow flow phenomenon were evaluated for demographic and coronary risk factor profile, as well as clinical outcomes, at baseline and following treatment. RESULTS: The study population consisted of 165 (76%) males and 52 (24%) females. The mean age of patients was 52.6±10 years. Mean ejection fraction was 48.2±5.4, 39.3% had diabetes, 43.3% had hypertension, 49.8% was a cigarette smoker, 41.9% had dyslipidemia, and 15% had a familial history of cardiac disease. Forty-nine percent was detected to have abnormal hsCRP levels. The most prevalent presenting complaint was atypical chest pain. Fifty-four percent of patients had slow blood flow in all three vessels. Thirty-six people had undergone repeat coronary angiography in a follow-up period of 5-7 years due to persisting or worsening clinical symptoms, of whom 6 (16.6%) showed significant coronary artery stenosis. Eight (22.2%) had mild CAD, and the rest still showed coronary slow flow without significant stenosis. The most common complaint during follow-up and after initiation of medical therapy was nonanginal chest pain. CONCLUSION: Patients with coronary slow flow phenomenon are predisposed to atherosclerosis and obstructive coronary artery disease. Therefore, this pathology should not be considered as a totally benign condition. Primary and secondary cardiovasculature preventive measures should be constituted and seem worthwhile in this patient population.

Association of left ventricular diverticula and sinus venosus atrial septal defect.

Left ventricular diverticula are congenital anomalies and are not as rare as previously thought. In adults, cardiac diverticula are generally accidental findings during imaging modalities, but concomitant disorders might frequently coexist. The pathophysiology, management, prognosis, and natural history of cardiac diverticula remain poorly understood and controversial. Definite diagnosis is often challenging due to similarities in appearance to other more common anomalies such as aneurysms, pseudoaneurysms, endocarditis, cysts, and hypertrophied trabeculations. We herein report a rare case of an adolescent presenting with sinus venosus atrial septal defect, partial anomalous venous connection, and left ventricular diverticula.

Comparison of in vitro fertilisation success in patients with polycystic ovary syndrome and tubal factor.

PURPOSE: This study is designed to compare the results of in vitro fertilisation (IVF) in polycystic ovary syndrome (PCOS) and tubal factor disorders. MATERIALS AND METHODS: This was a cohort study performed in Royan Institute from 2007 to 2009. For this evaluation, 183 patients with PCOS and 183 patients with tubal factor (control group), whose ages ranged from 22 to 35 years underwent the long protocol of pituitary suppression and were included in the study. RESULTS: In a defined time cycle, the number of ampoules used was higher for the control group (24.6 ± 0.9 versus 33.4 ± 0.9; p<0.0001). The PCOS group produced more oocytes (9.6 ± 0.5 versus 6.4 ± 0.3; p ≤ 0.0001) and embryos (3.7 ± 0.2 versus 2.7 ± 0.1; p=0.001). There were no significant differences in cancellation rate, the occurrence of ovarian hyperstimulation syndrome (OHSS) and cycles that resulted in lacked efficient follicle in the PCOS group and control group. Comparisons for biochemical pregnancy, implantation, clinical pregnancy and ongoing pregnancy rates showed no statistical difference. No significant differences were detected in miscarriage rates and complications. CONCLUSION: The outcome of IVF in patients with PCOS and in patients with tubal infertility is similar.