Evaluation of the Relationship between Sublingual Varices and Hypertension.

Objectives: Sublingual varices are characterized by abnormally dilated veins. Some systemic conditions such as cardiovascular disease have been suggested to be associated with sublingual varices. Due to the convenience in examining the sublingual area, the present study aimed to assess the relationship between sublingual varices and hypertension. Materials and Methods: In this descriptive-analytic study, 500 patients were categorized into two groups: those with sublingual varices and those without. Two oral medicine specialists assessed the lesions, and the blood pressure of all patients was measured while they were in a relaxed sitting position. Age and gender data were recorded for all participants. Statistical analysis included t-test, chi-square, and logistic regression, with significance set at P<0.05. Results: The frequency of sublingual varices was 21.8%. Mean systolic blood pressure was 139.68±19.01mmHg in patients with sublingual varices and 118.09±13.78mmHg in patients without the lesions (P=0.561). Mean diastolic blood pressure was 100.45±17.81mmHg and 80.31±12.08mmHg in patients with and without sublingual varices, respectively (P<0.001). Smoking was significantly more prevalent among patients who had the lesions (P<0.05). Gender (P=0.686) and age (P=0.875) showed no significant relationship with sublingual varices, while smoking and blood pressure levels were significantly associated with these varices (P<0.001). Conclusion: It is advisable to monitor and manage blood pressure in patients with sublingual varices who may not be aware of their blood pressure status. Our results showed that smoking could be one of the predictive factors for sublingual varices.

Upward spontaneous migration of ventriculoperitoneal shunt into the heart: A case report summary.

A male infant with a history of ventriculoperitoneal (VP) implantation due to congenital hydrocephalus presented with fever and lethargy at the age of 8 month-old. Pericardial effusion was detected in transthoracic echocardiography, and he underwent pericardial window operation and was discharged in a stable condition. At 11 months of age, he presented again with fever, lethargy, recurrent vomiting, and respiratory distress. In both plain chest radiography and transthoracic echocardiography, VP shunt migration to the heart cavity was observed. The VP shunt had entered into the right ventricle after perforating the diaphragm and pericardium. The patient underwent open-heart surgery due to vegetation at the tip of the VP shunt inside the right heart. Vegetation was removed and the tip of the shunt was returned to the peritoneal cavity. Two weeks after discharge, the patient presented again with symptoms of tachypnea and lethargy. The imaging revealed the entry of the VP shunt about two centimeters into the anterior mediastinum. The patient was transferred to the operation room and the VP shunt was shortened and re-inserted into the peritoneal cavity. Antibiotic treatment was continued for six weeks and the patient was discharged in stable condition. In follow-up visits after two years, the VP shunt functioned well and no particular complication was observed. This case demonstrates that in patients with VP shunt implantation presenting with pulmonary and cardiac symptoms such as respiratory distress, pericardial effusion, and cardiac tamponade after VP shunt implantation, the possibility of VP shunt catheter migration to the mediastinal cavity should be considered.

New solution for old challenge: Device closure of non-centrally positioned atrial septal defect.

Multiple interatrial defects, termed fenestrated ASDs that require closure are not uncommon. The problem arises when a centrally located defect or a patent foramen oval (PFO) is associated with another peripherally located defect. In cases like this, all attempts at crossing the true defect might totally fail or might be difficult because the wire or the catheter crosses the central defect repeatedly despite the use of a sizing balloon. In order to overcome such an issue, we introduce a new technique by which not only the procedure and the fluoroscopy time will be reduced, but also it ceases the mistakes about the number of defects, their size and location.

Aortic shelf as a normal variant diagnosed primarily as the aortic dissection: A case report.

Traumatic aortic dissection is most commonly caused following sudden deceleration injury. It most commonly involves descending thoracic aorta (DTA) and is associated with high mortality and morbidity if not treated urgently. Confirmation of diagnosis often requires contrast-enhanced computed tomography (CECT) or magnetic resonance imaging (MRI), which is time consuming, expensive, and often not available at many health-care facility. Transesophageal echocardiography (TEE) is equally efficient to CECT and MRI in diagnosing aortic dissection. It may also provide additional information that can be very useful for the management of the patient. In some cases, the likelihood of error in the diagnosis of such a critical condition with normal cardiovascular variations is expected. Herein, we describe a case with primary diagnosis of aortic dissection that led to final diagnosis of an aortic shelf that medically managed with a good long-term prognosis. In patients suspected to aortic dissection due to any cause, the specialized evaluation using the most accurate and sensitive tools is strongly recommended to discriminate normal vascular variations from major vascular defects requiring emergent surgical interventions.

The correlation between serum level of brain natriuretic peptide and amount of left to right shunt.

Introduction: Natriuretic peptides such as brain natriuretic peptide (BNP), atrial natriuretic peptide (ANP) and pro-BNP are secreted in response to atrial and/or ventricular stretch. Left to right shunts such as ventricular septal defect (VSD), atrial septal defect (ASD), and patent ductus arteriosus (PDA), are treated medically or surgically. We aimed to evaluate whether the serum level of pro-BNP would be useful to measure the amount of the shunt. Methods: In this cross sectional study, 60 infants and children, in whom physical examinations approved heart murmur, and had undergone echocardiography by which VSD, ASD, or PDA had been proven, were included in the study. The relationship between serum BNP levels and severity of shunt (Qp/Qs) based on echocardiographic and hemodynamic evaluations, was studied. Results: There was a significant relationship between serum level of pro-BNP and the amount of the shunt in the patients with VSD, ASD, and PDA (P=0.01). A positive correlation was seen between pro-BNP serum level and Qp/Qs ratio. The mean ± SE serum level of pro-BNP in patients with Qp/Qs ratio of less than 1.5, equal to 1.5-2, and more than 2 was 30.83±2.4, 217.88±44.6, and 217.13±51.8, respectively showing a significant relationship (P=0.0001). The cut-off point of pro-BNP demonstrating a Qp/Qs ratio more than 1.5 was measured at the level of 40.36 pg/mL, with a sensitivity and specificity of 92% and 79%, respectively. Conclusion: Based on our study, the cut-off point of 40.36 pg/mL or more for pro-BNP, showing a Qp/Qs ratio more than 1.5, can be considered as an indication for interventional procedures.