A report of fifty cases with incidental diagnosis of anomalous origin of the right coronary artery from the left sinus of Valsalva.

INTRODUCTION: Anomalous origin of the right coronary artery from the left sinus of Valsalva (R-ACAOS) is a relatively rare condition that can potentially lead to devastating outcomes. The current study aims to investigate the cardiac-related disorders among patients with incidental R-ACAOS diagnosis through computed tomography angiography (CTA). METHODS: The current cross-sectional study has been conducted on 50 patients diagnosed with R-ACAOS who underwent CTA. Based on CTA, the patients' were categorized as R-ACAOS with interarterial course and non-interarterial course. The demographic and medical characteristics, any history of cardiac intervention and New York Heart Association (NYHA) Functional Classification at the time of diagnosis were recruited. Patients were revisited to assess cardiac-associated variables, including symptoms, the presence of heart failure and current NYHA function class. RESULTS: The variables including the history of cardiac intervention (P-value<0.001), the presence of heart failure (P-value = 0.010) and NYHA function class at the time of diagnosis (P-value = 0.006) were remarkably higher among those with interarterial course of R-ACAOS; while, the other variables including chest pain at rest (P-value = 0.55) or on exertion (P-value = 0.12), current NYHA function class, current cardiac-associated symptoms except for dyspnea at rest (P-value = 0.012), mortality and coronary calium score did not differ (P-value>0.05). coronary interventions led to significantly improved NYHA function class (P-value<0.05). CONCLUSION: Based on the findings of the current study, R-ACAOS with interarterial course leads to significantly higher rates of atherosclerotic-related symptoms and events compared with the other types of RCA anomalies. Moreover, coronary interventions led to significantly improved NYHA functional class regardless of R-ACAOS category.

Comparison of the CPR Feedback Device Effect on the Effective Technique of the CPR in Two Modes of the Device Warning Being On and Off.

INTRODUCTION: Out-of-hospital cardiac arrest is a major public health problem with over 90% case fatality. Although it is known that good quality of cardiopulmonary Resuscitation (CPR) leads to improved patient outcomes, health care practitioners commonly perform sub-optimal CPR. The CPR feedback device is a small device designed to measure the number and depth of chest compressions (CC) and if the rate of compressions or the depth of the compressions is low or high, it will try to correct the CPR operation by announcing a warning to the resuscitator. The aim of this study was to evaluate the effectiveness of this device which was designed and made by the authors' technician study group member in improving CPR operations, to determine the need for it in all hospitals on a routine basis. METHOD: This cross-sectional study was performed on patients who have suffered from cardio-pulmonary arrest in Al-Zahra Hospital in 2020. Patients needed primary CPR for any reason, were randomly divided into two groups using random allocation software. The first group contains patients as the CPR Feedback device is on and alarm is on and warns, if resuscitation is ineffective, the second group also uses the device, but with the difference that the alarm is off. The data was analyzed by general linear model method (repeated measure ANOVA). RESULTS: 80 patients were studied, including 63 men (79%) and 17 women (21%). Patients were divided among two groups. There was no significant difference in demographic characteristics between two groups. The results showed that there was no significant interaction between group and time for the compression depth variable and there was no significant difference in the depth of compressions between the two groups(P>0.05). For the rate of compressions, there was a significant interaction between group and time. These results indicate that turning on the CPR feedback device's warning increases the number of compressions during CPR and, as a result, makes it more effective. The between-group effect which showed the difference in the number of compressions in the two groups, was statistically significant (P<0.001). CONCLUSION: These results indicated that turning on the CPR feedback device's warning increases the rate of compressions during CPR and, as a result, makes it more effective. Therefore, the use of real-time CPR feedback device during chest compression in real-time CPR improves the quality of CPR.

Practical anatomical landmark for optimal positioning of left-sided long-term central venous catheter (a pilot study).

BACKGROUND: Long-term central venous catheter (CVC) insertion in dialysis patients is an accepted method of hemodialysis. The appropriate CVC tip placement may reduce both early and late complications related to catheter and increase patency rate. This study aimed to evaluate a new, simple, and feasible method based on surface anatomy for the proper placement of tunneled CVC in the left internal jugular vein for hemodialysis or chemotherapy. MATERIALS AND METHODS: The study was carried out as a quasi-experimental model at Saint Al-Zahra Education Hospital in 2016. A total of forty patients with an indication of left-sided (upper) long-term CVC insertion were enrolled. The length of catheter to be inserted in the left internal jugular vein was considered as the sum of distance from the insertion point of the needle up to sternal notch plus the total distance between the left and right sternoclavicular joint and half-length of the sternum. The right atrium (RA) or superior vena cava-RA junction was the correct region for inserting the catheter tip. The collected data were analyzed using Fisher's exact test and t-test using SPSS (version 22). RESULTS: The patients were 63.75 ± 17.96 years of age, weighed 67.33 ± 13.20 kg, and height of 166.92 ± 8.99 cm. Catheters were inserted successfully in 95% of patients (n = 38). No significant relationship was found between the success of new method and age, gender, height, weight, body mass index, and sternum half-length plus the distance between the right and left sternoclavicular joint. CONCLUSION: "The mid - sternal length plus sternoclavicular joints spacing" as a new formula (based on anatomical landmarks) was found practical and safe and could easily be used among adult patients who undergo tunneled CVC in the left internal jugular vein.

Relationship between Pulmonary Artery Diameter and Pulmonary to Aortic Artery Diameter Ratio in High Risk Individuals for Obstructive Sleep Apnea without Pulmonary Artery Hypertension Based on the Berlin Questionnaire.

BACKGROUND: A significant association has been found between the pulmonary artery (PA) diameter and obstructive sleep apnea (OSA) in patients with pulmonary artery hypertension (PAH). We aimed to evaluate the relationship between the diameters of the PA trunk and aortic artery with their ratio as PAH markers in high risk cases for OSA based on the Berlin questionnaire without PAH. MATERIALS AND METHODS: This case-control study included 161 non-PAH patients admitted to a multi-slice CT scan ward. Filling out the Berlin questionnaire, the patients were divided into high and low risk cases for OSA. The diameters of the PA trunk and aortic ascending aorta and their ratio were assessed using the multi-slice CT scan. RESULTS: The PA to aortic ratios in the case and control groups were 0.89±0.17 and 0.88±0.17, respectively, which all were non-significant. With regard to gender, the PA diameter was significantly lower among males in the control group than in the case group (P=0.034). The mean PA to aortic ratio was slightly higher but statistically non-significant in the case group than in the control group. The aortic diameter showed a statistically significant increase by age in the case group (r=0.374, P=0.003) compared to the other group. However, the PA diameter increased significantly by age in both groups (r=0.184, P=0.020). CONCLUSION: The PA diameter can be considered as a predicting factor for future cardiovascular diseases in high risk males for OSA based on the Berlin questionnaire without PAH. More studies are required to confirm these findings.

Prognostic value of normal and non-obstructive coronary artery disease based on CT angiography findings. A 12 month follow up study.

Introduction: The advent of multi-slice computed tomography (CT) technology has provided a new promising tool for non-invasive assessment of the coronary arteries. However, as the prognostic outcome of patients with normal or non-significant finding on computed tomography coronary angiography (CTCA) is not well-known, this study was aimed to determine the prognostic value of CTCA in patients with either normal or non-significant CTCA findings. Methods: This retrospective cohort study was performed on patients who were referred for CTCA to the hospital. 527 patients with known or suspected coronary artery disease (CAD), who had undergone CTCA within one year were enrolled. Among them, data of 465 patients who had normal (no stenosis, n=362) or non-significant CTCA findings (stenosis <50% of luminal narrowing, n=103) were analyzed and prevalence of cardiac risk factors and major adverse cardiac events (MACE) were compared between these groups. In addition, a correlation between these factors and the number of involved coronary arteries was also determined. Results: After a mean follow-up duration of 13.11±4.63 months, all cases were alive except for three patients who died by non-cardiac events. Prevalence of MACE was 0% and 3% in normal CTCA group and non-significant groups, respectively. There was no correlation found between the number of involved coronary arteries and the prevalence of MACE (P = 0.57). Conclusion: A normal CTCA could be associated with extremely low risk of MACE over the first year after the initial imaging, whereas non-significant obstruction in coronary arteries may be associated with a slightly higher risk of MACE.

Coronary CT angiography by modifying tube voltage and contrast medium concentration: Evaluation of image quality and radiation dose.

BACKGROUND: Currently, there is an increasing interest in noninvasive imaging of cardiovascular system such as computed tomography coronary angiography (CCTA). The risks of radiation-induced cancer and contrast-induced nephropathy (CIN) have always been regarded as concerns which increased demand for CCTA using reduced radiation dose and iodine intake. We aimed to evaluate the image quality and radiation dose of CCTA by modifying tube voltage and concentration of contrast media. METHODS: The present study includes 105 patients who underwent CCTA for clinical indications. Specific inclusion and exclusion criteria in terms of patient's weight, body mass index, calcium score, and stenting were used. First group of patients scanned by 120 kV and 370 mg I/mL contrast medium, compared with second and third groups for which scanning was performed using 100 kV and 370 mg I/mL and 100 kV and 300 mg I/mL, respectively. Image quality was evaluated both subjectively and objectively. The effective dose and iodine intake were also measured. RESULTS: Using low kV protocols led to radiation dose reduction up to 38% and applying low contrast medium concentration with consequent reduced iodine intake up to 21%. Moreover, there were significant differences in image quality of new scanning protocols. CONCLUSION: Reduction in tube voltage with lowering of contrast medium concentration can reduce radiation dose and iodine intake with acceptable image quality.

Evaluation of image quality and radiation dose in low tube voltage coronary computed tomography angiography.

BACKGROUND: Coronary computed tomography angiography (CCTA) is an important modality in diagnosis of coronary artery disease (CAD). Owing to the fact that computed tomography (CT) examinations are performed using ionizing radiation; applying radiation dose-reduction strategies seems to be necessary. Lowering tube voltage (in kV) according to the patient's body mass index (BMI) or weight is an approach that is investigated by many researchers. The goal of this study was to evaluate the impact of low tube voltage CCTA on radiation dose and image quality in order to decrease radiation dose in selected patients who meet inclusion criteria of the introduced protocol. METHODS: Patients with clinical indications of CCTA who met inclusion criteria were classified in two groups randomly. Imaging of two groups was performed using 120 kV and 100 kV, respectively. Subjective and objective parameters of image quality and radiation dose of two groups were measured. Afterward, data were analyzed by appropriate statistical tests using SPSS software. RESULTS: While differences in image quality between two groups were not significant, radiation dose of patients who underwent 100 kV CCTA was significantly lower than the other group. Effective doses (EDs) of first and second groups were 22.30 ± 5.48 mSv and 13.82 ± 2.00 mSv, respectively (P < 0.001). CONCLUSION: Lowering tube voltage in non-obese patients is an effective and practical approach to radiation dose reduction without missing image quality that should be considered especially for female patients.

Cardiac computed tomography of an asymptomatic 48-year-old woman with ALCAPA syndrome.

Untreated ALCAPA cases most often die in infancy. Adults with untreated ALCAPA commonly present with mitral regurgitation, severe left ventricular dysfunction, and sometimes myocardial infarction. Herein, we present an asymptomatic adult female with ALCAPA recognized through cardiac computed tomography (CT). In ALCAPA, like other coronary anomalies, cardiac CT is often instrumental in providing unique noninvasive and clinically relevant evaluation. Herein, we present an atypical presentation of an asymptomatic middle-aged adult female with ALCAPA.