The fate of the fresh autologous pericardium after right ventricular outflow tract reconstruction.

Introduction: The autologous pericardium, treated or fresh, is used in reconstructive cardiovascular surgery. We aimed to describe the features of fresh pericardium utilized in right ventricular outflow tract (RVOT) reconstruction, years after the initial surgery. Methods: This cross-sectional study was performed on 72 patients (65.3% male, mean age =18.68 ± 9.63 y) with a history of RVOT reconstruction with the fresh autologous pericardium who underwent reoperation. During the surgery, a 1 × 1 cm sample was cut from the previous pericardial patch, and hematoxylin and eosin (H & E), Masson's trichrome, and immunohistochemistry (IHC) staining was conducted. All the stained slides were evaluated,and the descriptive results were explained. Results: The mean follow-up duration was 13.48 ± 7.38 years. In preoperative evaluations,53 (73.6%) patients exhibited no RVOT dilatation, 17 (23.6%) showed mild RVOT dilatation,and 2 (2.8%) had RVOT aneurysms. The H & E staining revealed no calcification in 80.55%(58/72), mild calcification in 9.72% (7/72), and moderate calcification in 9.72% (7/72) of the total samples. None of the specimens demonstrated a marked calcification. All the samples were positive for CD31, CD34, smooth muscle alpha-actin, and von Willebrand factor in IHC. In Masson's trichrome staining, on average, 64.74% (±18.61) of the tissue sections contained collagen fibers. Conclusion: The fresh autologous pericardium, utilized for RVOT reconstruction, showed viability, growth potential, positivity for endothelial cell markers, vascular differentiation,insignificant calcification, and no stenosis at long-term follow-up. We would, therefore, suggest it as a suitable choice for such reconstructive operations. Moreover, its usage during total correction of tetralogy of Fallot could be safe, feasible, and durable.

Evaluation of Acellular Dermal Matrix (ADM) as a Scaffold for Adipose-Derived Stem Cell Transfer in the Rat Model.

BACKGROUND: This study was designed for the evaluation of Acellular Dermal Matrix (ADM) as a scaffold for adipose-derived stem cell transferring in the rat model. METHODS: This experimental study was done in the Burn Research Center of Iran University of Medical Sciences and Bonyakhteh Research Center, Tehran, Iran according to the standards of laboratory animals. Overall, 26 healthy Sprague-Dawley rats were used. Two of them were used to prepare ADM. In group one, the first wound on each, rat was spread with the mixture of fibrin gel and autologous stem cell. Only the stem cells combined with fibrinogen were spread on the other wound. In group two, the first wound on each rat was covered only with ADM, and the second wound was covered with gauze Vaseline. To perform sampling we used observation and photography at 7-30 days. Overall, 48 samples were taken of all the rats using skin punch biopsy on the 30th day for histopathology evaluation. RESULTS: There were significant differences in each group; however, the difference between different groups on days was not significant. In pathology, epithelialization, vascularization, the amount of collagen, collagen arrangement, the number of fibroblasts, and inflammation indices were investigated. The total score in each group was used for analysis. In statistical analysis, there was no pathology score difference among groups. CONCLUSION: Using stem cells with or without ADM could not enhance the process of wound healing or improve pathology indices.

Large pericardial mesothelial cyst coexisting with hypertrophic obstructive cardiomyopathy.

BACKGROUND: Pericardial mesothelioma cyst occurs rarely, and is often found incidentally. The coexistence between large pericardial mesothelial cyst and hypertrophic obstructive cardiomyopathy (HOCM) can make difficulties in medical management. CASE REPORT: Our case was a 33-year-old man presented with dizziness and pallor while standing since four years before, and recent syncope. On admission, transthoracic echocardiography reveled presence of hypertrophic cardiomyopathy in association with relatively small right ventricular and atrium due to compression effect by a large echo-free space at the right side of heart suggestive of pericardial cyst. Cardiac computed tomography confirmed presence of HOCM and large pericardial cyst. Patient underwent surgical septal myectomy and large mesothelial pericardial cyst excision because of persistent symptoms and compression effect of cyst on the right chambers despite beta-blocker therapy. CONCLUSION: To best of our knowledge, the coexistence of the large pericardial mesothelial cyst and HOCM has not been reported before.

Concomitant cardiac and hepatic hemangiomas.

Primary tumors of the heart are rare with a reported incidence of about 0.002% to 0.3% at autopsy. A cardiac hemangioma is a form of benign primary cardiac tumor that often presents with atypical clinical symptoms. Hemangiomas are generally isolated lesions. Here, we report a patient with previous hepatic hemangioma who later was found to have a large coexistent cardiac hemangioma presenting with cardiac compressive symptoms.

An Intracardiac Mass in a Pregnant Woman Presenting With Ventricular Tachycardia.

A pregnant patient presented with symptomatic ventricular tachycardia. Echocardiography revealed a large intramyocardial mass. Surgical resection was attempted in conjunction with cryoablation of the surrounding myocardial tissue. Histologic examination of the resected mass revealed cardiac neurofibroma. To the best of our knowledge, this is the first report of cardiac neurofibroma in a pregnant patient in the absence of any neurocutaneous syndromes such as neurofibromatosis.

Unusual case of aortic coarctation complicated by mycotic pseudoaneurysm and bicuspid aortic valve endocarditis.

Coarctation complicated with mycotic pseudo-aneurysm is very rare. We are reporting a case of a 26-year-old man suffered from this pathology. As the incidence of mycotic pseudo-aneurysm is very rare in patients with aortic coarctation, the choice of this pathology for a patient presenting with unexplained fever is the only way to reduce the mortality risk.

Diagnostic Pitfalls and Challenges in Interpretation of Heart Transplantation Rejection in Endomyocardial Biopsies With Focus on our Experience.

BACKGROUND: The current trend of heart transplantation in recent years has taken a quantum leap forward. We decided to look back at our experience in this center. OBJECTIVES: Here, we focus on the diagnostic pitfalls and challenges in these biopsies. PATIENTS AND METHODS: Forty two patients based on the standard protocol of heart transplantation group, yielded 63 biopsy samples over a period of 33 months (April 2010 - December 2012). The mean age was 30.4 years (ranging from 16 to 58 years) with 51 males (81%) and 12 females (19%). All the patients were examined periodically and biopsy samples were taken from the right ventricular wall. RESULTS: Rarely fewer than three pieces of myocardial samples were procured. Scar, adipose tissues and blood clots may be seen instead. Quilty effect (nodular endocardial lesions composed of inflammatory cell infiltrates) was seen in 8 cases (12.7%). Other findings not directly related to rejection including early ischemic injury, Quilty effect and post-transplant lymphoproliferative disorders (PTLD) were not encountered. CONCLUSIONS: Specimen inadequacy was not a major problem in our center. It poses a great limitation, because suboptimal specimens sometimes mislead the pathologist. Other findings especially Quilty effect were within the range defined for this finding.

Bacteriologic profile of pericardial infections after cardiac surgery: study in an Iranian cardiovascular tertiary care center.

BACKGROUND: Bacterial pericarditis is an important cause of post-surgery mortality and morbidity. This can be a preventable complication and the involved pathogens vary according to the time and location. OBJECTIVES: The aim of this study was to investigate the bacteriologic profile in patients with pericardial infections after cardiac surgery in the largest tertiary care center for cardiovascular diseases in Iran. The results can be applied for prevention, diagnosis, and treatment of similar patients in Iran. PATIENTS AND METHODS: This prospective study was performed in Rajaie Cardiovascular Medical and Research Center (RCMRC), the largest tertiary care center for cardiovascular disease in Iran from March 2011 to March 2012. Patients who had undergone cardiac surgery with cardiopulmonary bypass and showed suggestive sign and symptoms of pericardial infections were registered and samples from their pericardial fluids were obtained to perform standard bacteriologic and antibiogram tests. RESULTS: A total of 158 patients were registered. Bacteriologic findings were positive in 30 patients (19%). Staphylococcus epidermidis was the most frequent isolated organism, which was found in 22 patients (73.3%) with eight of them being methicillin-resistant strains. CONCLUSIONS: The bacteriologic profile in our patient is specific to our own community. Knowledge about this profile can help us to improve prevention, diagnosis, and treatment of the affected patients.

Reliability and validity of the ''personal well-being index- cognitive disability'' on mentally retarded students.

OBJECTIVE: Having a good quality of life has always been desirable for humans, and the concept of a good life and the ways of achieving it have become important over the years. Personal wellbeing is the mental component of quality of life. Thus, the current study was conducted to assess the reliability and validity of the ''Personal Well-Being Index- Cognitive Disability'' on mentally retarded students. METHOD: 200 mentally retarded students in north districts of Tehran (districts 1, 2 and 3) were selected by systematic random sampling. The collected data using Personal Well-Being Index- Cognitive Disability was analyzed by Cronbach's alpha coefficient for internal consistency and linear multivariate regression for construct validity. RESULTS: Results confirmed the reliability and validity for the Personal Well-Being Index- Cognitive Disability in mentally retarded students of exceptional schools. Studying the internal consistency of seven items showed that all the items were correlated with the total score and their scores averages were similar to each other. This indicates that the test's questions have reliability with regard to evaluation of a common feature and results showed Personal Well-Being Index- Cognitive Disability had the most extensive coverage of construct validity. CONCLUSION: Personal Well-Being Index- Cognitive Disability scale could be applied to measure personal wellbeing in mentally retarded students.

Ventricular tachycardia caused by mesothelial cyst.

A 27 year-old- lady was evaluated due to recurrent ventricular tachycardia. After performing echocardiography and cardiac MRI, she was found to have large pericardial cyst. Pathologic examination confirmed it as mesothelial pericardial cyst. Up to our knowledge it is the first presentation of simple pericardial cyst as ventricular a tachycardia.

A Thirty-one-year Old Pregnant Woman With Infiltrative Cardiac Masses.

Primary cardiac tumors are rare in all ages. Their reported prevalence ranges from 0.001 to 0.03 percent in autopsy series. 25 percent of primary cardiac tumors are considered to be malignant, the majority of which are sarcomas. On account of the late presentation of symptoms in malignant heart masses, finding locally infiltrative tumors or systemically widespread cases at initial presentation is common. We present a case of malignant heart tumor in a thirty-one-year old woman who was first examined here after the termination of pregnancy.

Incidence of catheter-related infections in hospitalized cardiovascular patients.

BACKGROUND: Catheter Related Blood stream Infections (CRBSI) are prevalent and a potentially fatal complication pertaining to cardiovascular implant devices. There have been no major studies on bacterial colonization of catheters in cardiovascular patients in Iran. OBJECTIVES: To evaluate the incidence of catheter colonization of bacteria in the largest Iranian cardiovascular center. PATIENTS AND METHODS: March 2011 to 2012, Cauterization procedures performed on 60 patients hospitalized in Rajaie Cardiovascular Medical and Research Center, Tehran, Iran, with arterial or venous catheterization, inserted 48 hours or more, catheter evaluations done by culture methods. Blood cultures were also obtained simultaneously. RESULTS: Forty-four out of 60 catheters (73.3%) were positive with a significant colony count. Of 44 positive cases, 11 patients had positive blood culture. Three most frequently isolated microorganisms were Staph Albus [14 (32%)], Entrococcu [12 (27%)] and Acinetobacter [5 (11%)]. gram-positive cocci were sensitive to Vancomycin and Linezolid and gram-negative bacilli were sensitive to Amikacin, Gentamicin, Tobramycin and Imipenem. CONCLUSIONS: The study findings revealed that the catheter infection in our patients had sources other than normal skin flora. These results will assist in determining the possible source of the infections, furthermore, how they are transmitted, moreover aid in controlling and preventing these dangerous in- infections.

Pheochromocytoma-induced reverse tako-tsubo with rapid recovery of left ventricular function.

Pheochromocytoma is a rare, catecholamine-secreting tumor of neuroendocrine cells. It has been documented to present atypically as myocardial ischemia, arrhythmias, or congestive heart failure. We present the case of a patient who had transient cardiomyopathy with hypokinesia of the basal portions of the left ventricle and hyperkinesia of the apex triggered by a pheochromocytoma crisis similar to that of tako-tsubo cardiomyopathy, but with an inverse left ventricular contractile pattern ('inverted tako-tsubo').

Intraluminal ascending aorta fibroma.

Primary cardiac tumors are quite rare, especially in the pediatric age group, and their atypical presentations often prevent a timely diagnosis. Most primary cardiac tumors in the pediatric age group are benign. Fibromas are generally reported as the second most common primary cardiac tumors in the pediatric age group. These neoplasms are often intramural and involve the left ventricular free wall or the interventricular septum. Although benign, fibromas may become life-threatening by causing arrhythmias or obstruction to the blood flow. A case of supravalvular intraluminal ascending aorta fibroma in a 23-month-old girl, presenting with syncope, is described here; the location is rare and the presentation atypical for this type of tumor. Transesophageal echocardiography helped us to evaluate the anatomic details of the tumor and plan surgery.

Late occurrence of fatal aortitis: a complication of Aspergillus endocarditis following coronary artery bypass graft surgery.

The most common fungal organism to cause endocarditis is Candida which is followed by Aspergillus. Aspergillus endocarditis can occur in either the native or prosthetic heart valves, usually occurs post-operative after cardiac valve surgery. This case is illustrative of a 49-year-old man with previous history of coronary artery bypass grafting presenting with aortic valve endocarditis which was diagnosed as Aspergillus endocarditis. Unfortunately, despite medical and surgical therapy, progressive fatal aortic invasion occurred.

Intracardiac metastasis of malignant melanoma.

Aim To report a case of intracardiac metastasis of malignant melanoma with multiple mobile, large masses in left atrium (LA), left ventricle (LV) and right atrium (RA).

Cardiac cavernous hemangioma.

Among primary cardiac tumors, hemangiomas are relatively rare with a reported incidence of 2.8%. To date, less than 100 cases are reported in literature. We present a 40-year-old woman with atypical chest discomfort of 1 month duration, previous history of glomus tumor of hand and a large cavernous hemangioma of right atrium.