L-Carnitine supplementation reduces biomarkers of inflammatory and oxidative stress in patients with coronary artery disease: a randomised controlled trial.

OBJECTIVE: l-Carnitine has been suggested as a potential nutrient that alleviates the oxidative and inflammatory damages of coronary artery disease (CAD), but the results of the previous studies of the importance of this supplementation remains unclear. This study attempts to evaluate the effects of l-carnitine (LC) supplementation on oxidative stress and inflammatory biomarkers in patients with CAD. METHODS: A double-blind, randomised, placebo-trial was conducted on 75 CAD subjects. Patients were randomly assigned to receive LC (1000 mg/day) or placebo capsules over 3 months. Sera high-sensitivity C-reactive protein (hs-CRP), myeloperoxidase (MPO), nitrotyrosine (NT) and total antioxidant capacity (TAC) were assayed. RESULTS: A significant increase in serum TAC and a significant decrease in MPO, NT, and hs-CRP levels were detected following 12 weeks of LC supplementation, compared to the placebo. CONCLUSIONS: These results suggest that LC supplementation may exert beneficial effect on cardiovascular health through attenuate oxidative and inflammatory markers in CAD patients.

Age and sex-related differences in epidemiology, treatment, and mortality of patients with ST-segment elevation myocardial infarction in Iran.

Introduction: Few studies have investigated the characteristics of patients with ST elevation myocardial infarction (STEMI) according to age and sex in Iran. This study aims to investigate the risk factors profile, treatment, and mortality of STEMI based on age and sex. Methods: From 10th June 2016 to December 2019 a total of 2816, STEMI patients referred to the Imam Ali heart center of Kermanshah were included in the study. Profile of the risk factors, epidemiology, treatment and 30- day mortality for all cases in the age categories of 18-49, 50-64, and≥65 years were studied. Results: There were 1256 (44.6%) middle-aged STEMI patients, and 2181 (77.45%) were male. The elderly had a longer median door-to-balloon and symptom-to-balloon time and received less primary PCI. In the absence of primary PCI, the rate of 30-day mortality in women was higher than in men, and the mortality rate increased with age. The risk of death in middle-aged women was higher than that of men. Also, in the middle-aged group, after multivariable adjustment, previous bypass surgery, diabetes, and Killip class≥2 was associated with significant increase in the risk of death. Conclusion: The present study showed that young people with STEMI had a high risk of heart failure and anterior infarction compared to the older age groups. Women had more risk factors for STEMI and a higher mortality rate than men. Therefore, there is a need to educate young age groups and women to modify their lifestyles and intervene in the risk factors of heart diseases.

Cor triatriatum sinister with left superior vena cava, unroofed coronary syndrome and valvular pulmonary stenosis / Cor triatriatum sinistrum con vena cava superior izquierda, síndrome coronario destechado y estenosis de la válvula pulmonar

Abstract A 25-year-old woman with a history of recent dyspnea and palpitation was admitted to our center. Transthoracic echocardiography (TTE) showed an echogenic and septal muscular ridge along the left atrium which were indicative of cor triatriatum sinister (CTS). Further evaluation with transesophageal echocardiography (TEE) showed that a lower chamber of divided left atrium receiving lower right inferior pulmonary vein, mitral valve, left superior vena cava (LSVC) and unroofed coronary sinus (CS). Also, the lower chamber had an unrestrictive communication with the right atrium. The upper accessory chamber receiving one left and one right upper pulmonary vein and communicated with the right atrium by a small atrial septal defect (ASD). However, upper and lower pulmonary venous systems separated directly from each other by a muscular ridge without the presence of any window or hole to allows blood flow between these two accessory chambers. Although the absence of septum associated with the presence of LSVC and unroofed CS makes our case a unique or very rare type of this complex anomaly in an adult case. In our case, surgical removal of dividing muscular membrane with redirection of LSVC and unroofed CS to the right atrium are warranted.

Resumen Se trata de una paciente de sexo femenino, de 25 años de edad, con antecedentes recientes de disnea y palpitaciones que ingresó a nuestro centro. Un ecocardiograma transtorácico (ETT) evidenció un reborde ecogénico muscular del tabique de la aurícula izquierda indicativo de cor triatriatum sinistrum (CTS). En un estudio más a fondo con ecocardiografía transesofágica (ETE) se evidenció que una cámara inferior de la aurícula izquierda dividida recibía la vena pulmonar inferior derecha, la válvula mitral, la vena cava superior izquierda (VCSI) y el seno coronario (SC) destechado. Además, la cámara inferior tenía comunicación libre con la aurícula derecha. La cámara superior secundaria recibía una vena pulmonar superior izquierda y una derecha y se comunicaba con la aurícula derecha a través de una comunicación interauricular (CIA) pequeña. Sin embargo, los sistemas venosos pulmonares superiores e inferiores se encontraban separados entre sí por un reborde muscular sin la presencia de alguna ventana u orificio que permitiera el flujo de sangre entre estas dos cámaras secundarias. La ausencia del tabique junto con la presencia de la VCSI y el SC destechado hacen que nuestro caso sea un tipo único o extremadamente inusual de esta anomalía compleja en un caso en un adulto. En este caso, se justifica la extirpación quirúrgica de la membrana muscular divisoria con redireccionamiento de la VCSI y el SC destechado a la aurícula derecha.

A rare case of Watson syndrome.

Watson for the first time reported a case series of children in a family that presented with pulmonary valve stenosis, mental retardation, short stature, and small brown color skin lesions that are known as cafe-au-lait spots. We present a rare new variant of the syndrome in an adult patient with severe pulmonary valve stenosis, main, left, and right pulmonary artery aneurysm, short stature, mental retardation, coronary artery disease, and skin lesions. The patient underwent open cardiac surgery with pulmonary valvotomy and aneurysmorrhaphy of the main pulmonary artery and its right and left branches. The postoperative course was uneventful and the six-month follow-up with transthoracic echocardiography revealed no recurrence of aneurysm of repairing pulmonary arteries and good clinical outcome of the patient. Our patient had a unique characteristic of aneurysm of the main pulmonary artery and its both branches that has rarely been reported previously in the medical literature.

Combination of cardiac and carotid glomus tumour: a rare case report.

The most common tumour of the heart is myxoma but paraganglioma (also called glomus tumour in extracardiac sites) in the cardiac position is the rarest of them. While this tumour accounts for 0.8% of all primary benign tumours, the combination of both neoplasms is an exceedingly rare occurrence. Herein, we present a case of combined carotid glomus tumour and left atrial paraganglioma tumour in which respiratory distress was the presenting symptom of cardiac type but carotid tumour was asymptomatic. The case underwent a two-step resection of the neck and cardiac mass with an uncomplicated postoperative course and in the 1year follow-up, no recurrence of tumour in both sites was found on physical exam and imaging studies.

A Rare Location of Pseudoaneurysm in Subaortic Ring after Bentall Operation.

Bentall operation is considered a gold standard of surgery in the treatment of ascending aortic aneurysm. This operation with en-bloc resection of ascending aorta and aortic valve requires aortic valve with two coronary bottoms re-replacements in a prepared composite graft. The four important locations for the pseudoaneurysm include proximal and distal composite graft anastomosis and two coronary bottom sites. However, many complications have been reported with this technique but the most serious complication associated with this operation is defined as pseudoaneurysm. We report an exceedingly rare case of subaortic ring pseudoaneurysm in retro composite graft position enclosed by infected surgical that was used to control bleeding in this location. Dehiscence occurred between the aortic ring and the underlying left ventricular muscle. The aortic ring was separated from the underlying muscle by the high tensile strength of sewing ring sutures. The pseudoaneurysm compressing the left atrium without communicating with any cardiac chamber and presenting with high fever (39°C), chills, a few months after Bentall operation. The patient underwent redo operation and repair of the dehiscence's site. The 6-month follow-up revealed no recurrence of a pseudoaneurysm. The uniqueness of this case report is related to the site of pseudoaneurysm between the aortic ring and underlying left ventricular muscle that have not been reported in the medical literature so far.