Mahnoosh Foroughi | Shahid Beheshti University of Medical Sciences (original) (raw)

Papers by Mahnoosh Foroughi

Review Article Mitral Valve Surgery in Patients with Systemic

Copyright © 2014 Mahnoosh Foroughi et al. This is an open access article distributed under the Cr... more Copyright © 2014 Mahnoosh Foroughi et al. This is an open access article distributed under the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. Valvular heart disease is the common cardiac manifestation of systemic lupus erythematosus (SLE) with a tendency for mitral valve regurgitation. In this study we report a case of mitral valve replacement for mitral stenosis caused by Libman-Sacks endocarditis in the setting of SLE. In addition, we provide a systematic review of the literature on mitral valve surgery in the presence of Libman-Sacks endocarditis because its challenge on surgical options continues. Surgical decision depends on structural involvement of mitral valve and presence of active lupus nephritis and antiphospholipid antibody syndrome. Review of the literature has also shown that outcome is good in most SLE patients who have undergone valvular surgery, but ass...

Background: Electrosurgery helps surgeons to perform procedures faster and with less bleeding. Ai... more Background: Electrosurgery helps surgeons to perform procedures faster and with less bleeding. Aim of the study: This paper was designed to illustrate some aspects of electrical burns, their potential causes in our operating room and the method which guided us to the technical solutions of the problem. Material and methods: This case-control study included 129 patients who underwent cardiac operations at a tertiary university medical center. Forty-one patients experienced burn during the operation during this period. The demographic and perioperative characteristics of this group (as case group) were compared to the remainder (88 patients) who had operations on the same days, but had no burns (as control group). Causative factors and preventive measures were reviewed. Results: It was observed that a greater number of patients in the burn group had diabetes and hypertension, were operated on in an emergency setting (P = 0.001), and had a longer aortic clamp time. After the assessment...

Erythropoietin (Epo) is the main erythropoiesis hormone, activate the progenitor red blood cells ... more Erythropoietin (Epo) is the main erythropoiesis hormone, activate the progenitor red blood cells through proliferation, differentiation and maturation of red blood cells. However, it's another receptor in other tissues, including heart and endothelium, confirm its pluripotent activities. A numerous preclinical studies have shown Epo would be cardioprotective against ischemic events, reperfusion injury and apoptosis. The results of Epo in clinical studies were inconclusive with even associated increased risk of adverse outcomes. In this article, a comprehensive review of the Epo effects is evaluated in the coronary artery disease, cardiac surgery, heart failure and its safety through the results of the most recent clinical trials related to Epo in the cardiovascular disease. The analysis of the available clinical trials demonstrates the most determining factors; Epo dose and administration time related to myocardial ischemia onset. It seems the low dose Epo treatment has tissue p...

Background : CABG is among the most common cardiac procedures often done as on pump surgery. Ther... more Background : CABG is among the most common cardiac procedures often done as on pump surgery. There are however, there is always the risk for potential neurologic and neurocognitive insults in CABG. S100β is a biomarker for CNS damage. Cerebral oximetry using NIRS has been developed for CNS monitoring especially cardiac surgery. This study was designed to find the relationship between serum levels of s100β and cerebral oximetry in CABG patients. Methods : in an observational study, 44 adult 40-75 years patients entered the study for elective CABG. Serum levels of s100β were assessed at two times during CPB; i.e. just after aortic clamping and immediately after aortic declamping; while the results were compared with right and left cerebral oximetry readings (NIRS); however, NIRS was measured at baseline, during start of cardiopulmonary bypass (CPB), during aortic clamping, and finally at off-clamping the aorta. Repeated Measures ANCOVA (analysis of covariance), multiple linear regress...

Cardiopulmonary bypass and aortic clamping evokes the obligatory global myocardial ischemia and d... more Cardiopulmonary bypass and aortic clamping evokes the obligatory global myocardial ischemia and dysfunction with a significant inflammatory response. The discrepancy about cardioprotective effects of erythropoietin still exist. The aim of this study was to assess the clinical immunomodulatory effects of Erythropoietin (EPO) on serum inflammatory biomarkers (YKL-40, IL-6) and cardiac biomarkers, (pro-BNP, CK-MB and troponin). In this randomized double blind clinical trial, 132 patients admitted for elective coronary surgery with Cardiopulmonary Bypass (CPB) were randomly assigned in one of three groups: 1-group EPO-A (n = 35) infusion of 300 IU/Kg EPO after anesthesia induction and before undergoing CPB; 2- group EPO-CPB (n = 31) the same intervention during CPB; 3- placebo group (n = 66) saline infusion in the same volume. Cardiac enzymes and serum biomarkers were measured at intervals. There was a sharp increase in serum YKL-40 with a 24 h delay after CPB in all groups without sign...

Journal of Geriatric Cardiology : JGC, 2021

Ischemic heart disease (IHD) is known as the leading cause of death in both genders. Moreover, si... more Ischemic heart disease (IHD) is known as the leading cause of death in both genders. Moreover, significant sex differences were found in cardiac structure, function, pathophysiology, presentation, treatment, and outcome of IHD. The presence of unique risk factors such as exposure to menarche and pregnancy, more anemia, hypertension, and autoimmune disorders in women have recently received attention. Ischemic symptoms are more indefinite and vague in women compared to men as well as a delay in diagnosis, treatment, and worse outcomes compared to men. Women usually receive less evidence-based treatment and intervention, with less concern on preventive health care. Clinical trials primarily recruit male patients and women are underrepresented. Without any correct diagnosis, treatment, and prevention, these problems are accumulated and continue up to older age. Accordingly, with the belief of longer life in women and the increased prevalence of IHD with aging, it will become an importan...

Prolonged QT Interval and Coronary Artery Bypass Mortality Due to Heart Failure

Asian Cardiovascular and Thoracic Annals, 2009

QT-interval prolongation has been shown to predict mortality in coronary artery disease and heart... more QT-interval prolongation has been shown to predict mortality in coronary artery disease and heart failure. To assess the prognostic value of QT interval for death due to low cardiac output after coronary artery bypass grafting, the QT interval was measured in 3 consecutive beats on the preoperative electrocardiogram (leads II and V4)in30 patients who died perioperatively due to heart failure and a control group of 168 randomly matched hospital survivors during the same 3-year period. Mean corrected QT interval was significantly longer in the patients who died compared to the control group (480.7 ± 96.2 vs. 425.4 ± 21 ms). Among the variables evaluated, QT prolongation was the only independent predictor of perioperative death. In patients admitted for coronary artery bypass grafting, QT interval measurement is a simple clinical tool that may identify patients with a greater probability of a troublesome operative course.

The Results of Coronary Artery by Pass Graft in Diabetic Patients, Refered to Modarres Hospital During 1998-1999

JOURNAL OF ARMY UNIVERSITY OF MEDICAL SCIENCES OF THE I.R. IRAN (JAUMS), 2004

Background: Coronary artery bypass graft (CABG) surgery is one of the most common surgical proced... more Background: Coronary artery bypass graft (CABG) surgery is one of the most common surgical procedures in this era. The out come of this procedure depend on many factors, one of them is patient's underlying disease like diabetes. Materials and Methods: In this study we compared the results of CABG in diabetic versus non-diabetic patients. One hundred diabetic and one hundred non-diabetic candidates for operation has been selected and short term mortality and morbidity rates after surgery have been studied. Results: The ...

IRANIAN HEART JOURNAL (IHJ), 2004

The usual ways of malignancy spreading to the heart are through the systemic circulation, coronar... more The usual ways of malignancy spreading to the heart are through the systemic circulation, coronary arteries, lymphatic channels and direct extension from adjacent organs. This article presents two cases of metastatic sarcoma in the lung that invaded through the pulmonary vein to the left atrium and presented with signs of cerebrovascular accident. It seems that there is a tendency for primary cardiac sarcoma to invade the pulmonary veins. Only sarcomas have this ability to invade and extend antegradely through the pulmonary ...

IRANIAN HEART JOURNAL (IHJ), 2004

Background-Anomalous coronary artery disease is more common among patients with Tetralogy of Fall... more Background-Anomalous coronary artery disease is more common among patients with Tetralogy of Fallot (ToF). Methods-In order to determine the coronary anomalies in patients with ToF, 135 patients (80 males) with ToF, 9 months to 40 years of age were studied over 7 years (1995-2002) at Modarres Hospital in Tehran, Iran. Results-Eight out of the 135 patients (4 males) with ToF were associated with a surgicallyrelevant coronary artery anomaly (5.9%). The anomalous coronary arteries consisted of single ostium of the coronary artery (n = 5), the left anterior descending coronary artery originating from the right coronary artery (n = 2) or single right coronary artery (n = 2) and the right coronary artery arising from the left coronary artery (n = 1). Surgical technique employed in three ToF patients was transverse incision on the right ventricle, and commissurotomy via the pulmonary artery was the technique used for three other patients. In another patient, a composite graft between the right ventricle outflow tract and main pulmonary artery was inserted. In the remaining four patients with single ostium coronaries, routine repairs were done. Conclusions-Anomalous coronary artery disease is more common among patients with ToF. Bearing these anomalies in mind during primary repair could decrease the risk of surgery in patients with ToF

Introduction and History of Postoperative Care for Adult Cardiac Surgical Patients

The pain phenomena as a disabling state but normal fact in human have been noticed to alarm and c... more The pain phenomena as a disabling state but normal fact in human have been noticed to alarm and concern to the tissue injury and damage. Pain management is one the most worldwide clinical challenges in general population that is associated with considerable health care expenses, decreased productive time and impression on the quality of life. Numerous studies have been done to identify its pathophysiology and effective therapeutic agents. Attention to pain etiology, the relationship of inflammatory pathways, the molecular mechanisms and involved transmitters have given insights to novel approaches with more effective pain relief agents. In addition to over the counter analgesic and prescription medicine (NSAIDs, opioids, COX-2 inhibitors), there is no consensus about the analgesic role of herbal medicines. Cochrane library reviewed the place of herbal medicine in low back pain. They showed although the RCTs were not large trials and well-designed but herbal medicine could reduce pai...

Iranian Journal of Pharmaceutical Research : IJPR, 2017

The aim of this study was to estimate the monetary value of a QALY among patients with heart dise... more The aim of this study was to estimate the monetary value of a QALY among patients with heart disease and to identify its determinants. A cross-sectional survey was conducted through face-to-face interview on 196 patients with cardiovascular disease from two heart hospitals in Tehran, Iran, to estimate the value of QALY using disaggregated and aggregated approaches. The EuroQol-5 Dimension (EQ-5D) questionnaire, Visual Analogue Scale (VAS), Time Trade-Off (TTO) and contingent valuation WTP techniques were employed, first to elicit patients’ preferences and then, to estimate WTP for QALY. The association of patients’ characteristics with WTP for QALY, was assessed through Heckman selection model. The Mean willingness to pay per QALY, estimated by the disaggregated approach ranged from 2,799 to 3599 US dollars. It is higher than the values, estimated from aggregated methods (USD 2,256 to 3,137). However, in both approaches, the values were less than one Gross Domestic Product (GDP) per...

The Relation Between Post Cardiac Surgery Delirium and Intraoperative Factors

IRANIAN JOURNAL OF …, 2009

Results: In this study, the incidence of delirium after open heart surgery was 47%. This study in... more Results: In this study, the incidence of delirium after open heart surgery was 47%. This study indicates that delirium after heart surgery is associated with CPB time> 120 minutes, cross-clamp time> 75 minutes, intraoperative HTC< 30% and intraoperative temperature< 30 o ...

Introducing a method for safe air evacuation from oxygenator in cardiac surgery operating rooms during COVID-19 pandemic

Covid-19 pandemic provides new perspectives and possibly permanent changes in some existing guide... more Covid-19 pandemic provides new perspectives and possibly permanent changes in some existing guidelines and safety principles. Evacuated air from the exhaust reservoir and oxygenator, after close contact with the patient’s blood added contaminated secretions, drain into the operating room, a potential source for contamination. There are two air exhaust ways from the oxygenator in cardiopulmonary bypass (CPB) circuit; which might be the potential carrier of the Covid-19 virus and resulting contamination. In the current design, these two exhausts are connected to one antibacterial and antiviral filter and then they will attach to the ventilator's exhaust port with a three-way connector, in such a way that the contaminated air will be vented outside the operating room. It is recommended to use antibacterial and antiviral filters in the passage way of the contaminated air coming from Reservoir and Oxygenator exhaust, to be directly guided outside the operating room. In this article, ...

1. Odell JA. Coronary artery bypass grafting after previous stenting is associated with compromis... more 1. Odell JA. Coronary artery bypass grafting after previous stenting is associated with compromised long-term efficacy (letter). Ann Thorac Surg 2008; 86:1052. 2. Rao C, Stanbridge RL, Chikwe J, et al. Does previous percutaneous coronary stenting compromise the long-term efficacy of subsequent coronary artery bypass surgery? A microsimulation study. Ann Thorac Surg 2008; 85:501–7. 3. Tovar EA, Blau N, Borsari A, Landa DW, Packer JM. Severe deformity of a Palmaz-Schatz stent after normal surgical manipulation. Ann Thorac Surg 1997; 63:220 –1. 4. Tovar EA, Borsari A. Effects of surgical manipulation on coronary stents: should surgical strategy be altered? Ann Thorac Surg 1997; 63:37– 40. 5. Thielmann M, Leyh R, Massoudy P, et al. Prognostic significance of multiple previous percutaneous coronary interventions in patients undergoing elective coronary artery bypass surgery. Circulation 2006; 114(1 Suppl):I441–7. 6. Thielmann M, Neuhauser M, Knipp S, et al. Prognostic impact of previous ...

Background: Ventricular Septal Rupture (VSR) is a rare but challenging complication after myocard... more Background: Ventricular Septal Rupture (VSR) is a rare but challenging complication after myocardial infarction (MI). In the presence of acute MI, volume and pressure overload lead to acute heart decompensation. The present study was designed to evaluate the early surgical outcome of VSR for over 18 years. Method: This multicenter study was done during 2000-2018, in which 99 patients with post-MI VSR were included. Results: The patients (n=11) presenting hemodynamic deterioration at the time of hospital admission, died before any attempt for surgery. A consecutive series of 88 patients with surgical repair of VSR was evaluated. The mean interval from MI to VSR diagnosis was 7.5±7.2 days and from admission to the operation was 5±5 days. VSR location did not influence the outcome (p=0.1). The concomitant coronary bypass was done for all patients; two-vessel disease was more prevalent (39%). Only 25 patients survived and left the hospital (13 patients died in the operating room due to ...

Background : Despite the general concern about the safety of blood transfusion and mounting evide... more Background : Despite the general concern about the safety of blood transfusion and mounting evidence exist for more restrictive practice; there is no national consensus guideline and uniformity of institutions for blood transfusion associated with coronary artery bypass graft surgery in Iran. The aim of this study is an assessment of current transfusion practice and compares it with one decade ago. Method: The authors retrospectively analyzed the data of all patients undergoing elective surgery (first time operation) during one year, in two different decade interval (2003 and 2015) in a tertiary heart center. Results: A total of 801 patients were evaluated and compared (n=249 in 2015, n=552 in 2003). There is a significant increase in use of blood transfusion in both operating room and at ICU than the last decade (60.6% vs. 42.4%, P <0.001, and 54.4% vs. 39.9%, P <0.001, respectively). The incidence of preoperative anemia was four times higher in patients who received transfus...

Background: Atrial fibrillation is the most common but benign arrhythmia following cardiac surger... more Background: Atrial fibrillation is the most common but benign arrhythmia following cardiac surgery. Although this arrhythmia is often self-limited and vanishes in about 24 hours upon surgery a number of arrhythmias might ensue among which some might be really life-threatening. A multitude of therapeutic modalities have been proposed for the prevention of this arrhythmia and one of them is posterior pericardiotomy. This method has not been fully accepted by the peers yet and more studies are needed to prove its efficacy and benefits to the patients. Methods: In this single-blind randomized clinical trial, done over a 2-year period from February 2009 to January 2011, the effects of posterior pericardiotomy were evaluated in 174 patients (87 the case and 87 the control groups) undergoing elective coronary artery bypass grafting (CABG). The case group underwent CABG with posterior pericardiotomy while the control group underwent CABG-only operation. The postoperative incidence of arrhyt...

Introduction: a number of preventive or therapeutic strategies have been proposed to compensate f... more Introduction: a number of preventive or therapeutic strategies have been proposed to compensate for the inflammatory process during adult cardiac surgeries; none have been considered definitive. 1,25 (OH)2 Vitamin D3 is among the so called physiologic hormones with immunomodulatory effects. This study assessed the effect of oral Vitamin D on serum levels of IL-1, IL-6 and TNF-α in adult CABG. Materials and methods: in a double blind placebo controlled clinical trial, 80 patients entered the study after qualifying study criteria; being divided to Vitamin D and placebo groups, serum cytokines (IL-1, IL-6, and TNF-α) were measured preoperatively and also during the 1 st day after the operation. Results: serum TNF-α levels were similar in the 2 groups; however, postoperative levels of IL-1 and IL-6 were significantly lower in Vitamin D group. Conclusion: the current study demonstrated that oral Vitamin D supplements could augment immunomodulatory effects in adult patients undergoing car...

Review Article Mitral Valve Surgery in Patients with Systemic

Copyright © 2014 Mahnoosh Foroughi et al. This is an open access article distributed under the Cr... more Copyright © 2014 Mahnoosh Foroughi et al. This is an open access article distributed under the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. Valvular heart disease is the common cardiac manifestation of systemic lupus erythematosus (SLE) with a tendency for mitral valve regurgitation. In this study we report a case of mitral valve replacement for mitral stenosis caused by Libman-Sacks endocarditis in the setting of SLE. In addition, we provide a systematic review of the literature on mitral valve surgery in the presence of Libman-Sacks endocarditis because its challenge on surgical options continues. Surgical decision depends on structural involvement of mitral valve and presence of active lupus nephritis and antiphospholipid antibody syndrome. Review of the literature has also shown that outcome is good in most SLE patients who have undergone valvular surgery, but ass...

Background: Electrosurgery helps surgeons to perform procedures faster and with less bleeding. Ai... more Background: Electrosurgery helps surgeons to perform procedures faster and with less bleeding. Aim of the study: This paper was designed to illustrate some aspects of electrical burns, their potential causes in our operating room and the method which guided us to the technical solutions of the problem. Material and methods: This case-control study included 129 patients who underwent cardiac operations at a tertiary university medical center. Forty-one patients experienced burn during the operation during this period. The demographic and perioperative characteristics of this group (as case group) were compared to the remainder (88 patients) who had operations on the same days, but had no burns (as control group). Causative factors and preventive measures were reviewed. Results: It was observed that a greater number of patients in the burn group had diabetes and hypertension, were operated on in an emergency setting (P = 0.001), and had a longer aortic clamp time. After the assessment...

Erythropoietin (Epo) is the main erythropoiesis hormone, activate the progenitor red blood cells ... more Erythropoietin (Epo) is the main erythropoiesis hormone, activate the progenitor red blood cells through proliferation, differentiation and maturation of red blood cells. However, it's another receptor in other tissues, including heart and endothelium, confirm its pluripotent activities. A numerous preclinical studies have shown Epo would be cardioprotective against ischemic events, reperfusion injury and apoptosis. The results of Epo in clinical studies were inconclusive with even associated increased risk of adverse outcomes. In this article, a comprehensive review of the Epo effects is evaluated in the coronary artery disease, cardiac surgery, heart failure and its safety through the results of the most recent clinical trials related to Epo in the cardiovascular disease. The analysis of the available clinical trials demonstrates the most determining factors; Epo dose and administration time related to myocardial ischemia onset. It seems the low dose Epo treatment has tissue p...

Background : CABG is among the most common cardiac procedures often done as on pump surgery. Ther... more Background : CABG is among the most common cardiac procedures often done as on pump surgery. There are however, there is always the risk for potential neurologic and neurocognitive insults in CABG. S100β is a biomarker for CNS damage. Cerebral oximetry using NIRS has been developed for CNS monitoring especially cardiac surgery. This study was designed to find the relationship between serum levels of s100β and cerebral oximetry in CABG patients. Methods : in an observational study, 44 adult 40-75 years patients entered the study for elective CABG. Serum levels of s100β were assessed at two times during CPB; i.e. just after aortic clamping and immediately after aortic declamping; while the results were compared with right and left cerebral oximetry readings (NIRS); however, NIRS was measured at baseline, during start of cardiopulmonary bypass (CPB), during aortic clamping, and finally at off-clamping the aorta. Repeated Measures ANCOVA (analysis of covariance), multiple linear regress...

Cardiopulmonary bypass and aortic clamping evokes the obligatory global myocardial ischemia and d... more Cardiopulmonary bypass and aortic clamping evokes the obligatory global myocardial ischemia and dysfunction with a significant inflammatory response. The discrepancy about cardioprotective effects of erythropoietin still exist. The aim of this study was to assess the clinical immunomodulatory effects of Erythropoietin (EPO) on serum inflammatory biomarkers (YKL-40, IL-6) and cardiac biomarkers, (pro-BNP, CK-MB and troponin). In this randomized double blind clinical trial, 132 patients admitted for elective coronary surgery with Cardiopulmonary Bypass (CPB) were randomly assigned in one of three groups: 1-group EPO-A (n = 35) infusion of 300 IU/Kg EPO after anesthesia induction and before undergoing CPB; 2- group EPO-CPB (n = 31) the same intervention during CPB; 3- placebo group (n = 66) saline infusion in the same volume. Cardiac enzymes and serum biomarkers were measured at intervals. There was a sharp increase in serum YKL-40 with a 24 h delay after CPB in all groups without sign...

Journal of Geriatric Cardiology : JGC, 2021

Ischemic heart disease (IHD) is known as the leading cause of death in both genders. Moreover, si... more Ischemic heart disease (IHD) is known as the leading cause of death in both genders. Moreover, significant sex differences were found in cardiac structure, function, pathophysiology, presentation, treatment, and outcome of IHD. The presence of unique risk factors such as exposure to menarche and pregnancy, more anemia, hypertension, and autoimmune disorders in women have recently received attention. Ischemic symptoms are more indefinite and vague in women compared to men as well as a delay in diagnosis, treatment, and worse outcomes compared to men. Women usually receive less evidence-based treatment and intervention, with less concern on preventive health care. Clinical trials primarily recruit male patients and women are underrepresented. Without any correct diagnosis, treatment, and prevention, these problems are accumulated and continue up to older age. Accordingly, with the belief of longer life in women and the increased prevalence of IHD with aging, it will become an importan...

Prolonged QT Interval and Coronary Artery Bypass Mortality Due to Heart Failure

Asian Cardiovascular and Thoracic Annals, 2009

QT-interval prolongation has been shown to predict mortality in coronary artery disease and heart... more QT-interval prolongation has been shown to predict mortality in coronary artery disease and heart failure. To assess the prognostic value of QT interval for death due to low cardiac output after coronary artery bypass grafting, the QT interval was measured in 3 consecutive beats on the preoperative electrocardiogram (leads II and V4)in30 patients who died perioperatively due to heart failure and a control group of 168 randomly matched hospital survivors during the same 3-year period. Mean corrected QT interval was significantly longer in the patients who died compared to the control group (480.7 ± 96.2 vs. 425.4 ± 21 ms). Among the variables evaluated, QT prolongation was the only independent predictor of perioperative death. In patients admitted for coronary artery bypass grafting, QT interval measurement is a simple clinical tool that may identify patients with a greater probability of a troublesome operative course.

The Results of Coronary Artery by Pass Graft in Diabetic Patients, Refered to Modarres Hospital During 1998-1999

JOURNAL OF ARMY UNIVERSITY OF MEDICAL SCIENCES OF THE I.R. IRAN (JAUMS), 2004

Background: Coronary artery bypass graft (CABG) surgery is one of the most common surgical proced... more Background: Coronary artery bypass graft (CABG) surgery is one of the most common surgical procedures in this era. The out come of this procedure depend on many factors, one of them is patient's underlying disease like diabetes. Materials and Methods: In this study we compared the results of CABG in diabetic versus non-diabetic patients. One hundred diabetic and one hundred non-diabetic candidates for operation has been selected and short term mortality and morbidity rates after surgery have been studied. Results: The ...

IRANIAN HEART JOURNAL (IHJ), 2004

The usual ways of malignancy spreading to the heart are through the systemic circulation, coronar... more The usual ways of malignancy spreading to the heart are through the systemic circulation, coronary arteries, lymphatic channels and direct extension from adjacent organs. This article presents two cases of metastatic sarcoma in the lung that invaded through the pulmonary vein to the left atrium and presented with signs of cerebrovascular accident. It seems that there is a tendency for primary cardiac sarcoma to invade the pulmonary veins. Only sarcomas have this ability to invade and extend antegradely through the pulmonary ...

IRANIAN HEART JOURNAL (IHJ), 2004

Background-Anomalous coronary artery disease is more common among patients with Tetralogy of Fall... more Background-Anomalous coronary artery disease is more common among patients with Tetralogy of Fallot (ToF). Methods-In order to determine the coronary anomalies in patients with ToF, 135 patients (80 males) with ToF, 9 months to 40 years of age were studied over 7 years (1995-2002) at Modarres Hospital in Tehran, Iran. Results-Eight out of the 135 patients (4 males) with ToF were associated with a surgicallyrelevant coronary artery anomaly (5.9%). The anomalous coronary arteries consisted of single ostium of the coronary artery (n = 5), the left anterior descending coronary artery originating from the right coronary artery (n = 2) or single right coronary artery (n = 2) and the right coronary artery arising from the left coronary artery (n = 1). Surgical technique employed in three ToF patients was transverse incision on the right ventricle, and commissurotomy via the pulmonary artery was the technique used for three other patients. In another patient, a composite graft between the right ventricle outflow tract and main pulmonary artery was inserted. In the remaining four patients with single ostium coronaries, routine repairs were done. Conclusions-Anomalous coronary artery disease is more common among patients with ToF. Bearing these anomalies in mind during primary repair could decrease the risk of surgery in patients with ToF

Introduction and History of Postoperative Care for Adult Cardiac Surgical Patients

The pain phenomena as a disabling state but normal fact in human have been noticed to alarm and c... more The pain phenomena as a disabling state but normal fact in human have been noticed to alarm and concern to the tissue injury and damage. Pain management is one the most worldwide clinical challenges in general population that is associated with considerable health care expenses, decreased productive time and impression on the quality of life. Numerous studies have been done to identify its pathophysiology and effective therapeutic agents. Attention to pain etiology, the relationship of inflammatory pathways, the molecular mechanisms and involved transmitters have given insights to novel approaches with more effective pain relief agents. In addition to over the counter analgesic and prescription medicine (NSAIDs, opioids, COX-2 inhibitors), there is no consensus about the analgesic role of herbal medicines. Cochrane library reviewed the place of herbal medicine in low back pain. They showed although the RCTs were not large trials and well-designed but herbal medicine could reduce pai...

Iranian Journal of Pharmaceutical Research : IJPR, 2017

The aim of this study was to estimate the monetary value of a QALY among patients with heart dise... more The aim of this study was to estimate the monetary value of a QALY among patients with heart disease and to identify its determinants. A cross-sectional survey was conducted through face-to-face interview on 196 patients with cardiovascular disease from two heart hospitals in Tehran, Iran, to estimate the value of QALY using disaggregated and aggregated approaches. The EuroQol-5 Dimension (EQ-5D) questionnaire, Visual Analogue Scale (VAS), Time Trade-Off (TTO) and contingent valuation WTP techniques were employed, first to elicit patients’ preferences and then, to estimate WTP for QALY. The association of patients’ characteristics with WTP for QALY, was assessed through Heckman selection model. The Mean willingness to pay per QALY, estimated by the disaggregated approach ranged from 2,799 to 3599 US dollars. It is higher than the values, estimated from aggregated methods (USD 2,256 to 3,137). However, in both approaches, the values were less than one Gross Domestic Product (GDP) per...

The Relation Between Post Cardiac Surgery Delirium and Intraoperative Factors

IRANIAN JOURNAL OF …, 2009

Results: In this study, the incidence of delirium after open heart surgery was 47%. This study in... more Results: In this study, the incidence of delirium after open heart surgery was 47%. This study indicates that delirium after heart surgery is associated with CPB time> 120 minutes, cross-clamp time> 75 minutes, intraoperative HTC< 30% and intraoperative temperature< 30 o ...

Introducing a method for safe air evacuation from oxygenator in cardiac surgery operating rooms during COVID-19 pandemic

Covid-19 pandemic provides new perspectives and possibly permanent changes in some existing guide... more Covid-19 pandemic provides new perspectives and possibly permanent changes in some existing guidelines and safety principles. Evacuated air from the exhaust reservoir and oxygenator, after close contact with the patient’s blood added contaminated secretions, drain into the operating room, a potential source for contamination. There are two air exhaust ways from the oxygenator in cardiopulmonary bypass (CPB) circuit; which might be the potential carrier of the Covid-19 virus and resulting contamination. In the current design, these two exhausts are connected to one antibacterial and antiviral filter and then they will attach to the ventilator's exhaust port with a three-way connector, in such a way that the contaminated air will be vented outside the operating room. It is recommended to use antibacterial and antiviral filters in the passage way of the contaminated air coming from Reservoir and Oxygenator exhaust, to be directly guided outside the operating room. In this article, ...

1. Odell JA. Coronary artery bypass grafting after previous stenting is associated with compromis... more 1. Odell JA. Coronary artery bypass grafting after previous stenting is associated with compromised long-term efficacy (letter). Ann Thorac Surg 2008; 86:1052. 2. Rao C, Stanbridge RL, Chikwe J, et al. Does previous percutaneous coronary stenting compromise the long-term efficacy of subsequent coronary artery bypass surgery? A microsimulation study. Ann Thorac Surg 2008; 85:501–7. 3. Tovar EA, Blau N, Borsari A, Landa DW, Packer JM. Severe deformity of a Palmaz-Schatz stent after normal surgical manipulation. Ann Thorac Surg 1997; 63:220 –1. 4. Tovar EA, Borsari A. Effects of surgical manipulation on coronary stents: should surgical strategy be altered? Ann Thorac Surg 1997; 63:37– 40. 5. Thielmann M, Leyh R, Massoudy P, et al. Prognostic significance of multiple previous percutaneous coronary interventions in patients undergoing elective coronary artery bypass surgery. Circulation 2006; 114(1 Suppl):I441–7. 6. Thielmann M, Neuhauser M, Knipp S, et al. Prognostic impact of previous ...

Background: Ventricular Septal Rupture (VSR) is a rare but challenging complication after myocard... more Background: Ventricular Septal Rupture (VSR) is a rare but challenging complication after myocardial infarction (MI). In the presence of acute MI, volume and pressure overload lead to acute heart decompensation. The present study was designed to evaluate the early surgical outcome of VSR for over 18 years. Method: This multicenter study was done during 2000-2018, in which 99 patients with post-MI VSR were included. Results: The patients (n=11) presenting hemodynamic deterioration at the time of hospital admission, died before any attempt for surgery. A consecutive series of 88 patients with surgical repair of VSR was evaluated. The mean interval from MI to VSR diagnosis was 7.5±7.2 days and from admission to the operation was 5±5 days. VSR location did not influence the outcome (p=0.1). The concomitant coronary bypass was done for all patients; two-vessel disease was more prevalent (39%). Only 25 patients survived and left the hospital (13 patients died in the operating room due to ...

Background : Despite the general concern about the safety of blood transfusion and mounting evide... more Background : Despite the general concern about the safety of blood transfusion and mounting evidence exist for more restrictive practice; there is no national consensus guideline and uniformity of institutions for blood transfusion associated with coronary artery bypass graft surgery in Iran. The aim of this study is an assessment of current transfusion practice and compares it with one decade ago. Method: The authors retrospectively analyzed the data of all patients undergoing elective surgery (first time operation) during one year, in two different decade interval (2003 and 2015) in a tertiary heart center. Results: A total of 801 patients were evaluated and compared (n=249 in 2015, n=552 in 2003). There is a significant increase in use of blood transfusion in both operating room and at ICU than the last decade (60.6% vs. 42.4%, P <0.001, and 54.4% vs. 39.9%, P <0.001, respectively). The incidence of preoperative anemia was four times higher in patients who received transfus...

Background: Atrial fibrillation is the most common but benign arrhythmia following cardiac surger... more Background: Atrial fibrillation is the most common but benign arrhythmia following cardiac surgery. Although this arrhythmia is often self-limited and vanishes in about 24 hours upon surgery a number of arrhythmias might ensue among which some might be really life-threatening. A multitude of therapeutic modalities have been proposed for the prevention of this arrhythmia and one of them is posterior pericardiotomy. This method has not been fully accepted by the peers yet and more studies are needed to prove its efficacy and benefits to the patients. Methods: In this single-blind randomized clinical trial, done over a 2-year period from February 2009 to January 2011, the effects of posterior pericardiotomy were evaluated in 174 patients (87 the case and 87 the control groups) undergoing elective coronary artery bypass grafting (CABG). The case group underwent CABG with posterior pericardiotomy while the control group underwent CABG-only operation. The postoperative incidence of arrhyt...

Introduction: a number of preventive or therapeutic strategies have been proposed to compensate f... more Introduction: a number of preventive or therapeutic strategies have been proposed to compensate for the inflammatory process during adult cardiac surgeries; none have been considered definitive. 1,25 (OH)2 Vitamin D3 is among the so called physiologic hormones with immunomodulatory effects. This study assessed the effect of oral Vitamin D on serum levels of IL-1, IL-6 and TNF-α in adult CABG. Materials and methods: in a double blind placebo controlled clinical trial, 80 patients entered the study after qualifying study criteria; being divided to Vitamin D and placebo groups, serum cytokines (IL-1, IL-6, and TNF-α) were measured preoperatively and also during the 1 st day after the operation. Results: serum TNF-α levels were similar in the 2 groups; however, postoperative levels of IL-1 and IL-6 were significantly lower in Vitamin D group. Conclusion: the current study demonstrated that oral Vitamin D supplements could augment immunomodulatory effects in adult patients undergoing car...