JOURNAL OF CARDIO THORACIC MEDICINE
Year:2016 | Volume:4 | Issue:2|Papers Count:8

Transcatheter aortic valve replacement (TAVR) is a novel therapeuticintervention for the replacement of severely stenotic aortic valves in highrisk patients for standard surgical procedures. Since the initial PARTNERtrial results, use of TAVR has been on the rise each year. New deliverymethods and different valves have been developed and modified in orderto promote the minimally invasive procedure and reduce commoncomplications, such as stroke. This review article focuses on the currentdata on the indications, risks, benefits, and future directions of TAVR.Recently, TAVR has been considered as a standard-of-care procedure. Whilethis technique is used frequently in high-risk surgical candidates, studies havebeen focusing on the application of this method for younger patients withlower surgical risk. Moreover, several studies have proposed promising resultsregarding the use of valve-in-valve technique or the procedure in which thevalve is placed within a previously implemented bioprosthetic valve. However, ischemic strokes and paravalvular leak remain a matter of debate in thesesurgeries. New methods and devices have been developed to reduce theincidence of post-procedural stroke. While the third generation of TAVR valves(i.e., Edwards Sapien 3 and Medtronic Evolut R) addresses the issue ofparavalvular leak structurally, results on their efficacy in reducing the risk ofparavalvular leak are yet to be obtained. Furthermore, TAVR enters the field ofhybrid methods in the treatment of cardiac issues via both surgical andcatheter-based approaches. Finally, while TAVR is primarily performed oncases with aortic stenosis, new valves and methods have been proposedregarding the application of this technique in aortic regurgitation, as well asother aortic pathologies.TAVR is a suitable therapeutic approach for the treatment of aorticstenosis in high-risk patients. Considering the promising results in thecurrent patient population, recent studies have been conducted toevaluate the efficacy of this approach as a standard-of-care procedure.

Introduction: Limited data are available on the relationship betweennutritional status and tuberculosis. The aim of this study was to evaluateand compare the body mass index (BMI) and serum albumin level inpatients with active tuberculosis (ATB) and latent tuberculosis (LTB).Materials and Methods: A cross-sectional study was conducted on 17patients newly diagnosed with pulmonary TB who were referred in Iran, during September 2011 to March 2012 and 17 latent tuberculosisinfection individuals. Standard method was performed to collect an earlymorning fasting blood sample for albumin (by the bromocresolgreenmethod). Also (BMI) was calculated as body weight divided by heightsquared (kg/m2).Results: One-sample Kolmogorov-Smirnov test was used to check normaldistribution data The mean ± Standard deviation (SD) for albumin in thepatients and controls were 3.62±0/56 and 4.68±0.25, respectively. BMI inthe patients and controls were 19.46±2.79 and 25.4±3.46, respectively.The serum albumin level was significantly lower in the patient group, compared to the control group (P<0.001).BMI was significantly lower inthe patient group, compared to the control group (P<0.001).Conclusion: Our findings demonstrated that BMI and serum Albumin weresignificantly lower in the active tuberculosis patients than latent tuberculosisgroups.

Introduction: Lung cancer is one of the leading causes of cancer relateddeaths in the world. The incidence of lung cancer is increasing in India andthere is a need to understand the natural history of this disease.Aim of the study: To study the clinico- pathological- radiological profile ofpatients diagnosed with lung cancer from January 2013 to May 2015 at atertiary care teaching hospital.Materials and Methods: Inpatient records of all patients admitted duringthe study period were examined and all patients with a histologicallyproven diagnosis of bronchogenic carcinoma were recruited. Demographiccharacteristics, clinical, radiological and pathological details of eachpatient were recorded.Results: Fifty four patients with lung cancer were identified. Forty three(79.6%) were male and 11 (20.4%) were female. Thirty two (59.7%) weresmokers and 22 (40.7%) were non smokers. Cough and expectoration(61.1%) was the most common presenting symptom followed bybreathlessness (59.3%). Mass lesion (81.5%) was the most commonradiological presentation and adenocarcinoma (42.6%) was the mostcommon histological subtype. When compared to fiber opticbronchoscopy, image guided percutaneous biopsy had a better yield fordiagnosing lung cancer (51.9% vs 48.1%). But this difference was notstatistically significant (p=0.892)Conclusion: Adenocarcinoma is replacing squamous cell carcinoma as themost common type of lung cancer in India.

Introduction: Psychological symptoms of non-cardiac chest pain (NCCP)including perceptual, emotional, and behavioral problems can effectpatient perception of chest pain. This study was conducted to determinethe effect of metaphor therapy on mitigating depression, anxiety, stress, and pain discomfort in patients with NCCP.Materials and Methods: This randomized, controlled, trial was conductedon 28 participants, who had visited the emergency department ofKermanshah Imam Ali Heart Hospital because of experiencing NCCPduring the June to September 2014. The patients were randomly assignedto metaphor therapy and control groups (n=14 for each group) during afour-week period. Our data collection questionnaires included PainDiscomfort Scale (PDS) and Depression, Anxiety and Stress Scale (DASS).Chi-square and MANCOVA tests were run, using SPSS version 20.Results: Twenty patients (71.4%) completed the trial period until the finalassessment. Our findings showed that metaphor therapy couldn’t lowerdepression, anxiety, stress, and pain discomfort; In fact, there was not asignificant difference between the metaphor therapy and control groupsregarding the aforementioned variables (P>0.05).Conclusions: Although the study results did not support the effectivenessof metaphor therapy for NCCP, further studies on the potential role ofmetaphor therapy in attenuating NCCP symptoms seem to be necessary.

Introduction: Heart failure is a major hazard for public health. Despite recent advance inmedical therapy, there is not enough information on the outcome of off-pump coronaryartery bypass (OPCAB) and medical therapy on the patients with severe ventriculardysfunction and triple-vessel (CAD). This study aimed to compare treatment outcomesand mortality rate in patients undergoing off-pump coronary artery bypass (OPCAB)surgery and medical therapy who presented with severe ventricular dysfunction andtriple-vessel coronary artery disease (CAD).Materials and Methods: This retrospective cohort study was conducted on patients withsevere ventricular dysfunction and triple-vessel CAD during 2010-2011 in the Imam AliHospital of Kermanshah University of Medical Science. Patients were divided into twogroups of medical therapy (group one) and OPCAB (group two). Follow-up data werecollected after 30 months. Survival estimation was performed using Kaplan-Meiersurvival analysis and Cox regression model.Results: Of the 276 enrolled patients, 139 (50.4%) underwent group one and 137 (49.6%)group two. Study groups were homogenous in baseline characteristics, with the exceptionof hyperlipidemia (P=0.005). A significant difference was observed in cardiac mortalityrates between the study groups (hazard ratio: 0.260; 95% confidence interval: 0.105-0.644; P=0.004). However, no significant difference was observed between the groupsregarding the frequency of admission due to decompensate heart failure (P=0.17). Inaddition, the rate of admission due to acute coronary syndrome (ACS) in the first groupwas higher than the second group, significantly (P=0.001). Level of ejection fraction (EF)had a significant increase after coronary artery bypass graft (CABG) (28.50) compared tothe preoperative stage (27.59) (P=0.042). However, no significant increase in the level ofEF was observed in the first group before and after medical therapy (27.28 and 27.20, respectively) (P=0.83).Conclusion: According to the results of this study, the mortality rate associated withOPCAB was lower compared to medical therapy, ACS and EF enhancement in patientswith triple-vessel CAD and severe ventricular dysfunction.

Thoracobiliary fistula is a rare complication of hydatid cyst of the liverespecially in the calcified form. Surgery is the only medical option. Thetreatment consists of radical surgical procedures in the majority of thepatients. Conservative surgical treatments are performed with highmortality rate. Herein, we will describe two patients of calcified hydatidcysts of the liver whose condition becomes complicated withThoracobiliary fistula.The first patient was treated with right thoracotomy and resection ofpleural hydatid cysts. Then, were evacuated the ruptured laminatedmembrane and daughter cysts of infected hepatic hydatid cysts throughdiaphragmatic opening and sub diaphragmatic drainage of the calcifiedliver hydatid cyst. The second patient was also treated with rightthoracotomy, resection of pulmonary hydatid cysts, evacuation ofruptured bile stained laminated membrane and daughter cysts of hepatichydatid cysts through diaphragmatic opening and sub diaphragmaticdrainage of the calcified cyst cavity.Our patients underwent conservative surgery which posed a severe risk.Both cases are discussed together with review of the literature.

Aortic dissection occurs when a tear develops in the wall of the aorta, which israre in the young population. This fatal disorder is hard to diagnose, especiallyin young patients. We present the case of aortic dissection in a 15-year-old boyreferred to the Emergency Department of Yazd University of Medical Sciencesin November 2015. The patient presented to our department with suddenacute chest pain. Emergent computed tomography (CT) scanning of the brain, chest, and abdomen reflected bilateral pleural effusion, biluminal aorta, arterial flap in the upper part of the abdominal aorta, and dilated small bowlloop. The patient did not have any aortic dissection risk factors such as historyof connective tissue disease, congenital heart disease, coarctation of the aorta, and hypertension. The only noticeable point in the patient’s history wasswimming two hours before the onset of the chest pain. Aortic dissection is arare differential diagnosis in children with acute sudden chest pain.

Herein, we present the case of a 45-years-old woman with a foreign body(dental prosthesis) ingestion lodged in the esophagus (Figure.1). Theforeign body was extracted by rigid esophagoscopy after severemanipulation. In 24 hours, the patient became febrile with emphysema inthe neck. laboratory data showed leukocytosis and CT scan revealed signsof esophageal perforation (Figure.2). Surgical exploration and drainage ofthe neck and mediastinum performed through a collar incision in the neckextended to the anterior of SCM in both sides, but we didn' t performfeeding jejunostomy. We inserted one corrugated drain in every side of theneck (Figure.3).Patient was NPO for two weeks and brief total parenteralnutrition (TPN) provided her calory.Finally, we succeeded to fistulized theperforation to the skin and control the mediastinitis (Figure.4).Patientregained oral feeding gradually after two weeks NPO. The follow-upesophagogram revealed the passage of the contrast to the distal esophaguswith no leak and fistula.Early recognition of perforation could interruptmajor operation to control catastrophic complication.