Background: Thrombotic and thromboembolic events are important causes of mortality and morbidity in patients with prosthetic HEART VALVE. The aim of this study is to evaluate the factors that may contribute to prosthetic HEART VALVE thrombosis. Methods: This was a cross-sectional study in Rajaie HEART Center on patients with prosthetic HEART VALVE malfunction, within a year. According to the echocardiographic and fluoroscopic findings, the patients were divided into two groups (thrombosis and non-thrombosis groups). The patients’ demographic, clinical and laboratory data were recorded and analyzed with SPSS software. Results: A total of 142 patients participated in this study. Ninety-four patients (66. 2%) were diagnosed with thrombosis. There was a significant relationship between thrombosis and inadequate anti-coagulation (international normalized rati [INR] <2. 5) (odds ratio [OR]: 4. 15, 95% CI: 1. 98-9. 87, P = 0. 003), history of infection (OR: 12. 81, 95% CI: 3. 52-19. 02, P < 0. 001), prothrombin time (PT) check interval (OR: 2. 38, 95% CI: 1. 63-8. 47, P = 0. 019), atrial fibrillation (AF) rhythm (OR: 3. 96, 95% CI: 1. 75-8. 09, P = 0. 019), and plasma fibrinogen level (OR: 6. 90, 95% CI: 2. 58-14. 69). Conclusion: Based on this study, inadequate anti-coagulation, AF rhythm, recent infection and plasma fibrinogen level were the factors most contributing to prosthetic VALVE thrombosis. As there were many cases of thrombosis in patients with history of infection, this factor can be considered for risk assessment in prosthetic VALVE.

Introduction: All patients with HEART VALVE repair must use warfarin as an anticoagulant drug for a long time to prevent for ming and expanding clots. Objective: to control use of warfarin in patients with HEART vulve repair. Method: searching the internet and study other articles. Description: in patients with HEART VALVE repair, blood tends to clot when faced by external particles, therefore, the blood coagulation system should be weakened and clot formation should be stopped and prevented from expandeding by prescribing adequate warfarin. A set of test concerning blood and coagulants should be done as a base before starting any type of anticoagulant therapy, e.g. platelet count, and hematocrit, INR, PT tests. Warfarin act and its anticoagulant effect should be measured by INR, PT tests. The normal amount of INR is 1-1.5 which should be kept to 2-3.5 to obtain the desired condition. Hemorrhage is probable if INR increased to 4-5. It should be noted that certain drugs and foods increase or decrease INR,e.g. antiacids, barbiturates, and foods rich with vitamin k (greens) and liver reduce INR, while aspirin,heparin and alcohol increase it. These patients should carry a card specifying the name of the anticoagulant drug and the dosage. In a good recovery, warfarin should be taken for 3-6 months. An in-patient needs to do theINR, pt tests daily and after discharging the tests done weekly or monthly as directed by a physician. The dosage for warfarin will be decided according to the test result. Conclusion: Warfarin is of great importance to patients with HEART VALVE repair, thus training and instructing the patients on how to use it, and how to do INR, pt test on time can successfully help in recovering the HEART VALVE.

Objective- Evaluation of the natural history of prosthetic HEART VALVEs is very important because of their serious complications. This study was performed to assess the natural history, efficiency and durability of prosthetic HEART VALVEs implanted from 1976 to 1993 at our center in Tehran. We also compared these results with other reports. Methods- Data of this cross-sectional descriptive study were collected by questionnaire from 4672 files in our hospitals medical records department. Results- 4672 patients, 51 % male and 49% female, aged 32.7±4 years, were evaluated in this study. The average age of females at operation was higher than that of males (33.6 vs. 31.6 yrs.). The most frequent underlying etiology for valvular HEART diseases was rheumatic fever (80.37%) and congenital diseases (8.24%). The mechanical prosthetic VALVEs have been used more frequently than bioprosthetic VALVEs (92.7% versus 7.3%). The Bjork-Shiley and St. Jude mechanical VALVEs were the most widely used prostheses, respectively. The most common complication with the prosthetic VALVEs was paravalvular leak, which was seen more commonly with the tilting disc type VALVEs. The most common cause of prosthesis-related death was paravalvular leak in our center. Conclusion- The new generation bi-leaflet prosthetic VALVEs are low-profile prostheses which exhibit the least obstruction to forward flow and the best hemodynamic function in our department, compared to the other prosthetic VALVEs (Iranian HEART Journal 2003; 4 (2,3): (15-19).

Background: Atrial fibrillation (AF) is the most common complication after cardiac surgery and a major cause of morbidity and increased cost of care. Suitable treatment and prevention of postoperative AF are important for patients' improved health and rehabilitation. This study evaluates the risk factors of paroxysmal AF in patients who underwent valvular HEART surgery.Method: Between April and October 2006, 392 patients who underwent HEART VALVE surgery at our center were included in this prospective study. All relevant clinical, echocardiographic, and laboratory data were gathered in all the patients.Results: Postoperative AF occurred in 52 (13.3%) patients. In the univariate analysis, the presence of aortic VALVE disease, mitral VALVE disease, dyslipidemia, preoperative digoxin consumption, postoperative adrenergic use, intra-aortic balloon pump (IABP) insertion in post-surgery intensive care unit, and large left atrium were significantly associated with the occurrence of postoperative AF (all P<0.05). However, in the stepwise logistic regression model, dyslipidemia (OR: 2.39, 95% CI: 1.12-5.09, P=0.020), left atrium dimension (OR: 0.12,95% CI: 0.76-0.28, P<0.001), IABP (OR: 7.10, 95% CI: 1.98-25.47, P=0.001), preoperative digoxin use (OR: 2.55, 95% CI: 1.38-4.71, P=0.002), postoperative adrenergic use (OR:3.70, 95% CI: 1.77-7.73, P<0.001), aortic VALVE replacement (OR:0.38, 95% CI: 0.20-0.69, P=0.0001), and mitral VALVE replacement (OR:3.53, 95% CI: 1.75-7.10, P<0.001)remained independently predictive of postoperative AF.Conclusions: The result of this study showed that dyslipidemia, left atrium dimension, mitral VALVE replacement, aortic VALVE replacement, IABP, and adrenergic use in ICU and digoxin use preoperatively were the independent predictors of AF after valvular surgery. Therefore, clinical data and echocardiography may be useful in preoperative risk stratification of high-risk patients for the occurrence of postoperative AF.

Background: The interest in beating HEART surgery is growing since better results can be obtained with this procedure compared to conventional myocardial protection techniques using cardioplegic solutions. This led us to consider mitral VALVE replacement with beating HEART.Objectives: This study aimed to determine the safety and efficacy of beating HEART mitral VALVE replacement without cross clamp.Methods: This prospective study was conducted on the patients with isolated mitral VALVE disease requiring mitral VALVE replacement according to ACC / AHA guidelines. In this study, 15 patients underwent mitral VALVE replacement using beating HEART technique (Group A) and 15 ones underwent mitral VALVE replacement using arrested HEART technique (Group B). The patients were randomized using block randomization. The data were analyzed using the SPSS statistical software.Results: Preoperative parameters were comparable in the two groups. Most of the patients in both study groups were in NYHA class III or IV. Postoperatively, however, most of the patients in the two groups were either in NYHA class I or II. No mortality occurred in the beating HEART group, while one mortality occurred in the arrested HEART group. The results showed a significant difference between the two groups regarding the mean bypass time, mean operating time, mean ICU stay, and mean length of hospital stay.Conclusions: Beating HEART mitral VALVE replacement is equally safe as the arrested HEART technique. Thus, it is recommended as an appropriate alternative to the arrested HEART technique for mitral VALVE replacement.

Introduction: It is well-documented that right-sided HEART dysfunction and significant tricuspid VALVE regurgitation (TVR) have adverse effects on patient outcomes after left-sided HEART VALVE surgery. Therefore, the evaluation of right ventriclular (RV) function and TR severity in patients who had undergone mitral VALVE replacement (MVR), associated with/without concomitant surgery on tricuspid VALVE, could be helpful for deciding on the necessity of concomitant tricuspid VALVE intervention before surgery. Materials and Methods: A total of 222 patients with MVR for rheumatic disease were evaluated in our Echocardiography Lab in Ghaem Hospital, Mashhad, Iran, within 2013-2018. The patients were divided into four groups, according to their type of concomitant TV. The subjects (n=11) with concomitant indications for coronary artery bypass grafting (CABG) or history of coronary artery disease were excluded from the study. Results: Signi5icant (at least moderate) TVR was found in 60% of the patients. All patients with rheumatic tricuspid VALVE had significant TVR. After excluding the patients with significant pulmonary hypertension, there was no difference in the prevalence of significant TR, between the patients with tricuspid VALVE repair and those without any intervention on tricuspid VALVE (P=0. 178). Furthermore, no difference was observed between the patients with/without any intervention on tricuspid VALVE considering RV size and function. Conclusion: In patients with left VALVE surgery concomitant with TR, tricuspid VALVE repair and replacement could preserve RV size and function, for a long time. During the correction of the left-side valvulopathy, it seems rational to adopt more interventional consideration for patients with tricuspid VALVE regurgitation, especially those with rheumatic tricuspid VALVE involvement.