Journal of

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Despite all the diagnosis and treatment processes of pulmonary thromboembolism (PTE), it is still associated with a high rate of mortality. We describe a massive PTE case of a 73-year-old woman with unusual clinical manifestations.

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Introduction: Atrial fibrillation (AF) is the most common complication of cardiac surgery which may cause remarkable morbidity and complications. Identifying predicting factors of this arrhythmia can help prophylactic therapy. The present study is designed to investigate the hypothesis that HsCRP level and P-wave characteristics are associated with the incidence of post-operative AF.
Methods: In this prospective study, 50 consecutive patients undergoing coronary artery bypass graft (CABG) operation during a 1-year period at Vali-e-asr Hospital, Birjand, Iran were enrolled. All the patients underwent electrocardiography (ECG) before surgery and P-wave duration and height were measured. In addition, blood samples were collected the day before surgery as well as 12, 24 and 72 hours after surgery to measure CRP serum levels. Patients were monitored after surgery to detect probable AF rhythm. Data was analyzed using SPSS 16.
Results: Of the 50 patients, 10 (20%) developed AF in the postoperative phase during days 1 to 5, while the other 40 patients (80%) had stable sinus rhythm. P-wave duration and height were significantly different in patients who subsequently developed postoperative AF with the mean values of 109.5±15.7 and 0.14±0.03, respectively. Mean HsCRP levels before and 12, 24, and 72 h after operation showed no significant difference.
Conclusions: Patients prone to AF arrhythmia can be identified by measuring P-wave duration and height in preoperative ECG. Hs.CRP levels before and after CABG surgery may not contribute to AF prediction.

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Introduction: Opium addiction is a social and health problem in many parts of the world, including Iran. The exact effects of this substance on the cardiovascular system and postoperative complications are not clear And the results of studies in this regard are also contradictory, Therefore, the present study aims to compare short-term mortality After coronary artery bypass surgery In two groups Opium consumer And non-consumer was done.
Methods: This cross-sectional study was performed on 194 patients who were hospitalized during September 2013 to September 2015 In Valiasr Hospital of Birjand, they were under CABG operations conducted. In this study, short-term mortality)Hospital and a month After discharge) Through existing records And phone calls were reviewed. All data were analyzed by SPSS 22 software and analyzed using descriptive and inferential statistics.
Results: Of the 194 patients who had undergone surgery twenty-three patients (12.2%) used opioid Among them, In the form of Inhaler, 13 patients (56.5%) orally And 3 patients (13%) was a combination of orally and inhaled. In general, there is a case of mortality during surgery And 7 cases (77.77%) of mortality occurred in the Hospital ward. During the one month follow up, There was a death case. Among the non-addicted patients164 case were alive and 7 died And among addicted patients as well 22 cases were alive And there was a death case. Finally, the results showed, No statistically significant difference between the mortality after surgery, Blood lipids, and diabetes, In two groups Opium consumer And non-consume(p>0/05). But hypertension in the non-addicted group was significantly higher (p <0.05).
Conclusions: Based on the results of this study, there was no significant relationship between opioid dependence and short-term mortality in patients after CABG surgery. Due to low sample size and cross-sectional study, The design of cognitive studies with higher sample sizes seems to be necessary in order to discover causal relationships.

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• Patent ductus arteriosus (PDA) is an inborn heart defect in which the ductus arteriosus (i.e., a vascular structure between the pulmonary artery and aorta that usually closes shortly after birth) remains open. Because most patients with PDA are diagnosed and treated when they are infants, this is a relatively rare congenital heart defect among adults. Herein, we present the cases of PDA in adults, which were detected during cardiac surgery.

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• Arrhythmia is one of the most common cardiovascular complications during anesthesia. Its occurrence has been reported in 70% of patients undergoing general anesthesia for various surgical procedures. Premature ventricular complex usually follows a benign course and shows a good response to medical therapy. In this study, a case was reported that did not respond to the usual treatment of ventricular tachycardia and frequent premature ventricular complex.

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• Introduction: Heart valve disease in pediatricsis an increasing global concern, especially in developing countries. This study aims to determine the clinical outcomes of pulmonary valve replacement (PVR) surgery in pediatrics.
• Methods: The authors retrospectively identified all pediatrics undergoing PVR surgery at Imam Reza hospital (Mashhad, Iran) between 2000 and 2020. Their medical records were reviewed for demographic characteristics, clinical data (intra-operative and postoperative), and follow-up results. Echocardiography and electrocardiography were performedonall patients before the surgery and periodically after the surgery.
• Results: Among 50 pediatrics undergoing surgical PVR, 38 (76%) were female and others were male (14%), with a mean age of 10.39±5.31 years. The leading cause of PVR was the Tetralogy of Fallot. There was a significant relationship between age at the time of surgery and the size of the pulmonary valve(P=0.02).There were also statistically significant differences between QTc intervals before and after surgery (P=0.001). Further more, there was a significant correlation between QTc intervals before and after surgery and the ageof pediatrics at the time of surgery (P=0.01, r=-0.6).There was also a statistically significant relationship between the ICU stay (P=0.01) and the weaning time of the mechanical ventilation (P=0.03).
• Conclusion: It is recommended that this procedure ispostponed as much as possible to decrease postoperative life-threatening events in pediatrics.In addition, if this surgery is conducted with good surgical and nursing management, it can be safe with low complications among other cardiac valve procedures.

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• The Tetralogy of Fallot is the most common cyanotic congenital heart disease that is often associated with chromosomal aberration had a high prevalence rate of all congenital heart diseases. The association of the Tetralogy of Fallot (ToF) with other congenital cardiac defects, especially with hypertrophic cardiomyopathy, is infrequent. While, unlike the tetralogy of Fallot, hypertrophic cardiomyopathy is accompanied by specific gene loci.
• We report this scarce association in a 6-month male infant, cyanotic since birth and known with ToF, in her first hospital admission for treatment of recurring cyanotic crises. After the preliminary evaluations and the unsuccessful stenting of the patent ductus arteriousus (PDA) under an angiographic manner, he was prepared to undergo cardiac surgery to establish a modified Blalock-Taussig Shunt procedure. The patient was discharged in good condition and suggested that his parents follow up on his cardiac function after it. On follow-up at the age of three, the child had no cyanotic crises in this period.

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• Introduction: Peripheral arterial disease in coronary artery disease (CAD) is associated with poor cardiovascular outcomes. This issue is more highlighted in patients undergoing coronary artery bypass graft surgery after catheterization procedures.
• Methods: This study was observational on participants who recourse to the heart clinics and candidates for coronary angiography, based on inclusion and exclusion criteria. In the first, coronary angiography was performed, and so, if the patients had significant involvement of coronary arteries and had at least one inclusion criteria, for assessment of peripheral arterial disease (PAD), peripheral angiography through the femoral artery was performed. The statistical analysis was done by SPSS software (Version 16) and the data were analyzed using the descriptive statistics method, variance analysis, and Fisher's Exact Test. The level of significance was considered to be (0.05).
• Results: Among all patients, there was no significant difference in the demographic variables such as gender (P= 0.497) and age (P= 0.069). The commonest peripheral artery involved in patients was the right femoral artery. A statistically significant relationship between gender and PAD was seen (P=0.001). There was no significant relationship between the type of involved coronary artery and gender (p=0.043; Fisher's Exact Test = 10.719).
• Conclusion: More than one-third of participants with CAD had peripheral arterial involvement in iliofemoral arteries in this study. This situation increased the risk of complications in vascular blind catheterization. So, Improving PAD detection is crucial for more effective cardiovascular prevention and treatment.