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   2012| October-December  | Volume 13 | Issue 4  
    Online since January 9, 2013

 
 
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ORIGINAL ARTICLES
Study of mitral valve in human cadaveric hearts
SA Gunnal, MS Farooqui, RN Wabale
October-December 2012, 13(4):132-135
DOI:10.4103/1995-705X.105729  PMID:23439693
Objectives: The mitral valve is a complex structure that is altered by disease states. The classical image of the mitral valve is a bicuspid valve with two leaflets and two papillary muscles. The reason for the present study is to study the morphology and morphometry of the mitral valve. Materials and Methods: This study was carried out on 116 human cadaveric hearts. Hearts were opened along the left border through the atrioventricular valve. The diameter and circumference of the annulus was measured and the number of valve leaflets was observed. Results: The mean annular diameter was 2.22 cm. The mean circumference of mitral valve annulus was 9.12 cm. The standard description of the mitral valve is bicuspid. In the present study, we found the number of cusps to be variable, from monocuspid to hexacuspid and classified them accordingly. Conclusions: The mitral valve is not always a bicuspid valve. The number of cusps varies greatly. An increase in the number of the cusp and their improper approximation most likely causes various valvular disorders.
  5 3,045 194
REVIEW ARTICLE
Vulnerable plaque: From bench to bedside; local pacification versus systemic therapy
Sazzli Kasim, Darragh Moran, Eugene McFadden
October-December 2012, 13(4):139-145
DOI:10.4103/1995-705X.105731  PMID:23439781
Critical coronary stenoses accounts for a small proportion of acute coronary syndromes and sudden death. The majority are caused by coronary thromboses that arise from a nonangiographically obstructive atheroma. Recent developments in noninvasive imaging of so-called vulnerable plaques created opportunities to direct treatment to prevent morbidity and mortality associated with these high-risk lesions. This review covers therapy employed in the past, present, and potentially in the future as the natural history of plaque assessment unfolds.
  3 2,565 101
CASE REPORTS
Spontaneous coronary artery dissection: Case report and review of literature
Monodeep Biswas, Arjinder Sethi, Stephen J Voyce
October-December 2012, 13(4):149-154
DOI:10.4103/1995-705X.105737  PMID:23439852
Spontaneous coronary artery dissection (SCAD) is an unusual cause of acute coronary syndrome or sudden cardiac death. SCAD has most frequently been described as presenting as an acute coronary syndrome in females during the peripartum period. It may also be associated with autoimmune and collagen vascular diseases, Marfan's syndrome, chest trauma, and intense physical exercise. The most common presentation of SCAD is the acute onset of severe chest pain associated with autonomic symptoms. This condition has a high mortality rate if not identified and treated promptly. Here, we present a case of SCAD presenting with stroke, followed by a brief review.
  2 4,566 131
ORIGINAL ARTICLES
Atrial fibrillation and early clinical outcomes after mitral valve surgery in patients with rheumatic vs. non-rheumatic mitral stenosis
SJ Mirhosseini, Sadegh Ali-Hassan-Sayegh, Mehdi Hadadzadeh, Nafiseh Naderi, S. M. Y Mostafavi Pour Manshadi
October-December 2012, 13(4):136-138
DOI:10.4103/1995-705X.105730  PMID:23439740
Background: Atrial fibrillation (AF) is the most common arrhythmia after open heart surgery that can lead to early morbidity and mortality following operation. Mitral stenosis (MS) is a structural abnormality of the mitral valve apparatus that can be resulted from previous rheumatic fever or non-rheumatic fever such as congenital mitral stenosis, malignant carcinoid disease etc. This study was designed to test the hypothesis that type of mitral stenosis can affect the incidence, duration and frequency of AF post mitral valve replacement. Materials and Methods: We selected fifty patients with rheumatic mitral stenosis and 50 patients with non-rheumatic mitral stenosis who were candidates for mitral valve replacement (MVR) surgery. Pre-operative tests such as CRP, ESR, CBC, UA, ANA, APL (IgM, IgG), ANCA, RF were performed on participants' samples and the type of mitral stenosis, rheumatic or non-rheumatic, was determined clinically. Early post-operative complications such as infection, bleeding, vomiting, renal and respiratory dysfunction etc., were recorded. All patients underwent holter monitoring after being out of ICU to the time of discharge. Results: The mean age of patients was 48.56 ± 17.64 years. 57 cases (57%) were male, and 43 cases (43%) were female. Post-operative AF occurred in 14 cases (14%); 3 cases (6%) in non-rheumatic mitral stenosis group, and 11 cases (22%) in the rheumatic mitral stenosis group. There was a significant relationship between the incidence of AF and type of mitral stenosis (P = 0.02). Renal dysfunction after MVR was higher in rheumatic MS group than in non-rheumatic MS group (P = 0.026). There was no relationship between the type of mitral stenosis (rheumatic or non-rheumatic) and early mortality after mitral valve replacement (P = 0.8). Conclusion: We concluded that the type of mitral stenosis affect post-operative outcomes, especially the incidence of atrial fibrillation and some complications after mitral valve replacement.
  2 3,852 223
CASE REPORTS
Mobile pedunculated left ventricular masses in a man with recurrent emboli
Rostam Esfandiar Bakhtiari, Arsalan Khaledifar, Majid Kabiri, Zahra Danesh
October-December 2012, 13(4):146-148
DOI:10.4103/1995-705X.105734  PMID:23439797
A 51-year-old man was found to have left ventricular masses by transthoracic echocardiography, one attached to the posterior wall of the left ventricle and another attached to the anterolateral wall of the left ventricle. He had several events of systemic embolization over the last few weeks. Surgical excision was recommended to avoid further embolization. The patient underwent successful resection of the left ventricular masses under cardiopulmonary bypass through the left atrial and transverse aortotomy approach. Histopathologic exam was diagnostic for organized thrombi.
  1 2,413 91
A PICTURE IS WORTH A THOUSAND WORDS
A coin in the heart
Leili Pourafkari, Rezayat Parvizi, Ahmad Separham, Samad Ghaffari
October-December 2012, 13(4):155-155
DOI:10.4103/1995-705X.105738  PMID:23437417
  - 1,407 124
ART AND MEDICINE
A heart at El Kurru Royal Necropolis of Napata (Kush)
Siddiq I Khalil
October-December 2012, 13(4):156-157
DOI:10.4103/1995-705X.105740  PMID:23437418
  - 1,551 60
HISTORY OF MEDICINE
The Air of History (Part II) Medicine in the Middle Ages
Rachel Hajar
October-December 2012, 13(4):158-162
DOI:10.4103/1995-705X.105744  PMID:23437419
  - 7,768 153
ORIGINAL ARTICLES
Clinical outcome, and survival between primary percutaneous coronary intervention versus fibrinolysis in patients older than 60 years with acute myocardial infarction
H Falsoleiman, GH Fatehi, M Dehghani, MT Shakeri, Baktash Bayani, Mostafa Ahmadi, Atoosheh Rohani
October-December 2012, 13(4):129-131
DOI:10.4103/1995-705X.105728  PMID:23439588
Objective: The aim of the present study was to compare the short-term and 6-month clinical outcome, and survival in patients older than 60 years with ST-elevation myocardial infarction randomized to either primary percutaneous coronary intervention (PPCI) or thrombolysis. Materials and Methods: 82 patients with STEMI older than 60 years were randomized to either primary PCI or thrombolysis from September 2006 to August 2008. Angiograms were reviewed by two interventionalists not involved in the study. Patients randomized to primary PCI received Aspirin and 600 mg Clopidogrel. Heparin was administered in conjunction with PCI. Patients randomized to thrombolysis received Aspirin followed by streptokinase infusion for one hour. Rescue PCI was considered if there was ongoing pain and ST-segment resolution was <50% at 90 min. after initiation of thrombolysis or chest pain recurred with ST-segment elevation within 24 hours. All patients were followed up for 6 months. End points were reinfarction and cardiac death using competing-risks regression estimation. Results: The mean time from hospital admission to start of streptokinase infusion was 31 ± 15 min and door to balloon time was 70 ± 25 min. There was no significant difference between the groups in the number of deaths and reinfarctions at 6 months. As expected, the fibrinolysis group had a higher rate of revascularization and heart failure. Conclusion: The higher rates of heart failure and need for revascularization in the fibrinolysis group reinforces benefits of PPCI in patients older than 60 years. PPCI in those who are 60 years and above with AMI is safe and cost effective.
  - 2,036 171
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