Complexity of some congenital heart diseases sometimes necessitates a combination of intervention... more Complexity of some congenital heart diseases sometimes necessitates a combination of interventional procedures and surgery, amongst which intraoperative stent implantation is one of the most common. We herein report a successful hybrid procedure in a cyanotic adult patient who had undergone no procedure in childhood. The patient was a 24-year-old cyanotic male (oxygen saturation in the room air was 65%) who presented with dyspnea. According to echocardiography, catheterization, and cardiac magnetic resonance imaging data, the patient was amenable to the Fontan surgery. However, because of significant left pulmonary stenosis and his age, he first underwent a hybrid procedure (Glenn shunt and left pulmonary artery [LPA] stenting). After the procedure, oxygen saturation rose to 83%. At six months' follow-up of the patient, exercise capacity and cyanosis had improved significantly, with O2 saturation having reached near 85% by pulse oximetry.
Objective- The true incidence of congenital cardiovascular malformations is difficult to determin... more Objective- The true incidence of congenital cardiovascular malformations is difficult to determine accurately, partly because of difficulties in definition. About 0.8 percent of live births are complicated by a cardiovascular malformation. Hypoxia and cyanosis, the common complications of all cyanotic disease, may be life-threatening in severe forms. Today, the trend is towards the total surgical correction of these anomalies in early life. As the accomplishment of this strategy in various parts of the world is not possible, palliative procedures like systemic-pulmonary shunt have retained their importance. Methods- Data were collected from the files of 180 patients, for whom systemic-pulmonary shunt was performed by a single surgical group at our center between March 1992 and May 2006. Our aim was to determine the outcome of shunt operation in terms of success rate, morbidity, and mortality. Results- The median age and weight of the patients was 24 months and 10.5 kilograms, respec...
The Journal of Tehran University Heart Center, 2013
Complexity of some congenital heart diseases sometimes necessitates a combination of intervention... more Complexity of some congenital heart diseases sometimes necessitates a combination of interventional procedures and surgery, amongst which intraoperative stent implantation is one of the most common. We herein report a successful hybrid procedure in a cyanotic adult patient who had undergone no procedure in childhood. The patient was a 24-year-old cyanotic male (oxygen saturation in the room air was 65%) who presented with dyspnea. According to echocardiography, catheterization, and cardiac magnetic resonance imaging data, the patient was amenable to the Fontan surgery. However, because of significant left pulmonary stenosis and his age, he first underwent a hybrid procedure (Glenn shunt and left pulmonary artery [LPA] stenting). After the procedure, oxygen saturation rose to 83%. At six months’ follow-up of the patient, exercise capacity and cyanosis had improved significantly, with O2 saturation having reached near 85% by pulse oximetry.
The Journal of Tehran University Heart Center, 2018
An isolated right superior vena cava (RSVC) draining into the left atrium represents a very rare ... more An isolated right superior vena cava (RSVC) draining into the left atrium represents a very rare congenital malformation, especially in the absence of a partial anomalous pulmonary venous return. This condition leads to hypoxemia, cyanosis, and clubbing without any other signs of heart defects. We describe an 8-year-old girl, who was referred to our hospital due to unexplained cyanosis. Segmental approach in transthoracic echocardiography showed left atrial drainage of the RSVC, which was subsequently confirmed by contrast echocardiography and angiography. Surgical repair via trans-section and anastomosis of the superior vena cava to the right atrium was performed to prevent the complications of right-to-left shunting and cyanosis. During a 4-year follow-up, the patient remained in very good clinical status and her serial echocardiography was normal except for very mild left atrial and left ventricular enlargement.
Severe cardiovascular disorders, including aortic dissection and aneurismal dilation of the aorta... more Severe cardiovascular disorders, including aortic dissection and aneurismal dilation of the aorta, are the main life-threatening complications of the Marfan syndrome 1 . Approximately two thirds of individuals who have this syndrome have chest wall deformities such as pectus excavatum or pectus carinatum 2 . When a patient with pectus excavatum needs aortic surgery, the surgeon may face a major clinical challenge in choosing the optimal surgical approach 3 . We present a case of the Marfan syndrome with severe pectus excavatum who underwent aortic surgery (Iranian Heart Journal 2012; 13 (1):55 -58).
Blunt trauma of chest can affect all of the thoracic structures such as cardiac valve. Traumatic ... more Blunt trauma of chest can affect all of the thoracic structures such as cardiac valve. Traumatic tricuspid valve injury is a rare condition with extended clinical manifestation based on the severity of the injury. Diagnosis and treatment may miss for years. We present a case of young male with tricuspid regurgitation (TR) secondary to rupture of anterior chordae following blunt chest trauma 2 years ago. Valvular repair by the technique of bicuspidization and ring annuloplasty was done and postoperative echocardiography showed no TR.
Background: Acute kidney injury (AKI) after cardiac surgery is a relatively common complication a... more Background: Acute kidney injury (AKI) after cardiac surgery is a relatively common complication affecting short- and long-term survival. The renoprotective effect of vitamin D (VitD) has been confirmed in several experimental models. This study was conducted to evaluate the effect of high-dose VitD administration in patients with VitD insufficiency on the incidence of postoperative AKI, the urinary level of tubular biomarkers, and serum anti-inflammatory biomarker after coronary artery bypass graft. Design and Method: In this randomized double-blind controlled clinical trial, the patients were randomly allocated to either the VitD group (n = 50), receiving 150,000 IU VitD tablets daily for 3 consecutive days before surgery or the control group (n = 61), receiving placebo tablets. Results: There was no difference in the incidence of postoperative AKI between the groups. Both of the urinary levels of interleukin-18 and kidney injury molecule-1 were significantly increased after the op...
ObjectiveThe true incidence of congenital cardiovascular malformations is difficult to determine ... more ObjectiveThe true incidence of congenital cardiovascular malformations is difficult to determine accurately, partly because of difficulties in definition. About 0.8 percent of live births are complicated by a cardiovascular malformation. Hypoxia and cyanosis, the common complications of all cyanotic disease, may be life-threatening in severe forms. Today, the trend is towards the total surgical correction of these anomalies in early life. As the accomplishment of this strategy in various parts of the world is not possible, palliative procedures like systemic-pulmonary shunt have retained their importance. MethodsData were collected from the files of 180 patients, for whom systemic-pulmonary shunt was performed by a single surgical group at our center between March 1992 and May 2006. Our aim was to determine the outcome of shunt operation in terms of success rate, morbidity, and mortality. ResultsThe median age and weight of the patients was 24 months and 10.5 kilograms, respectively...
Journal of Cardiovascular Pharmacology and Therapeutics
Background: Vitamin D plays an important role in immune system and in the regulation of inflammat... more Background: Vitamin D plays an important role in immune system and in the regulation of inflammatory cytokines. Coronary artery bypass graft (CABG) with cardiopulmonary bypass (CPB) is associated with an extensive inflammatory response. The aim of this study is to examine the effect of vitamin D treatment on the apoptosis and inflammatory changes developed after CABG. Methods: This trial was conducted on 70 patients undergoing CABG with CPB. Patients were randomly administered either in placebo or in the group of orally consuming 150 000 IU vitamin D daily for 3 consecutive days before surgery. The right atrium sample was taken to assess caspases 2, 3, and 7 activity using immunohistochemistry method. The serum level of interleukin-10 (IL-10) and insulin-like growth factor 1 (IGF-1) were compared at intervals. Results: The average number of positive cells for caspases 2 and 3 were less in vitamin D group ( P = .006 and P < .001, respectively). There was an increase in serum level...
Catheter -induced right atrial thrombi (CRAT) is a serious complication of central venous cathete... more Catheter -induced right atrial thrombi (CRAT) is a serious complication of central venous catheterization. Herein we report a case of large hypermobile right atrial thrombi in a 57- year-old man with hemodialysis catheter in right internal jugular vein.
Congenital lesions of the mitral valve are relatively rare and are associated with a wide spectru... more Congenital lesions of the mitral valve are relatively rare and are associated with a wide spectrum of cardiac malformations. The surgical management of congenital mitral valve malformations has been a great challenge. The aim of this study was to evaluate the early and intermediate-term outcome of congenital mitral valve (MV) surgery in children and to identify the predictors for poor postoperative outcomes and death. In this retrospective study, 100 consecutive patients with congenital MV disease undergoing mitral valve surgery were reviewed in 60-month follow-up (mean, 42.4 ± 16.4 months) during 2008 - 2013. Twenty-six patients (26%) were under one-year old. The mean age and weight of the patients were 41.63 ± 38.18 months and 11.92 ± 6.12 kg, respectively. The predominant lesion of the mitral valve was MV stenosis (MS group) seen in 21% and MR (MR group) seen in 79% of the patients. All patients underwent preoperative two-dimensional echocardiography and then every six months after surgery. Significant improvement in degree of MR was noted in all patients with MR during postoperative and follow-up period in both patients with or without atrioventricular septal defect (AVSD) (P = 0.045 in patients with AVSD and P = 0.008 in patients without AVSD). Decreasing trend of mean gradient (MG) in MS group was statistically significant (P = 0.005). In patients with MR, the mean pulmonary artery pressure (PAP) had improved postoperatively (P &amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;lt; 0.001). Although PAP in patients with MV stenosis was reduced, this reduction was not statistically significant (P = 0.17). In-hospital mortality was 7%. Multivariate analysis demonstrated that age (P &amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;lt; 0.001), weight (P &amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;lt; 0.001), and pulmonary stenosis (P = 0.03) are strong predictors for mortality. Based on the echocardiography report at the day of discharge from hospital, surgical results were optimal (up to moderate degree for MR group and up to mild degree for MS group) in 85.7% of patients with MS and in 76.6% of patients with MR. Age (P = 0.002) and weight (P = 0.003) of patients are strong predictors for surgical success in multivariate analysis. Surgical repair of the congenital MV disease yields acceptable early and intermediate-term satisfactory valve function and good survival at intermediate-term follow-up. Strong predictors for poor surgical outcome and death were age smaller than 1 year, weight smaller or equal than 6 kg, and associated cardiac anomalies such as pulmonary stenosis.
Complexity of some congenital heart diseases sometimes necessitates a combination of intervention... more Complexity of some congenital heart diseases sometimes necessitates a combination of interventional procedures and surgery, amongst which intraoperative stent implantation is one of the most common. We herein report a successful hybrid procedure in a cyanotic adult patient who had undergone no procedure in childhood. The patient was a 24-year-old cyanotic male (oxygen saturation in the room air was 65%) who presented with dyspnea. According to echocardiography, catheterization, and cardiac magnetic resonance imaging data, the patient was amenable to the Fontan surgery. However, because of significant left pulmonary stenosis and his age, he first underwent a hybrid procedure (Glenn shunt and left pulmonary artery [LPA] stenting). After the procedure, oxygen saturation rose to 83%. At six months' follow-up of the patient, exercise capacity and cyanosis had improved significantly, with O2 saturation having reached near 85% by pulse oximetry.
Complexity of some congenital heart diseases sometimes necessitates a combination of intervention... more Complexity of some congenital heart diseases sometimes necessitates a combination of interventional procedures and surgery, amongst which intraoperative stent implantation is one of the most common. We herein report a successful hybrid procedure in a cyanotic adult patient who had undergone no procedure in childhood. The patient was a 24-year-old cyanotic male (oxygen saturation in the room air was 65%) who presented with dyspnea. According to echocardiography, catheterization, and cardiac magnetic resonance imaging data, the patient was amenable to the Fontan surgery. However, because of significant left pulmonary stenosis and his age, he first underwent a hybrid procedure (Glenn shunt and left pulmonary artery [LPA] stenting). After the procedure, oxygen saturation rose to 83%. At six months' follow-up of the patient, exercise capacity and cyanosis had improved significantly, with O2 saturation having reached near 85% by pulse oximetry.
Objective- The true incidence of congenital cardiovascular malformations is difficult to determin... more Objective- The true incidence of congenital cardiovascular malformations is difficult to determine accurately, partly because of difficulties in definition. About 0.8 percent of live births are complicated by a cardiovascular malformation. Hypoxia and cyanosis, the common complications of all cyanotic disease, may be life-threatening in severe forms. Today, the trend is towards the total surgical correction of these anomalies in early life. As the accomplishment of this strategy in various parts of the world is not possible, palliative procedures like systemic-pulmonary shunt have retained their importance. Methods- Data were collected from the files of 180 patients, for whom systemic-pulmonary shunt was performed by a single surgical group at our center between March 1992 and May 2006. Our aim was to determine the outcome of shunt operation in terms of success rate, morbidity, and mortality. Results- The median age and weight of the patients was 24 months and 10.5 kilograms, respec...
The Journal of Tehran University Heart Center, 2013
Complexity of some congenital heart diseases sometimes necessitates a combination of intervention... more Complexity of some congenital heart diseases sometimes necessitates a combination of interventional procedures and surgery, amongst which intraoperative stent implantation is one of the most common. We herein report a successful hybrid procedure in a cyanotic adult patient who had undergone no procedure in childhood. The patient was a 24-year-old cyanotic male (oxygen saturation in the room air was 65%) who presented with dyspnea. According to echocardiography, catheterization, and cardiac magnetic resonance imaging data, the patient was amenable to the Fontan surgery. However, because of significant left pulmonary stenosis and his age, he first underwent a hybrid procedure (Glenn shunt and left pulmonary artery [LPA] stenting). After the procedure, oxygen saturation rose to 83%. At six months’ follow-up of the patient, exercise capacity and cyanosis had improved significantly, with O2 saturation having reached near 85% by pulse oximetry.
The Journal of Tehran University Heart Center, 2018
An isolated right superior vena cava (RSVC) draining into the left atrium represents a very rare ... more An isolated right superior vena cava (RSVC) draining into the left atrium represents a very rare congenital malformation, especially in the absence of a partial anomalous pulmonary venous return. This condition leads to hypoxemia, cyanosis, and clubbing without any other signs of heart defects. We describe an 8-year-old girl, who was referred to our hospital due to unexplained cyanosis. Segmental approach in transthoracic echocardiography showed left atrial drainage of the RSVC, which was subsequently confirmed by contrast echocardiography and angiography. Surgical repair via trans-section and anastomosis of the superior vena cava to the right atrium was performed to prevent the complications of right-to-left shunting and cyanosis. During a 4-year follow-up, the patient remained in very good clinical status and her serial echocardiography was normal except for very mild left atrial and left ventricular enlargement.
Severe cardiovascular disorders, including aortic dissection and aneurismal dilation of the aorta... more Severe cardiovascular disorders, including aortic dissection and aneurismal dilation of the aorta, are the main life-threatening complications of the Marfan syndrome 1 . Approximately two thirds of individuals who have this syndrome have chest wall deformities such as pectus excavatum or pectus carinatum 2 . When a patient with pectus excavatum needs aortic surgery, the surgeon may face a major clinical challenge in choosing the optimal surgical approach 3 . We present a case of the Marfan syndrome with severe pectus excavatum who underwent aortic surgery (Iranian Heart Journal 2012; 13 (1):55 -58).
Blunt trauma of chest can affect all of the thoracic structures such as cardiac valve. Traumatic ... more Blunt trauma of chest can affect all of the thoracic structures such as cardiac valve. Traumatic tricuspid valve injury is a rare condition with extended clinical manifestation based on the severity of the injury. Diagnosis and treatment may miss for years. We present a case of young male with tricuspid regurgitation (TR) secondary to rupture of anterior chordae following blunt chest trauma 2 years ago. Valvular repair by the technique of bicuspidization and ring annuloplasty was done and postoperative echocardiography showed no TR.
Background: Acute kidney injury (AKI) after cardiac surgery is a relatively common complication a... more Background: Acute kidney injury (AKI) after cardiac surgery is a relatively common complication affecting short- and long-term survival. The renoprotective effect of vitamin D (VitD) has been confirmed in several experimental models. This study was conducted to evaluate the effect of high-dose VitD administration in patients with VitD insufficiency on the incidence of postoperative AKI, the urinary level of tubular biomarkers, and serum anti-inflammatory biomarker after coronary artery bypass graft. Design and Method: In this randomized double-blind controlled clinical trial, the patients were randomly allocated to either the VitD group (n = 50), receiving 150,000 IU VitD tablets daily for 3 consecutive days before surgery or the control group (n = 61), receiving placebo tablets. Results: There was no difference in the incidence of postoperative AKI between the groups. Both of the urinary levels of interleukin-18 and kidney injury molecule-1 were significantly increased after the op...
ObjectiveThe true incidence of congenital cardiovascular malformations is difficult to determine ... more ObjectiveThe true incidence of congenital cardiovascular malformations is difficult to determine accurately, partly because of difficulties in definition. About 0.8 percent of live births are complicated by a cardiovascular malformation. Hypoxia and cyanosis, the common complications of all cyanotic disease, may be life-threatening in severe forms. Today, the trend is towards the total surgical correction of these anomalies in early life. As the accomplishment of this strategy in various parts of the world is not possible, palliative procedures like systemic-pulmonary shunt have retained their importance. MethodsData were collected from the files of 180 patients, for whom systemic-pulmonary shunt was performed by a single surgical group at our center between March 1992 and May 2006. Our aim was to determine the outcome of shunt operation in terms of success rate, morbidity, and mortality. ResultsThe median age and weight of the patients was 24 months and 10.5 kilograms, respectively...
Journal of Cardiovascular Pharmacology and Therapeutics
Background: Vitamin D plays an important role in immune system and in the regulation of inflammat... more Background: Vitamin D plays an important role in immune system and in the regulation of inflammatory cytokines. Coronary artery bypass graft (CABG) with cardiopulmonary bypass (CPB) is associated with an extensive inflammatory response. The aim of this study is to examine the effect of vitamin D treatment on the apoptosis and inflammatory changes developed after CABG. Methods: This trial was conducted on 70 patients undergoing CABG with CPB. Patients were randomly administered either in placebo or in the group of orally consuming 150 000 IU vitamin D daily for 3 consecutive days before surgery. The right atrium sample was taken to assess caspases 2, 3, and 7 activity using immunohistochemistry method. The serum level of interleukin-10 (IL-10) and insulin-like growth factor 1 (IGF-1) were compared at intervals. Results: The average number of positive cells for caspases 2 and 3 were less in vitamin D group ( P = .006 and P < .001, respectively). There was an increase in serum level...
Catheter -induced right atrial thrombi (CRAT) is a serious complication of central venous cathete... more Catheter -induced right atrial thrombi (CRAT) is a serious complication of central venous catheterization. Herein we report a case of large hypermobile right atrial thrombi in a 57- year-old man with hemodialysis catheter in right internal jugular vein.
Congenital lesions of the mitral valve are relatively rare and are associated with a wide spectru... more Congenital lesions of the mitral valve are relatively rare and are associated with a wide spectrum of cardiac malformations. The surgical management of congenital mitral valve malformations has been a great challenge. The aim of this study was to evaluate the early and intermediate-term outcome of congenital mitral valve (MV) surgery in children and to identify the predictors for poor postoperative outcomes and death. In this retrospective study, 100 consecutive patients with congenital MV disease undergoing mitral valve surgery were reviewed in 60-month follow-up (mean, 42.4 ± 16.4 months) during 2008 - 2013. Twenty-six patients (26%) were under one-year old. The mean age and weight of the patients were 41.63 ± 38.18 months and 11.92 ± 6.12 kg, respectively. The predominant lesion of the mitral valve was MV stenosis (MS group) seen in 21% and MR (MR group) seen in 79% of the patients. All patients underwent preoperative two-dimensional echocardiography and then every six months after surgery. Significant improvement in degree of MR was noted in all patients with MR during postoperative and follow-up period in both patients with or without atrioventricular septal defect (AVSD) (P = 0.045 in patients with AVSD and P = 0.008 in patients without AVSD). Decreasing trend of mean gradient (MG) in MS group was statistically significant (P = 0.005). In patients with MR, the mean pulmonary artery pressure (PAP) had improved postoperatively (P &amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;lt; 0.001). Although PAP in patients with MV stenosis was reduced, this reduction was not statistically significant (P = 0.17). In-hospital mortality was 7%. Multivariate analysis demonstrated that age (P &amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;lt; 0.001), weight (P &amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;lt; 0.001), and pulmonary stenosis (P = 0.03) are strong predictors for mortality. Based on the echocardiography report at the day of discharge from hospital, surgical results were optimal (up to moderate degree for MR group and up to mild degree for MS group) in 85.7% of patients with MS and in 76.6% of patients with MR. Age (P = 0.002) and weight (P = 0.003) of patients are strong predictors for surgical success in multivariate analysis. Surgical repair of the congenital MV disease yields acceptable early and intermediate-term satisfactory valve function and good survival at intermediate-term follow-up. Strong predictors for poor surgical outcome and death were age smaller than 1 year, weight smaller or equal than 6 kg, and associated cardiac anomalies such as pulmonary stenosis.
Complexity of some congenital heart diseases sometimes necessitates a combination of intervention... more Complexity of some congenital heart diseases sometimes necessitates a combination of interventional procedures and surgery, amongst which intraoperative stent implantation is one of the most common. We herein report a successful hybrid procedure in a cyanotic adult patient who had undergone no procedure in childhood. The patient was a 24-year-old cyanotic male (oxygen saturation in the room air was 65%) who presented with dyspnea. According to echocardiography, catheterization, and cardiac magnetic resonance imaging data, the patient was amenable to the Fontan surgery. However, because of significant left pulmonary stenosis and his age, he first underwent a hybrid procedure (Glenn shunt and left pulmonary artery [LPA] stenting). After the procedure, oxygen saturation rose to 83%. At six months' follow-up of the patient, exercise capacity and cyanosis had improved significantly, with O2 saturation having reached near 85% by pulse oximetry.
Uploads
Papers by Ramin Baghaei