Background and Objectives:Physical activity is one of the core components in cardiac rehabilitation and secondary prevention programs. This study investigated the effect of an intervention based on the health action process approach (HAPA) together with family support in the maintenance of physical activity and exercise capacity in coronary heart disease after discharge from rehabilitation.Method and Materials:In this randomized controlled trial, 96 patients with coronary heart disease were randomly assigned to control and intervention groups at the end of a rehabilitation program at Afshar Hospital, Yazd, Iran. HAPA Constructs and family support using a self-reported questionnaire and maximal oxygen uptake through a treadmill exercise test were measured prior to and 4 months after the intervention.Results:HAPA-based intervention together with family support increased scores of HAPA constructs and family support in the intervention group compared with the control group. The results showed that physical activity and exercise capacity in the intervention group was significantly higher than the control group after the intervention.Conclusion:HAPA-based intervention together with family support can be a useful tool for maintenance of physical activity and exercise capacity in coronary heart disease.

Background: Symptomatic or asymptomatic deep vein thrombosis (DVT) is a common complication following coronary artery bypass graft (CABG), in which less than 1% of these patients suffer from clinically evident pulmonary embolism (PE DVT in CABG. (Cardiol J 2013; 20, 2: 139-143)

No abstract

Background:Atrial fibrillation (AF) occurs in 30% patients on the second or third day post operation; therefore, it is the most prevalent and complicated arrhythmia after open heart surgery. White blood cell (WBC) count seems to be most significantly associated with cardiovascular disorders. This study was designed to evaluate the exact relationship between preoperative WBC count and post-Coronary artery bypass graft (CABG) AF in patients with severe left ventricle (LV) dysfunction who underwent elective off-pump coronary artery bypass.Methods:This study was conducted on 104 patients from among 400 patients with severe LV dysfunction undergoing elective off-pump CABG surgery from February 2011 to February 2012, in Afshar Cardiovascular Center, Yazd, Iran. Patients with emergency surgery, unstable angina creatinine higher than 2.0 mg/dL, malignancy, or immunosuppressive disease were excluded. Preoperative serological tests of the participants, such as WBC counts, were saved in their medical dossiers. Of the 400 patients undergoing CABG, AF was found in 54 cases; these 54 male patients formed the experimental group and 60 other patients in the intensive care unit (ICU) and hospital stay without postoperative AF were part of the control group.Results:The average age of the patients was 68.5±12.8 years. WBC counts in patients with and without AF three days before surgery were 12,340±155 and 8,950±170, respectively. On surgical day, WBC counts in the patients with and without AF were 13,188±140 and 9,145±255, respectively (P value three days before surgery: 0.04; P value on surgical day: 0.01). Of the 54 male patients with postoperative AF (POAF), duration of AF was more in cases with elevated WBC count (12,000-14,000) than in those with lower elevated WBC count (10,000-12,000) (]P=0.025), but there was no relationship between frequency of recurrence of AF and grading of elevation of WBC count (]P=0.81).Conclusion:These findings show that three days before surgery and on surgery day, there was a difference in WBC count between both groups. So, preoperative WBC count may predict the incidence and duration of AF; however, it cannot be a predictor of the frequency of recurrence of AF. Finally, WBC count is an independent marker for POAF and duration of AF.

I nterrupted aortic arch (IAA) is a rare congenital abnormality (incidence rate, 3 per million live births per annum). Loss of luminal continuity between the ascending and descending portions of the aorta is the main pathologic condition.1 Some cardiac malformations-including patent ductus arteriosus, ventricular septal defect, bicuspid aortic valve (BAV), left ventricular (LV) outflow tract obstruction, and aortopulmonary window-have customarily been associated with IAA.2 On the basis of the site of the lesion, 3 types of disease have been reported. In type A, arch interruption occurs distal to the origin of the left subclavian artery (this is also known as interruption at the aortic isthmus). In type B, the lesion is distal to the origin of the left common carotid artery; and in type C, the interruption is between the common carotid arteries.3 Because of the high mortality rate-75% by 10 days and 90% at 12 months of life (without surgical correction in infancy)-IAA is very rare among adults. 2,3 In this report, we describe the case of a 76-year-old woman with asymptomatic IAA, severe tricuspid regurgitation (TR), and BAV, a perhaps unique combination of pathologic conditions that no one, to our knowledge, has reported before. Case ReportIn August 2014, a 76-year-old woman was referred to our department for dyspnea on exertion (New York Heart Association functional class II), which had begun one month before referral. No other relevant information was found in her medical history. Upon physical examination, her peripheral pulses were palpable symmetrically, over the carotid arteries and in the upper limbs. We heard a machine-like murmur over the right scapula and a soft systolic murmur over the left sternal border space. Lower-limb pulses were not palpable. Chest radiographs revealed no pathologic abnormalities. An electrocardiogram showed sinus rhythm and right bundle branch block.Transthoracic echocardiography revealed a normal LV ejection fraction (0.55), severe right ventricular dysfunction, BAV, mild aortic valve regurgitation, and severe tricuspid valve regurgitation (pulmonary artery pressure, 40 mmHg). Coronary angiography was performed via a right radial artery approach. The left anterior descending artery and the right coronary artery had significant stenoses. Aortography showed enlargement of the ascending aorta, BAV, normal aortic arch dimensions, and occlusion of the aorta immediately distal to the origin of the left subclavian artery (Fig. 1). Computed tomographic (CT) angiographic findings were compatible

No abstract

BackgroundDoppler sonography is a type of sonography used for imaging the blood flow in the vessels and heart. This technique uses ultrasound waves with high frequency. In some patient candidates for venous graft, the identification of the suitable vein is not possible with clinical examination.ObjectiveThis study compared the effects of preoperative color Doppler sonography of lower extremity veins on the postoperative outcomes of saphenectomy.MethodsThis randomized clinical trial was conducted on 100 candidates of an off-pump coronary artery bypass graft (CABG) hospitalized in Afshar Hospital in Yazd in 2015. Patients were divided into two groups: 50 patients in the study group and 50 patients in the control group. Patients in the study group underwent color Doppler sonography of lower extremity veins using the Medison 8000 Live device. Patients in the control group were assessed preoperatively by routine venous examination without undergoing color Doppler sonography. The prepping and draping methods and also the preoperative antibiotics were the same for both groups. The patients were assessed for wound infection, edema, hematoma, and DVT 2 days, 1 week, and 1 month after surgery. Data were analyzed by SPSS version 16 using t-test, Chi-square, and Fisher’s exact test.ResultsThe length of incision for saphenectomy was 29.20 ± 3.71 cm in the Doppler group and 28.98 ± 3.72 cm in the non-Doppler group with no significant difference between the two groups (p=0.768). The two groups were not significantly different with respect to age, gender, diabetes, hypertension, hyperlipidemia, smoking, and history of peripheral vessels disease, postoperative infection, postoperative organ edema, postoperative hematoma, and postoperative DVT.ConclusionPreoperative color Doppler sonography of the saphenous vein before saphenectomy has no effect on reducing the postoperative complications, and saphenectomy on the basis of intraoperative examination of the vein course by the surgeon has acceptable consequences.Clinical trial registrationThe trial was registered at the Thai Clinical Trials Registry (TCTR) (http://www.clinicaltrials.in.th) with the TCTR ID: TCTR20160708001.FundingThe authors received no financial support for the research, authorship, and/or publication of this article.

Purpose:Atrial fibrillation (AF) is the most common type of arrhythmia following elective off-pump coronary bypass graft (CABG) surgery, occurring on the 2nd or 3rd postoperative day. Postoperative atrial fibrillation and early complications may be the cause of long term morbidity and mortality after hospital discharge. High sensitive C-reactive protein (hsCRP) seems to be most significantly associated with cardiovascular disorders. This study was designed to evaluate whether preoperative hsCRP (≥3 mg/dl) can predict post-elective off-pump CABG, AF, and early complications in patients with severe left ventricle dysfunction (Ejection Fraction (EF)<30%).Methods:This study was conducted on 104 patients with severe left ventriclar dysfunction (EF < 30%), undergoing elective off-pump CABG surgery during April to September 2011 at the Afshar Cardiovascular Center in Yazd, Iran. Patients undergoing emergency surgery and those with unstable angina, creatinine higher than 2.0 mg/dl, malignancy, or immunosuppressive disease were excluded from the study. The subjects were divided into two groups: Group I with preoperative increased hsCRP (>3 mg/dl) (n=51) and group N with preoperative normal hsCRP (<3 mg/dl) (n=53). We evaluated post-CABG variables including incidence, duration, and frequency of AF, early morbidity (bleeding, infection, vomiting, renal and respiratory dysfunctions), ICU or hospital stay and early mortality. Data were then analyzed by Analysis of Variance (ANOVA), Chi-square and Fisher exact test for quantitative and qualitative variables.Results:The average age of the patients was 62.5 years, 75 cases (72.1%) were male, and 39 (37.5%) were female. Postoperative AF occurred in 19 cases (18.2%); 17 cases (33.3%) had hsCRP≥3 mg/dl and 2 cases (3.8%) had hsCRP≤3 mg/dl (P=0.03). Postoperative midsternotomy infection, respiratory dysfunction, and hospital stay were significantly higher in group I compared with group N (P<0.05). No statistical significant differences were identified between the two groups concerning other postoperative complications (bleeding, vomiting, renal dysfunction and ICU stay) (P>0.05).Conclusion:Preoperative hsCRP ≥3 mg/dl can predict incidence of postoperative atrial fibrillation and early complications such as midsternotomy infection, respiratory dysfunction, and hospital stay following elective off-pump CABG.