Hoorak Poorzand

Constrictive pericarditis associated with an anomalous left anterior descending artery is a very rare and complex condition. The aim of this report is to highlight the diagnostic challenges and surgical management in this disease. A 40-year-old man with right heart failure, dyspnea, and ascites, underwent comprehensive cardiac evaluation and surgery. The pulmonary valve was dysplastic, causing severe right ventricular outflow tract (RVOT) obstruction. During resection, the left anterior descending artery was inadvertently transected and bypassed with a saphenous vein graft. RVOT reconstruction, pulmonary valve replacement, and tricuspid valve repair were performed. Postoperative follow-up showed satisfactory ventricular and valve function; however, structural changes and reduced right ventricular function persisted. Non-invasive coronary imaging is necessary when angiography is not feasible, and the limitations of transesophageal echocardiography should be considered. Chronic right ventricular changes may not be fully reversible, emphasizing the need for long-term follow-up.

Background: COVID‐19 infection can cause significant long‐term health problems for patients. While there is no universally accepted definition for long COVID, it is usually identified by persistent symptoms that extend past 4 weeks after the initial SARS‐CoV‐2 infection with no other explanation. The cardiovascular system is one of the most important systems involved in long COVID, and even asymptomatic patients have evidence of cardiovascular injury after COVID‐19. This study aims to determine the long‐term risk of developing cardiac arrhythmias after SARS‐CoV‐2 infection. Methods: A comprehensive systematic search on Scopus, PubMed, Science Direct, and Web of Science databases was performed on August 24th, 2025. Cohort articles consisting of a healthy control group with no history of COVID‐19 infection and individuals who recovered from COVID‐19 for at least 30 days were included. Hazard Ratio (HR) and 95% confidence intervals (CI) were estimated using random‐effect models. Results: Fourteen studies were eligible for the meta‐analysis. The overall arrhythmia risk was higher in patients with long COVID (HR: 1.74, 95% CI [1.39, 2.10], I ² = 99.65%). Specific arrhythmias examined included atrial fibrillation (HR: 1.49, 95% CI [1.24, 1.73], I ² = 98.57%), sinus tachycardia (HR: 1.69, 95% CI [1.21, 2.18], I ² = 99.51%), sinus bradycardia (HR: 1.58, 95% CI [1.50, 1.66], I ² = 65.80%), and ventricular arrhythmias (HR: 1.72, 95% CI [1.48, 1.95], I ² = 96.89%). Patients with a more severe initial infection were at a higher risk of developing arrhythmias. Conclusions: The risk of developing cardiac arrhythmias is increased after COVID‐19 infection in the long term.

Reduced left ventricular (LV) function predicts poor outcomes in end‐stage renal disease (ESRD). This study aimed to identify the pre‐renal transplantation echocardiographic parameters that can predict post‐renal transplantation LV failure. This prospective longitudinal study was conducted on patients with ESRD who underwent renal transplantation during 1 year. All patients underwent echocardiography, including ejection fraction (EF), global longitudinal strain (GLS), left ventricular end‐systolic diameter (LVESD), left ventricular end‐diastolic volume (LVEDV), left ventricular end‐diastolic diameter (LVEDD), interventricular septal (IVS) thickness, peak velocity of early diastolic transmitral flow (E), peak velocity of late transmitral flow (A), early diastolic myocardial relaxation (Em), E/A, E/Em, Left atrial volume (LAV) index, tricuspid regurgitation peak gradient (TRPG), systolic pulmonary artery pressure (SPAP), tricuspid annular plane systolic excursion (TAPSE), 1 week before and 1 month after renal transplantation. Fifty patients participated in the current study. All echocardiographic parameters improved after transplantation. Post‐renal transplantation LV dysfunction was observed in 21 (42%) patients. Pre‐renal transplantation echocardiographic parameters (LVEDV, LVESD, LVEDD, IVS, E/Em, TRPG, SPAP, and LAV index) could predict post‐transplantation LV failure with high accuracy (AUC: 0.978).

Purpose This study aimed to investigate the relationship between symptoms of patients with severe mitral stenosis (MS), evaluated by the New York Heart Association (NYHA) functional class and Duke Activity Status Index (DASI) score, and echocardiographic parameters. We evaluated patients with severe rheumatic MS diagnosed as mitral valve area (MVA) less than 1.5 cm². All patients underwent transthoracic echocardiography and the left atrium (LA) reservoir auto-strain (LASr) analysis. In addition, DASI and NYHA scores were determined to evaluate the functional capacity and symptoms of MS patients. We evaluated 60 patients with MS with a mean age of 50.13 ± 10.28 and a median DASI score of 26.95 (26.38). There were 6 (10%) and 28 (46.7%) patients with NYHA class I and II, and 25 (40.0%) and 2 (3.3%) patients with NYHA class III and IV, respectively. NYHA class was positively correlated with LA area (LAA, r = 0.638), LA volume (LAV, r = 0.652), LAV index (LAVI, r = 0.62), E (r = 0.45), A (r = 0.25), and pulmonary artery pressure (PAP, r = 0.34), while negatively correlated with LASr (r = − 0.73) and MVA (r = − 0.417). Furthermore, the DASI score was positively associated with LASr (r = 0.81) and MVA (r = 0.52) while negatively correlated with LAA (r = − 0.62), LAV (r = − 0.65), LAVI (r = − 0.56), E (r = − 0.46), A (r = − 0.3), and PAP (r = − 0.32). Our findings indicate that LAA, LAV, LAVI, E, A, PAP, MVA, and LASr are associated with NYHA and DASI scores in MS patients. Additionally, the LASr had the strongest correlation between all measured parameters in severe MS patients.

Rationale: Partial anomalous pulmonary venous connection is a rare congenital anomaly in which one or more pulmonary veins are connected to the venous circulation leading to left to right heart shunt. Although correction of anomalous pulmonary venous connection is achieved through surgery, there are rare instances where the abnormal pulmonary vein has dual connection to both left atrium and the major systemic veins. Under these circumstances, catheter-based treatment might become a feasible option. Patient concerns: A 22-year-old female presented with exertional dyspnea, holo-systolic murmur in left sternal border, and fixed splitting of S2 in examination. Diagnosis: The patient was diagnosed with secundum type atrial septal defect (ASD) and dual drainage of left upper pulmonary vein. Interventions: The patient was candidate for device closure. Under TEE guidance, occluder devices were deployed in the upper part of vertical vein and subsequently in place of ASD. Outcomes: Echocardiogram in the next day showed complete occlusion of flow through the vertical vein and ASD. Dual antiplatelet was prescribed on discharge. Follow-up echocardiography after 3 months showed obvious improvement in RV size. Due to suspicion for clot formation, TEE was done and thrombosis with approximate length of extension of 15 mm was detected back to the device. The patient is following for 5 years. Repeated TEE after 2 years did not show any change in the burden of clot. Lessons: For comprehensive evaluation of patients with ASD, assessment of pulmonic veins is crucial and in the presence of a vertical vein, the dual drainage of pulmonic veins should be considered.

Background: Partial anomalous pulmonary venous connection (PAPVC) is a rare congenital anomaly in which one or more pulmonary veins are connected to the venous circulation leading to left to right heart shunt. Although correction of anomalous pulmonary venous connection is achieved through surgery, there are rare instances where the abnormal pulmonary vein has dual connection to both left atrium and the major systemic veins. Under these circumstances catheter-based treatment might become a feasible option. Case presentation: We report a case of atrial septal defect (ASD) and dual drainage of left upper pulmonary vein, which were successfully addressed by occluder devices and followed carefully while detecting early clot formation behind the implanted device in the vertical vein.Conclusion: For comprehensive evaluation of patients with ASD, assessment of pulmonic veins is crucial and in the presence of a vertical vein, the dual drainage of pulmonic veins should be considered.

Purpose: Infective endocarditis (IE) remains a disease with high morbidity and mortality. The aim of this study was to determine the clinical characteristics and echocardiographic features of patients with IE.Methods: We analyzed patients with either definitive or probable diagnosis of IE who were hospitalized in a teaching hospital in Mashhad, Iran between June 2011 and January 2020. Patients who survived were followed up by echocardiography for at least 6-month after hospital discharge.Results: A total of 82 cases with IE were included of which 62 (75.6%) received definitive diagnosis. The mean age was 39.7 ± 18.7 years and 52 (63.4%) were male. The most common preexisting structural cardiac abnormality that predispose patients to IE were congenital heart diseases (28 %) of which bicuspid aortic valve was more common (n = 12, 14.6%), followed by ventricular septal defect (n = 9, 11%) and Tetralogy of Fallot (TOF) (n = 2, 2.4%). Three (3.6 %) cases had rheumatic heart disease and 12 (14.6 %) were injecting drug users. The most common causative pathogen was Staphylococcus aureus, detected in 7 (19.4%) cases. Follow-up echocardiography revealed right or left ventricular failure in 10 (12.1%) cases. Cardiac complications occurred in 41 (50%) cases and systemic complications in 63 (76.8%). All-cause mortality was 41.5% (n = 34) and 6 (18.1%) patients died due to cardiovascular complications.Conclusions: The short- and long-term prognosis in IE was poor and the predictors for in-hospital and 1-year mortality were defined as heart failure and septic shock. Congenital heart disease and intravenous illicit drug using (IVDU) were the most common predisposing condition which may necessitate a revision in the IE prophylaxis recommendations.

Background: Water pipe smoking has become a vitally important public health issue in the world with untruthful assumed less harmful effect. Objective: The aim of this study was to systematically review the association of water pipe tobacco smoking and risk of coronary artery disease (CAD). Methods: Up to September 25, 2018, we electronically searched the PubMed, Embase, and ISI Web of Science with no time restriction. We included observational studies and excluded conference abstracts, editorials, case-reports, case series, and reviews. With fixed model effect, we conducted Meta-analysis to evaluate the association between Water pipe smoking and coronary artery disease. Heterogeneity among studies was assessed by I2 square test. Publication bias was assessed by Egger test. P<0.05 set as significant level. Results: Among 248 paper records identified through database search, 52 full texts were eligible for full text assessment whereas 49 papers were excluded. Additionally, three studies were eligible for meta-analysis, which involved 58,960 adults with 1334 in the water pipe smoker group. Risk of CAD was increased in water pipe smokers compared to individuals who had never smoked water pipe but the result did not reach statistical significance (OR=1.18, 95% CI: 0.98- 1.38, p=0.06). We found that heavy water pipe smoking (40 to 50 sessions of water-pipe smoking/year) was associated with CAD compared to lower smokers defined as less than 40 to 50 water pipe/year (OR=2.001, 95% CI: 1.13-2.87). Conclusions: Heavy Water pipe smoking was associated to coronary artery disease on a clinical level. It seems very crucial to increase public awareness on adverse effects of water pipe smoking and its cessation in clinical setting.