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Intravascular ultrasound guided transcatheter electrosurgical revascularization of an interrupted aortic arch. J Cardiol Cases 2022; 26:56-58. [DOI: 10.1016/j.jccase.2022.02.011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2022] [Revised: 02/06/2022] [Accepted: 02/19/2022] [Indexed: 11/18/2022] Open
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Holland M, Schulz A, Feins EN, Baird CW. Neonates with Right Aortic Arch Requiring Arch Reconstruction: A Single-Institution Experience. Ann Thorac Surg 2021; 113:2054-2060. [PMID: 33864758 DOI: 10.1016/j.athoracsur.2021.04.005] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/14/2020] [Revised: 03/05/2021] [Accepted: 04/05/2021] [Indexed: 11/01/2022]
Abstract
BACKGROUND Reconstruction of a right aortic arch (RAA) is rarely required in the newborn period and has rarely been reported. METHODS All patients who underwent a RAA repair in the neonatal period from a single institution were retrospectively reviewed. The primary outcome measures included survival, complications, and reintervention. RESULTS Between 1984 to 2020, 15 patients were identified. Nine patients (60%) presented with an interrupted aortic arch (IAA), five (33%) with a hypoplastic arch, and one (7%) with anomalous origin of the brachiocephalic vessels. All patients had associated complex congenital heart disease. Median age at surgery was six days (range, 2-29), median weight 3.11 kg (range, 2.5-4.18). Genetic syndromes were prevalent and 77% of IAA patients had DiGeorge syndrome. Surgical techniques included end-to-side (27%), end-to-end (27%) or side-to-side anastomosis (13%) and placement of an interposition graft (7%). 65% required patch augmentation. Median intensive care unit and total hospital length of stay were 20 days (range, 7 - 92) and 28 days (range, 10 - 240), respectively. At median follow-up of 3.97 years (range, 0.19-36), 13 of 15 (87%) patients were alive. Vocal cord paralysis was found in 27%, hemidiaphragm paralysis in 13% and significant airway compression in 27%. Overall, 27% patients required reintervention on the aortic arch; two surgical and two percutaneous balloon dilation. CONCLUSIONS RAA reconstruction in the newborn period is rare and associated with complex lesions with an acceptable reintervention rate.
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Affiliation(s)
- Margaret Holland
- Boston Children's Hospital, Harvard Medical School, Department of Cardiac Surgery, Boston, MA
| | - Antonia Schulz
- Boston Children's Hospital, Harvard Medical School, Department of Cardiac Surgery, Boston, MA
| | - Eric N Feins
- Boston Children's Hospital, Harvard Medical School, Department of Cardiac Surgery, Boston, MA
| | - Christopher W Baird
- Boston Children's Hospital, Harvard Medical School, Department of Cardiac Surgery, Boston, MA.
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Andrianova EI, Naimo PS, Fricke TA, Robertson T, Bullock A, Brink J, d'Udekem Y, Brizard CP, Konstantinov IE. Outcomes of Interrupted Aortic Arch Repair in Children With Biventricular Circulation. Ann Thorac Surg 2020; 111:2050-2058. [PMID: 32721457 DOI: 10.1016/j.athoracsur.2020.05.146] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/20/2020] [Revised: 05/13/2020] [Accepted: 05/18/2020] [Indexed: 11/18/2022]
Abstract
BACKGROUND To evaluate the outcomes after surgical repair of interrupted aortic arch in patients with biventricular circulation. METHODS We reviewed all children from a single institution (N = 177) who had interrupted aortic arch repair between 1978 and 2018. Patients were separated into simple (n = 122) and complex (n = 55) group based on their concomitant anomalies. RESULTS Median age at repair was 6 days (range, 1-298 days) and median weight was 3.1 kg (range, 0.95-5.1 kg). Median follow-up time was 11.5 years (mean 12.6 years; range, 0.1-35.9 years). Overall early mortality was 11.9% (21 of 177) and there were 5 late deaths. Era of surgery did not impact on overall survival (P = .37). Between 2000 and 2018, there was a significant difference in early mortality between the simple and complex group (3.2% [2 of 62] vs 24.1% [7 of 29], P = .002). There was an improvement in mortality in the simple group over time (P = .03). Competing risks analysis showed at 15 years after the initial operation 14% had died without arch reoperation, 15.2% had undergone aortic arch reoperation, and 70.8% were alive without arch reoperation. Reoperation on the aortic arch was more common in the complex group compared to the simple group (20.0% [11 of 55] vs 9.0% [11 of 122], P< .001). CONCLUSIONS Survival of patients with interrupted aortic arch and associated simple anomalies has improved over time, although mortality in patients with complex congenital cardiac lesions remains high.
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Affiliation(s)
- Eleonora I Andrianova
- Department of Paediatrics, University of Melbourne, Melbourne, Australia; Department of Cardiothoracic Surgery, Royal Children's Hospital, Melbourne, Australia
| | - Phillip S Naimo
- Department of Paediatrics, University of Melbourne, Melbourne, Australia; Department of Cardiothoracic Surgery, Royal Children's Hospital, Melbourne, Australia; Heart Research Group, Murdoch Children's Research Institute, Melbourne, Australia
| | - Tyson A Fricke
- Department of Paediatrics, University of Melbourne, Melbourne, Australia; Department of Cardiothoracic Surgery, Royal Children's Hospital, Melbourne, Australia; Heart Research Group, Murdoch Children's Research Institute, Melbourne, Australia
| | - Terry Robertson
- Department of Cardiology, Women's and Children's Hospital, Adelaide, Australia
| | - Andrew Bullock
- Department of Cardiology, Perth Children's Hospital, Perth, Australia
| | - Johann Brink
- Department of Paediatrics, University of Melbourne, Melbourne, Australia; Department of Cardiothoracic Surgery, Royal Children's Hospital, Melbourne, Australia; Heart Research Group, Murdoch Children's Research Institute, Melbourne, Australia
| | - Yves d'Udekem
- Department of Paediatrics, University of Melbourne, Melbourne, Australia; Department of Cardiothoracic Surgery, Royal Children's Hospital, Melbourne, Australia; Heart Research Group, Murdoch Children's Research Institute, Melbourne, Australia
| | - Christian P Brizard
- Department of Paediatrics, University of Melbourne, Melbourne, Australia; Department of Cardiothoracic Surgery, Royal Children's Hospital, Melbourne, Australia; Heart Research Group, Murdoch Children's Research Institute, Melbourne, Australia
| | - Igor E Konstantinov
- Department of Paediatrics, University of Melbourne, Melbourne, Australia; Department of Cardiothoracic Surgery, Royal Children's Hospital, Melbourne, Australia; Heart Research Group, Murdoch Children's Research Institute, Melbourne, Australia.
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Alnasser SA, Martin AH, Preventza OA, Coselli JS, de la Cruz KI. Proximal Descending Thoracic Aortic Pseudoaneurysm in a 24-Year-Old Man after 2 Childhood Repairs of Interrupted Aortic Arch. Tex Heart Inst J 2020; 47:27-29. [PMID: 32148449 DOI: 10.14503/thij-17-6252] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
Improved management of interrupted aortic arch has increased long-term survival rates. Longer life expectancies in neonates and children surgically treated for interrupted aortic arch may necessitate complex reinterventions when sequelae develop in adulthood. We report the case of a 24-year-old man who had undergone initial repair of interrupted aortic arch type B at one week and reintervention at 6 years of age. He presented with a 5.5 × 9-cm pseudoaneurysm of the proximal descending thoracic aorta. He underwent surgical replacement of his distal aortic arch and proximal descending thoracic aorta, with a bypass to his left subclavian artery. In addition to our patient's case, we discuss considerations in treating recipients of early interrupted aortic arch repairs as they live longer and undergo multiple reinterventions.
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Jegatheeswaran A, Jacobs ML, Caldarone CA, Kirshbom PM, Williams WG, Blackstone EH, DeCampli WM, Duncan KF, Lambert LM, Walters HL, Tchervenkov CI, McCrindle BW. Self-reported functional health status following interrupted aortic arch repair: A Congenital Heart Surgeons' Society Study. J Thorac Cardiovasc Surg 2019; 157:1577-1587.e10. [PMID: 30770109 DOI: 10.1016/j.jtcvs.2018.11.152] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/13/2018] [Revised: 10/15/2018] [Accepted: 11/11/2018] [Indexed: 11/15/2022]
Abstract
OBJECTIVES Improved survival after congenital heart surgery has led to interest in functional health status. We sought to identify factors associated with self-reported functional health status in adolescents and young adults with repaired interrupted aortic arch. METHODS Follow-up of survivors (aged 13-24 years) from a 1987 to 1997 inception cohort of neonates included completion of functional health status questionnaires (Child Health Questionnaire-CF87 [age <18 years, n = 51] or the Short Form [SF]-36 [age ≥18 years, n = 66]) and another about 22q11 deletion syndrome (22q11DS) features (n = 141). Factors associated with functional health status domains were determined using multivariable linear regression analysis. RESULTS Domain scores of respondents were significantly greater than norms in 2 of 9 Child Health Questionnaire-CF87 and 4 of 10 SF-36 domains and only lower in the physical functioning domain of the SF-36. Factors most commonly associated with lower scores included those suggestive of 22q11DS (low calcium levels, recurrent childhood infections, genetic testing/diagnosis, abnormal facial features, hearing deficits), the presence of self-reported behavioral and mental health problems, and a greater number of procedures. Factors explained between 10% and 70% of domain score variability (R2 = 0.10-0.70, adj-R2 = 0.09-0.66). Of note, morphology and repair type had a minor contribution. CONCLUSIONS Morbidities associated with 22q11DS, psychosocial issues, and recurrent medical issues affect functional health status more than initial morphology and repair in this population. Nonetheless, these patients largely perceive themselves as better than their peers. This demonstrates the chronic nature of interrupted aortic arch and suggests the need for strategies to decrease reinterventions and for evaluation of mental health and genetic issues to manage associated deteriorations.
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Affiliation(s)
- Anusha Jegatheeswaran
- Division of Cardiac Surgery, Department of Surgery, University of Toronto, Hospital for Sick Children, Toronto, Ontario, Canada.
| | - Marshall L Jacobs
- Division of Cardiac Surgery, Department of Surgery, Johns Hopkins University, Baltimore, Md
| | - Christopher A Caldarone
- Division of Cardiac Surgery, Department of Surgery, University of Toronto, Hospital for Sick Children, Toronto, Ontario, Canada
| | - Paul M Kirshbom
- Division of Cardiothoracic Surgery, Department of Surgery, Levine Children's Hospital, Charlotte, NC
| | - William G Williams
- Division of Cardiac Surgery, Department of Surgery, University of Toronto, Hospital for Sick Children, Toronto, Ontario, Canada
| | - Eugene H Blackstone
- Department of Thoracic and Cardiovascular Surgery, Lerner Research Institute, Cleveland Clinic Foundation, Cleveland, Ohio
| | - William M DeCampli
- Division of Cardiac Surgery, Department of Surgery, University of Central Florida College of Medicine, Arnold Palmer Hospital for Children, Orlando, Fla
| | - Kim F Duncan
- Division of Cardiothoracic Surgery, Department of Surgery, University of Nebraska Medical Center, Omaha, Neb
| | - Linda M Lambert
- Division of Cardiothoracic Surgery, Department of Surgery, University of Utah, Primary Children's Hospital, Salt Lake City, Utah
| | - Henry L Walters
- Division of Cardiovascular Surgery, Department of Surgery, Wayne State University, Children's Hospital of Michigan, Detroit, Mich
| | - Christo I Tchervenkov
- Division of Pediatric Cardiac Surgery, Department of Surgery, McGill University, Montreal Children's Hospital, Montreal, Québec, Canada
| | - Brian W McCrindle
- Department of Pediatrics, Division of Cardiology, University of Toronto, Hospital for Sick Children, Toronto, Ontario, Canada
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Burbano-Vera N, Zaleski KL, Latham GJ, Nasr VG. Perioperative and Anesthetic Considerations in Interrupted Aortic Arch. Semin Cardiothorac Vasc Anesth 2018; 22:270-277. [DOI: 10.1177/1089253218775954] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Interrupted aortic arch (IAA) is defined as the loss of luminal continuity between the ascending and descending aorta and is classified based on the anatomic level of interruption. IAA is associated with a number of intracardiac anomalies with the most common being patent ductus arteriosus, ventricular septal defect, and left ventricular outflow obstruction. There is also a strong association between type B interruption and 22q11 deletion syndrome. The perioperative management of the neonate with IAA begins in the intensive care unit with optimization of end-organ perfusion and function. Survival depends on the prompt initiation of prostaglandin E1 in order to maintain ductal patency, careful management of the patient’s ratio of pulmonary to systemic blood flow (Qp:Qs), and a thorough understanding of the physiologic implications of the surgical plan, type of interruption, and associated syndromes and anomalies. This review will focus on the anatomy, physiology, and perioperative anesthetic management considerations specific to the management of IAA.
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Affiliation(s)
- Nelson Burbano-Vera
- Boston Children’s Hospital, Boston, MA, USA
- Harvard Medical School, Boston, MA, USA
| | - Katherine L. Zaleski
- Boston Children’s Hospital, Boston, MA, USA
- Harvard Medical School, Boston, MA, USA
| | - Gregory J. Latham
- Seattle Children’s Hospital, Seattle, WA, USA
- University of Washington, Seattle, WA, USA
| | - Viviane G. Nasr
- Boston Children’s Hospital, Boston, MA, USA
- Harvard Medical School, Boston, MA, USA
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Suárez de Lezo J, Romero M, Pan M, Suárez de Lezo J, Segura J, Ojeda S, Pavlovic D, Mazuelos F, López Aguilera J, Espejo Perez S. Stent Repair for Complex Coarctation of Aorta. JACC Cardiovasc Interv 2016; 8:1368-1379. [PMID: 26315741 DOI: 10.1016/j.jcin.2015.05.018] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/11/2015] [Revised: 04/13/2015] [Accepted: 05/07/2015] [Indexed: 11/19/2022]
Abstract
OBJECTIVES This study sought to determine whether several anatomic or evolving characteristics of the coarctation may create challenging conditions for treatment. BACKGROUND Stent repair of coarctation of aorta is an alternative to surgical correction. METHODS We analyzed our 21-year experience in the percutaneous treatment of complex coarctation of aorta. Adverse conditions for treatment were as follow: 1) complete interruption of the aortic arch (n = 11); 2) associated aneurysm (n = 18); 3) complex stenosis (n = 30); and 4) the need for re-expansion and/or restenting (n = 21). Twenty patients (33%) belonged to more than 1 group. Ten interruptions were type A and 1 was type B. The mean length of the interrupted aorta was 9 ± 11 mm. The associated aneurysms were native in 8 patients and after previous intervention in 10 patients. Aneurysm shapes were fusiform in 8 patients and saccular in 10. The following characteristics defined complex stenosis as long diffuse stenosis, very tortuous coarctation, or stenosis involving a main branch or an unusual location. Patients previously stented at an early age, required re-expansion and/or restenting after reaching 16 ± 5 years of age. RESULTS Two patients had died by 1-month follow-up. The remaining 58 patients did well and were followed-up for a mean period of 10 ± 6 years. Late adverse events occurred in 3 patients (5%). All remaining patients are symptom-free, with normal baseline blood pressure. Imaging techniques revealed good patency at follow-up without associated aneurysm or restenosis. The actuarial survival free probability of all complex patients at 15 years was 92%. CONCLUSIONS Stent repair of complex coarctation of aorta is feasible and safe. Initial results are maintained at later follow-up.
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Affiliation(s)
- José Suárez de Lezo
- Department of Cardiology, Reina Sofia University Hospital, University of Córdoba and Instituto Maimónides para la Investigación Biomédica en Córdoba, Córdoba, Spain.
| | - Miguel Romero
- Department of Cardiology, Reina Sofia University Hospital, University of Córdoba and Instituto Maimónides para la Investigación Biomédica en Córdoba, Córdoba, Spain
| | - Manuel Pan
- Department of Cardiology, Reina Sofia University Hospital, University of Córdoba and Instituto Maimónides para la Investigación Biomédica en Córdoba, Córdoba, Spain
| | - Javier Suárez de Lezo
- Department of Cardiology, Reina Sofia University Hospital, University of Córdoba and Instituto Maimónides para la Investigación Biomédica en Córdoba, Córdoba, Spain
| | - José Segura
- Department of Cardiology, Reina Sofia University Hospital, University of Córdoba and Instituto Maimónides para la Investigación Biomédica en Córdoba, Córdoba, Spain
| | - Soledad Ojeda
- Department of Cardiology, Reina Sofia University Hospital, University of Córdoba and Instituto Maimónides para la Investigación Biomédica en Córdoba, Córdoba, Spain
| | - Djordje Pavlovic
- Department of Cardiology, Reina Sofia University Hospital, University of Córdoba and Instituto Maimónides para la Investigación Biomédica en Córdoba, Córdoba, Spain
| | - Francisco Mazuelos
- Department of Cardiology, Reina Sofia University Hospital, University of Córdoba and Instituto Maimónides para la Investigación Biomédica en Córdoba, Córdoba, Spain
| | - José López Aguilera
- Department of Cardiology, Reina Sofia University Hospital, University of Córdoba and Instituto Maimónides para la Investigación Biomédica en Córdoba, Córdoba, Spain
| | - Simona Espejo Perez
- Department of Radiology, Reina Sofia University Hospital, University of Córdoba and IMIBIC, Córdoba, Spain
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Single center experience of aortic bypass graft for aortic arch obstruction in children. Heart Vessels 2016; 32:76-82. [PMID: 27120172 DOI: 10.1007/s00380-016-0842-x] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/21/2015] [Accepted: 04/15/2016] [Indexed: 11/27/2022]
Abstract
The purpose of this study is to access the outcomes of aortic bypass graft placement in children. This is a retrospective review of all children having aortic bypass graft placement for aortic arch obstruction for the first time between 1982 and 2013 at a single institution. The actuarial survival and the freedom from aortic arch reoperation were calculated and compared between the groups. Seventy consecutive children underwent aortic bypass graft placements. The median age and body weight at the operation were 14 days and 3.6 kg. There were 7 early deaths, 6 late deaths, and 7 heart transplants during the median follow-up of 10.8 years (0.0-31.5 years). The actuarial transplant free survival was 64.7 % at 20 years and the freedom from aortic arch reoperation was 50.5 % at 10 years. Between the children younger than 1 year old and older than 1 year old, there were significant differences in actuarial transplant free survival (56.4 vs. 100 % at 15 years, p = 0.0042) and in the freedom from aortic arch reoperation (18.7 vs. 100 % at 10 years, p < 0.001). The children who received aortic bypass graft larger than 16 mm in size had no aortic arch reoperation at 15 years. The aortic bypass graft placement for aortic arch obstruction can be done with low mortality and morbidity for children who can receive bypass graft larger than 16 mm in size. However, it should be avoided for the neonates and infants except selected situations.
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Mehrpooya M, Eskandari R, Salehi M, Shajirat Z, Golabchi A, Satarzadeh R, Zand-Parsa AF. Undiagnosed interrupted aortic arch in a 59-year-old male patient with severe aortic valve stenosis: A case report and literature review. ARYA ATHEROSCLEROSIS 2014; 10:230-2. [PMID: 25258640 PMCID: PMC4173315] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/12/2013] [Accepted: 09/09/2013] [Indexed: 11/03/2022]
Abstract
BACKGROUND Interrupted aortic arch (IAA) is defined by a lack of the luminal continuity between the ascending and descending thoracic aorta. It is a rare, severe congenital heart defect which without surgery is associated with high mortality in the neonatal period. The aims of this study were to present a case with IAA who was alive until the age of 59 years without any surgical intervention and to review the literatures that have presented IAA cases. CASE REPORT The patient was admitted with respiratory distress and pulmonary edema. Echocardiography showed the sever stenosis in aortic valve and sever left ventricular dysfunction. Cardiac catheterization and angiography confirmed interrupted aorta (type A). The descending thoracic aorta was supplied by extensive collateral vessels from the vertebrobasilar system down to the posterior chest wall and the spine. Surgical correction including coronary artery bypass graft and aortic valve replacement and repair of interruption of the aorta was performed. Three weeks later the patient was died due to uncontrollable gastrointestinal bleeding and hospital acquired pneumonia. We described diagnosis and management of our case. CONCLUSION This case was very interesting for us, because the patient had not been diagnosed until the recent presentation. Similar cases with this diagnosis do not reach adulthood, but our patient was alive up to 59 years of age.
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Affiliation(s)
- Maryam Mehrpooya
- Assistant Professor, Department of Cardiology, School of Medicine, Imam Khomeini Hospital, Tehran University of Medical Sciences, Tehran, Iran,Correspondence to: Maryam Mehrpooya,
| | - Ramin Eskandari
- Assistant Professor, School of Medicine, Iran University of Medical Sciences, Tehran, Iran
| | - Mehrdad Salehi
- Associate Professor, Department of Cardiology, School of Medicine, Imam Khomeini Hospital, Tehran University of Medical Sciences, Tehran, Iran
| | - Zeinab Shajirat
- Department of Cardiology, School of Medicine, Imam Khomeini Hospital, Tehran University of Medical Sciences, Tehran, Iran
| | - Allahyar Golabchi
- Fellowship of Interventional Electrophysiology, Cardiac Electrophysiology Research Center AND Rajaie Cardiovascular Medical and Research Center, Iran University of Medical Sciences, Tehran, Iran
| | - Roya Satarzadeh
- Associate Professor, Department of Cardiology, School of Medicine, Imam Khomeini Hospital, Tehran University of Medical Sciences, Tehran, Iran
| | - Amir Farhang Zand-Parsa
- Associate Professor, Department of Cardiology, School of Medicine, Imam Khomeini Hospital, Tehran University of Medical Sciences, Tehran, Iran
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