Multidisciplinary Cardiovascular Annals

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In Collaboration with Society of Cardiovascular Surgeons

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The official journal of IR Society of Cardiac Surgeons (ISCS) was founded in 2006 entitled IR Journal of Cardiac Surgeons and was a national journal with the aim of scientific improvement and creation of a connection between cardiac surgeons. From fall 2016, this journal is going to be republished with a new international standard format under the name of Multidisciplinary Cardiovascular Annals (MCA). The main objective of this journal is to cover multidisciplinary aspects focusing on cardiovascular diseases and serve as a global forum for scientists, researchers, physicians, surgeons, and other health professionals to find current advances in the areas of Cardiology and Cardiovascular Diseases.

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Now showing 1 - 20 of 211

Evaluation of the Quality of Life and Related Factors in the Nursing Staff of Selected Hospitals in Tehran, Iran
(Brieflands, 2021-07-31) Ali Sadeghpour Tabaei; Mohammad Ali Najafikhah; Bahador Baharestani; Hooman Bakhshandeh Abkenar; Sepehr Sadeghpour Tabaei; Mobin Naqshbandi; Roohallah Alizadehsani; Mohaddeseh Behjati
Background: There are various ways to improve the quality of life of social groups. Evaluation of these strategies and improvement of the quality of life of nursing staff should be prioritized by the healthcare administration. Objectives: This study aimed to measure the quality of life and related factors in the nursing staff of three selected hospitals. Methods: This periodic descriptive study was conducted on 200 nurses working in three hospitals of Tehran, Iran. The quality of life data were collected using the World Health Organization Quality of Life (WHOQOL-BREF) questionnaire, and the demographic data were collected and analyzed in SPSS for Windows, version 16 (released in 2007, SPSS Inc., Chicago, USA). Results: The average scores of physical, mental, social, and environmental health were measured in this study. Mental health showed the highest score, whereas environmental health had the lowest score. No significant correlation was found between the nurses’ income level and quality of life. Conclusions: The environmental and social health scores were significantly higher in married women as compared to men. Also, the score of social health was higher in married nurses, regardless of gender. Therefore, improvement of nurses’ quality of life should be prioritized by health managers in healthcare plans in the light of various factors described in this study.
Conference Abstracts: 7th Iranian Joint Cardiovascular Congress, Tehran, Iran (27 February - 1 March 2019)
(Brieflands, 2019-03-31) Alireza Alizadeh Ghavidel
This article does not have an abstract.
Iranian Society of Cardiac Surgeons Position Statement for the Treatment of Patients in Need of Cardiac Surgery in the COVID-19 Pandemic Period (Version I)
(Brieflands, 2020-05-17) Esmaeil Asdaghpour; Ramin Baghaei; Naser Jalilifar; Hassan Radmehr; Mahmoud Shirzad; Mohammad Reza Mirzaaghayan; Mohhamad Ali Yousefnia; Nicholas Austin; Alireza Alizadeh Ghavidel; Zargham Hossein Ahmadi; Ahmad Ali Amirghofran; Ahmad Amin; Kamran Babazadeh; Rezayat Parvizi; Saeid Hosseini; Amir Nasser Jadbabaei; Alireza Jahangirifard; Manouchehr Hekmat; Minoosh Shabani; Parham Sadeghipour; Mohammad Abbasi Tashnizee; Maziar Gholampour Dehaki; Ata Firouzi; Mohsen Mirmohammadsadeghi; Akbar Nikpajouh
The effects of recent Covid-19 pandemic on this planet must be viewed with a wise eye and we should learn that human beings are interconnected chains, and that ignoring the laws of existence will undoubtedly continue with reflections similar to the way we are today. Although the community of heart surgeons is not at the forefront of the treatment of this epidemic, they are ready to rush to the aid of other colleagues if necessary. The aim of preparing this protocol is to prioritize cardiac surgery procedures, maintain blood and blood product reserves and provide the appropriate care for patients while taking precautions for the safety of medical staff. The general recommendation in this first version of protocol is to postpone all elective cardiac surgeries and perform emergent and urgent cases according to suggested personal protection strategies for Covid-19.
The Role of Bradykinin and Angiotensin Converting Enzyme Inhibitors in Myocardial Protection: A Review of Randomized Control Trials
(Brieflands, 2018-07-31) Shervin Ziabakhsh Tabary; Alireza Sanei Motlagh
Context: Bradykinin as a principal active agent of kallikrein-kinin can mediate the powerful cardioprotective mechanism. Both the bradykinin and angiotensin converting enzyme inhibitors (ACE-I) can stimulate this protective pathway through the B2 kinin receptors. We performed a systematic review to determine the effects of bradykinin on cardiac biomarkers and outcomes after surgery or coronary intervention. Evidence Acquisition: We searched the PubMed, Cochrane CENTRAL, and Scopus databases up to the end of August 2017. Only randomized controlled trials were included. Results: From a total of 1081 citations, 8 RCTs totaling 268 patients were included for review. Bradykinin could reduce the blood pressure and cause a slight increase in heart rate. But these changes were not significant in comparison to control groups. The major effect of bradykinin or ACE-I on cardiac biomarkers were related to creatine kinase-MB (CKMB). The ST-segment shift was much lower in patients treated with ACE-I as well as the ST-segment peak elevation. Conclusions: The remote ischemic preconditioning (RIPC) stimulus decreased expression of B1 and B2 kinin receptors and this suggested the role of kinins in cardioprotection. ST-segment shift could be reduced by administration of ACE-I before coronary interventions. In patients who were unresponsive to initial preconditioning ischemia, the infusion of intracoronary enalaprilat during the angioplasty could elicit adequate myocardial protection. The effect of bradykinin is dose dependent. Low doses of bradykinin prevent the increased leukocyte adhesion induced by ischemia reperfusion. High doses activate the bradykinin B2 receptors and lead to increase in leukocyte adhesion. The stimulation of kinin receptor pathway causes a reduction in infarct size, troponin T, peak CKMB levels, and edema of the myocardium. Considering the importance of bradykinin and ACE-I in cardiovascular interventions, further RCTs are required to determine the dosage and precise details of functional pathways of these agents.
Gallbladder Necrosis Following Fenestrated Endovascular Aneurysm Repair
(Brieflands, 2024-07-31) El Hadhri Saif El Hak; Chaouch Nazih; Hentgen Benjamin; Boughanmi Khawla; Ahed Fallouh
Fenestrated endovascular aortic repair of aneurysms with challenging necks has advanced significantly over the last three decades. In cases with extremely hostile proximal necks, such as the one described here (a common trunk between the superior mesenteric artery and the celiac artery), it may be necessary to cover the celiac trunk to ensure better graft attachment and avoid endoleaks. However, unexpected events can still occur, even with collateral circulation present. To our knowledge, this is the second reported case of gallbladder necrosis following fenestrated endovascular aortic repair.
Are All Flexible Mitral Annuloplastic Rings the Same? An in Vivo Study
(Brieflands, 2015-03-31) J Rasmussen
Objectives: The overall purpose of this experimental study is to assess the biomechanical properties of two different flexible mitral annuloplasty rings (Medtronic Simulus and Medtronic Duran) in comparison to a completely rigid annuloplasty ring and the native valve. The evaluation and comparison of the rings will be based on 3D geometry of the mitral annulus, leafletcoaptation geometry and leaflet curvature during the heart cycle. Force quantification and distribution on the valve will also be evaluated. Material and methods: The two different types of annuloplasty bands and the rigid ring will be surgically implanted and tested in an acute porcine model. Twenty animals (80kg) will be used for testing, equally distributed into 4 groups; a Duran group (flexible), a Simulus group (flexible), a Classic group (fully rigid) and a native group. Before and after ring implantation, the dynamic 3D geometry and leaflet coaptation will be assessed by sonomicrometry and by 2D echocardiography, respectably. Dedicated force transducers attached directly to the annuloplasty rings will measure annular deformational forces in the septal-lateral and commissural dimensions. A comprehensive analysis of the impact of flexible properties of the annuloplasty rings on mitral leaflet motion and stress distribution will be performed from simultaneous recordings and calculations of the mentioned parameters throughout the cardiac cycle. Results: Pending. Conclusion: We hypothesize that the Medtronic Simulus ring, compared to the Medtronic Duran Ring, provide better support of the mitral annulus by reducing annular motion and the resulting deformational forces of mitral annulus during the cardiac cycle.
Cardiac Hemangioma: A Benign Tumor with Different Morphological Appearances
(Brieflands, 2011-09-30) Kambiz Mozaffari; ramin Baghaei
Hemangiomas are rare primary cardiac neoplasms with a reported incidence of 2.8% of all neoplastic lesions of the heart and pericardium. So far, fewer than a hundred documented cases have been reported. We present two cases treated and diagnosed as having cardiac hemangiomas. Both of the patients had uneventful postoperative courses
Mortality of Pulmonary Artery Banding
(Brieflands, 2011-05-31) Mohammad Abbasi Tashnizee; Mahmood Hosseinzadeh Maleki
Although pulmonary artery banding (PAB) seems to be a technically simple procedure it presents several peculiarities and is related to a significant morbidity and mortality. We lack information on this procedure in our center
The correlation between the blood group A and coronary artery disease
(Brieflands, 2013-09-29) Khalil Zarrabi
In recent years, lots of studies have been conducted in order to determine the correlation between the blood groups and the cardiovascular diseases. Most studies report a correlation between the blood group A and the Coronary Artery Disease. However, no similar studies have been conducted in Fars province; therefore, we decided to investigate the issue in this province
Modified Floating Wire: A Novel Aorto-Ostial Coronary Stenting Technique
(Brieflands, 2024-01-31) Pejman Mansouri; Mohammad Hadi Mansouri; Ali Kazemian; Seyedeh Melika Hashemi; Ehsan Khalilpour; Afshin Amirpour; Alireza Khosravi; Morteza Abdar
We present a modified floating wire technique for aorto-ostial coronary stenting. This novel approach ensures accurate ostial alignment without stent protrusion. The technique involves using a second wire as a marker at the true ostium to guide optimal stent placement. A balloon catheter is advanced on the floating wire to delineate the aorto-ostial plane. This method reduces the need for contrast media, prevents deep intubation of the guide catheter, and resembles the stent draw-back technique. The modified floating wire technique offers a safe and effective method for aorto-ostial coronary stenting and has potential for broader clinical application.
Determination of the Relationship Between Serum Uric Blood Levels and the Severity of Coronary Artery Disease in Angiography of Patients with Acute Coronary Syndrome
(Brieflands, 2019-02-13) Mohsen Maadani; Mohammad Ali Sadrameli; Sami Samiei Amlashi; Mohammadreza Hashemimanesh; Mostafa Moomivand; Fariba Rajabi; Mohammad Fallah Anboohi; Ali Ghasemi; Jalil Golshani Monfared
Background: Uric acid as an inflammatory marker has been hypothesized as a precursor of atherosclerosis and its role has been evaluated in recent studies. Objectives: In our study we wanted to assess its effect on the severity and extent of coronary artery disease in patients presenting to emergency department with acute coronary syndrome. Methods: In this cross-sectional descriptive study, we enrolled all patients with ACS who attended to Shahid Rajaie Emergency Department from May 2016 to May 2018. All patients were sampled for their laboratory evaluation of serum uric acid and routine other lab tests. Besides, their traditional risk factors and medications were recorded and all patients underwent coronary angiography while their SYNTAX score was measured. Results: Two-hundred and six patients were included in our study in which 153 were male (74.3%) and the rest were female (25.7%). The mean age of all patients was 58.37 ± 10.48. From all traditional CAD risk factors, only hyperlipidemia had a direct relation with hyperuricemia (P value < 0.001). Inverse relation was demonstrated between LVEF and serum uric acid level (correlation coefficient -0.126 and P value = 0.047). Analysis also proved a strong relationship between the number of vessels involved and serum uric acid level and the higher serum uric acid level, the more vessels were involved (in SVD 5.29 ± 1.42 mg/dL, 2VD 5.81 ± 162 mg/dL, 3VD 6.14 ± 1.06 mg/dL and 3VD + LM 6.63 ± 1.70 mg/dL and P value = 0.004). Consequently, there was a significant relation between serum uric acid level and SYNTAX score (hyperuricemia prevalence in patients with SYNTAX score less than 22 was 15.8%, in the group of 22 - 32 SYNTAX score 28.6% and in patients with more than 32 SYNTAX score was 41.4% with P value = 0.007). Conclusions: Serum uric acid level measurement in patients presenting with acute coronary syndrome is both sensitive and efficient and could help in determining the patients’ general probability of atherosclerotic disease.
A Case of Beating Heart High Risk Aortic Valve Replacement in the Setting of Previous Bypass Graft Surgery
(Brieflands, 2016-10-01) Maziar Khorsandi; Scott Dougherty; Kasra Shaikhrezai; Dena Khorsandi; Edward Thomas Brackenbury
Background: Conventional aortic valve replacement (AVR) surgery has been performed using cardioplegic cardio-respiratory arrest method. However this technique is often challenged when the surgeon is faced with a patient who has undergone previous coronary artery bypass grafting surgery (CABG), poor residual cardiac reserve and multiple comorbidities. Here the surgeon’s technical ability is challenged in performing careful dissection in order to preserve the integrity of the coronary artery grafts and to ensure myocardial protection from ischaemic damage. Case and Operative Strategy: We present a case of a 76-year-old man with a past history of previous CABG surgery and severe peripheral vascular disease who presented with acute heart failure secondary to severe aortic stenosis requiring urgent AVR. Our safety surgical strategy included preoperative, prophylactic insertion of intra-aortic balloon pump and performing beating heart AVR in the setting of good bilateral arterial conduits and absence of the native coronary circulation. We also performed bi-caval cannulation to allow for potential fallback position of delivering retrograde cardioplegia into the coronary sinus under direct vision in case significant myocardial ischemia was encountered during cross clamping. The patient had an uneventful beating heart AVR surgery and remained asymptomatic on follow-up. Conclusions: Beating heart AVR can be performed safely in the setting of good bilateral arterial conduits. Careful forward planning by prophylactic insertion of intra-aortic balloon pump and bi-caval cannulation allowing the option of delivering cardioplegia directly into the coronary sinus in case myocardial ischaemia was encountered during cross-clamping, would allow for beating heart AVR to be performed safely.
Study of the Relationship Between Mean Platelet Volume and LAD as a Culprit Vessel in NSTEMI
(Brieflands, 2020-07-29) Ahmad Separham; Alireza Shahsavani; Ali Heidari Sarvestani
Background: Among acute coronary patients, the ratio of non ST-elevation myocardial infarction (NSTEMI) is increasing and according to recent studies, less than 30% of myocardial infarctions (MIs) are due to ST-elevation myocardial infarction (STEMI). Unlike STEMI, in NSTEMI the ECG is not able to identify the culprit vessel. Objectives: In this study, we aimed to evaluate the association of mean platelet volume (MPV) and NSTEMI due to left anterior descending lesion. Methods: In this cross sectional study 349 patients with NSTEMI were included. Major cardiac risk factors (cigarette, diabetes mellitus (DM), hypertension (HTN), hyperlipidemia (HLP), angiographic findings, and drug history of patients were extracted from patients’ medical files. Then the MPV in complete blood count results and angiography findings were analyzed for any association. According to culprit lesions patients were divided into left anterior descending (LAD) and non-LAD groups. Results: There was a significant difference between the two groups (LAD vs. non-LAD) according to platelet count (P = 0.014), MPV (P = 0.001), HLP (0.024) and DM (0.048). Multivariate regression model has shown the MPV (OR = 0.46, 95%CI = 0.27 - 0.78) and DM (OR = 0.18, 95%CI = 0.06 - 0.54) as independent risk factors for NSTEMI due to LAD lesion. The significant positive correlation was also seen between MPV and left ventricle ejection fraction (LVEF) (r = 0.22, P = 0.006). The area under the curve (AUC) of MPV for predicting LAD culprit lesion was calculated as 69% (P < 0.0001). At cut off point of 9.15, has sensitivity and specificity of MPV for predicting LAD as culprit vessel was 100% and 30% respectively. Conclusions: In NSTEMI patients MPV might be a good tool to differentiate patients with LAD as culprit vessel.
Danon Disease: A Challenging Case with Diagnosis of Hypertrophic Cardiomyopathy
(Brieflands, 2019-01-31) Ahmad Amin; Meysam Khoshavi; Sepideh Taghavi; Nasim Naderi; Nejat Mahdieh; Zahra Emkanjoo; Mitra Chitsazan
Danon disease is an X-linked dominant glycogen storage disease characterized by cardiomyopathy, skeletal myopathy, and intellectual disability. Danon disease has a rapidly progressive natural course, hence early diagnosis is crucial to achieve a proper management plan. This case concerns a 30-year-old male of Danon disease presenting with symptoms and signs of systolic heart failure, with no intellectual impairment and skeletal muscle involvement at presentation. Thus, he was initially misdiagnosed and managed as idiopathic sarcomeric hypertrophic cardiomyopathy. To the best of our knowledge, this is the first report of Danon disease in Iran, further implicating previous cases overlooked by local cardiologists.
Comparison of the Effects of Hypothermia and Normothermia on Cognitive Functions After Coronary Artery Bypass Surgery
(Brieflands, 2021-07-31) Mohsen Ziyaeifard; Alireza Ghavidel; Abbas Moradi; Mostafa Fatahi; AmirHosein Salehzadeh; Hamid Heidarzadeh
Background: Cognitive impairment is among the most prevalent complications in patients undergoing CABG. Selection of the proper temperature is one of the main moderating factors in cognitive impairment following CABG. Today, heart surgery is done using the two methods of hypothermia and normothermia. However, there is no consensus over the method with the least side effects. Objectives: This study aims to compare the effects of hypothermia and normothermia on cognitive functions after undergoing CABG during the hospitalization period. Methods: A total of 130 patients in this cohort observational study were divided into two groups of normothermic (n = 65) and hypothermic (n = 65). In the hypothermic group, the temperature was down to 32°C, and in the normothermic group, the temperature decreased to 35°C. After the surgery and transferring the patients to the ICU, demographic information and MMSE questionnaires were completed from the second to the sixth day at the same time. Results: The results showed no significant differences between the two groups in educational and social demographic characteristics (P > 0.05). Besides, there was no significant differences between the two groups in the history of the disease (P = 1.000). In addition, there was no significant relationship between cognitive performance scores of the two groups before the surgery (P = 1.000). However, there was a significant relationship between the two groups from the second (P = 0.003), third (P = 0.000) and the fourth day (P = 0.023) after the surgery. In the normothermic group, on the second, as well as third and fourth days 14 and 9 patients suffered from cognitive impairment, respectively. Besides, in the hypothermic group, on the second, third, and fourth days after surgery, 28, 30, and 23 patients suffered from cognitive impairment, respectively. However, there was no significant relationship between the two groups on the fifth and sixth days after the surgery (P = 0.079). Conclusions: The present study showed that during hospitalization after undergoing CABG, cognitive impairment in patients with the normothermic method was less severe than that in patients with the hypothermic method. Besides, clinical outcomes were more satisfactory in the former group.
Surgical AF ablation THC experince in 216 case and demo of technique
(Brieflands, 2015-03-31) K Abbasi
Objectie: Treatment of permanent AF in cases which are candidate of open heart surgery is a mandatory step in care. Diffrent ways for this topic are available. Material & Method: since 2009 216 case of valve surgery concomitanly treated by radiofrequenc LT. ATRIAL OR BIATRIAL AF ablation short term and 6 month results are presented. Results: 100% procedural sucess 85% in hospital convertion to NSR 64% 6 month sinus rhythm. No procedure related complication at the end presentation of video of surgical procedure
ST-Segment Elevation Myocardial Infarction with Normal Coronary Arteries Angiography
(Brieflands, 2020-07-31) Morteza Motedayen; Hamid Khederlou
Myocardial infarction (MI) is the most frequent cause of ischemic heart death. MI is generally assumed to be due to arterial thrombosis superimposed on an atherosclerotic plaque in an epicardial coronary artery. Total occlusion of an epicardial coronary artery leads to ST elevation, while non-occlusive lesion leads to ST depression. We hereby have reported a case of ST-segment elevation myocardial infarction with normal coronary arteries angiography. A 35-year-old man presented with typical chest pain, nausea, vomiting and cold sweating. ECG obtained at admission and 30 minutes later revealed sinus tachycardia with ST-segment elevations (> 2 mm) in leads V2-V5. Cardiac biomarkers including creatine phosphokinase (CPK), creatine kinase muscle-brain (CK.MB) and troponin high sensitive were elevated. The standard treatment for MI including pain relief, aspirin, thrombolysis if indicated and beta blockade were begun for the patient. STEMI was confirmed and thus, angiography was performed. Coronary angiography revealed normal coronary arteries without any angiographic evidence of stenosis, coronary artery dissection, embolism, plaque rupture or vasospasm.
Heart Transplant Survival Rate in Iran: A Single-Center Registry Report
(Brieflands, 2015-03-31) mehrdad Salehi
to determine I-month and I-year survival rate in recipients of heart transplants in Imam Khomeini Medical Center. Methods: we analyzed the outcomes of 69 patients who underwent heart transplantation between 2007 and 2010. The 1-month and 1-year survival rates were calculated, and we assessed prognostic factors such as donor and recipient age and sex, graft ischemic time during surgery, and liver and kidney function tests. Results: increased donor age had a significant negative effect on survival rate (p=0.005). Sex differences between donor and recipient had no association with transplant outcome and survival rate. The overall 1-month and 1-year survival was 82.6% (n=54) and 70% (n=48), respectively. Conclusion: heart transplantation is a lifesaving procedure for and-stage heart disorders. Mortality after heart transplantation depends on numerous factors, and thus survival rates differ among centers. The 1-month and 1-year survival rates after heart transplantation in our center currently stand at 82.6% and 70% respectively
The Frequency of Dysphagia after Intraoperative Transesophageal Echocardiography in Open Cardiac Surgery
(Brieflands, 2017-01-01) Tooraj Babaei; Alireza Jahangiri Fard; Behshid Ghadrdoost; Hooman Bakhshandeh; Mohsen Ziyaeifard; Seyed Mostafa Alavi
Objectives: The current study tries to assess the causative factors of dysphagia and omit them to find the exact contribution of TEE for this symptom among patients who suffer from elective open cardiac surgery in different age ranges in both sexes. Methods: In this observational study, 100 patients between 30-80 years of age with ASA < III and EF > 40% who were candidate for elective open cardiac surgery in a referral hospital in Tehran in 2011 were recruited. The patients were divided into two groups based on TEE performance; patients who needed to perform TEE based on medical indication were considered the case group and the other patients who did not have indication for TEE, formed the control group. Results: Total frequency of dysphagia was 13% in all patients disregarding TEE performance while 6 (12%) and 7 (14%) of controls and cases showed this symptom respectively. Odynophagia was the other symptom to be assessed for its frequency in this study and showed 13% total frequency considering all participants disregarding the groups. This symptom was reported exactly similar to dysphagia which was 6 (12%) in controls and 7 (14%) in cases. The participants’ gender was not effective on the distribution of dysphagia where 6 (11.3%) females and 7 (14.9%) males were involved with no significant difference. Conclusions: Intraoperative trans-esophageal echocardiography during cardiac surgeries has greater usefulness than complications and is worth using in this case as well.
Long-Term Results of Balloon Pulmonary Valvuloplasty
(Brieflands, 2018-01-31) Ata Firouzi; Hamid Reza Sanati; Reza Kiani; Farshad Shakerian; Ali Zahedmehr; Kazhal Karimi
Background: The purpose of our study was to prove the hypothesis that balloon pulmonary valvuloplasty could effectively reduce valvular gradient ranged 30 to 50 mmHg to less than 30 mmHg in long-term follow-up. Methods: This cross-sectional study was performed on 271 consecutive patients aged 12 to 67 years who suffered from severe pulmonary stenosis who were scheduled for balloon pulmonary valvuloplasty at Shahid Rajaie Heart Center in Tehran between 2003 and 2013. Two years after the procedure, the patients were examined by transthoracic echocardiography and parameters related to pulmonary valve and right ventricular condition were reassessed. Among all 271 patients who were initially included into the survey, 37 patients (13.7%) had pulmonary valve gradient 30 to 50 mmHg that included our final targeted population for assessment. Results: Valvular gradient significantly dropped down from 93.19 ± 39.77 mmHg to 38.78 ± 26.26 (P < 0.001). Among all 271 patients initially assessed, in two patients with valvular gradient less than 30 mmHg, the gradient remained unchanged long-term after procedure. In 37 patients with gradient ranged 30 to 50 mmHg before procedure, the gradient reduced to less than 30 mmHg in 32 patients with an overall rate of 86.5%, but remained in the same range in 4 patients and even increased to higher than 50 mmHg in 2 patients. There was a strong positive relationship between the change in valvular gradient and initial right ventricular systolic pressure (beta = 0.519, P < 0.001). Conclusions: Majority of patients with moderate pulmonic stenosis with gradient of 30 to 50 mmHg benefit from this procedure to achieve gradient less than 30 mmHg in long-term follow-up.

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