Background: Pheochromocytomas are rare tumors originating in chromaffin cells which predominantly are located in adrenal glands. Sustained or paroxysmal hypertension (HT) is the most frequent sign of pheochromocytoma. In some cases, it is associated with the classic triad including episodic headaches, sudoresis, and tachycardia; however, we present a case of pheochromocytoma with first presentation of cardiomyopathy. Case presentation: The authors describe a rare case of a pheochromocytoma which was first presented with cardiomyopathy in a 7-year-old patient. The patient was admitted with malaise, abdominal pain, polydipsia, and myalgia. Further evaluations revealed hyperglycemia, mild dehydration and sinus tachycardia but no HT. Echocardiography demonstrated some of the signs of cardiomyopathy which was incorrectly diagnosed as viral myocarditis. The patient was discharged with this diagnosis but he presented again with HT crisis a few months later. A diagnosis of pheochromocytoma was assigned after the evaluation of the HT secondary causes. The diagnosis was confirmed by metanephrine assay and the tumor was localized in the adrenal gland using the abdominal MRI. Conclusion: Pheochromocytoma can present itself with normotensive cardiomyopathy. Therefore, the possibility of pheochromocytoma should be considered in patients with cardiomyopathy especially in those with positive familial history.

Introduction: Natriuretic peptides such as brain natriuretic peptide (BNP), atrial natriuretic peptide (ANP) and pro-BNP are secreted in response to atrial and/or ventricular stretch. Left to right shunts such as ventricular septal defect (VSD), atrial septal defect (ASD), and patent ductus arteriosus (PDA), are treated medically or surgically. We aimed to evaluate whether the serum level of pro-BNP would be useful to measure the amount of the shunt. Methods: In this cross sectional study, 60 infants and children, in whom physical examinations approved heart murmur, and had undergone echocardiography by which VSD, ASD, or PDA had been proven, were included in the study. The relationship between serum BNP levels and severity of shunt (Qp/Qs) based on echocardiographic and hemodynamic evaluations, was studied. Results: There was a significant relationship between serum level of pro-BNP and the amount of the shunt in the patients with VSD, ASD, and PDA (P=0.01). A positive correlation was seen between pro-BNP serum level and Qp/Qs ratio. The mean ± SE serum level of pro-BNP in patients with Qp/Qs ratio of less than 1.5, equal to 1.5-2, and more than 2 was 30.83±2.4, 217.88±44.6, and 217.13±51.8, respectively showing a significant relationship (P=0.0001). The cut-off point of pro-BNP demonstrating a Qp/Qs ratio more than 1.5 was measured at the level of 40.36 pg/mL, with a sensitivity and specificity of 92% and 79%, respectively. Conclusion: Based on our study, the cut-off point of 40.36 pg/mL or more for pro-BNP, showing a Qp/Qs ratio more than 1.5, can be considered as an indication for interventional procedures.

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Objectives: Ventricular septal defect (VSD) is the most common congenital heart disease (CHD) (40%). Traditionally, VSDs have been repaired surgically; however, recently VSD closure by device has been developed. This study aimed to compare these two methods in terms of effectiveness, outcomes, and complications. Materials and Methods: This study was conducted on VSD patients who were treated by either surgery or trans catheter technique in Madani Heart Center from March 2011 to March 2017. The required data regarding effectiveness, outcomes, and complications were recorded based on the patient’s documents. The extracted data were analyzed by SPSS version 18.0. Results: A total of 93 patients were enrolled (43 patients in transcatheter [A] and 50 patients in open-heart surgery [B] group) in this study. The gender distribution was approximately the same. The mean age of group A was 10.55 years while it was 8.8 years for group B. The duration of ICU and hospital stay, total hospitalization cost, and frequency of blood products transfusion were significantly lower in group A than in group B. However, postoperative pacemaker insertion, arrhythmias, thromboembolism, and mortality rates did not show any significant difference between the two groups. The success rates in group A and B were 97.7% and 96%, respectively. Conclusions: The results of our study demonstrated that open-heart surgery, due to its nature, required longer hospital and ICU stay, higher cost, and higher blood transfusion rate than transcatheter therapy, but it was associated with similar complications and success rates. Therefore, device closure in appropriately selected patients is recommended as an alternative to the surgical approach.

Background Kawasaki disease (KD), which is the second most prevalent vasculitis disease in children after IgA vasculitis, can cause serious cardiovascular complications. Early detection of cardiac involvement in KD is an essential part in managing and preventing the cardiac sequels. Although some cardiac biomarkers such as cardiac troponin I (cTnI) and N-terminal pro-brain natriuretic peptide (NT-proBNP) have recently been suggested for early diagnosis of cardiac involvement in patients with KD, their applicability is still unclear. Thus, this study aimed to compare the levels of cTnI and NT-proBNP in KD child patients with or without cardiac involvement. Methods In this cross sectional study, 32 children with KD who were admitted to the children teaching hospital of Tabriz University of Medical Sciences between April 2015 and April 2018, were consecutively included in the study. For all involved children, the coronary artery involvement defined as coronary artery aneurysm or perivascular brightness of coronary arteries was examined by transthoracic echocardiography, and their serum levels of NT-proBNP and cTnI were measured. Results Of 32 enrolled patients, 4 (9.4%) had cardiac involvement including 3 patients with perivascular brightness of coronary arteries and 1 patient with small aneurysm of the coronary arteries. In all study patients, the cTnI levels were lower than 0.35 and the NT-proBNP assessments revealed an average of 678.5 pg/ml. Children with cardiac involvement had significantly higher NT-proBNP (p-value, 0.001). ROC analysis for power of the NT-proBNP in predicting the cardiac involvement, revealed an excellent power for NT-proBNP (AUC=1.000, p=0.001). Both sensitivity and specificity of NT-proBNP at the optimum cut-off point of 1354 pg/ml were 100 percent. Conclusion Unlike the cTnI, the NT-proBNP can serve as an excellent objective test for early detection of cardiac involvement. Therefore, in KD-patients with high levels of NT-proBNP additional therapy and closer follow up should be considered.