Showing papers by "Jerzy Sadowski published in 2011"

Clinical experience with the ATS 3f Enable® Sutureless Bioprosthesis.

Abstract: The ATS 3f Enable® Bioprosthesis is a self-expanding valve with a tubular design that allows for decreased leaflet stress and preservation of aortic sinuses. We report the midterm results of a prospective, multicenter clinical study evaluating the safety and efficacy of this stented bioprosthesis in patients undergoing isolated aortic valve replacement with or without concomitant procedures.

Increased thrombin generation and platelet activation are associated with deficiency in high molecular weight multimers of von Willebrand factor in patients with moderate-to-severe aortic stenosis

Abstract: Background High molecular weight von Willebrand factor (vWF) multimers (HMWM) are often deficient in patients with severe aortic stenosis (AS) owing to shear stress-enhanced proteolysis of vWF It has also been reported that AS is associated with increased activation of blood coagulation Objective To investigate whether patients with AS with a deficiency in vWF HMWM have enhanced thrombin generation and platelet activation in vivo Design Based on the analysis of vWF HMWM performed using immunolocalisation, 11 subjects with vWF HMWM deficiency (low %HMWM group) were identified and compared with 42 patients with AS with a normal distribution of vWF HMWM (normal %HMWM group) Plasma thrombin markers thrombin-antithrombin complexes (TAT) and prothrombin factor 1+2 (F12) plus platelet activation markers soluble CD40 ligand (sCD40L), β-thromboglobulin and P-selectin were also measured Patients 48 consecutive patients with severe AS and five with moderate AS, free of angiographically-proven coronary artery disease and clinically overt bleeding, were studied Results Patients in the low %HMWM group had 348% higher maximal transvalvular gradient (p=00003) and 448% higher mean gradient (p=00002) than those in the normal %HMWM group Thrombin formation was enhanced in the low %HMWM group (F12, 2845±637 vs 2169±625 pmol/l, p=0004; thrombin-antithrombin, 489±13 vs 406±09 μg/l, p=002) and both markers showed inverse correlations with the percentage of vWF HMWM (r=−059, p=0002; r=−042, p=003, respectively) In the low %HMWM group sCD40L (2794±607 vs 2214±417 pmol/l, p=0003) and β-thromboglobulin (731±92 vs 645±85 IU/ml, p=004), but not P-selectin, were also higher than in the remaining patients with AS Conclusion Patients with advanced AS deficient in vWF HMWM are characterised by enhanced thrombin formation and platelet activation This observation indicates the ambivalent impact of high shear stress in AS on haemostasis and might help explain two aspects of AS—Heyde syndrome and increased risk of thromboembolism

Mechanisms of increased vascular superoxide production in human varicose veins.

Abstract: INTRODUCTION Varicose vein disease is one of the most common morbidities in the developed countries. Recent studies have shown that oxidative stress is increased in varicose veins (VV) and venous insufficiency. However, the exact mechanisms of oxidative stress in VV remain unknown. OBJECTIVES The aim of the study was to measure superoxide anion production and analyze its enzymatic sources in VV in comparison with control human saphenous veins (HSV). Superoxide production was also compared between the proximal and distal segments of the veins. PATIENTS AND METHODS Proximal and distal segments of varicose veins (14 patients, aged 52 ±3.5 years) and control veins (15 patients, aged 56 ±4 years) were obtained during VV removal or elective coronary artery bypass graft surgery, respectively. Subjects were matched for age, sex, and the major risk factors for atherosclerosis. Superoxide was measured by lucigenin-enhanced chemiluminescence (5 μmol/l) in the presence and absence of oxidase inhibitors. RESULTS Superoxide production was increased in VV compared with control HSV. This increase was particularly evident in the distal segments of VV. There was a significant correlation between superoxide production in the proximal and distal segments of HSV but not of VV. Nicotinamide adenine dinucleotide phosphate (NADPH) oxidases and uncoupled nitric oxide synthase (NOS) were the major sources of superoxide in VV, because their inhibitors greatly attenuated superoxide production in VV. CONCLUSIONS NADPH oxidases and NOS could represent valuable drug targets for pharmacological treatment and prevention of varicose vein disease. Oxidative stress may provide a link between endothelial dysfunction, inflammation, and immune activation and the development of chronic venous dysfunction.

Characteristics of the heart failure population in Poland: ZOPAN, a multicentre national programme

Abstract: Background: It is difficult to define the optimal management of elderly heart failure (HF) patients with complex comorbidities. Thus, comprehensive characterisation of HF patients constitutes a crucial pre-condition for the successful management of this fragile population. Aim: To analyse the ‘real life’ HF patients, including the evaluation of their health conditions, management and their use of public health resources. Methods and results: We examined 822 consecutive patients diagnosed with HF in NYHA classes II–IV in primary care practices. The mean age was 68.5 years, and 56% were male. Only 23% of the patients who were of pre-retirement age remained professionally active. Ischaemic or hypertension aetiology was found in 90% of participants. Nearly all patients had multiple comorbidities. Most patients received converting enzyme inhibitors (88%) and beta-blockers (77%), 60% of them both, although dosing was frequently inadequate. During the six months preceding the study, 31% had cardiovascular hospitalisation and 66% required unscheduled surgery visits. Conclusions: The real life HF population differs from trial populations. Most of the real life patients who had not yet reached retirement age were professionally inactive, mainly due to a disability caused by cardiovascular conditions. Moreover, extremely few participants were free from any comorbidity. Compared to 20th century Polish data, there has been an improvement in the overall quality of HF-recommended pharmacotherapy. It must be stressed, however, that the percentage of those on optimal dosage remains unsatisfactory. Kardiol Pol 2011; 69, 1: 24-31

Development, implementation, and multicenter clinical validation of the TeleDICOM--advanced, interactive teleconsultation system.

Abstract: There is a need to make medical diagnosis available to critically ill patients on-site, without the necessity of time-consuming and risky transportation to larger reference hospitals. The teleconsultation of medical images is possible with the use of Internet-based TeleDICOM software developed in Krakow, Poland. Interactive consultation between two or more centers offers real-time voice communication, visualization of synchronized Digital Imaging and Communications in Medicine images, and use of interactive pointers and specific calculation tools. If direct interaction between physicians is not needed, the system can also be used in “offline” mode. In 2006, TeleDICOM was successfully deployed in the John Paul II Hospital in Krakow as well as a dozen other cooperating medical centers throughout southeast Poland. It is used for routine referral for cardiosurgical procedures. Aims of the study were to evaluate the image quality, software stability, constant availability, data transmission speed, and quality of real-time synchronized viewing of the images during the TeleDICOM teleconsultation; to evaluate the clinical utility of the TeleDICOM system; and to analyze the compatibility of TeleDICOM with the storage data formats of various imaging machine manufacturers. The analysis of angiographic offline teleconsultations was based on 918 patients referred remotely for coronary artery bypass grafting (CABG). The echocardiographic teleconsultations were performed during 63 live interactive consultations, several of them were presented to live during medical conferences. Measurement tools of the TeleDICOM software were tested against original measurement tools of echocardiographic machines from four different manufacturers. As a result of TeleDICOM consultation, a CABG decision was made in 806 of 918 patients consulted (87.8%). In remaining 12 patients, medical therapy or percutaneous angioplasty was recommended. CABG was performed in 98.6% of the admitted patients. Treatment decisions were changed after admission in 1.4% of patients—however, in all cases, it was not related to analysis of angiography data but rather to the change of clinical condition of the patients. All medical personnel involved in both offline and interactive teleconsultations judged the system positively in all assessed aspects. Lesser scores were observed only in the centers connected by slower networks. Measurements performed in the ECHO-TeleDICOM module were accurate as compared with those performed on a standard echo-machine (correlation r > 0.980, p < 0.001), independently of the echocardiograph model. Conclusion: This study demonstrates that telemedicine can improve patients' management using a clinically effective teleconsultation system. The TeleDICOM system is suited for professional use in the field of cardiovascular disease. It is also prepared for remote live demonstrations of clinical cases during large medical meetings.

Treatment strategies in severe symptomatic carotid and coronary artery disease

Abstract: Coexistent carotid artery stenosis (CS) and multivessel coronary artery disease (CAD) is not infrequent. One in 5 patients with multivessel CAD has a severe CS, and CAD incidence reaches 80% in those referred for carotid revascularization. We reviewed treatment strategies for concomitant severe CS and CAD. We performed a literature search (MEDLINE) with terms including carotid artery stenting (CAS), coronary artery bypass grafting (CABG), carotid endarterectomy (CEA), stroke, and myocardial infarction (MI). The main therapeutic option for CS-CAD has been (simultaneous or staged) CEA-CABG. This, however, is associated with a high risk of MI (in those with CEA prior to CABG) or stroke (CABG prior to CEA), and the cumulative major adverse event rate (MAE – death, stroke or MI) reaches 10–12%. With increasing adoption of CAS, a sequential strategy of CAS followed by CABG has emerged. Registries (usually single-centre) indicate an MAE rate of ≈7% for CAS followed by CABG (frequently after >30 days, due to double antiplatelet therapy). Recently, 1-stage CAS-CABG has been introduced. This involves different antiplatelet regimens and, in some centers, preferred off-pump CABG, with a cumulative MAE of 1.4–4.5%. No randomized trial comparing different treatment strategies in CS-CAD has been conducted, and thus far reported series are prone to selection/reporting bias. In addition to the established surgical treatment (CEA-CABG, sequential/simultaneous), hybrid revascularization (CAS-CABG) is emerging as a viable therapeutic option. Larger, preferably multi-centre, studies are required before this can become widely applied.

Depression and Quality of Life in Terms of Personal Resources in Heart Transplant Recipients

Abstract: Background Heart transplantation is the first option for treatment of heart failure engendering increased survival and quality of life among recipients. However, this surgical intervention causes many psychological problems such as depression and anxiety. Protective factors and personal recourses are significant forces behind healthy adjustments to life stresses. Purpose The aim of this study was to estimate the prevalence of depression among heart transplant recipients. Procedure The study consisted of a sample of 46 patients after heart transplantation. Standardized instruments used to measure the key constructs were Beck Depression Inventory Short Form for the prevalence of depression, World Health Organization Quality of Life - BREF for quality of life, Sense of Coherence (SOC-29), and Coping Orientation to Problems Experienced BREF to identify coping strategies. The data were analyzed statistically. Results We found that sense of coherence and coping strategies were significant predictors for quality of life and prevalence of depression, which were significantly associated with each others. Strategies focused on the problem are moderate quality of life with an age of recipient. Recipients who have a tendency to use emotion-focused strategies and are older showed a poorer quality of life, were less satisfied with their health, and displayed a prevalence of depression. Conclusions These results suggested that assessment of coping strategies and sense of coherence should be explored in heart transplant recipients with skills training in this domain.

Importance of evaluating conduction block in radiofrequency ablation for atrial fibrillation

Abstract: OBJECTIVE: Atrial fibrillation (AF) is the most frequently diagnosed cardiac arrhythmia. Anti-arrhythmic drugs may be used to suppress ectopic foci and interrupt reentry circuits, but are often insufficient to treat recurrent AF and have a number of adverse effects. Alternative therapies, such as catheter and surgical ablation, have been explored. This investigation examines the importance of assessing exit block when performing surgical ablation during beating-heart treatment of AF. METHODS: This was an evaluation of pooled data from multicenter prospective results obtained in AF patients who received ablation with a new, irrigated, vacuum-integrated device that creates linear lesions during beating-heart/open-chest or minimally invasive, portaccess procedures. Electrocardiogram or Holter data were collected intra-operatively and at 1, 3, 6, and 12 months. Outcomes were also evaluated for patients who were or ‘were not’ tested for exit block following the ablation procedure. RESULTS: A total of 93 patients were treated (61 open-chest surgeries, 32 port-access procedures). There were no device-related complications and no operative mortality. At 341 days’ average follow-up, 71/86 (83%) patients were free from AF, 66/86 (77%) were in sinus rhythm, and 60/86 (70%) were free from AF and off Class I and III anti-arrhythmic drugs (AADs). At 12 months, 23/23 (100%) patients with exit block confirmed were AF free compared with 13/21 (62%) patients with exit block not tested (p ≤ 0.01, Fisher’s exact test); 20/23 (87%) were in sinus rhythm compared with 12/21 (57%) patients with exit block not tested (p ≤ 0.05, Fisher’s exact test); and 20/23 (87%) were AF free without Class I and III AADs compared with 10/21 (48%) patients with exit block not tested (p ≤ 0.01, Fisher’s exact test). Both open-chest and port-access procedures yielded decreases in left-atrial size from baseline to 6 months’ followup. Patients undergoing port-access procedures also observed an increase in left-ventricular ejection fraction, which was also significant at 6 months.

Health Behavior of Patients After Heart Transplantation as an Indicator of Patient Compliance

Abstract: Introduction Life after heart transplantation (HTX) does not only mean adherence to medical recommendations, but also implementation of healthy habits each day. It is necessary to change health-related customs, diet, and lifestyle, as well as to maintain a high standard of hygiene. Some patients make the necessary lifestyle modifications prior to surgery, as a result of pre–heart failure conditions, such as coronary heart disease or hypertension or diabetes. People who suddenly fall ill must make these changes immediately after the operation. The transplantation team working with patients after HTX since 1988 performs a program of secondary prophylaxis. Patients work with a physician, psychologist, physiotherapist, nursing team, and dietitian. The program is based on the processual model of health behavior Health Action Process Approach by Ralf Schwarzer. The goal of the study was to describe and assess compliance to a healthy lifestyle among patients living with a heart transplant. Methods The study was conducted using the Health Behavior Inventory developed and standardized by Z. Juczynski. The scale examined three types of behavior lowering/raising the risk of illness as associated with compliance to medical recommendations, maintaining health, and reducing disease risk. Participants included 100 HTX patients including 23 women and 77 men of overall age range 21–75 years (average = 53.5). Results The results are as follows: General indicator of health behaviors—7.3 sten. Subscales: proper nutrition habits—3.5; prophylactic behavior—4.1; positive psychological attitude—3 health practices—3.8. Conclusions Heart transplant patients require professional, interdisciplinary assistance to shape healthy behaviors with motivational and volitional phases. Patients who follow medical recommendations experience a much better quality of life, protecting the new heart from negative effects of bad habits.

[Catheter-based renal sympathetic denervation for the treatment of resistant arterial hypertension in Poland - experts consensus statement].

Abstract: 1Klinika Kardiologii i Angiologii Interwencyjnej, Instytut Kardiologii, Warszawa; 2Klinika Nadciśnienia Tętniczego, Instytut Kardiologii, Warszawa; 3Oddział I Wewnętrzny i Nefrologii, Międzyleski Szpital Specjalistyczny, Warszawa; 4Zakład Nadciśnienia Tętniczego, Gdański Uniwersytet Medyczny, Gdańsk; 5I Katedra i Klinika Kardiologii, Warszawski Uniwersytet Medyczny, Warszawa; 6I Zakład Radiologii Klinicznej, Warszawski Uniwersytet Medyczny, Warszawa; 7Klinika Chirurgii Serca, Naczyń i Transplantologii, Collegium Medicum, Uniwersytet Jagielloński, Kraków; 8Pracownia Hemodynamiki Szpitala Uniwersyteckiego, Collegium Medicum, Uniwersytet Jagielloński, Kraków; 9I Klinika Kardiologii i Nadciśnienia Tętniczego, Instytutu Kardiologii, Collegium Medicum, Uniwersytet Jagielloński, Kraków; 10Klinika Kardiologii Inwazyjnej, Centralny Szpital Kliniczny, MSWiA, Warszawa; 11Klinika Nefrologii, Endokrynologii i Chorób Przemiany Materii, Śląski Uniwersytet Medyczny, Katowice; 12I Klinika Kardiologii, Uniwersytet Medyczny, Poznań; 13HTA Audit

Association between selected risk factors and the incidence of venous obstruction after pacemaker implantation: demographic and clinical factors

Abstract: Background : Venous obstruction and subsequent pulmonary embolism belong to the most common and dangerous complications of pacemaker implantation. Thus, identification of patients at risk of venous obstruction seems to be of critical importance. Aim : To determine risk factors of venous obstruction following pacemaker implantation. Methods : Eighty one patients with permanent cardiac pacing (31 F, 50 M; mean age 71.1 ± 7.6 years) were included. Prior to pacemaker implantation, the following factors were evaluated in each patient: indications for pacemaker implantation, heart failure severity assessed using the NYHA classification, coexisting diseases, a history of tobacco smoking, medications used before the procedure (antiplatelet drugs, anticoagulants, antibiotics), a history of thrombotic or infectious complications, and previous temporary cardiac pacing. Type of venous access and procedure time were also assessed. Venous ultrasound examination to evaluate veins in both upper extremities, shoulder areas and the neck was performed before pacemaker implantation and 6 and 12 months following the procedure. Computed tomography and conventional digital subtraction angiography were performed to confirm the diagnosis of venous obstruction. Results : The patients were divided into two groups based on the occurrence of venous obstruction after pacemaker implantation. Group I (n = 71, 29 F, 42 M; mean age 71.0 ± 7.7 years) included patients without venous obstruction, and group II (n = 10, 2 F, 8 M; mean age 71.6 ± 7.0 years) included patients diagnosed with venous obstruction. Each patient was followed for 19 months. In group II (12.3% of the study population), venous obstruction developed mean 13 months after pacemaker implantation. In this group, symptomatic venous obstruction was observed in 3 patients (3.7% of the study population), mean 15 months after pacemaker implantation. Risk factors for venous obstruction included a history of myocardial infarction, temporary cardiac pacing, arrhythmia, venous anomalies, NYHA class III and IV heart failure, a history of infection, and tobacco smoking. Depending on the number of risk factors, the probability of development of venous obstruction was described by the following equation: e –14.6 + 3.19x /1 + e –14.6 + 3.19x , where x is the number of risk factors. In patients who had more than 6 risk factors, almost a 100% probability of the occurrence of venous obstruction was observed. Conclusions : 1. Risk factors for venous obstruction include a history of myocardial infarction, temporary cardiac pacing, arrhythmia, venous anomalies, infections, NYHA class III and IV heart failure, and tobacco smoking. 2. In patients who had more than 6 risk factors, almost a 100% risk of venous obstruction was observed. Kardiol Pol 2011; 69, 10: 1033–1040

Early and Late Indications for Implantation of Cardiac Pacemakers in Patients After Heart Transplantation: A Single-Center Experience

Abstract: Background Data regarding the incidence and predictors of permanent pacemaker (PPM) implantation following cardiac transplantation are still limited and inconsistent. The aim of our study was to assess the incidence and indications for PPM implantation in cardiac transplant recipients in a single center. Methods We retrospectively analyzed the records of 508 consecutive patients including 425 men and an overall mean age of 45 y who underwent heart transplantation from 1988 to 2011 at our institution, using the biatrial surgical technique. Results Twenty-three (4.5%) subjects developed intermittent third-degree atrioventricular block (AVB) or sinus node dysfunction (SND) requiring PPM: 7 early ( 3 months) after transplantation. The incidence of AVB was higher than SND early (0.98% vs 0.4%; P P P P Conclusion The incidence of PPM after heart transplantation was 4.5%. AVB was the main indication for PPM early and late after transplantation. The time interval from transplantation to PPM implantation was shorter among SND compared with AVB patients.

Increased prevalence of cardiovascular risk factors in patients with acute coronary syndrome and indications for treatment with oral anticoagulation

Abstract: Background : Antiplatelet drugs currently constitute the basic treatment of coronary artery disease (acute coronary syndrome [ACS], stable angina and patients treated with percutaneous coronary interventions [PCI]). The number of patients with indication for dual antiplatelet therapy with comorbidities with high thrombo-embolic risk (such as atrial fibrillation [AF], venous thrombotic disease, valvular diseases) is increasing. That is why the need for simultaneous administration of dual antiplatelet and oral anticoagulant therapy (triple therapy) has become more common recently. The AF is the most common indication for chronic anticoagulation. Because of the lack of large randomised trials regarding triple therapy, characteristics of this group has not been well established. Aim : To assess the presence of cardiovascular (CV) risk factors and concomitant diseases in patients with ACS requiring triple therapy. Methods : Retrospective analysis included 2279 patients diagnosed with ACS who were admitted to the Departments of Cardiology in Cracow in 2008. In this group, 365 (16%) patients had indications for chronic anticoagulation. Demographic and clinical characteristics of these patients were compared with those of patients included in other published registries. Results : Patients requiring triple therapy were aged 73.2 ± 9.5 years. Hypertension was diagnosed in 80%, hyperlipidaemia in 63%, smoking in 36%, prior myocardial infarction in 33%, prior stroke in 15%, previous treatment with PCI in 13%, coronary artery bypass grafting in 7%, diabetes in 36%, heart failure in 46%, anaemia in 33% and chronic ulcer disease or gastroesophageal reflux disease in 9%. The mean left ventricular ejection fraction was 46 ± 15%. Compared with other registries of patients without indications for triple therapy, our patients had significantly more frequently hypertension, diabetes and were older. Conclusions : Patients after an ACS requiring triple therapy have more often a history of comorbidities and CV risk factors when compared with the group of patients with ACS without indication for triple therapy. Kardiol Pol 2011; 69, 9: 907–912

Surgical ablation for atrial fibrillation using the Ex-Maze III procedure on the beating heart in patients undergoing mitral valve surgery.

Abstract: Background : The Ex-Maze III procedure is a recently developed surgical method for ablation of atrial fibrillation (AF). The procedure uses epicardial approach and can be performed on the beating heart. Aim : To evaluate the efficacy and safety of Ex-Maze III ablation in patients undergoing mitral valve (MV) surgery. Methods : The study group consisted of 20 consecutive patients (8 males, mean age 67 years) who underwent MV surgery and had concomitant AF. Eighteen patients were diagnosed with long-standing permanent AF and 2 patients with paroxysmal AF. The mean duration of AF was 9.5 years prior to surgery. All the patients underwent the Ex-Maze III procedure on the beating heart immediately before the MV surgery (MV replacement in 17 patients and MV repair in 3 patients). The patients were followed 1, 3, 6 and 12 months after procedure with ECG and 24-h ambulatory ECG monitoring (at 12 months). Results : There were no serious complications in the study group. All the patients were in AF immediately after the procedure and underwent electrical or pharmacological cardioversion (4 and 16 patients, respectively). The proportion of patients remaining in sinus rhythm was 15 (75%) patients at 1 month, 16 (80%) patients at 3 months, 17 (85%) patients at 6 months and 12 months after procedure. Conclusions : The Ex-Maze III procedure for ablation of AF on the beating heart is safe and effective in patients with AF undergoing concomitant MV surgery. In order to better evaluate the outcomes of the procedure a prospective randomised multicentre study is needed. Kardiol Pol 2011; 69, 12: 1228–1232

[Hybrid ablation of the left atrium on beating-heart - initial experience].

Abstract: WSTĘP Leczenie chirurgiczne migotania przedsionkow (AF) jest rzadko polecaną alternatywą dla leczenia zachowawczego, co jest uzasadnione [1]. Ablacja chirurgiczna, choc jest metodą bardzo skuteczną, ma jednak bardzo inwazyjny charakter i wiąze sie ze stosunkowo wysokim ryzykiem środoperacyjnym [2]. Wiekszośc stosowanych obecnie metod chirurgicznej ablacji lewego przedsionka (LA) wymaga otwarcia klatki piersiowej poprzez sternotomie pośrodkową lub niewielką torakotomie 1lub obustronną [3]. W zaleceniach Europejskiego Towarzystwa Kardiologicznego kardiochirurgiczne procedury ablacji LA mają klase zalecen 2B [4]. W ostatnich kliku latach rozwinely sie kardiochirurgiczne techniki maloinwazyjne, pozwalające na zmniejszenie ryzyka powiklan operacyjnych i oferujące akceptowalne wyniki, rowniez kosmetyczne [5]. Najbardziej zaawansowaną obecnie metodą chirurgicznej ablacji LA jest metoda torakoskopowa. Wykorzystuje ona dostep typu port access [6]. Jej odmianą jest ablacja zarowno lewego, jak i prawego przedsionka. Krakowska kardiochirurgia od 2006 r. stosuje z powodzeniem te wlaśnie metode w wybranych przypadkach, w ktorych zarowno leczenie zachowawcze, jak i ablacja endokardialna nie są wystarczająco skuteczne. Niedoskonalością stosowania metody epikardialnej jest brak mozliwości wykonania szczelnej linii aplikacyjnej wokol zyl plucnych, co wiąze sie z aspektami technicznymi i trudnym dostepem elektrody ablacyjnej do tkanki serca. Dojście epikardialne nie gwarantuje skutecznych aplikacji ponad zylą plucną prawą i lewą gorną oraz ponizej zyly plucnej dolnej prawej. Konsekwencją wykonania niepelnej linii okrązającej zyly plucne mogą byc nowe formy arytmii wymagające dalszych ablacji. Wiadomo rowniez, ze skutecznośc ablacji przezskornych u pacjentow z przetrwalym AF jest ograniczona [7]. W tej grupie chorych ze wzgledu na zaawansowany remodeling przedsionkow sama izolacja zyl plucnych [8] nie jest wystarczająca i wymaga uzupelnienia wykonaniem dodatkowych linii ablacyjnych w przedsionkach. Dlatego tez powstala koncepcja polączenia uzupelniających sie typow procedur, czyli ablacji endokardialnej i epikardialnej. Wychodząc z tego zalozenia, w ośrodku w ktorym pracują autorzy niniejszej pracy, podjeto inicjatywe ablacji hybrydowych przeprowadzanych sekwencyjnie obiema metodami. Okazalo sie, ze do tego typu procedur konieczne jest wykorzystanie sali hybrydowej, przeznaczonej do wykonywania procedur z pogranicza kardiologii i kardiochirurgii. Pierwsze wspolne procedury ablacji epikardialnej i endokardialnej przeprowadzono 15 stycznia 2009 r. Zespol kardiochirurgow wykonal epikardialną ablacje torakoskopową, natomiast zespol kardiologow ablacje endokardialną.

Dynamics of the troponin I levels in the first days after heart transplantation (HTX) in the own material - a pilot study Dynamika zmian stężeń troponiny I w pierwszych dobach po przeszczepieniu serca (HTX) w materiale własnym - pilot study

Abstract: Background: Troponin is a valuable and highly used marker for the assessment of the myocardial damage. Elevated tro ponin levels are the result of myocardial injury irrespective of etiology. Aim: Evaluation of dynamics of troponin I changes in the first days (since “0” to 3 rd day) after heart transplantation (HTX). Material and methods: Retrospective analysis of 42 patients aged 21 to 62 years, average age 47.4 ±12.4. Study group consisted of the patients which hearts were harvested by two surgeons according to the identical protection scheme using CELSIOR cardioplegic solution. In all patients troponin I levels in the following days after HTX were measured. Dynamics of troponin I changes was assessed, using the onestep immunoenzymatic test (normal values to 0.1 ng/ml) in all of the patients in the first days after HTX. The highest daily value was taken into the analysis. Results: Average troponin I levels in the subsequent days after HTX were as follows: 21.7 ±22.1; 21.3 ±22.5; 17.6 ±20.3; 13.2 ±15.3 ng/ml. Based on ANOWA (Kruskal-Wallisa) test statistically significant troponin I levels decrease in the consecutive days after HTX (p = 0.0002) was noted. The biggest decrease was observed between days “0” and “3” and between days “1” and “3” (respectively: 54.1 and 53.7%); the smallest decreased appeared between days “0” and “1” after HTX (0.7%). Conclusion: Immediately after HTX significantly elevated troponin I levels can be observed that could be connected with perioperative myocardial injury caused by the heart harvesting and transplantation.

Influence of selected donor characteristics on the troponin I levels after heart transplantation: a single centre experience Wpływ wybranych czynników związanych z dawcą serca na wartości poziomów troponiny I po przeszczepieniu serca - opis na podstawie materiału własnego

Abstract: Introduction: The selected factors connected with the heart donor may influence the extent of the harvested heart injury. Aim of the study: To assess the influence of selected factors connected with heart donor on troponin I levels in the perioperative period (from day 0 to day 3). Material and methods: Retrospective analysis included 30 patients (4 females, 26 males) aged 22 to 62 years, average 48.5 ±11.00. The study group consisted of the patients whose hearts were harvested according to the same scheme. In all patients, troponin I levels were measured on the consecutive days after HTX. The following features were analyzed: donor’s age, cause of donor’s death, vasopressants’ use and total ischemic time (TIT). Troponin I levels were measured by one step immunoenzymatic test (normal values up to 0.1 ng/ml). Results: A inverse significant correlation between TIT (mean 218.8 min ±44.2) and troponin I levels in the period between day 0 and two days after HTX was observed. No influence of vasopressants on troponin I levels was noted. The weak trend towards (r = 0.3; p = 0.17) the positive correlation between donor’s age and troponin I levels on the 1st day after HTX was observed. Similarly, the weak trend towards the positive correlation between stroke and higher troponin I levels on the 1st postoperative day (p = 0.16) was observed. Conclusion: TIT does not correlate positively with increased troponin I values. The relationship demands further analysis. The donor’s age and stroke as the cause of the donor’s death

Evaluation of the aortic valve gradient in the patients with stentless 3F bioprothesismade of equine pericardium – one year follow-up

Abstract: Background: The acute result of surgical replacement of aortic valve is reduction of the transvalular gradient. The aim of the study was evaluation of the aortic valve gradient in one year follow-up (FU) of the patients with left ventricle hypertrophy after equine pericardial stentless bioprothesis replacement (3F Therapeutics, Lake Forest, USA, Medtronic, Inc., Minneapolis, USA). Material and methods: 40 patients with left ventricle hypertrophy [8 women and 32 men aged 23-78, mean 57 (± SD 10.2)] qualified to aortic valve replacement. Ultrasound eva luation of the gradient was performed in 1; 3-6 and 11-14 month FU after surgery. Results: Mean and maximal gradients were: 8.6 mmHg (± SD = = 4.8) and 16.1 mmHg (± SD = 8.8) after procedure, after 3-6 months FU were 7.8 mmHg (± SD = 3.7) and 14.5 mmHg (± SD = 7), 7.7 mmHg (± SD = 2.8) and 14.4 mmHg (± SD = 5.2) 11-14 months FU. Conclusions: Mean gradient and maximal gradient were low and there were no statistically significant changes during 1-year FU in comparison to baseline values.

Participation of Tenascin C in Native and Homograft Aortic Valve Degeneration* Udział tenascyny C w degeneracji natywnych i homogennych

Abstract: Background. Tenascin C (TnC) is a connective tissue matrix glycoprotein influencing cell proliferaton, migration and apoptosis. TnC participates in the development of pathological processes in the circulatory system including, as recently demonstrated, valvular degeneration leading to aortic valve stenosis. Homograft durability is limited by its degeneration, similar to changes appearing in cases of a typical aortic stenosis, which currently are regarded as an active remodeling process with expression of inflammatory modulators, as well as participation of cells and extracellular factors (including TnC), which under physiological conditions are involved in bone formation. Objectives. The aim of the study was a comparison of TnC expression in native stenotic aortic valves and degenerating aortic valve homografts. Material and Methods. The material included two groups of aortic valves removed during routine surgery: native stenotic valves (n = 10) and dysfunctional aortic valve homografts (n = 10). Frozen valve sections were used for immunohistochemical detection of TnC, and also for identification of cells differentiated towards myofibroblasts (SMA), macrophages (CD68) and endothelial cells (CD34, vWF). Results. TnC immunoreactivity was observed in both valve types, being significantly higher in native stenotic valves than in homografts (p = 0.007). The proportion of myofibroblasts in the total valvular cell population was insignificantly higher in native valves than in homografts. In homografts showing significantly lower total celullarity than native valves (p = 0.003), macrophages were more numerous (p = 0.005), and located mostly on the valve leaflet surfaces, while in native valves they were almost absent in this location. Conclusions. The presence of TnC in the stroma of native stenotic aortic valves and in homografts indicates a participation of active remodeling mechanisms in the pathogenesis of degeneration in both types of valves. However, a significantly lower level of TnC and lower cellularity in homografts suggests that changes leading to their dysfunction, to some extent, include passive degeneration (Adv Clin Exp Med 2011, 20, 2, 157–164).

Echokardiografia pierwszym krokiem w diagnostyce guzów nerki Echocardiography as a first diagnostic step in kidney tumours

Abstract: Intracardiac tumours are usually found after clinical symptoms lead to a positive imaging study, or as an incidental finding of imaging study, usually echocardiography. Cardiac tumours range from non-neoplastic lesions to high grade malignancies. The majority of primary cardiac tumours are myxomas (in 75% cases) or sarcomas (about 10% cases). In this paper we present cases of 2 patients with right atrial tumour, extending from renal carcinoma, invading renal vein and inferior vena cava into right atrium. Two different therapeutic strategies were undertaken in those patients.

Percutaneous coronary intervention and aortic valve implantation in a patient with breast cancer

Abstract: We present a case of a 70 year-old female with severe aortic stenosis, multivessel coronary artery disease and breast cancer who successfully underwent complex percutaneous coronary revascularisation, transapical aortic valve implantation and mastectomy. Kardiol Pol 2011; 69, 11: 1165–1167

Echocardiography as a first diagnostic step in kidney tumours

Abstract: Intracardiac tumours are usually found after clinical symptoms lead to a positive imaging study, or as an incidental finding of imaging study, usually echocardiography. Cardiac tumours range from non-neoplastic lesions to high grade malignancies. The majority of primary cardiac tumours are myxomas (in 75% cases) or sarcomas (about 10% cases). In this paper we present cases of 2 patients with right atrial tumour, extending from renal carcinoma, invading renal vein and inferior vena cava into right atrium. Two different therapeutic strategies were undertaken in those patients. Kardiol Pol 2011; 69, 8: 849–853

How to improve adherence to treatment among heart transplant recipients? Literature review and own experience

Abstract: Wstęp: Przeszczepianie narządów jest skuteczną, uznaną i bezpieczną metodą leczenia schyłkowej niewydolności narządów. Celem transplantacji jest przedłużenie życia, poprawa jego jakości i powrót chorego do społeczeństwa. Brak adherencji u pacjentów po przeszczepieniu oscyluje w granicach od 5% do 70% (1 na 5 pacjentów). Z powodu braku adherencji wzrasta siedmiokrotnie prawdopodobieństwo niewydolności graftu, co jest trzecią główną przyczyną epizodów odrzucania przeszczepionego narządu. Cel pracy: Ocena przestrzegania zaleceń u chorych po przeszczepieniu serca (heart transplantation – HTX) na podstawie badań własnych oraz ocena interwencji pielęgniarskich wpływających na poprawę adherencji na podstawie literatury i doświadczeń własnych. Materiał i metody: Badanie przeprowadzono u 66 pacjentów (16 kobiet, 50 mężczyzn) w wieku 23–76 lat, od roku do 18 lat po HTX, w trakcie wizyt ambulatoryjnych i hospitalizacji na Oddziale Klinicznym Chirurgii Serca, Naczyń i Transplantologii Szpitala Jana Pawła II. Do oceny przestrzegania zaleceń wykorzystano kwestionariusz Morisky’ego podzielony na dwie części dotyczące stosowania leków immunosupresyjnych oraz innych leków. Wyniki: Ze zgromadzonych danych wynika, że 35% pacjentów przyznało, że zdarzyło się im zapomnieć zażyć leki immunosupresyjne, a 41% – inne leki; 3–6% vs 21,21–30,3% przerwało zalecone leczenie. Przegląd literatury i Evidence Based Nursing wskazuje na konieczność łączenia różnorodnych metod zwiększających adherencję. Interwencje podjęte przez pielęgniarkę: • ocena przyczyny niestosowania się do zaleceń, • dobranie formy i metod edukowania pacjentów, • promowanie samoopieki, • współpraca z lekarzem. Summary