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Background: Extracorporeal circulation is associated with systemic inflammatory response syndrome. Therefore, the diagnosis of infection should be differentiated from a typical postoperative course., Aim: The aim of the study was to evaluate the kinetics of inflammatory biomarkers in children in the first days after cardiac surgery with extracorporeal circulation., Methods: Prospective data were collected from 51 consecutive children referred for surgical treatment in Department of Paediatric Cardiac Surgery, St. Adalbertus Hospital in Gdańsk, between February and August 2015. Blood samples were collected on the first, second, and third postoperative days and sent to the institutional laboratory for routine investigations: white blood cell count, serum C-reactive protein (CRP) and procalcitonin concentrations., Results: The highest levels of procalcitonin were on the first postoperative day (median 3.53 ng/mL), although the peak values of CRP concentration and white blood cell count were on the second postoperative day (96 mg/L and 17.3 G/L). In the group of patients with foreign material implantation (Contegra® or Gore-Tex®), the higher values of procalcitonin concentration and white blood cell count were measured in the subsequent postoperative days., Conclusions: The kinetics of analysed inflammatory biomarkers on the first days after cardiac surgery for congenital heart disease in children have different characteristics. The knowledge about the kinetics of inflammatory biomarkers could be useful in determining the possibility of evolving infections in the early postoperative period.

Background and Aim: Acute endocarditis (AE) is still rare disease in the paediatric population; nevertheless, the children suffering from AE usually need heart valve repair or replacement in emergency settings., Methods: We present a case of emergency mitral valve replacement with the use of Melody balloon expandable stented bioprosthesis in a two-year-old patient with AE and subsequent mitral (bicuspid) valve incompetence after aggressive infective destruction with the symptoms of critical multi-organ failure., Results: The patient, with a history of rapid deterioration after two-week-long septicaemia in the course of AE, was operated urgently after initial antibiotic treatment because of huge vegetations into the mitral valve orifice. A Melody TVP 22 valve was expanded over a 16-mm TyShak balloon and implanted into a mitral position (Melody-MVR) with good result., Conclusions: Based on current knowledge concerning heart valve reconstructions and institutional experience, we conclude that infected mitral valve in children should be primarily repaired; nevertheless, the Melody valve could be reasonably con-sidered as a mitral prosthesis in such conditions.

Background: Comprehensive cardiac rehabilitation (CCR) is an important element of the comprehensive management of grown-up congenital heart disease (GUCH) patients after surgical correction of congenital heart disease (CHD) but access to this treatment is still limited. We still lack Polish guidelines on CCR, including controlled training in young adults several years after surgical correction of CHD., Aim: To assess the effect of a CCR program on physical capacity, exercise tolerance, quality of life, and severity of depressive symptoms in GUCH patients long-term after surgical correction of CHD., Methods: We studied 57 CHD patients (30 females, 27 males, mean age 23 ± 3.4 years) at least 12 months after surgical correction of a ventricular septal defect (VSD) or ostium secundum atrial septal defect (ASD II). All patients were offered a CCR program, and 31 of them participated (rehabilitation group [Reh]) and 26 refused (non-rehabilitated group [NReh]). All patients underwent baseline cardiopulmonary exercise testing (CPET) using a cycloergometer and a ramp protocol with an initial load of 20 W followed by 10 W load increments per minute. Psychological evaluation included the Beck Depression Inventory (BDI) and the Euro QoL 5D questionnaire to evaluate quality of life. Patients were reassessed 30 days after the initial evaluation using the same investigations., Results: During CPET, all patients reached peak exercise intensity at the level of 15-17 in the Borg scale without complications. Resting HR was lower in the Reh group (74 ± 8 bpm) compared to the NReh group (81 ± 14 bpm). During CPET, patients in the Reh group reached significantly higher peak HR and percent maximum HR. Workload increased nonsignificantly (144 W vs. 124 W, p = 0.121), while duration of exercise and peak oxygen consumption was significantly longer in the Reh group compared to the NReh group (14 min vs. 11 min, p = 0.001; and 27.5 mL/kg/min vs. 23 mL/kg/min, p = 0.003, respectively). Patients in the NReh group showed non significantly higher severity of depressive symptoms compared to the Reh group, as evaluated using BDI at 30 days (mean score 4.8 vs. 2.2, respectively, p = 0.59). In contrast, subjectively and objectively rated quality of life was significantly higher in the Reh group compared to the NReh (score 89 vs. 74.4, p < 0.01; and 94 vs. 83, p < 0.01, respectively)., Conclusions: Implementation of a CCR program improves physical capacity, exercise tolerance, and quality of life and reduces depressive symptoms in patients late after surgical correction of CHD. Introduction of such programs seems reasonable as a supplement to the holistic care for GUCH patients.

Background: Paediatric hybrid cardiovascular procedures are becoming increasingly popular due to the wide spectrum of cardiovascular abnormalities and a large population of patients who could benefit from hybrid therapy. Contemporary hybrid procedures are introduced in the settings where routine cardiac surgery or cardiac interventions would not allow satisfactory results. Combining cardiac surgery and interventional cardiology techniques appears more beneficial and less invasive for the patient., Aim: To present results of hybrid procedures performed in the treatment of selected congenital heart disease in our centre in 2008-2013., Methods: We retrospectively analysed consecutive 80 patients referred for hybrid procedures., Results: Overall, 73 patients survived, with 4 early and 3 late deaths., Conclusions: Hybrid procedures in children with congenital heart disease combine the experience of cardiac surgery and interventional cardiology. Hybrid treatment is an alternative option for selected borderline patients. Initial results of hybrid treatment encourage further development of these methods and strategies to provide optimal benefits for the patients.

Background: Hybrid treatment of congenital heart disease is indicated in a selected group of borderline patients who do not have clear indications for either surgery or interventional treatment. Hybrid procedures take the best from cardiac surgery and interventional cardiology to reduce patient risk and trauma. Hybrid closure of ventricular septal defect (VSD) and atrial septal defect (ASD) without the use of extracorporeal circulation (ECC) might be less traumatic for patient., Aim: To compare levels of inflammatory markers and clinical symptoms of systemic inflammatory response syndrome during early postoperative care after conventional cardiac surgery and hybrid treatment., Methods: Our study group of 36 paediatric cardiac surgical patients in Gdansk included 22 children with perimembraneous VSD and/or ASD who underwent cardiac surgery using with ECC and 12 children with muscular VSD and 2 children with ASD who underwent hybrid treatment. We retrospectively evaluated inflammatory markers including C-reactive protein (CRP) level, white blood cell (WBC) count and mean platelet volume (MPV), and clinical variables including total duration of stay in the ward, blood transfusions, prolonged respiratory support, fever, arrhythmias, catecholamine support and wound infections. The Mann-Whitney U test was used to compare CRP levels, WBC count and MPV between the study groups., Results: Surgical outcomes were good in all children, with no residual leakage. A similar, predictable increase in inflammatory markers (CRP, WBS, MPV) was found in all groups: conventional cardiac surgery with ECC, hybrid treatment without ECC, and hybrid treatment with ECC. Comparison of these groups showed no statistically significant differences between levels of inflammatory markers as well as other clinical variables., Conclusions: Hybrid septal defect closure induces systemic inflammatory response syndrome activation as measured by CRP level, WBC count, and MPV, which is similar to that observed after cardiac surgery using ECC. Elevations of CRP level, WBC count, and MPV were similar after hybrid treatment with or without ECC. No significant differences were noted between trends of postoperative changes in the levels of inflammatory markers after treatment.

Background: The long-term impact of surgical correction of congenital heart defects (CHD) on exercise capacity and quality of life (QoL) has not been well established., Aim: To evaluate exercise capacity, QoL, physical activity and depression in young adult patients with a history of congenital heart defect surgery (GUCH) for simple left-to-right shunts, and to compare these parameters with those obtained in healthy volunteers., Methods: The study group consisted of 30 young adults with congenital heart defects (14 males, 16 females), aged 18-36 (mean 24.6) years who underwent corrective cardiac surgery at least 10 years earlier. The control group comprised 30 healthy students (15 males, 15 females), aged 21-28 (mean 24.4) years. We performed cardiopulmonary exercise testing on bicycle ergometer, QoL and physical activity tests, and depression inventory., Results: In young adult GUCH patients the exercise parameters were lower when compared to healthy peers. The Stanford questionnaire showed that physical activity was diminished as well as QoL in EuroQoL5 test. The Beck inventory showed more expressed depression in GUCH group., Conclusions: The exercise capacity, physical activity and QoL of young adults with a history of surgical treatment of CHD are worse than observed in healthy peers, and the health status does not fulfil the definition of complete recovery.

Hybrid approach becomes a promising conception of an alternative treatment for muscular ventricular septal defects (VSD) closure in infants. In this paper we report epicardial echocardiography imaging that enabled successful hybrid procedure performed in premature infant referred for surgical correction of a large perimembraneous VSD with simultaneous perventricular approach for concomitant muscular VSD.

The case of 61 year-old woman with congenital coronary artery fistula connecting left main coronary artery and the right atrium is presented. The patient was admitted to the Cardiology Department because of the first atrial fibrillation episode. During hospitalisation the congenital heart defect was diagnosed thanks echocardiography and multi-slice computed tomography. Three months later the percutaneous closure of the fistula with Amplatzer Duct Occluder was performed. The direct and 6-months results were very good.

Paravalvular leak (PVL) is a complication observed in patients after prosthetic valve replacement. The incidence of PVL is estimated as 2-3%. The cause of PVL may be paravalvular infection, suture continuity disruption, damage of tissues around the annulus or limitation of disc mobility by thrombus or vegetation. The preferable method of treatment of PVL is surgery. Recently, percutaneous closure of PVL became an alternative method. We present a case of successfully completed percutaneous closure of PVL with the use of Amplatzer occluder device in a patient with mitral PVL.