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Five heart recipients were followed up with mycophenolate mofetil and low dose cyclosporine due to progressive severe chronic postcyclosporine renal failure. Cyclosporine was gradually withdrawn and finally eliminated from immunosuppressive regimen to slow the rate of renal function loss. Improvement of renal function was observed. In the follow up after cyclosporine elimination no risk increase of acute rejection and no deterioration of left ventricle function was observed. Non-calcineurin inhibitors model in heart recipients can be the treatment of choice (but only in very selective cases) in patients with severe chronic renal insufficiency.

Background: Pulmonary hypertension (PH) with pulmonary vascular resistance (PVR) 320-480 ARU resistant to therapy is a contraindication for orthotopic heart transplantation (HTX)., Aim of the Study: evaluation of pulmonary hypertension in candidates for heart transplantation., Study Population and Methods: 44 patients (pts) with dilated cardiomyopathy (Group I) and 34 patients with ischemic heart disease (Group II) were assessed. Evaluation of PH was done according to the following protocol: 1st measurement (cardiac catheterization): PVR (pulmonary vascular resistance) > or = 320 ARU--infusion of NTG (nitroglycerine) 1 microg/kg/min. (during 10 min.), 2nd measurement: PVR > or = 320 ARU--infusion of NTG 2 microg/kg/min. (during 10 min.), 3rd measurement: final PVR evaluation. If PVR was less than 320 ARU in 2nd or 3rd measurement, the reversibility of PH was diagnosed, and when PVR > or = 320 ARU was observed in 3rd measurement, fixed PH was diagnosed., Results: No significant difference in baseline PVR between the groups was observed (Group I--332,7 ARU and Group II--327.6 ARU). In 23 patients with PVR > or = 320 ARU reduction of mean values of PVR, MPAP (mean pulmonary artery pressure) and TPG (transpulmonary gradient) was seen (p < 0.001), significantly more prominent in 11 pts from Group I. There was no correlation between duration of the disease and degree of PH. HTX was performed in 25 patients. PVR at 72 hours after HTX was similar in 7 pts with reversible PH and 18 pts with PVR < 320 ARU in 1st measurement., Conclusions: 1. Nitroglycerine used according to the protocol is sufficient in determining PH. 2. The reversibility of PH could depend on type of cardiomyopathy but not directly on symptom duration.

Introduction: Valsalva sinus aneurysms and fistulas (ASV; FSV) are rare aortic pathologies and present in only a few percent of patients with aorta and/or left arterial orifice disease. Etiology of ASV and FVS is congenital and acquired., Materials and Methods: 40 patients (pts) were operated on in the Department of Cardiovascular Surgery and Transplantology from 1978 to 2002 due to pathology of Valsalva sinus (< 1% of all operations in ECC). 18 pts were diagnosed with Valsalva sinus aneurysm and 22 with its fistula. Inflammatory etiology was confirmed in 22 pts (5%). Most common pathology was localized in the right and/or coronary lacking Valsalva sinus (30 pts-75%). FSV penetrated into the right atrium or ventricle in 20 pts (91%). Among accompanying pathologies aortic valve insufficiency was most frequently found. In 80% of pts with ASV aortic allografts were implanted. In 70% of pts with FSV, fistula was sutured with interrupted pledgeted mattress sutures. Accompanying anomalies were corrected simultaneously. Mechanical aortic valve was implanted in 9 pts., Results: 2 pts died in the early post-operative period and 3 in the follow up. Reoperation (with good results) was performed in 4 pts. At discharge all pts were in NYHA I/II except 1 pt in NYHA III. Objective estimation of patient's cardiopulmonary sufficiency did not differ from the subjective one. 24 pts performed normal life activities after operation. The echocardiography confirmed effectiveness of surgical treatment., Conclusion: 1. ASV and FSV require different surgical techniques. 2. Surgical treatment efficiently reduced symptoms. 3. Allografts were found very useful. 4. Accompanied anomalies should be treated simultaneously.

Introduction: In our department left ventricular aneurysmectomy was performed using only classic Cooley technique until 1989. Since then a modified technique was introduced: left ventricular geometry reconstruction modo Stoney simultaneously with the excision of scarred endocardium., Aim: Comparison of early clinical results after left ventricular aneurysmectomy using classic (Group A) and modified technique (Group B)., Material and Methods: Retrospective data analysis of early clinical outcome of patients (pts) operated from 1989 to 2000: classic technique 74 pts [63M (85.1%); 11F (14.9%); average age 52.26 +/- 10.35 years], modified technique 86 pts [74M (86%); 12F (14%); average age 55.83 +/- 9.3]., Results: No statistically significant differences between groups considering number of critically stenosed coronary arteries, left ventricular ejection fraction and left ventricular diameters were observed. Mean number of bypass grafts (gr. A 1.55, gr. B 1.69); aortic crossclamping time (gr. A 48.1 (24-77) +/- 12.9; gr. B 50.9 (0-91) +/- 16.1) were not significantly different between groups. In gr. A, 11 (14.8%) pts died: low output syndrome (LOS) 3 pts, LOS and ventricular dysrhythmias (VD) 5 pts, VD 3 pts. In gr. B 4 (4.6%) pts died: LOS 3 pts; LOS and VD 1 pt. Among other complications LOS and VD occurred significantly more frequently in gr. A. In both groups average postoperative ejection fraction increased; twice higher in gr. B than A., Conclusions: Modified technique: 1. Significantly decreases incidence of ventricular dysrhythmias in comparison to classic technique. 2. Significantly lowers incidence of low output syndrome and mortality rates in comparison to classic technique.

Background: Left ventricular true aneurysm is described as distinct area of the left ventricular wall with systolic dyskinesia where typical myocardial structure is replaced with fibrous tissue. Transmural infarction following occlusion of left anterior descending coronary artery is the most common cause of formation of the left ventricular aneurysm., Case Report: A 51-year old white male, with the history of inferolateral wall myocardial infarction 6 years ago was admitted to the emergency department at the local hospital last year because of sudden cardiac arrest due to ventricular fibrillation in the course of inferolateral myocardial infarction. Later on the patient did not come back to work, felt very weak and had dyspnea on mild exertion. Coronary angiogram performed one year later (the patient refused coronary angiography examination at the time of myocardial infarction) showed normal coronary arteries with a recessive right coronary artery. The left coronary artery was wide with normal contrast flow. Ventriculography showed large, true dyskinetic aneurysm with mural thrombus in the apical segment of the left ventricular wall. Left ventricular ejection fraction was 30%. Patient was qualified for the aneurysmectomy. A large dyskinetic aneurysm (8 cm) of the apical and anterolateral segment of the left ventricular wall was detected intraoperatively. A fresh thrombus weighing 9 g was evacuated from the inside of the aneurysm. Stoney's aneurysmectomy was performed. Histopathology showed a typical picture of scar tissue without signs of active inflammation., Conclusion: Normal coronary angiogram does not exclude development of large true aneurysm of left ventricular wall of typical localization for acute occlusion of left anterior descendent artery.

Between January 1991 and September 1997, in the Cardiovascular Surgery Department of the Institute of Cardiology of Jagiellonian University Medical School, 23 patients underwent emergency CABG due to acute myocardial ischaemia in result of failed PTCA. Over the same period of time invasive cardiologists performed 1883 PTCAs out of which 23 (1.2%) were emergency cardiosurgical procedures, and in 38 patients, stents were implanted in the damaged coronary arteries. The patients' age ranged from 37 to 67 years (median 52.2). In all patients good left ventricular function was preserved, median ejection fraction being 64%. Two patients required IABP to support left ventricular function. 1-4 bypass grafts were implanted (median 1.9 per patient). In one patient, internal mammary artery was collected and then implanted into anterior interventricular branch. The most common complication was myocardial infarction which occurred in 12 patients (52%). In ten patients low output was observed postoperatively. One operated patient (a female died (4.3%). The mean time of hospitalization was 11 days. Emergency myocardial revascularisation procedures performed after failed PTCA, bring higher risk of mortality and dangerous postoperative complications.