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Copyright of Anaesthesiology & Rescue Medicine / Anestezjologia i Ratownictwo is the property of Akademia Medycyny Publishing House and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Copyright of Polish Surgery / Chirurgia Polska is the property of VM Medica-VM Group (Via Medica) and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

We present a case of the left atrial myxoma 6 years after atrial fibrillation ablation. The initial diagnosis of the mass revealed on echocardiography was a thrombus. Failure of anticoagulant treatment and transesophageal echocardiography led to diagnosis of myxoma, confirmed intraoperatively and histologically.

Background: Acute aortic dissection is one of the most serious life-threatening conditions, with mortality during the first 48 hours reaching 50%., Aim: To assess short and long-term effects as well as safety of surgical treatment of aortic dissection combined with aortic valve repair., Methods: The study group consisted of 57 patients (38 males, 19 females, mean age 47.9 +/- 13 years) with dissection of the ascending part of the aorta (type A aortic dissection) who underwent surgery in our institution between 1985 and 1999. Follow-up duration ranged from 2 to 16 years -- mean 6 years. Control transthoracic or transesophageal echocardiography was performed in 37 patients., Results: Early mortality was 21%. There were 12 perioperative deaths and 3 late non-cardiovascular deaths. Three patients underwent repeated surgery due to (1) aortic valve insufficiency, (2) pseudoaneurysm at the site of the anastomosis between proximal part of the vascular prosthesis and the aorta, and (3) fistula between aorta and right atrium., Conclusions: Aortic dissection type A is more frequent in males than females. The main causative factor is hypertension. Early mortality is significantly higher in patients undergoing emergency surgery compared with elective procedures. Heart failure symptoms (NYHA class) improve postoperatively in the majority of patients. Aortic valve repair is effective and relatively safe, and is an alternative to the aortic valve replacement with coronary arteries reimplantation.

Unlabelled: The aim of the thesis is the evaluation of efficacy of surgical treatment for complex valvular heart diseases. An inclusion criterion to this analysis was the performance of a mitral valve replacement (MVR) and aortic valve replacement (AVR) for an artificial valve and a tricuspid valve replacement or plastic operation (TVR or pl. TV). Such operative procedures were carried out simultaneously. Twenty five operations were performed from 1995 to 1999. TVR was carried out in 2 patients, pl. TV in 21 patients and the Revuelt method was adopted for this purpose, whereas in two cases a tricuspid valve plastic operation was performed sewing in the annulus. In the two cases the revascularization of the right coronary artery was carried out simultaneously. In another case a myxoma removal from the left atrium was additionally carried out. One patient died due to renal failure during hospitalization on the 9th day after the operation. Three patients died subsequently in the first, second and third year after operation. The causes of subsequent deaths among the patients examined in the period of five years after the operation were thrombotic-embolic complications., Conclusions: Early and subsequent results of simultaneous tri-valvular operations are good. The most frequent and difficult postoperative complication in this group of patients is a low output syndrome. Subsequent complications and deaths are most often due to thromboembolic complications, therefore a particular attention should be paid to the anticoagulant treatment in this group of patients.

Unlabelled: The aim of the study was to analyze the risk and operative results in bypassed patients with ischemic heart disease (IHD) older than 65 years., Material: The study group was 117 patients over 65 years old (66-87, mean 71 years) and the controls were 233 patients below 65 years old (31-64, mean 51 years), who underwent coronary artery grafting., Methods: The frequency of such risk factors as diabetes, smoking, hypertension and IHD and myocardial infarction (MI) family history were performed. Theoretical operative risk in study group and in control group were estimated using: Parsonnette, The Cleveland Clinic Foundation and Euro Score scales. The number of anastomoses, the frequency of using the internal mammary artery (IMA) graft to left anterior descending (LAD) coronary artery and perfusion, aorta clamping and repercussion times were compared in both groups. The operative mortality, Q wave MI and stroke were analysed in study and control groups as the operative results., Results: There was the higher percent of women and patient with hypertension and lower percent of smokers in the study group. The total cholesterol, HDL-cholesterol, LDL-cholesterol, PAI-1, fibrinogen, creatinine levels and the number of the patients with cerebral or peripheral atherosclerosis were similar in both groups. The triglycerides level was higher in the study group. In the study group the use of IMA, as the conduit was lower. There was no difference in the perfusion time, aorta clamping time and reperfusion time. An operative mortality was higher in the older group (8.5% vs 2.6%; p < 0.05). The perioperative Q wave MI rate was 7.7% and 4.3% (ns) and stroke rate was 3.4% and 2.6% (ns). Estimated in our patients, theoretical operative mortality in the study group was 6.5-8.7% and in the control group was 2.1-2.7%, and there was no statistical differences compare to real operative mortality. The most adequate to real mortality was theoretical mortality estimated using EuroScore scale., Conclusions: 1. Coronary bypass surgery mortality was higher in the patients over 65 years old and the myocardial infarction was the main reason of death. 2. Using operative risk scales, the prognosis individual operative risk mortality to every patient can be estimated and if this risk is too high it is possible to eliminate some risk factors or desist from operative treatment.

276 patients aged 65 years or more, who underwent coronary artery bypass grafting in the Department of Cardiac Surgery, Medical University of Łódź in 1999 and 2000, were assessed. The analyzed group consisted of 193 men (69.93%) and 83 women (30.07%). The mean age of the patients was 69.14 years (+/- 3.42, age range from 65 to 79 years), 18 (6.52%) patients were in the first functional class of CCS classification, 55 pts (19.93%) in the second, 106 pts (38.41%) in the third and 97 pts (35.14%) in the fourth class. 87 patients (31.52%) had no history of myocardial infarction, 137 pts (49.28%) had a history of 1 infarction and 53 pts (19.2%) of 2 or more myocardial infarctions. 68.12% of patients smoked cigarettes. Arterial hypertension was observed in 176 pts (63.77%), diabetes mellitus in 50 pts (18.11%), chronic renal failure in 10 pts (3.62%), a history of stroke in 8 pts (2.9%), peptic ulcer in 42 pts (15.22%). Left ventricular ejection fraction below 30% was observed in 16 (5.8%) patients. 10 pts (3.62%) underwent coronary angioplasty and in 26 pts (9.42%) critical stenosis of the left main stem was observed. All patients were operated on cardiopulmonary bypass and myocardial protection was obtained by the use of cold crystalloid cardioplegy solution based on St. Thomas Hospital formula. 224 patients (81.16%) were operated electively. In early postoperative period the following complications were observed: death--35 (12.68%), low cardiac output syndrome--84 (30.43%), need of use of intraaortic contrapulsation--31 (11.23%), perioperative myocardial infarction--44 (15.94%). Respiratory complications were observed in 83 pts (30.07%), neurological complications in 7 pts (2.54%), acute renal failure in 25 pts (9.06%), intestinal bleeding in 5 pts (1.81%). Rethoracotomy was necessary in 12 of the operated (4.35%). Currently the age of a patient is considered as one of many risk factors and should not be treated as a contraindication to surgical revascularization procedure. In the analyzed material mortality correlated with a number of risk factors. It is to remember that the elderly have higher prevalence of coexisting diseases and that is why their exposure to the perioperative complications is also higher.

36 patients aged 65 years or more, who underwent mitral valve replacement in the Department of Cardiac Surgery, Medical University of Łódź in 2000, were assessed. This group consisted of 22 women (61.1%) and 14 men (38.9%). The mean age of the patients was 68.5 years (+/- 2.96, age range from 65 to 76 years). The analysis of preoperative clinical state of the patients revealed prevalence of diabetes mellitus in 19 pts (52.78%), chronic bronchitis in 9 pts (25%), arterial hypertension in 14 (38.89%), pulmonary hypertension in 21 pts (58.33%), atrial fibrillation in 25 pts (69.44%), ventricular arrhythmia in 2 pts (5.56%) and cigarette smoking in 15 pts (41.67%). The mean left ventricular ejection fraction was 48.89% (+/- 9.26, from 30% to 70%). All patients were operated on cardiopulmonary by-pass and cardioprotection was obtained by the use of cold crystalloid cardioplegy solution based on St. Thomas Hospital formula. 6 patients (16.67%) underwent myocardial revascularization procedure simultaneously. In early postoperative period the following complications were observed: death--6 (16.67%), low cardiac output syndrome--5 (13.89%), need of use of intraaortic contrapulsation--2 (5.56%), need of use of inotropic agents--9 (25%), respiratory failure with the need of prolonged intubation--4 (11.11%), acute renal failure--4 (11.11%), stroke--2 (5.56%), need of temporary cardiac pacing--5 (13.89%), need of rethoracotomy--1 (2.78%). The results of mitral valve replacement procedures in patients over 65 years are less satisfactory than those of aortic valve replacement procedures in the same age group, however deaths considered patients with number of risk factors. The older age of the patients should not be treated at the moment as a contradiction to the cardiac surgery, but should be considered as a one of many risk factors.

Unlabelled: We have used hypothermic retrograde brain perfusion (RBP) as a cerebral protection concurrently with hypothermic circulatory arrest (HCA) since September 1994. Till January 2000, 59 patients with ascending and arch aortic aneurysms were operated on (32 emergency cases with acute aortic dissection, 27 elective, including 5 with the chronic dissection). Cardio-pulmonary bypass (CPB) was established, using a common femoral artery and two venous caval cannulae, general hypothermia, aorta cross-clamping, and cold crystalloid intermittent cardioplegia via the coronary orifices. In 10 patients with De Bakey type I dissection, in whom the intimal tear was localised either in the arch or high in the ascending aorta near the orifice of the brachiocephalic trunk, and in 1 patient without dissection, after implementing HCA, continuous RBP was carried on with cold oxygenated blood via the superior caval cannula from its additional connection with the arterial line. After accomplishing the distal anastomosis (in 6 cases with the top of the arch containing the orifices of the brachiocephalic arteries and upper descending thoracic aorta, in 1 case using artificial arch, in 4 cases before the orifice of the brachiocephalic trunk) RBP was finished and CPB re-established. The incompetent aortic valve was repaired by suspension of its commissures and the prosthesis was anastomosed proximally above the coronary orifices. Seven patients died, one (with megaaorta syndrome) during the operation, 2 of myocardial failure on the 2nd postoperative day, and 3 of multiple organ disorder (including stroke with hemiparesis in 2) in the 2nd postoperative week (all but one after regaining consciousness). One patient died suddenly at home six weeks after the operation. Four patients are alive, without any neurological damage., Conclusion: This simple and economical method effectively protects the brain against ischaemia and emboli, without technically prolonging or complicating the operation.

30 patients aged 65 years or more, who underwent aortic valve replacement in the Department of Cardiac Surgery, Medical University of Łódź in 2000, were assessed. This group consisted of 19 women (63.3%) and 11 men (36.7%). The mean age of the patients was 71.83 years +/- 3.76, age range from 66 to 78 years. The analysis of preoperative clinical state of the patients revealed prevalence of diabetes mellitus in 23 pts (76.7%), chronic bronchitis in 4 pts (13.3%), arterial hypertension in 8 pts (26.7%), pulmonary hypertension in 8 pts (26.7%), atrial fibrillation in 4 pts (13.3%), ventricular arrhythmia in 13 pts (43.3%) and cigarette smoking in 8 pts (26.7%). The mean left ventricular ejection fraction was 50.8% (+/- 8.12%, from 31% to 64%). All patients before aortic valve replacement procedure underwent coronary angiography. All patients were operated on cardiopulmonary by-pass and myocardial protection was obtained by the use of cold crystalloid cardioplegy solution based on St. Thomas Hospital formula. 7 patients (23.3%) underwent myocardial revascularization procedure simultaneously. In early postoperative period the following complications were observed: death--2 (6.67%), low cardiac output syndrome--4 (13.33%), need of use of intraaortic contrapulsation--3 (10%), need of use of inotropic agents--13 (43.33%), respiratory failure with the need of prolonged intubation--8 (26.67%), acute renal failure--2 (6.67%), stroke--1 (3.33%), need of temporary cardiac pacing--4 (13.33%), need of rethoracotomy--2 (6.67%). The results of aortic valve replacement procedures in patients over 65 years age good, in spite of prevalence of number risk factors in these patients. The high rate (23.3%) of patients requiring simultaneous myocardial revascularization is remarkable. The age of a patient should not be treated as a contradiction to the cardiac surgery.