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The benefits of oral anticoagulation (OAC) therapy are undeniable. However, such treatment is contraindicated in 2%-10% of patients. According to the latest guidelines, percutaneous left atrial appendage occlusion (LAAO) may be considered in stroke prevention.We analyzed the data of patients from the Polish population, who had undergone LAAO procedures in the Silesian Province based on limited reports.The data from the SILCARD database of all patients who underwent LAAO between 2006 and 2019, and the data from the databases of the centers performing the procedures in the Silesian Province were included in the LAAO SILESIA registry. We analyzed the efficacy and safety of the procedure and its relationship with the occurrence of stroke and bleeding in the post-hospital follow-up.We analyzed 649 patients with the mean values of CHA2DS2-VASc and HAS-BLED scores of 4.1 and 3.2, respectively. The predominant indication for LAAO was a history of bleeding during OAC. The most frequent in-hospital major adverse cardiac events were anemia, which required blood transfusion (5.5%), and pericardial effusion, which was treated either conservatively (0.9%) or interventionally (1.2%). During hospitalization, stroke was detected in 4 patients and three patients died of any cause. LAAO reduced the annual risk of stroke by 84% and the annual risk of bleeding by 27%.Based on a "real-life" cohort of patients from the Silesian Province, we concluded that LAAO is related to low in-hospital major cardiovascular adverse events. In the long-term follow-up, LAAO reduced the rates of stroke and bleeding.

Introduction Left ventricular endomyocardial biopsy (LV-EMB) is the only procedure that allows a direct assessment of the left ventricular myocardium, thus enabling the diagnosis of myocarditis or other myocardial diseases. Aim To describe the characteristics of a population that underwent LV-EMB, as well as to address the periprocedural and technical aspects of the LV-EMB. Material and methods Since its initiation in our center in 2016, a total of 43 patients have undergone LV-EMB. In the manuscript, the indications for LV-EMB and the detailed technical aspects of its safe performance, including the equipment used, are described. A large part of the text is also devoted to the possible complications of LV-EMB. Results The results of the initial population that underwent LV-EMB in our center are presented. The patients who were qualified for LV-EMB were predominantly male (85.7%), with a mean age of 38.8 years. Of those, 38 (88.3%) had acute heart failure. The mean left ventricular ejection fraction was 19.6%. The primary indications for LV-EMB were unexplained heart failure with a left ventricular ejection fraction < 35% and (1) hemodynamic abnormalities or electrical instability of the heart and/or (2) recent worsening of heart failure (NYHA class II, III, or IV) with no response to standard therapy for 2 weeks. The mean fluoroscopy time was 5.4 min, and the mean radiation dose was 87 mGy. No periprocedural complications were found. Conclusions The results of the analysis indicate that LV-EMB can be performed safely by skilled physicians in an experienced center.

Introduction Randomized trials have proven the feasibility and safety of the bioresorbable vascular scaffold (BVS) in selected populations of patients. Data concerning the results of BVS in "real-world" registries with an appropriate sample size are limited. Aim Assessment of early- and long-term outcomes of patients undergoing bioresorbable scaffold implantation in an all-comers population of the ZABRZE-BVS registry. Material and methods The ZABRZE-BVS registry is a prospective registry including consecutive patients treated in the period 2013-2016 with the intention to implant a BVS (ABSORB, Abbott Vascular, Santa Clara, California). The primary endpoint was occurrence of the 12- and 24-month device-oriented composite endpoint (DoCE) defined as cardiac death, target-vessel myocardial infarction (TV-MI) or target lesion revascularization (TLR). The secondary endpoint includes occurrence of patient-oriented composite endpoint (PoCE) at 12 and 24 months, device (lesion basis) and procedural success (patient basis). Results A total of 456 patients during 467 procedures received 588 scaffolds in 563 lesions. Of note, 25.4% of patients presented with diabetes mellitus and 62.3% had an acute coronary syndrome. In QCA analysis, 78.7% of patients had type B2/C lesions, minimal lumen diameter was 0.78 ±0.54 mm, whereas post-procedural acute lumen gain was 1.61 ±0.61 mm. Median follow-up was 781 days. The cumulative rate of DoCE was 6.7% at 12 months and 12.2% at 24 months. Rates of 12- and 24-month PoCE were 12.4% and 20.1%, respectively. The percentage of device success was 98.7%, while the procedural success rate was 96.9%. Conclusions The Absorb BVS was successfully and safely implanted in an unselected group of patients. Scaffold thrombosis developed predominantly in patients with acute coronary syndrome (ACS).

To evaluate the incidence and severity of the impairment of selected cognitive functions in patients after sudden cardiac arrest (SCA) in comparison to patients after myocardial infarction without SCA and healthy subjects and to analyze the influence of sociodemographic and clinical parameters and the duration of cardiac arrest on the presence and severity of the described disorders.The study group comprised 30 cardiac arrest survivors, the reference group comprised 31 survivors of myocardial infarction without cardiac arrest, and the control group comprised 30 healthy subjects. The Mini-Mental State Examination (MMSE), the Digit Span test from the Wechsler Adult Intelligence Scale, Lauretta Bender's Visual-Motor Gestalt Test, and the Benton Visual Retention Test (BVRT) were used to assess the presence of cognitive impairment. An original questionnaire developed by the author was used for overall mental state assessment.The Bender test demonstrated a significant difference in the presence and severity of visual-motor skills between the study group and the control group, while BVRT and MMSE revealed increased incidence of cognitive impairment in the study group. The Bender and BVRT (D/D)/SS (version D, method D, scaled score) scales indicated cognitive impairment in 53.3% of these patients, while the BVRT (C/A)/SS test indicated cognitive impairment in 40%. For the reference group, the values were 32.3% and 12.9%, respectively. No correlation was found between the severity of cognitive impairment and the duration of cardiac arrest.Impairment of visual-motor skills, short-term visual memory, concentration, and visual-motor coordination occurs much more frequently and is more severe in individuals after SCA than in healthy individuals. Impairment of memory trace storage and recall after delay occurs more frequently in patients after SCA than in patients after myocardial infarction without cardiac arrest and in healthy individuals. SCA duration did not have any influence on the severity of the described disorders.Ocena częstości występowania i nasilenia zaburzeń wybranych funkcji poznawczych u pacjentów po nagłym zatrzymaniu krążenia (NZK) w odniesieniu do osób po przebytym zawale mięśnia sercowego bez NZK i osób zdrowych oraz analiza wpływu niektórych parametrów socjodemograficznych i klinicznych oraz czasu trwania NZK na obecność i nasilenie opisywanych zaburzeń poznawczych.Grupę badaną utworzyło 30 osób po NZK, grupę odniesienia – 31 osób po zawale serca bez NZK, a grupę kontrolną – 30 osób zdrowych. Do oceny obecności zaburzeń wybranych funkcji poznawczych użyto Krótkiej skali oceny stanu psychicznego (MMSE), Testu powtarzania cyfr ze Skali inteligencji Wechslera dla dorosłych, Testu zdolności wzrokowo-motorycznych Lauretty Bender oraz Testu pamięci wzrokowej Bentona (BVRT). Oryginalnie opracowany kwestionariusz posłużył do ogólnej oceny stanu psychicznego.W teście Lauretty Bender stwierdzono istotną różnicę w występowaniu i nasileniu zaburzeń zdolności wzrokowo-motorycznych w grupie badanej w stosunku do grupy kontrolnej, a w teście BVRT i MMSE – częstsze występowanie zaburzeń poznawczych w grupie badanej. U tych osób zaburzenia poznawcze mierzone skalami Bender i BVRT (D/D)/WP występowały u 53,3% badanych, a testem BVRT (C/A)/WP – u 40% osób. Dla grupy odniesienia wartości te wynosiły odpowiednio 32,3% i 12,9%. Nie wykazano zależności nasilenia zaburzeń poznawczych od czasu trwania NZK.Zaburzenia zdolności wzrokowo-motorycznych, krótkotrwałej pamięci wzrokowej, koncentracji oraz koordynacji wzrokowo-ruchowej u osób po przebytym NZK występują znacznie częściej i są bardziej nasilone niż u osób zdrowych. Zaburzenia zdolności przechowywania śladu pamięciowego i odtwarzania go po odroczeniu występują u chorych po przebytym NZK częściej niż u pacjentów po przebytym zawale mięśnia sercowego bez NZK i u osób zdrowych. Czas trwania NZK nie miał wpływu na nasilenie opisywanych zaburzeń.

The following description presents a case of a 75-year-old female patient with non-ST-segment elevation acute coronary syndrome in whom there occurred an infrequent complication of percutaneous coronary angioplasty: uncontrolled intracoronary stent displacement from a balloon catheter. During the attempt to retrieve the device using the “small-balloon” technique, further slippage of the stent from the balloon catheter to the right deep femoral artery was observed. Therefore, it was decided to provide a commercial intravascular microloop, whereby the stent was successfully retrieved outside the vascular system.

Background: Transcatheter aortic valve replacement (TAVR) has proven to be a valuable alternative to conventional surgical aortic valve replacement in high risk and surgically in operable patients who suffer from severe symptomatic aortic stenosis. However, a significant number of complications, associated with both the learning curve and device specificity, have required attention and subsequent improvement. The Symetis transapical TAVR system is a self-positioning bioprosthesis composed of a non-coronary leaflet of surgical quality porcine tissue valve sewn into a self-expanding nitinol stent that iscovered with a PET-skirt. Methods: From June to September 2013 six patients have been operated on severe aortic stenosis using the new TAVR device. All patients have undergone critical assessment of a local Heart Team and have been disqualified from conventional AVR. Five were woman. Mean age was 82.3 ± 2.0 (mean LogEuroScore 23.9 ± 14.3). Four patients suffered from coronary artery disease — two had history of previous percutaneous coronary intervention with intracoronary stents, while the next two had history of coronary artery bypass grafting. Diabetes was frequent (n = 3) as well as chronic obstructive pulmonary disease (n = 4). Carotid artery disease was encountered in three patients similarly to atrial fibrillation. Mean left ventricular ejection fraction (LVEF) was 51.5 ± 11.8%, but one patient had suffered from low-flow-low-gradient aortic stenosis with LVEF of 29%. Results: The procedure was carried out successfully in all six cases. Two patients have received the valve sized L, three — M and one — S. Mean procedure time was 180 ± 19 min, mean cine 7.2 ± 1.2 min. Mean X-ray dose 930 ± 439 mGy, while mean volume of contrast given was 135 ± 61 mL. In all patients but one perivalvular leak (PVL) was not present. One patient had trace of PVL. Also, good LVEF was noted in all patients. Similar findings were obtained 30 days post procedure. No strokes, transient ischaemic attack or other cerebrovascular incidents were observed. Conclusions: This brief clinical communication reports the first Polish experience with the second generation of TAVR device — the Symetis Acurate Transapical Aortic Valve. While it lacks large patient population and longer follow-up, it reveals that TAVR procedure can be performed safely, with minimal X-ray exposure time and contrast given and successfully — with almost nonexistent PVL and no cerebrovascular incidents or heart rhythm disturbances. Heart Team approach is vital, and transapical access should not be treated inferiorly, but rather as an equally appealing TAVR option.

The natural course of myocardial infarction (MI) leads to ischemic necrosis [(1)][1]. Experimental research indicates that hemorrhagic conversion of the myocardial necrotic area can increase the risk of serious complications of MI and may have a negative influence on its clinical course. After

The aim of the present study was to evaluate the effect of chronic total occlusion (CTO) localization in nonifarct-related artery (IRA) on 12 months mortality in patients with NSTEMI and multivessel coronary artery disease (MV CAD) treated with PCI We analyzed consecutive records of 991 patients

Background: Anxiety is a common and serious problem in ischaemic heart disease. Anxiety-associated somatisation disorders may imitate symptoms of coronary artery disease or coexist with ischaemic heart disease. Despite multiple visits to various specialists, patients with somatisation are frequently misdiagnosed and therefore mistreated. Identification of patients with anxiety disorders among patients complaining of chest pain is a prerequisite for appropriate management. By its nature, coronary angiography is a diagnostic test that can give rise to anxiety. However, dynamics of anxiety in this setting may be variable depending on coexisting mental disorders. Aim: The purpose of this study was to determine whether the presence of significant atherosclerotic lesions in coronary arteries affects anxiety level changes following coronary angiography. Methods: A group of 90 female patients who underwent coronary angiography was divided into two groups: the first one included 48 patients without significant coronary stenoses, and the other one included 42 patients with confirmed significant atherosclerotic lesions. Dynamics of anxiety level changes from the hospital admission, through the post-examination period, until 6 to 9 months after coronary angiography was evaluated with three-time measurement of anxiety using the Spielberger’s State-Trait Anxiety Inventory. In addition, intensity of anxiety as a trait was measured twice (at the first and the third examination). Results: The highest intensity of anxiety as a state was noted in both groups at the first measurement. A significant reduction in anxiety was observed at the second measurement, more pronounced in the group without significant coronary lesions. At the third measurement, women with confirmed significant coronary lesions showed the lowest level of anxiety, while the level of anxiety increased compared to the second measurement in the group of patients without significant coronary lesions. At the third measurement, women without significant coronary lesions showed a significantly higher level of anxiety compared to the group with significant coronary lesions. Intensity of anxiety as a trait was significantly lower at the final measurement in the group of patients with confirmed significant coronary stenoses. Conclusions: In women demonstrating no significant atherosclerotic lesions in coronary angiography, anxiety does not resolve permanently but reappears after several months. In this group, is seems justified to consider a diagnosis of an anxiety disorder in the form of a somatoform disorder. Those patients should be offered psychiatric therapy.

It has been proven that presence of chronic total occlusion (CTO) in other than infarct-related artery (IRA) in patients with NSTEMI is associated with higher rates of in-hospital and long-term mortality than in patients without CTO. However, there is a lack of data regarding the influence of the