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Uvod: Extrakorporalni membranova oxygenace (ECMO) je metoda mimotělniho oběhu se vzrůstajicim užitim u kardiogenniho soku nebo refrakternich srdecnich zastav. Pece o tyto pacienty je vesměs vazana na centra s kardiochirurgii. Technický vývoj usnadil zavedeni okruhu bez chirurgicke asistence a pro management oběhove podpory neni nutna přitomnost perfuzionisty.

Bifurkacni leze tvoři 15-20 % vsech intervenovaných koronarnich lezi a jejich osetřovani je i přes výrazný pokrok v intervencni kardiologii i nadale spojeno s technickými obtižemi a horsi klinickou efektivitou. Zakladnim doporucovaným postupem pro osetřovani bifurkacnich lezi je "provisional stenting". Jako alternativni postup lze zvažit některou z dvoustentových technik. V nasem registru jsme se rozhodli posoudit bezpecnost, technickou a klinickou uspěsnost při použiti dedikovaneho bifurkacniho stentu Tryton Side Branch. Do registru bylo zařazeno 201 pacientů neselektovane populace osetřených v obdobi mezi cervnem 2012 a dubnem 2016 v Kardiovaskularnim centru Krajske nemocnice Liberec, u kterých bylo zvažovano užiti bifurkacniho stentu Tryton. Uspěsnost osetřeni bifurkacnich lezi při užiti stentu Tryton byla 85,07 %. Pacienty jsme pote sledovali v obdobi sesti měsiců od osetřeni. K infarktu myokardu doslo u tři pacientů, k revaskularizaci bylo nutno přistoupit pouze u tři pacientů, z toho vsak ani jednou nebylo potřeba osetřit cilovou tepnu nebo lezi. Otazka osetřovani bifurkacnich lezi zůstava do budoucna stale otevřena, jako možna alternativa se jevi užiti dedikovaných bifurkacnich stentů. Bifurkacni stent Tryton ma výhodu v ochraně bocni větve, jejiž osetřeni může být u větsiny standardnich technik problematicke. Stent Tryton lze dle nasich dat s výhodou použivat zejmena u bifurkacnich lezi s velkou bocni větvi (≥ 2,5 mm). Data z naseho registru tak svědci pro vysokou bezpecnost a uspěsnost osetřovani tohoto typu bifurkacnich lezi pomoci stentu Tryton. © 2019, CKS.

The second part of the review deals in detail with the diagnostics and treatment of toxic alcohols poisoning and management and indication of extracorporeal removal techniques in intoxication with other drugs, theophylline, valproic acid, metformin and metformin associated lactic acidosis, respectively. The extracorporeal treatment enhances the clearance of the toxin and corrects patients metabolic disturbances as well. It is necessary to use this treatment in severe intoxications. Indication of this invasive procedure falls within clinicians and nephrologists competence being advised by a toxicologist. This review could help make fast decisions.

Supporting clearance of a toxic substance by an extracorporeal removal technique is one of the advanced treatment methods applied in poisoned patient management. General indications stem from toxicokinetics of the poison while individual indications are determined by poisoning severity. The first part of this review deals in detail with particular options of extracorporeal treatment in toxicology and also with its specific application when treating lithium and salicylates poisoning or dabigatran overdose. The aim of this review is to facilitate the clinicians and nephrologists decision making whether to indicate this invasive procedure, to communicate and summarize the existing recommendations and to highlight the most important ways of how to treat poisoning by specific toxic substances.

Localized pericardial calcification is a relatively rare finding of often unknown etiology. We present the case of a 68-year-old man who was found to have bulky pericardial calcification, resulting in external compression of epicardial coronary arteries. (Level of Difficulty: Beginner.), Graphical abstract, Localized pericardial calcification is a relatively rare finding of often unknown etiology. We present the case of a 68-year-old man who was found to…

We report a case of a successful surgical treatment of congenital heart defect in a 47-year-old man who experienced an atrial septal defect closure seven years ago. Nevertheless even after the operation he still suffered from increasing shortness of breath, which reached grade NYHA III last year. This state was caused by a partial anomalous venous return (PAPVR) from the left lung to the left brachiocephalic vein. This fact was overlooked during the first operation. Surgical treatment of newly diagnosed, at the time undifferentiated concomitant cardiac defect in the field of previous surgery requires a comprehensive assessment of the patient's condition and a choice of optimal tactics and strategies.

The objective of our study was to identify changes in the coagulation and serum concentration of soluble P-selectin (sP-sel) after i.v. bolus of 0.75 mg/kg enoxaparin in a group of 33 patients during PCI.As compared to baseline, i.v. enoxaparin increased anti -Xa activity and FIIa inhibition together with APTT and thrombin time tests within 20 min, that persisted for 60 min. At 6 h, the results of all tests had returned to baseline. In contrast, the level of prothrombin fragments (F1 + 2) decreased persistingly for a period of 6 h (baseline 1.19 ± 0.42 nmol/l, after 20 min 1.03 ± 0.46 nmol/l, after 60 min 1.06 ± 0.43 nmol/l, after 6 h 0.95 ± 0.40 nmol/l, p0.001 vs. baseline for all values). In addition, i.v. enoxaparin decreased serum sP-sel level (baseline 111.80 ± 37.05 ng/ml, after 20 min 87.80 ± 33.17 ng/ml, after 60 min 86.45 ± 29.15 ng/ml, after 6 h 92.24 ± 31.34 ng/ml, p0.001 vs. baseline value for all). sP-sel level mildly correlated with both F Xa inhibition (r = -0.275, p0.05) and F1 + 2 level (r = 0.274, p0.05).Intravenous enoxaparin induced target F Xa inhibition (0.6 IU/ml) for 60 min in 82% of study patients. During the 6 h of monitoring, a decrease of thrombin generation (F1 + 2) and sP-selectin levels were observed.

Background Surgical revascularisation in patients with acute myocardial infarction with ST-Segment Elevation (STEMI) is usually considered as a second choice when direct angioplasty/stent fails. However, improvements in surgical technique and postoperative care may justify coronary artery bypass grafting (CABG) in STEMI. Methods This was a retrospective analysis of prospectively gathered data of 135 patients with acute STEMI, treated with CABG in our department from February 2008 to December 2012. Patients were divided into two groups – operated up to 6 hours (35 patients) and 6 to 24 hours (100 patients) from onset of symptoms. Results Preoperatively, 18 (13%) patients were in cardiogenic shock, 10 (7.4%) had mechanical ventilation, and 36 (27%) had intra-aortic balloon counterpulsation (IABC). Mean number of distal anastomoses was 3.3 (range, 1 to 5), cardiopulmonary bypass time 122.7 + 52.6 minutes. In hospital (30-day) mortality was 8.1% (11 patients) with no significant difference in both groups (p = 0.541); 45 (33%) patients had one MACE, again with no difference in both groups (p = 0.89). Risk factor analysis revealed that Killip class at admission, cardiogenic shock, preoperative need for catecholamines, ventilation and low ejection fraction are risk factors for early mortality. Conclusions Acute CABG in patients with STEMI can be performed with good results. Risk factors for early mortality and morbidity are cardiogenic shock, poor haemodynamic status and impaired ejection fraction. Time from infarction to reperfusion did not influence the results.

Out of hospital cardiac arrest (OHCA) has a poor outcome. Recent non-randomized studies of ECLS (extracorporeal life support) in OHCA suggested further studies to define population that would benefit from ECLS. Ongoing prospective randomized study compares prehospital intraarrest hypothermia

The differentiation between chronic pulmonary thromboembolic hypertension (CTEPH) and pulmonary arterial hypertension (PAH) remains a clinical challenge. The aim of our study was to evaluate the usefulness of both echocardiographically and invasively derived pulmonary artery pulsatility indexes in the etiologic differentiation of patients with CTEPH and PAH. We retrospectively analyzed the results of echocardiographic and invasive hemodynamic examinations in 125 patients with either CTEPH (n = 62) or PAH (n = 63). Invasive data were obtained in 52 patients with CTEPH and 43 PAH patients. Using echocardiography, pulmonary artery systolic (PASP), diastolic (PADP) and mean (PAMP) pressures were estimated from velocities of tricuspid regurgitation and pulmonary regurgitation, respectively. Pulse pressure (PP) was calculated as the difference between PASP and PADP. To obtain pulmonary artery pulsatility indexes, we normalized PP by PASP (PP/PASP), by PAMP (PP/PAMP) and by PADP (PP/PADP). Pulsatility indexes assessed by echocardiography did not differ between CTEPH and PAH patients except for PP/PAMP [PP/PAMP (1.82 ± 0.33 vs. 1.40 ± 0.3, p < 0.001)]. Invasively derived pulsatility indexes were significantly higher in subjects with CTEPH (0.60 ± 0.08 vs. 0.53 ± 0.09 for PP/PASP; 0.98 ± 0.21 vs. 0.81 ± 0.21 for PP/PAMP; 1.58 ± 0.52 vs. 1.21 ± 0.41 for PP/PADP; all p < 0.001). The areas under the receiver-operating characteristic curves analysis showed that no cutoff value allowed discriminating between CTEPH and PAH by using echocardiographically or invasively derived pulsatility indices. Invasively derived pulmonary artery pulsatility indexes as well as echocardiographically determined PP/PAMP indexes are higher in CTEPH compared to PAH. However, due to the important overlap no optimal threshold values of these parameters can be given to allow satisfactory discrimination of the two diseases in clinical practice.

The Svelte (New Providence, NJ) sirolimus-eluting coronary stent utilizing a bioresorbable amino acid-based (PEA) drug carrier is mounted on a novel Integrated Delivery System (IDS) consisting of a low-compliant balloon with balloon control bands (BCBs) affixed to a 0.014 integrated wire with

To the Editor: One-third of patients with ST-segment elevation myocardial infarction, usually those presenting late, show ongoing left ventricular (LV) remodeling and poor clinical outcome despite primary percutaneous coronary intervention (PCI) ([1][1]). Cardiac transfer of bone marrow-derived stem

This article summarizes current knowledge on the mutual position of surgical and interventional treatment of patients with multivessel coronary artery disease. It focuses on the possibilities of their combined use – so called hybrid myocardial revascularization. The use of minimally invasive surgery combined with current technologies of coronary interventions offers new opportunities, taking advantages of both procedures and eliminating some of their disadvantages. This previously rarely used technique could improve the clinical outcomes and treatment comfort in selected groups of patients.