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Introduction. Acute respiratory distress syndrome (ARDS) is one of the most serious complications during the postoperative period in cardiac surgery. Venovenous extracorporeal membrane oxygenation (VV-ECMO) has proven to be a valuable therapy in ARDS when standard therapy is insufficient. Our aim is to present a case of severe ARDS which was succesfully treated by VV-ECMO. Case outline. A 54-year-old male patient was urgently admitted to our hospital due to anterior wall myocardal infarction. Urgent coronarography was performed, which found severe three-vessel coronary disease. Triple coronary artery bypass grafting (CABG) was performed. After surgery, due to prolonged respiratory insufficiency, the patient was diagnosed with ARDS and VV-ECMO was placed. Nine days later, normal values of gase exchange were achieved and the patient was succesfully weaned from VV-ECMO. Conclusion. We showed that when conventional therapy for ARDS is not effective, use of ECMO should be considered.

Minimally invasive options for coronary artery bypass graft (CABG) surgery progressed dramatically in the last decades. Minimally invasive CABG surgery is presented trough these forms: minimally invasive direct coronary artery bypass (MIDCAB), endoscopic atraumatic coronary artery bypass (EndoACAB), robot-assisted direct coronary artery bypass (RADCAB), total endoscopic coronary artery bypass (TECAB), and hybrid coronary revascularisation (HCR). Unfortunately, these are still limited only to the specialised centres across the world and have not been accepted by the majority of cardiac surgeons. A surgeon who is starting to practice minimally invasive CABG surgery needs to be ready for long duration of the interventions, higher rate of conversions to sternotomy and significant learning curve. Excellent results that have been published on the subject of minimally invasive revascularisation methods support the potential of these alternative approaches to evolve in the near future.

Introduction. The incidence of aortic dissection ranges 3–5 cases per 100,000 person-years. In women under the age of 40 who acquire aortic dissection, almost half of the cases happen during pregnancy. Case outline. We report a case of a 22-year-old pregnant woman in the 16th gestational week with a history of arterial hypertension and known aortic dilatation, who was admitted with aortic dissection. She underwent the Bentall procedure, in which her aortic valve, ascending aorta, and proximal part of the aortic arch were replaced using valved composite graft. On the next day, the evacuation abortion was made, since the fetus didn’t survive the operation. Six years later, the patient stopped taking anticoagulation therapy and was admitted for prosthetic valve thrombosis, which was successfully treated with intravenous heparin. One year later, the patient died of a myocardial infarction due to coronary thromboembolism, confirmed on autopsy. Conclusion. Preconceptional counseling in women with a known aortic disease is of the utmost importance. Aortic dissection in pregnant women is an acute life-threatening condition for both mother and fetus that should be managed by a multidisciplinary team. After a mechanical heart valve implantation, lifetime oral anticoagulants are mandatory.

Medical staff that makes the initial contact with patient with aortic dissection has a goal to rise a suspicion and recognize aortic dissection, as well as to safely transport the patient to a health center capable of providing the definite treatment. First step in the prehospital management is providing oxygen support via breathing mask to prevent organ damage. It is important to monitor all vital functions during transport, including heart rhythm and diuresis, in order to have a continuous insight into the patient's current state and in case of a deterioration react appropriately. Blood pressure control is the main goal of the medical treatment in aortic dissection. Systolic blood pressure should be kept between 100-120 mmHg, whereas the target heart rate is 60 beats per minute. Therapy should be started with intravenous administration of beta-blocker or non-dihydropyridine calcium channel blocker, followed by a vasodilator infusion. For pain management intravenous administration of opiates is recommended. In case of shock, intravenous fluid replacement with crystalloids should be initiated immediately, along with vasopressor therapy with noradrenalin or phenylephrine. In case of shock, the patient should be intubated and mechanically ventilated with the appropriate sedation.