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Pulmonary hypertension (PH) in patients with heart failure (HF) contributes to a poorer prognosis. However, in those with dilated cardiomyopathy (DCM), the true prevalence and role of PH is unclear. Therefore, this study aimed to analyze the profile of DCM patients at various levels of PH risk, determined via echocardiography, and its impact on outcomes. The 502 DCM in- and out-patient records were retrospectively analyzed. Information on patient status was gathered after 45.9 &plusmn, 31.3 months. Patients were divided into 3 PH-risk groups based on results from echocardiography measurements: low (L, n = 239, 47.6%), intermediate (I, n = 153, 30.5%), and high (H, n = 110, 21.9%). Symptom duration, atrial fibrillation, ventricular tachyarrhythmia, ejection fraction, right atrial area, and moderate or severe mitral regurgitation were found to be independently associated with PH risk. During the follow-up period, 83 (16.5%) DCM patients died: 29 (12.1%) in L, 31 (20.3%) in I, and 23 (20.9%) in H. L-patients had a significantly lower risk of all-cause death (L to H: HR 0.55 (95%CI 0.32&ndash, 0.98), p = 0.01), while no differences in prognosis were found between I and H. In conclusion, over one in five DCM patients had a high PH risk, and low PH risk was associated with better prognoses.

Background: Fibrosis of the extracellular matrix (ECM) in dilated cardiomyopathy (DCM) is common and compromises both systolic and diastolic function. The aim of this study was to investigate the kinetics of ECM fibrosis markers over a 12 month follow-up in patients with DCM based on the severity of diastolic dysfunction (DD). Methods: Seventy consecutive DCM patients (48 ± 12.1 years, ejection fraction 24.4 ± 7.4%) were included in the study. The grade of DD was determined using the ASE/EACVI algorithm. Markers of ECM fibrosis were measured at baseline and at 3 and 12 month follow-ups: collagen type I and III (PICP, PINP, PIIICP, PIIINP), transforming growth factor beta-1 (TGF1-b), connective tissue growth factor (CTGF) and galectin-3 were measured. Results: Patients were divided into three groups according to DD severity: 30 patients with grade I, 18 with grade II and 22 with grade III of DD. Levels of PICP, PINP were increased over a 12-month period, while PIIINP decreased and PIIICP unchanged. Levels of TGF1-b decreased from the 3 to the 12-month points in grade I and II DD, and in grade III they remained unchanged. Levels of CTGF decreased over 12 months in grade III DD but were unchanged in grades I and II. Galectin-3 levels remained the same over all observation periods, irrespective of DD grade. Conclusions: Regardless of the DD grade, markers of collagen type I synthesis increased, markers of collagen type III decreased. Levels of TGF and CTGF had a tendency to decrease. Galectin-3 was revealed not to be a marker discriminating the severity of DD.

Aims The hybrid technique of single-photon emission tomography and computed tomography with technetium99m-hexamethylpropyleneamine oxime–labelled leucocytes (99mTc-HMPAO-SPECT/CT) is an emerging diagnostic technique in patients with cardiac device-related infective endocarditis (CDRIE). This prospective study assessed the 99mTc-HMPAO-SPECT/CT diagnostic profile and its added value to the modified Duke criteria (mDuke) in CDRIE diagnostic work-up. Methods and results The study examined 103 consecutive patients with suspected CDRIE, who underwent 99mTc-HMPAO-SPECT/CT. Diagnostic accuracy was calculated based on a final clinical CDRIE diagnosis, including microbiology, echocardiography, and a 6-month follow-up. Subsequently, we compared the diagnostic value of the initial mDuke classification with a classification including 99mTc-HMPAO-SPECT/CT positive results as an additional major CDRIE criterion: mDuke-SPECT/CT. Overall, CDRIE was diagnosed in 31 (31%) patients, whereas 35 (34%) 99mTc-HMPAO-SPECT/CT were positive. 99mTc-HMPAO-SPECT/CT was characterized by 86% accuracy, 0.69 Cohen’s kappa coefficient, 84% sensitivity, 88% specificity, 93% negative, and 74% positive predictive values. The original mDuke displayed 83% accuracy, 0.52 kappa, whereas mDuke-SPECT/CT had 88% accuracy, and 0.73 kappa. Compared with mDuke, mDuke-SPECT/CT showed significantly higher sensitivity (87% vs. 48%, P Conclusion In patients with CDRIE, 99mTc-HMPAO-SPECT/CT provides high diagnostic accuracy, whereas a negative scan excludes CDRIE with high probability. Inclusion of 99mTc-HMPAO-SPECT/CT into mDuke diagnostic criteria yields significantly higher sensitivity and a reduction in possible CDRIE diagnoses.

Background: Atrial fibrillation (AF) is the most common arrhythmia in patients with dilated cardiomyopathy (DCM). However, the epidemiology as well as clinical and prognostic significance of AF in DCM are poorly defined. Aims: We aimed to assess the impact and prognostic value of AF in DCM as well as to investigate the concept of AF‑induced DCM. Methods: Hospital records of 285 patients with DCM from 2012 to 2018 with follow-up were analyzed. Results: Atrial fibrillation was present in 89 patients (31%). They were older, more frequently male, hadhigher body mass index, New York Heart Association class, heart rate (HR), creatinine levels, and larger atria (all P < 0.05) than patients without AF. During follow‑up (mean [SD], 35 [24] months), death occurred in 20 of the 82 available patients with AF and 22 of the 188 patients without AF (24% and 12%, respectively; P = 0.007). Atrial fibrillation was independently associated with a worse outcome (hazard ratio, 2.4; 95% CI, 1.3–4.3) and was found to be the major cause of DCM in 21 patients (24%). The diagnostic accuracy of the most optimal predictive model for AF‑induced DCM was 0.935 (95% CI, 0.903–0.967). Despite numerical differences, survival was similar in DCM patients with and without AF (P = 0.15). Conclusions: Almost one‑third of patients with DCM had AF. Most of the parameters analyzed differed between patients with and without AF, and AF was found to be an independent prognostic factor of DCM. One‑fourth of patients with DCM and AF met the diagnostic criteria for AF‑induced DCM.

Infective endocarditis (IE) is a life-threatening disease, establishing a diagnosis is often challenging. The aim of this prospective study was to evaluate and compare the diagnostic performance of the combined use of single photon emission tomography and computed tomography with technetium99m-hexamethylpropyleneamineoxime—labeled leukocytes (99mTc-HMPAO-SPECT/CT) with transthoracic echocardiography (TTE) in patients with suspected IE. We enrolled 40 consecutive patients (12 females, 28 males, mean age: 58.6 ± 18) with suspected IE in the years 2015–2016. All patients underwent clinical evaluation, TTE and 99mTc-HMPAO-SPECT/CT for the assessment of lesions typical for IE. Scans were evaluated for the presence and location of increased radioactivity foci, corresponding to the accumulation of radiolabeled leukocytes in inflammatory lesions. After 6 months, the patients were re-evaluated clinically and with TTE. Final IE diagnosis was established in 14 (35%) patients. Lesions typical for IE were shown in 28 (70%) TTEs and 16 (40%) 99mTc-HMPAO-SPECT/CTs. The latter tests were characterized by 90% accuracy, 93% sensitivity, 88% specificity, 96% negative predictive value (NPV), 81% positive predictive value (PPV). TTE demonstrated 60% accuracy, 93% sensitivity, 42% specificity, 92% NPV, and 46% PPV. 99mTc-HMPAO-SPECT/CT was characterized by a lower number of false-positive results compared to TTE (3 vs. 15). In patients with suspected IE, 99mTc-HMPAO-SPECT/CT yields a smaller number of false-positive results, significantly higher diagnostic accuracy, specificity and PPV than TTE. It helps to differentiate IE infectious and sterile echocardiographic lesions and reduces by 27% the number of misdiagnosed IE classified in the ‘possible IE’ category by modified Duke Criteria.

The systemic amyloidosis are diseases induced by misfolded proteins. These insoluble proteins deposit in extracellular space. Infiltration the heart by amyloid can result in progressive diastolic and systolic dysfunction and restrictive cardiomyopathy phenotype – left ventricle hypertrophy and stiffness. More than 20 different precursor proteins have the propensity to form amyloid fibrils. One of the most common amyloid infiltrating the heart is transthyretin amyloid (ATTR) - mostly inherited disease. ATTR is generally considered a mainly neurological disease, but it is phenotypically heterogeneous and the clinical spectrum of the disease varies widely, which makes the diagnosis a real challenge. Although, the early diagnosis improve the prognosis, especially due to new drug introduced in ATTR - tafamidis. In this article we would like to present the case series of transthyretin amyloidosis, which was diagnosed by heart scintigraphy or genetic testing.

Hypertrophic cardiomyopathy (HCM) is a primary disease of the myocardium that is defined by the presence of regional (more frequent) or global myocardial hypertrophy, which usually results in functional cardiac impairment. We present a case of a 34-year-old man with apical HCM who was admitted to the cardiology department due to cardiac hypertrophy in the echocardiogram. The management of HCM patients is directed at heart failure treatment and decreasing left ventricular outflow tract or intraventricular gradient, if present. According to the patient’s calculated 5-year mortality risk, assessed using the HCM Risk-SCD Calculator, indications for implantation of an implantable cardioverter defibrillator were evaluated. JRCD 2017; 3 (5): 180–183

Background: The dynamics of the extracellular matrix (ECM) fibrosis process in dilated cardiomyopathy (DCM) may be assessed non-invasively by means of serum markers of fibrosis. Aim: To explore the kinetics of serum markers of fibrosis during a 12-month follow-up in DCM. Methods: We included 70 consecutive DCM patients (pts) (48 ± 12.1 years, EF 24.4 ± 7.4%) with new-onset (n = 35, duration 6 months). Markers of collagen type I and III synthesis – procollagens type I and III carboxy- and amino-terminal peptides (PICP, PINP, PIIICP, PIIINP), and ECM metabolism controlling factors – tumor growth factor beta-1 (TGF1-β), and connective tissue growth factor (CTGF) – were measured in serum at baseline, and at 3- and 12-month follow-up. All pts underwent endomyocardial biopsy to determine the presence and extent of ECM fibrosis. Results: Markers of collagen type I synthesis (PICP and PINP) were almost homogenously increased over the 3- and 12-month period, whereas PIIINP values decreased and PIIICP levels were unchanged in new-onset and chronic DCM, and in pts with and without ECM fibrosis. Both TGF-β and CTGF levels decreased over the observation period. Kinetics of serum markers of collagen synthesis and fibrosis controlling factors did not differ between DCM pts categorized according to disease duration and fibrosis status. Conclusions: The kinetics of collagen type I and III synthesis in DCM move in opposite directions, with production of collagen type I consistently increasing, and the synthesis of collagen type III decreasing. Levels of TGF and CTGF, which are proven fibrosis-stimulating factors, had a tendency to decrease. Regardless of disease duration or fibrosis status, the kinetics of serum markers of collagen synthesis, TGF and CTGF were similar in DCM. A better understanding of the kinetics of serum markers of fibrosis in DCM may help to develop more tailored therapeutic approaches to fibrosis.

Left ventricular reverse remodeling (LVRR) is reported in dilated cardiomyopathy (DCM) patients (pts). However, numerous definitions of LVRR exist. Measurements of serum markers of fibrosis provide insight into myocardial fibrosis. The relationship between LVRR and fibrosis is poorly understood. From July 2014 until October 2015, we included 63 consecutive DCM pts (48 ± 12.1 years, EF 24.4 ± 7.4%) with completed baseline and 3-month follow-up echocardiograms. LVRR was assessed on the basis of four differing definitions. Procollagens type I and III carboxy- and amino-terminal peptides (PICP, PINP, PIIICP, and PIIINP), collagen 1, ostepontin, tumor growth factor beta-1, connective tissue growth factor, and matrix metalloproteinases (MMP-2, MMP-9), and their tissue inhibitor (TIMP-1) were measured in serum. In addition, all pts underwent right ventricular endomyocardial biopsy. Depending on the definition chosen, LVRR could be diagnosed in between 14.3 and 50.8% pts. Regardless of the LVRR definition used, the frequency of LVRR was similar in fibrosis negative and positive DCM. Minor differences of markers of fibrosis were detected between pts with and without LVRR. For every LVRR definition, adjusted and unadjusted models were constructed to evaluate the predictive value of serum fibrosis parameters. Only an increase of TIMP-1 by 1 ng/ml was found to independently increase the probability of LVRR by 0.016%. The choice of a particular definition of LVRR determines the final diagnosis, and this has a profound impact on subsequent management. LVRR is unrelated to biopsy-detected ECM fibrosis. Serum markers of fibrosis are only weakly related to LVRR, and are not of use in the prediction of LVRR.

Cardiovascular diseases in pregnancy are the most common causes of maternal mortality in developed world and an important cause of heart failure, stroke, and arrhythmia. Cardiac disease complicates 0.4–4% of all pregnancies, and arrhythmias are among the most common cardiac complications [1]. In some cases, pregnancy triggers exacerbations of pre-existing arrhythmias, whereas in others it may manifest for the first time [2]. A prior history of arrhythmias or structural heart disease and family history of sudden death are the factors that matter to risk of tachyarrhythmias during pregnancy [3]. Due to extraordinary ethical considerations in pregnant women, there are only a few randomized studies and little data on efficacy or safety of antiarrhythmic drugs applied during pregnancy [4]. Therefore, much of clinical care is guided by general knowledge about hemodynamic changes in pregnant women, universal principles of treatment of arrhythmias and finally by gained experience in that area. Multi-disciplinary approach remains the overriding principle in management of pregnant woman with arrhythmias, including collaboration with gynecological and obstetric center. JRCD 2016; 2 (6): 177–180

Brugada syndrome is an autosomal dominant genetic disease with variable expression characterized by abnormal electrocardiographic findings – right bundle branch block and ST-segment elevation in the anterior precordial leads, without evidence of structural heart disease. Individuals affected by the disease have an increased risk of ventricular tachyarrhythmias and sudden cardiac death (SCD). We present a case of a 33-year old man who was admitted to cardiology department after sudden cardiac arrest due to ventricular fibrillation. Evaluation for a structural heart disease was negative and routine tests did not reveal the cause of cardiac arrest. Retrospective evaluation of the patient electrocardiograms showed changes consistent with Brugada type 2 pattern that were variable over time. Performed pharmacological challenge with sodium channel blocker – ajmaline – provided an ambiguous result. Nevertheless, the patient was qualified for an implantable cardioverter defibrillator implantation as a secondary SCD prophylaxis. He underwent the procedure without complications and was discharged home in good general condition without symptoms.

Peripartum cardiomyopathy (PPCM) is defined as an idiopathic cardiomyopathy, presenting with heart failure (HF) secondary to left ventricular systolic dysfunction (LVSD) at the end of pregnancy or in the early months after delivery. Importantly, there should be no other identifiable cause of HF. The pathophysiology of PPCM is not fully understood and is probably multifactional. The data on the PPCM prognosis are sparse. Though initial reports suggested that mortality in PPCM vary geographically. We present a case of a a nulliparous 25-year-old Caucasian woman, who gradually developed dyspnea on exertion and fatigue 2 months after successful vaginal twin deliv- ery. She did not have any typical risk factors for cardiovascular diseases, her family history was unremarkable, and the whole pregnancy period was uneventful. After initiation of anti-HF therapy her clinical status gradually improved and she was discharged home with only mild symptoms and improved LV systolic function. JRCD 2015; 2 (3): 85–88

Hypertrophic cardiomyopathy (HCM) is the most common inheritable cardiac disorder with an estimated prevalence of 1:500 in the general population. In minority of patients, with the prevalence approximately of 3–5%, HCM progresses into dilated, end-stage or burn-out phase, characterized by LV wall thinning, systolic dysfunction and LV cavity dilatation. We present a case of a 45 year-old man with endstage HCM with postcapillary pulmonary hypertension, who was experimentally treated with sildenafil. It resulted in noticeable clinical and haemodynamical improvement. JRCD 2014; 2 (1): 23–26

Recent data indicate that substantial proportion of cardiomyopathy patients have in fact more than one phenotype, the phenomenon termed as overlap or mixed cardiomyopathy. The molecular mechanisms and pathology as well as clinical management and prognosis of overlap cardiomyopathy is largely unknown and speculative. We report the case of 51-year-old man who was admitted due to progressive intolerance of physical activity with concomitant shortness of breath. He underwent complex cardiological studies, including invasive examinations and endomyocardial biopsy. However, despite exhaustive diagnostic work-up, the final diagnosis is still not one-hundred percent certain, and we eventually diagnosed him with overlap cardiomyopathy as most probably two phenotypes of hypertrophic and restrictive cardiomyopathy coexist. Perhaps, cardiomyopathies are far too complex entities to be easily labeled with one or another term. Accumulated data on the clinical course of various cardiomyopathies provide numerous evidence on the continuum rather than onceforever diagnosis. JRCD 2014; 1 (6): 21–28

The changes in hemodynamics, as well as changes in the aortic media during pregnancy, put the women with bicuspid aortic valve (BAV) and significant aortic stenosis (AS) and/or dilated aortic roots at risk for complications during this period. From 1988–2014,89 pregnant patients with BAV, mean 26.8 ±4.6 years, were observed. There were 52 patients with AS: 22 with mild AS, 30 with moderate to severe AS and 37 patients with aortic insufficiency (AI). Medical history, physical examination, NYHA class assessment, ECG and echocardiography were performed during each trimester (TR) of pregnancy and after delivery. During pregnancy all patients with mild AS remained in NYHA class I. All of them delivered vaginally healthy babies on term. Patients with moderate to severe AS in I TR remained in NYHA class I-II, in 6/30 patients clinical deterioration was observed within III TR. Seventeen women with severe AS delivered by cesarean section, the remaining vaginally. In the group of IA clinical deterioration was observed in III TR in 5/37 patients with severe AI, enlarged left ventricle (LV) and depressed systolic function. Six of them delivered by cesarean section, the remaining vaginally. Conclusions: Patients with mild AS tolerate well the increased cardiovascular demand of pregnancy. In patients with severe AS pregnancy intensifies the hemodynamic disorders. Volume overload of pregnancy is well tolerated in patients with mild and moderate IA. Cardiac complications can be expected in patients with severe IA, LV enlargement and impaired systolic function. In the observed group of BAV patients there was no pregnancy-associated dissection. JRCD 2014; 2 (1): 9–14

The mediastinal tumors are rare but potentially fatal diseases. Teratomas are derived from multipotent germ-line cells. In majority of cases mediastinal tumours are incidentally detected on chest X ray. We present 19-year-old patient with recurrent pericarditis recurrent pericarditis. After comprehensive diagnostic process it was figured out that the reason for recurrent pericarditis was large mediastinal teratoma. Once the correct diagnosis has been made, the patient could have been completely cured. JRCD 2014; 1 (6): 29–32

A 30‑year‑old woman with Turner Syndrome was admitted to our centre in 12th week of her first pregnancy with a history o surgical correction of coarctation of aorta. She was asymptomatic with good general condition. Transthoracic echocardiography revealed a bicuspid aortic valve with moderate regurgitation and an ascending aorta aneurysm. In angio‑MR the narrowing of the isthmus of the aorta over 50% was seen with peak systolic gradient found in echocardiography approximately 41 mmHg. She was prescribed metoprolol and was closely monitored, the course of pregnancy was uneventful. In 24th week of pregnancy steroids were administered as a preparation for earlier delivery. She delivered in 34th week of pregnancy a healthy baby weighting 2100 grams. Caesarean section was performed in the cardiothoracic surgery ward and after delivery she underwent percutaneous angioplasty of coarctation of aorta with stent implantation. Six weeks after labour she underwent the Bental de Bono procedure with artificial aortic valve implantation. In six‑month observation patient was in good general condition, echocardiography showed normal ascending aorta diameter. JRCD 2013; 1 (4): 16–20

Pregnancy in women with pulmonary arterial hypertension due to congenital heart disease is associated with significant morbidity and mortality both in the mother and fetus. We report a case of a 25-year-old woman with Eisenmenger’s syndrome who got pregnant when treated with bosentan. Bosentan was changed to sildenafil. During the course of pregnancy she developed ischemic stroke. She delivered in the 33 week of gestation. We present our treatment approach and review the current literature on pregnany in pulmonary arterial hypertension. JRCD 2013; 1 (3): 27–31

Background: Transcatheter Aortic Valve Replacement (TAVR) is typically performed under general anesthesia with endotracheal intubation (GA). There is growing data in the literature however, that th...

Pulmonary arterial hypertension (PAH) is a progressive disease leading to right ventricular failure and death, if not treated adequately. Pregnancy in women with PAH is associated with significantly high mortality, thus current guidelines strongly recommend, that pregnancy in PAH female patients should be avoided and in the case of pregnancy, termination at early stage is recommended. We present results of a study aimed at assesing maternal and newborn outcomes in gravidas with PAH. Five pregnant females with PAH in the mean age of 29.6 ±8.23 years were included in the study. In two patients idiopathic PAH (IPAH) and in three PAH due to congenital heart defects and Eisenmenger syndrome were diagnosed. Three patients received PAH-specific therapy (monotherapy) prior to pregnancy. During pregnancy two women received sildenafil, then treprostinil (one started in 33rd week of gestation, second few hours before labour). Two patients did not received PAH specific therapy due to non-availability in Poland at that time and one according to treatment denial. In one case spontaneous abortion at the 8th week of pregnancy occurred and one of the patients reported 4 previous miscarriages. Two patients are still alive, one is lost to follow-up and two of them died: one in the postpartum period and the second ca. 18 month after abortion. All newborns survived.Considering the high mortality rate among pregnant women with PAH, pregnancy is strongly contraindicated. If the patient decides to continue pregnancy she should be under medical care in a specialist centre with a multidisciplinary approach and PAH specific treatment should be administered.

Short QT (SQTS) syndrome is a rare inherited autosomal dominant cardiac channelopathy associated with malignant ventricular and atrial arrhythmias. It is the severest form of the major channelopathies, with cardiac arrest or sudden cardiac death (SCD) as the most common presentation. We report a case of a young patient in whom ventricular fibrillation was the first manifestation of the disease.

A 45-year-old man with a 2-month history of breathlessness, fatigue and irregular heart rate was referred to our centre after first-ever cardiopulmonary decompensation. At presentation he was stable with heart rate of 120/min, blood pressure of 140/90 mmHg, in NYHA class II. 12-lead ECG showed atrial fi brillation, low R-waves voltage and deep S-waves with non specific ST changes in V1-V6. A posterior-anterior chest X-ray showed an enlarged cardiac silhouette, whereas on lateral picture an unusual structure was identified in the thorax cavity. An echocardiogram showed an enlarged, hypertrophied left ventricle (LV) with severe global systolic impairment. A computed tomography revealed an intestinal loop, characterized as the anterior Morgagni type congenital diaphragm hernia, in the anterior mediastinum resulting in the heart dislocation to the right side. Cardiac magnetic resonance revealed a thinned apex coupled with increased trabeculation at the apex, posterior, lateral and anterior wall. The measurements of double-layered LV wall, confi rmed the diagnosis of LV non-compaction (LVNC). This case is an illustrate of a constellation of rare anomalies of LVNC, persistent left superior vena cava with a congenital anterior Morgagni-type diaphragm hernia, causing heart dextroposition. On multidisciplinary team meeting the general decision of conservative treatment was made with typical systolic heart failure pharmacotherapy, restoration of sinus rhythm, considering referral to ICD and/or CRT-D, and regular clinical and echocardiographic follow-up of both patient and patient’s pedigree. JRCD 2012; 1: 18–23 Key words: Cardiac malposition; Dextroposition; Diaphragmatic hernia; Left ventricular non-compaction

A 34-year-old female with Ebstein’s anomaly presented to our centre at 19th week of her fi rst pregnancy with a history of dyspnea, palpitations and syncopes. Echocardiogram showed typical signs of Ebstein’s anomaly with severe tricuspid regurgitation, large atrial septal defect with left-to-right shunt and elevated right ventricular systolic pressure. She was prescribed metoprolol and anticoagulation with low-molecular-weight heparin. The pregnancy course was uneventful. She delivered by vaginal route in 36th week of pregnancy a healthy male baby weighing 2140 g. On the 6th day after delivery she experienced tachycardia, dyspnea, dizziness. Clinical examination and additional studies revealed only slight limb oedema and low haemoglobin level. After treatment with furosemide and prescription of folic acid and iron supplementation she was discharged home in a good clinical condition after 4 days. JRCD 2012; 1: 13–17 Key words: Tricuspid valve regurgitation; Atrial septal defect; Pulmonary hypertension

The study aimed to compare the outcome of pregnancy in women with valvular heart diseases. Material : Two hundred and fifty-nine pregnant women with cardiac diseases, aged 18–42, were observed. Group I—158 patients with mitral valve disease: 30 patients with mitral stenosis; 44 patients with mitral regurgitation, 33 patients with combined mitral valve disease, 51 patients with mitral valve prolapse; Group II–54 patients with aortic valve disease: 32 pateints with aortic stenosis, 22 with aortic regurgitation; Group III—47 patients after valve replacement (36 mechanical; 11 homograft valves). Medical history and physical examination, NYHA class assessment, ECG, and echocardiography were performed during consecutive trimesters of pregnancy and after delivery. Results : Clinical deterioration was observed in 38 patients–in 25 women of Group I, 6 women of Group II, and 7 women of Group III. Newborns outcome: 250 healthy (10 prematures, 12 with intrauterine growth retardation), 6 aborted, 2 stillbirths, 1 neonatal death. Method of delivery: 200 vaginally, 53 cesarean sections. Conclusions : (1). Pregnants with critical mitral valve stenosis form a high-risk group of life-threatening complications. (2) In women with severe aortic stenosis, pregnancy could lead to sudden clinical status deterioration. (3) Cardiac complications can be expected in patients with left ventricular enlargement and its depressed function. (4) Key factors influencing successful course of pregnancy and labour in patients with prosthetic valves: adequate left ventricular function, properly functioning valves, and effective anticoagulation.

Chronic ischemic mitral regurgitation (IMR) is associated with a markedly worse prognosis after myocardial infarction (MI).The study aimed to evaluate the relationship between anterior and posterior mitral leaflet angle (MLA) values, left ventricle remodeling and severity of ischaemic mitral regurgitation (IMR). Methods: Forty-two patients (age 63.5 ± 9.7 years, 36 men) with chronic IMR (regurgitant volume, RV > 20 ml; >6 months after MI) underwent transthoracic echocardiography (TTE) and cardiovascular magnetic resonance (CMR) imaging. Anterior and posterior MLA, determined by echocardiography, were correlated with indices of LV remodeling, mitral apparatus deformation and IMR severity by CMR. The anterior and posterior MLA was 25.41 ± 4.28 and 38.37 ± 8.89° (mean ± SD). In 5 patients (11.9%) the posterior MLA was ≥45°. There was a significant correlation between anterior MLA and RV (r = 0.74, P = 0.01). For patients with RV > 30 ml this correlation was stronger (r = 0.97, P = 0.005) and, in addition, there was a correlation between the RV and posterior MLA (r = 0.90, P = 0.037), between tenting area and posterior MLA (r = 0.90, P = 0.04), and between tenting area and anterior MLA (r = 0.82, P = 0.08). With regard to LV remodeling parameters, there was weaker but significant correlation between posterior MLA and LV end-diastolic volume index (r = 0.35, P = 0.031), LV end-systolic volume index (r = 0.37, P = 0.021), stroke volume (r = 0.35, P = 0.03), sphericity index (r = 0.33, P = 0.041). Anterior MLA correlated with wall motion score index (r = 0.41, P = 0.019). Besides, there was a correlation between posterior MLA and left atrial volume (r = 0.41, P = 0.012). Measurement of anterior and posterior MLA may play an important role in evaluating patients with IMR.