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An extremely rare case of type IV dual left anterior descending coronary artery coexisting with myocardial bridging in a 50-year old Caucasian man with acute coronary syndrome is presented. Emergency cardiac catheterisation revealed no coronary atherosclerotic lesions. The potential causal relationship between the type IV dual left anterior descending coronary artery and myocardial ischaemia was discussed. We also summarised the current knowledge on the epidemiology and clinical significance of dual left anterior descending coronary artery in the adult population.

A case of a delayed perforation of the right ventricle by the pacemaker lead in a 67-year-old woman is presented. Perforation, mimicking stenocardial symptoms, was incidentally diagnosed on a computed tomography chest scan. Percutaneous lead extraction was successfully performed, with simultaneous implantation of a new pacemaker lead.

The role of magnetic resonance imaging (MRI) as a diagnostic tool of coronary arteries disease has increased over the last years. Cardiac magnetic resonance (CMR) is a preferable tool in assessment of ventricular mass and function, presence and size of post infarct scaring and anomalies of coronary arteries. CMR becomes also a useful method in evaluation of myocardial viability. Examination with gadolinium dye allows for evaluation of myocardial perfusion and viability. The extent of the post infarct late enhancement zone has an important prognostic value in the recovery of the left ventricle function. Dobutamine, adenosine or dypirydamol stress CMR becomes a promising noninvasive diagnostic modality in detection of coronary artery disease. At present coronary arteries magnetic resonance angiography is being developed as well as CMR spectroscopy.

Percutaneous coronary interventions (PCI) with stent implantation play an important role in the revascularization therapy of coronary artery disease. Introduction of drug eluting stents (DES) diminished problem of restenosis but brought several new major problems like i.e. late stent thrombosis. This makes bare metal stents (BMS) still popular choice for some patients. Coronary-artery-computed-tomography becomes useful device in the noninvasive diagnostics measure of restenosis after PCI. Development of 64-slice computed tomography (CT) enables the noninvasive imaging and evaluation of stents with diameter higher than 3,0 mm and detection of significant restenosis with a low number of false positive results. CT allows with high accuracy to exclude in-stent restenosis among patients with atypical angina, especially those localized in proximal segments of coronary arteries. Future development of CT is needful since evaluation of significant number of examinations remains difficult or impossible due to presence of artifacts.

Cardiac resynchronization therapy (CRT) is an acknowledged treatment for advanced heart failure in acquired dilated cardiomyopathy, resistant to pharmacotherapy. Although there are no therapeutic standards regarding heart failure originating from congenital heart defects with systemic right ventricle, a number of CRT implantations by transvenous approach in congenitally corrected transposition of the great arteries (CCTGA) have been reported since 2001, even though none of them expressly referred to a case concomitant with dextrocardia and situs inversus anomaly. We present a 57 year-old patient with dextrocardia and CCTGA, who underwent surgical closure of interatrial and interventricular septal defects at the age of 19, and in whom a VVI pacemaker was subsequently implanted at age 36. A three-lead CRT system was implanted by transvenous approach. Imaging techniques, including multi-slice computed tomography, targeted to pacing system and unusual anatomical relationships were applied. Within a 20-month follow-up, a significant improvement of functional NYHA class, systemic right ventricle ejection fraction and exercise capability were observed. Entirely transvenous CRT system implantation is feasible in patients with dextrocardia and CCTGA, and has substantial potential for long-term benefits.

Background: Late gadolinium enhancement (LGE) on cardiac magnetic resonance imaging (CMR) has been shown to be associated with ventricular arrhythmias, however, its prognostic role in predicting sudden cardiac death has not yet been established., Aim: To explore a potential relationship between LGE visualised by CMR and life-threatening ventricular tachyarrhythmia in hypertrophic cardiomyopathy (HCM)., Methods: The LGE in CMR was assessed in 55 HCM patients. We compared the frequency and extent of LGE in HCM patients with sustained ventricular tachycardia (VT) or who survived ventricular fibrillation (VF) or sudden death [group VF (+)] versus HCM patients without these tachyarrhythmias [group VF (-)]. There were 14 patients in the VF (+) group and 41 patients in the VF (-) group, and they were followed for a mean period of 37 months., Results: In group VF (+), adequate ICD intervention occurred in 9 patients (8 patients with VF and one patient with sustained VT), and VF arrest occurred in 5 patients (4 patients were resuscitated and one patient had a witnessed sudden death). In group VF (+) all patients had LGE whereas in group VF (-) 85% patients presented this abnormality (p = 0.13). Moreover, there were no statistical differences between groups in the following parameters: age, total left ventricular (LV) mass, maximal LV wall thickness, mass of hyperenhanced myocardium and percent of hyperenhanced myocardium., Conclusion: In HCM patients with life-threatening ventricular tachyarrhythmia LGE was both qualitatively and quantitatively comparable with patients without these tachyarrhythmias.

Successful delivery of progenitor cells to the injury zone is a prerequisite for any effect of myocardial regeneration therapy. This key issue, however, has received far less attention than, for instance, a potential need for cell type selection or ex-vivo expansion, the optimal timing of cell application or multimodal functional evaluation after cellular transplantation. By combining myocardial perfusion scintigraphy, magnetic resonance imaging and 99Tc-HMPAO-labelled autologous bone marrow-derived CD34+ cells visualisation, we show in a 63-year-old man with a large anterior myocardial infarction that transcoronary applied cells (via the central lumen of an inflated over-the-wire balloon positioned in the stent implanted in primary PCI) graft preferentially to the infarct border zone. This is consistent with the idea that the area of myocardial 'irreversible' injury (i.e. the no-perfusion zone on perfusion scintigraphy or late enhancement zone on magnetic resonance) remains largely inaccessible to transcoronary-applied cells; thus other techniques need to be considered if the cell delivery is aimed at the zone of irreversible injury. The potency of such combined high-resolution visualisation provides grounds for comparing the efficacy of different methods of cell delivery after a recent myocardial infarction in man.

Background: Atherosclerosis and vascular calcifications are common causes of morbidity and mortality in maintenance haemodialysis patients. In addition to the well-known traditional risk factors, uraemia-specific factors appear to enhance dramatically the progression of the pathological processes involved. The aim of the present study was to evaluate the degree of atherosclerosis and vascular calcifications in chronic haemodialysis patients using non-invasive imaging methods, and to identify potentially involved factors., Methods: The study included 73 patients (36 females, 37 males), aged 25-75 years, who were on haemodialysis treatment for 12-275 months (mean dialysis vintage 73.8 months). We assessed the following circulating parameters: calcium (Ca), phosphorus, 'intact' parathyroid hormone (iPTH), 25OH vitamin D, lipids, oxidized LDL (ox-LDL), Lp(a), homocysteine, leptin, IL-1-beta, IL-6, CRP, TGF-beta, TNF-alpha, (PDGF), advanced oxidation protein products (AOPP) and myeloperoxidase activity (MPO). Coronary artery calcification score (CACS) was assessed using multi-row spiral CT (MSCT). Intima-media thickness index of the common carotid artery (CCA-IMT) and presence of cervical artery atherosclerotic plaques were evaluated by ultrasonography., Results: Coronary artery calcifications were observed in 79.5% of the patients, with CACS ranging from 0 to 4987. In univariate analysis, a positive correlation was observed between CACS and age, BMI, iPTH, CRP, IL-6 and CCA-IMT, whereas an inverse correlation existed with 25OH vitamin D, TGF-beta and PDGF. CCA-IMT ranged from 0.4 to 1.1 mm. It was positively correlated, in univariate analysis, with age, CACS, CRP and Il-6, and negatively with 25OH vitamin D, TGF-beta and PDGF. Only CACS remained as independent predictive factor of CCA-IMT in multivariate analysis. Atherosclerotic plaques were found in the carotid arteries of 53 patients (72%). The number of plaques was positively correlated with age, CACS, phosphorus, MPO, CRP and IL-6, and inversely with 25OH vitamin D in univariate analysis. In multivariate regression analysis, only age and CACS remained as independent variables., Conclusion: In addition to classic risk factors, the degree of atherosclerosis and vascular calcification in our dialysis patient population were associated with several factors that are frequently abnormal in advanced chronic renal failure, but except age, all of them were interdependent. Notably, as in the general population, CACS was an independent predictor of the degree of atherosclerosis in haemodialysis patients.

Background: Physical training is a well-known complementary treatment for chronic heart failure (CHF); however, many aspects require further studies. One of them is the impact on remodeling of the left ventricle (LV). The purpose of this study was to evaluate the effect of 6 months of training on LV, exercise capacity and safety issues in patients with ischemic CHF., Methods: Fifty patients (mean age 60.1+/-9.2 years) with ischemic CHF, New York Heart Association (NYHA) classification class II and III and left ventricular ejection fraction (LVEF)

Introduction: Syncope are serious problems in paediatrics. Approximately 15% of children and adolescents at the age of 8-18 years experience at least one episode of syncope. Neurocardiogenic syncope are the most common (60-80%). Cardiogenic syncope are rare (6%), although they require special attention due to their background., Aim of the Study: Evaluation of incidence, causes, methods of treatment and prognosis in cardiogenic syncope in children and adolescents., Material and Methods: Retrospective analysis was made in 18 patients with syncope and different pathology of cardiovascular system. Patients were chosen among 766 children treated in the University Hospital for Children in Cracow from January 2005 to June 2006 due to syncope or pre-syncope. The patients were divided into 2 groups depending on the main cause of syncope: Gr I n = 6 due to arrhythmias without structural heart disorders and Gr II n = 12 due to heart diseases or defects. In all patients physical exam and additional test were analysied carefully (ECG, Holter study, chest X ray, ECHO, angio-TK in 1 patient, and catheterisation with angiography in 3 children)., Results: Cardiogenic syncope appeared more frequently in children with structural abnormalities in the heart (Gr II--12 pts/ 66%), rather than in children with arrhythmias (Gr I--6 pts / 33%). Family history was positive in both groups in 17%. Median age at the moment of first episode was 10.3 y +/- 5.0 in Gr I and 12.8 y +/- 3.0 in Gr II. Syncope in Gr II were frequently (33%) initiated by an effort or stress. In Gr I physical examination did not reveal serious symptoms except for irregularity of heart rate, and general condition of children was good (NYHA I). In 5 pts (58%) in Gr II heart murmur and prominent impulse of the left ventricle were found. Symptoms of congestive heart failure were observed in 4 pts (33%) and their condition was poor (III/IV class according to NYHA). In ECG and/or Holter study in Gr I arrhythmias and/or long QTc were found. Pharmacotherapy was sufficient in treatment of serious arrhythmias and prophylaxy of syncope. In Gr II in most cases hypertrorepolarization abnormalities were found. In these children treatment was multidirectional and included both antiarrhythmic drugs, implantation of cardioverter defibrillator (ICD), operation and even heart transplantation., Conclusions: Cardiogenic syncope are rare causes of loss of consciousness and indicate on serious pathology in the cardiovascular system. Heart structural diseases or defects influence severity on clinical course, complex treatment and serious prognosis while in children with arrhythmias pharmacotherapy is effective and prognosis is usually good.

Atherosclerosis and calcifications in the cardio-vascular system are the most frequent causes of increased morbidity and mortality in patients with end-stage renal disease treated with hemodialyses. The aim of this study was to estimate the atherosclerosis progression and presence of calcifications in the circulatory system in patients treated with hemodialyses using, non-invasive imaging diagnostic techniques and to search for the relationships between these changes and microinflammation and oxidative stress during two years. The study was performed in 73 patients (36 female and 37 male), aged 25 to 75 years (mean -49.5), treated with hemodialyses, 3 times/week for 12 to 275 months (mean -73.8). In each patient before starting hemodialysis levels of: ox-LDL, Lp (a), procalcitonin, IL-1beta, IL-6, CRP, TGFbeta, TNFalpha, PDGF, AOPP and MPO were determined. Presence of artery calcifications was detected by Multi-Row Spiral Computed Tomography (MSCT) and expressed as coronary artery calcification score (CACS). Ultrasonography was used to evaluate CCA-IMT. During the study CACS increased significantly after 12 and 24 months (p < 0.00001) as compare with baseline. After 12 months, CACS increase significantly correlated with procalcitonin level (r = 0.30 p = 0.01) and after 24 months with CRP (r = 0.46; p = 0.0002) and IL-6 (r = 0.36; p = 0.005). Independent factor of coronary artery calcification progression after 24 months of observation was only CRP (beta = 0.569). CCA-IMT increased during the study and this increase was statistically significant (p < 0.00001). CCA-IMT increase correlated with CACS growth after 12 (r = 0.36; p = 0.003) and 24 months (r = 0.39; p = 0.002). After 12 months significant relationship was noted with procalcitonin (r = 0.29; p = 0.022). After 24 months CCA-IMT correlated with AOPP (r = -0.30; p = 0.017). The independent factor of CCA-IMT progression after 24 months of observation was only CACS (delta CACS beta = 0.49). From the performed study, we can conclude that exacerbation of atherosclerosis and calcification in the circulatory system of patients treated with maintenance hemodialyses depends on microinflammation and oxidative stress. Reasonable tools for diagnostic algorithm estimation of atherosclerosis advancement in this group of patients are non-invasive, visual diagnostic techniques such as MSCT and ultrasonography.

Introduction: Recent evidence shows poor efficacy of over-the-wire balloon catheter (OTW) coronary occlusive technique adopted widely for intracoronary bone marrow stem cell (BMSC) delivery. The waterfall effect of OTW-balloon inflation/deflation with reactive > or = 2-fold flow velocity increase might be partly responsible for poor BMSC retention., Aim: To evaluate the safety, feasibility and tolerability of perfusion-infusion BMSC delivery with the facilitation of cell rolling in contact with the coronary endothelium (a pre-requisite for downstream transmigration)., Methods: We randomly assigned 11 patients (age 41-72 years) with first anterior myocardial infarction treated with PTCA+stent and LVEF < or =45% at 6-9 days to OTW in-stent occlusive (3 x 3 min.) BMSC delivery or cell infusion via a perfusion catheter with multiple side holes (SH-PC)., Results: OTW and SH-PC patients had a similar infarct size (mean peak CK 4361 vs 4717 U/L), LVEF (41.2% vs 40.3%), infused mononuclear cell number (2.99 x 108 range 0.61-7.48 x 108 vs 3.28 x 108 range 1.64-4.39 x 108), CD 34(+) number (1.79 x 106 vs 1.62 x 106), cell viability (91.5% vs 91.8%) and clonogenicity (CFU assay). None of the SH-PC, but 67% of OTW patients, had ST-segment elevation with chest pain (and nsVT in one) that limited OTW occlusion tolerance to 50-110 sec. At 6 months DLVEF in the OTW vs SH-PC patients was +4.2% (2-6) vs +8.8% (5-16) by MRI and +4.8 (2-7) vs +13.8% (2-24) by SPECT., Conclusions: Our work indicates that the SH-PC technique can be used safely for intracoronary BMSC transplantation. Further research is needed to determine whether the putative advantages of physiological SH-PC delivery translate into enhanced BMSC homing.

Difficulties in the differential diagnosis of left ventricular aneurysm - a case report. A case of a 55-year-old male with a post- infarction left ventricular aneurysm is described. The results of such non-invasive tests as echocardiography, angiography and magnetic resonance did not allow to differentiate between true and false aneurysm. The patient underwent successful surgery which revealed the presence of true left ventricular aneurysm. Difficulties in the differentiation between true aneurysm and pseudoaneurysm are discussed.

Background: Accelerated vascular calcification is an important cause of excess mortality in patients on dialysis therapy. The aim of the study was to evaluate the trends in coronary artery calcification (CAC) score (CaSc) during a 1-year period in a group of stable peritoneal dialysis (PD) patients and identify factors that may be associated with CaSc changes., Methods: Sixty-one stable patients (28 women, 33 men) on PD therapy with a mean age of 50.4 +/- 13.6 years were included. Forty-seven patients survived the entire study period on PD therapy and were suitable for the final analysis. CaSc was assessed at baseline and after 12 months by using multislice spiral computed tomography. Proinflammatory cytokines (interleukin-6, tumor necrosis factor-alpha [TNF-alpha]), acute-phase proteins (C-reactive protein [CRP], fibrinogen), calcium-phosphate balance, and lipid profile were assessed at baseline and after 6 and 12 months., Results: Median CaSc was 22.6 Agatston units (range, 0 to 5,502.8 Agatston units) at baseline and increased to 84 Agatston units (range, 0 to 5,001.3 Agatston units) at a 1-year follow-up (P < 0.05). In the entire group of patients, 3 subgroups were identified: patients with progression (n = 21; P = 0.02 for the difference between initial versus follow-up CaSc), patients with regression (n = 12; P = 0.05), and subjects without change in CaSc after 1 year (n = 14). Patients without progression showed no calcifications at baseline and follow-up and were younger, less overweight, and characterized by significantly lower mean TNF-alpha, leptin, and CRP levels during 1 year compared with both progressors and regressors. Mean serum phosphate and calcium x phosphate product (Ca x P) values were gradually increasing from regressors through the no-calcification group to progressors (P < 0.01 for phosphate levels, P < 0.02 for Ca x P product). Significant correlations were found between changes in CaScs and mean values for phosphate (R = 0.44; P < 0.0005) and Ca x P product (R = 0.38; P < 0.005)., Conclusion: Chronic nonspecific inflammation does not directly attribute to progression in CaScs. Calcium-phosphate balance abnormalities appear to be the only important factors promoting CAC, although a permissive or promoting role of inflammation cannot be ruled out.

Introduction: Calcium score is the subject of wide research in evaluating atherosclerotic progression. The study aimed to determine whether an association exists between the presence of aortic valve calcium (a-CS) and coronary calcium (ca-CS) in patients with aortic valve stenosis as detected by multislice computed tomography (MSCT)., Method: We examined 45 patients (27M; 18F); aged 67 (SD 9.5) with the aortic valve stenosis mean grad. 47.8 mmHg; max. grad. 75.3 mmHg; mean aortic valve area 1.02 cm2. The quantitative evaluation of calcifications on the aortic valve (a-CS) and in the coronary arteries (ca-CS) was performed in all patients with the use of MSCT and conventional coronary angiography (CCA). Aortic valve and total coronary artery calcium score were analysed. U-Mann-Whitney test and Pearson's correlation were used in the statistical analysis. The correlation coefficients between a-CS and ca-CS and between the lesions in coronarography and ca-CS were calculated., Results: There was a weak correlation between aortic valve calcifications and coronary artery calcifications p=0.05, r=0.1. In 18 patients no coronary calcifications were found, none of the patients had lesions in CCA. In all patients with ca-CS > 400 there were significant stenoses in coronary arteries. A correlation between significant stenoses in CCA and ca-CS was established (p<0.01)., Conclusions: Aortic valve calcium score (a-CS) may indicate the advancement of coronary artery calcifications in the patients with aortic valve stenosis. In this particular group ca-CS correlates well with stenoses in coronary arteries, as identified by CCA. Patients with the ca-CS > 400 are at high risk of coronary arteries stenoses, which is significant information in operation procedure qualification and time to surgery.

After myocardial infarction the assessment of myocardium viability is essential for further treatment and prognosis. Many adaptation phenomena occur in the ischaemic myocardium. When the compensation mechanisms are exhausted necrosis and apoptosis take place. Magnetic resonance is a method which makes possible an accurate assessment of myocardium viability and the visualization of the irreversible impairment including the scar. This paper defines and systematizes the physiopathological phenomena that occur in the ischaemic myocardium. It presents the magnetic resonance tomography method as recommended in the assessment of the myocardial viability. It compares CMR with other at present frequently used methods of myocardium viability assessment. We present particular procedures of viability assessment in CMR with special attention drawn to the phenomenon of myocardial late enhancement basing on our own three-year experience in using magnetic resonance in cardiologic diagnostics.

Conventional coronary angiography is the undisputed gold standard for the detection of coronary artery disease. A small but not negligible risk related to the procedure, cost, and radiation exposure have given rise to the development of noninvasive alternatives such as multi-slice computed tomography, and magnetic resonance coronary angiography. In some patients classic X-ray coronary angiography involves high risk and technical difficulties. Fast, non-complicated and easy to use non-invasive imaging procedures should be developed to avoid unnecessary or technically difficult, uncomfortable situations for patients with documented myocardial ischemia. We present three cases of patients who underwent coronary artery bypass graft surgery or were disqualified from it on the basis of MSCT imaging.

Purpose: CMR is a helpful additional diagnostic method in cardiac imaging. Thanks to high spatial and temporal resolution and high quality of obtained images this method is used in patients with poor echocardiographic acoustic window. We present a case of a patient, in whom CMR was conclusive as a non-invasive method of aortic valve stenosis assessment before qualification to cardiosurgery., Methods: CMR was performed in a 70-year-old female A. C. who was under cardiological control due to symptomatic aortic stenosis. Because of difficulties in echocardiographic examinations (TTE) the aortic valve area was impossible to evaluate and aortic gradient value was difficult to assess and it differed in consecutive TTE performed over a short period (maximal gradient: 66-91 mmHg; mean gradient: 37-50 mmHg). The patient underwent CMR (Magnetom Vision Plus 1.5 T, Siemens) with the use of cine gradient echo sequences which made possible morphological and functional assessment of the valve and left ventricle. LV mass indices, IVS thickness, EF, aortic valve area, maximal aortic valve gradient were measured., Results: CMR revealed: left ventricle muscle hypertrophy (IVS--1.8 cm; LV mass index--210 g/m2), EF--70%, no regional contractility disturbances and aortic valve area less than 1 cm2. In aortic valve and anulus extensive calcifications were visualised as low intensity signal area. Turbulent flow through aortic valve was found, maximal gradient about 64 mmHg. On the basis of all clinical symptoms and measurements based on imaging methods, the patient was qualified for cardiosurgery which was held in the Department of Cardiovascular Surgery and Transplantology. Coronary angiography revealed no significant stenosis. The operation was performed in extracorporeal circulation, general hypothermia and cardioplegia. Calcified aortic valve leaflets were excised and replaced by artificial valve (St. Jude Medical 21A Masters). The patient is in good health and was discharged., Conclusions: CMR is a valuable non invasive imaging method complementary to TTE in morphological and functional assessment of aortic valve and left ventricle, especially in patients with poor acoustic window in TTE.

Background: Impaired left ventricular (LV) function with decreased ejection fraction (EF) is a frequent finding in patients with ischaemic heart disease. As a non-invasive method, cardiovascular magnetic resonance (CMR) has become an important diagnostic method in cardiology within the past decade, especially for assessing myocardial function., Aim: The purpose of this study is to compare EF estimated with 99mTc gated SPECT (GSPECT) and with CMR., Methods: The study was performed in a group of 35 patients (11 F, 24 M; mean age 57 SD 10) after myocardial infarction. EF in CMR procedure was calculated using cine gradient echo sequences. GSPECT measured EF was estimated by Tc 99., Results: The mean value of EF measured with scintigraphy was 50.5 +/- 17%, and measured with CMR 48.3 +/- 15%. The difference in mean values of EF was not statistically significant., Conclusions: 1. EF in CMR was highly concordant with GSPECT. 2. The mean value of EF measured with CMR in 75% of study patients was smaller than in the scintigraphy group, but the difference was not statistically significant. 3. CMR is a simple, precise and reproducible diagnostic method for monitoring left ventricle systolic function, and which is an additional non-invasive imaging technique in cardiac diagnosis.

The main cause of increased morbidity and mortality in patients on maintenance hemodialysis are cardiovascular complications due to accelerated atherosclerosis. Lipid profile disturbances, increased levels of homocysteine (HC), fibrinogen, iPTH as and Ca-P abnormalities seem to be the important factors in atherosclerosis progression. The aim of the study was to evaluate the advancement of atherosclerosis in patients on maintenance hemodialysis and to assess levels of pro-atherosclerotic factors. The study included 50 patients (30 M, 20 F) aged 21-75 years (mean 48.6 y) hemodialyzed three times a week for 12 to 282 months (mean 114.5 m). The homocysteine, fibrinogen, iPTH, calcium, phosphate and indices of lipid metabolism such as total cholesterol, HDL, LDL, triglicerides, Lp (a) and Apo B were measured before hemodialysis. To evaluate the advancement of atherosclerosis, all patients underwent MSCT using Somatom plus 4 apparatus with calcium scoring (CS) calculation and B-mode ultrasound for IMT using Acuson 128 XP 10 apparatus. The above applied methods helped to evaluate changes in central and peripheral arteries. In CS testing, coronary artery calcifications were present in 36 patients (72%). The CS ranged from 0 to 4345, with the mean CS being 584 (SD = 1012). The CS correlated significantly with age (r = 0.39; p < 0.005), P (r = 0.33; p < 0.05), CaxP product (r = 0.39; p < 0.05), iPTH (r = 0.43; p < 0.001) and with IMT (r = 0.56; p < 0.0001). The IMT ranged from 0.5 to 1.5, with mean of 0.89 (SD = 0.28). The IMT correlated significantly with age (r = 0.54; p < 0.0001), time on dialysis (r = 0.40; p < 0.01), fibrinogen (r = 0.43; p < 0.02), LDL (r = 0.30; p < 0.05), P (r = 0.29; p < 0.05), and CaxP product (r = 0.3; p < 0.05). Based on our study, we conclude that age, time on dialysis, increased levels of homocysteine, LDL cholesterol, fibrinogen, P, and iPTH as well as Ca-P disturbances are strong predictors of atherosclerosis in HD patients.

The authors described the usefulness of magnetic resonance imaging in the evaluation of the viability of the left ventricular myocardium in a patient with a history of cardiac infarction treated with primary coronary angioplasty (primary PCI) and with symptoms of postreperfusion injury of the left ventricular muscle (no-reflow phenomenon). The perfusion of the left ventricular myocardium was evaluated with the use of paramagnetic contrast. The heart movement was evaluated at rest and after the administration of a small dose of dobutamine. The use of magnetic resonance tomography made it possible to pinpoint the area of stunned and necrotic myocardium.

Magnetic resonance imaging (MRI) is a non-invasive method characterised by high temporal and spacial resolution that makes it possible to obtain very high-quality pictures. It is a less invasive method than TEE and is very significant in the diagnosis of heart tumours. MRI makes it possible to assess the parameters influencing hemodynamic as well as morphological qualities of the tumour such a its size, its movement, its relation to the surrounding structures and the presence of a capsule. With the use of additional programming, it is possible to evaluate, indirectly, the metabolism of the diagnosed lesion as well as the degree of blood perfusion. Thus, MRI diagnosis of the heart is a valuable complementary technique in the verification of the diagnosis and in the referral to cardiosurgical treatment. The aim of this paper is to present the use of MRI in the diagnosis of an abscess of the mitral valve anulus in a female patient who did not agree to the transoesophageal echocardiography (TEE). In this case, the usefulness of MRI to establish the diagnosis of the anular abscess of the mitral valve was proved. The final diagnosis was confirmed during the operation.

Unlabelled: The aim of the study was to assess usefulness of multislice spiral computed tomography--MSCT (Somatom Plus 4 Volume Zoom, Siemens) in non-invasive assessment of the potency of coronary artery bypass grafts both venous and arterial grafts as well as stents., Methods: The study was performed using the MSCT method with Heart View Software with retrospective electrocardiographic gating. Nonionic, hypo-osmolar contract media was infused into a peripheral vein to highlight the coronary arteries and bypasses. All patients, due to clinical indications, underwent coronary and bypass angiography., Material: Two group of patients (82 persons) in total were evaluated: after aorto-coronary bypassing (Group I--57 persons, incl. 40 males and 17 females) and after stent implantation (Group II--25 persons, incl. 19 males and 6 females). The patients were referred to invasive diagnostics for recurrence and aggravation of clinical symptoms., Results: In group I, the patency of 187 bypasses was evaluated (21 arterial and 166 venous). In MSCT, was found in 131 of the bypasses patency (114 venous and 4 arterial). 56 bypasses, (52 venous and 4 arterial) were obstructed. In the bypassography performed were obstructed 53 (5 venous and 3 arterial), 134 bypasses were patent (116 venous and 18 arterial). In the bypass patency assessment using MSCT compared to coronarography, specificity of 94.7% and sensitivity of 92.4% were achieved. In group II, patency was evaluated in 26 stents: 21 implanted to native vessels and 5 in venous bypasses. 19 stents in native vessels were found patent, whereas 2 were obstructed. In the coronary bypasses performed, patency was confirmed in 19 stents and 2 were obstructed. In MST obstruction was demonstrated in 4 stents in coronary bypasses, which was confirmed in bypassography. One stent was assessed patient in both methods., Conclusion: The MSCT method is useful for assessment of patency of venous and arterial bypasses as well as stents.

New opinions about myocardial adaptation during ischaemia are described in presented article. Myocardial preservation mechanisms in response to ischaemia are divided into metabolic adaptation like preconditioning and hibernation and anatomic mechanisms of adaptation like development of collateral circulation. Adaptation in clinical conditions can be observed in few situations. 1) During repeated in short period of time exercise tests (warm up). Adaptation may express through increasing tolerated ischemic burden, lenghtening time of exercise, increasing of ischaemic threshold and double product during successive exercise tests (predominately second). This phenomenon called warm up is a clinical counterpart of myocardial preconditioning. 2) In study during coronary angioplasty demonstrated that decrease of ST-segment, intensity of thoracic pain and serum lactacidaemia was lower during the second balloon inflation than the first. 4) The example of myocardial adaptation is repeated atrial stimulation. Ischaemic myocardium should be treated like some kind of mosaic of necrosis, hibernation, stunning and normal viability.