Search

BACKGROUND Left ventricular assist devices (LVAD) are used to treat heart failure. Preoperative prediction of RV function after LVAD implantation is crucial. Correlations were found between preoperative echo and RV function after LVAD implantation. MATERIAL AND METHODS We retrospectively reviewed 23 male patients (8 ischemic, 15 nonischemic cardiomyopathy) with LVAD implantation (17 HeartWare, 6 HeartMate II) at the Silesian Center for Heart Diseases from 1 January 2013 to 28 October 2014. Preoperative TTE data of RV function included RVFAC (fractional area change), TAPSE (tricuspid annulus plane systolic excursion), RV diameter (RV4), and RV/LV (right/left ventricle) ratio. Postoperative hemodynamic mean pulmonary pressure (mPAP), central venous pressure (CVP), cardiac output (CO), and cardiac index (CI) were measured and recorded every 2 h up to 10 days (1, 2, …120) and correlated. Study endpoints were mortality, discharge from ICU, and RV dysfunction. RESULTS There were no RV dysfunctions. Correlations of CO and CI with RV4 and RV/LV ratio were significantly positive at many time points, with TAPSE and FAC positive or negative. Correlations mPAP with RV4 were significantly positive: 1, 2, 3, 7, 8, 57, 58, 59. With RV/LV ratio positive: 44, 47, with TAPSE in 36. With FAC positive 11, 13-15, 22 and negative 57. Correlations CVP with RV4 were negative, with positive significance in 1, 52. With RV/LV ratio positively 52, 54, 56 and negative 71, 72, 73. With TAPSE were negative significantly: 30, 68. With FAC positive 11, 12, 13, 14 and negative: 68. CONCLUSIONS RV4 and RV/LV ratio before LVAD implantation are more predictive for postoperative RV function than RVFAC and TAPSE, probably because RVFAC and TAPSE are load-dependent.

Background and Aim: Transcatheter aortic valve implantation (TAVI) has proven to be a valuable alternative to conventional surgical aortic valve replacement in high-risk and surgically inoperable patients who suffer from severe symptomatic aortic stenosis. With the second generation of TAVI devices improvements in both handling and performance are highly demanded. This brief clinical communication reports the first Polish experience with the second generation of transfemoral TAVI device--Symetis Acurate Neo., Methods: From November 19th 2014 until February 18th 2015 nine (n = 9) patients with severe symptomatic aortic stenosis have been operated on using the Symetis Acurate Neo. Patients were subject to seven-day evaluation and 30-day phone follow-up., Results: The procedure was safely and successfully performed in all patients. A SMALL (S) valve (21-23 mm equivalent) was used in two patients, MEDIUM valve (M; 23-25 mm equivalent) in five patients, and a LARGE valve (L; 25-26 mm equivalent) in two patients. In three cases post-release balloon dilatation was required. There were no intraoperative complications and no major adverse events (as per VARC classification) during initial hospitalisation, including conduction or rhythm disturbances. In all cases, the mean gradient on the prosthetic valves was 7.8 mm Hg (10.2 mm Hg on the "S" valves). Rapid improvement in patients' functional class was noted. Perivalvular leak was evaluated as "mild" in three cases, "trace" in one, and "not existing" in five., Conclusions: This initial experience with the Symetis Acurate Neo demonstrates its good safety profile and excellent haemodynamics. Low radial stress of the valve results in minimal incidence of atrioventricular rhythm disturbances, and a sealing crown for nearly non-existent paravalvular leak.

Despite advances in surgical techniques and postoperative medical management, the mortality rates for cardiac reoperations remain high. The risk is most commonly associated with failed resternotomy complicated by fatal injury to the myocardium or its structures. This short case report documents the first use of an endoluminal balloon occlusive device in order to prevent aneurysmal sack damage and coronary vessel injury in a patient with a giant aortic aneurysm after failed aortic surgery. The safe aortic occlusion allowed for closed-chest cardioplegia delivery and subsequent aortic unloading, thus facilitating a difficult but uneventful resternotomy., (© The Author 2014. Published by Oxford University Press on behalf of the European Association for Cardio-Thoracic Surgery. All rights reserved.)

The frozen elephant trunk (FET) technique is a modification of the traditional elephant trunk method, which was introduced by Borst in 1983 in order to treat extensive thoracic aortic aneurysms. The crux of the new method is the different type of aortic prosthesis, consisting of a Dacron part (with or without branches leading to the arterial vessels which exit the aortic arch) and a port for extracorporeal circulation with a self-expanding nitinol stentgraft. This combination enables a complete one-stage treatment of the pathologies within the arch and the proximal segment of the descending aorta; moreover, it facilitates the performance of a two-stage hybrid treatment of extensive thoracic aortic aneurysms involving a significant part of the descending aorta. This article presents the cases of four patients with extensive aortic disease, who were implanted with Thoraflex prostheses (Vascutek, Scotland).

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.

Background: The concept of a hybrid approach, combining the most effective techniques of surgical and endocardial catheter ablation has resulted in the creation of the convergent ablation procedure. This novel, pericardioscopic, hybrid approach can be an effective option for highly symptomatic patients with persistent atrial fibrillation (PSAF) and longstanding persistent atrial fibrillation (LSPAF) for whom standalone surgical or endocardial ablation procedures offer sometimes unsatisfactory outcomes., Aim: To assess the safety, efficacy and effectiveness of a hybrid epicardial and endocardial radiofrequency ablation for the treatment of PSAF and LSPAF., Methods: Single-centre, prospective, non-randomised clinical study. Between August 2009 and December 2011, 27 patients with PSAF (n = 5) and LSPAF (n = 22) underwent hybrid ablation (HABL). Mean age was 52.52 ± 11.27 years, and the mean EHRA class was 2.5; 14 (51.8%) patients had a history of electrical cardioversion (n = 6) or catheter ablation (n = 8). Five patients had left ventricular ejection fraction (LVEF) of less than 35%. Mean AF duration for all patients was 3.46 ± 2.5 years. All patients were on antiarrhythmic drugs (AAD) and oral anticoagulation. Patients were scheduled for three, six and 12 month follow-up with seven day Holters, REVEAL® XT and ECHO measurements., Results: The HABL procedure was feasible in all patients. At six months post procedure, 72.2% (13/18) of patients were in SR, and 66.5% (12/18) were off class I/III AADs. Four patients were in AF and one patient developed right atrial flutter. At one year post procedure, 80% (8/10) of patients were in SR and off class I/III AADs. At two year post procedure, 100% (6/6) of patients were in SR and off class I/III AADs. Rapid change in left ventricular function was noted in patients with low LVEF (≤ 35%) prior to the procedure. Patients with LVEF +40% had less apparent improvement., Conclusions: Hybrid, epicardial and endocardial, radiofrequency ablation is feasible and safe, effectively restoring sinus rhythm in the vast majority of patients with PSAF and LSPAF.

Background: severe symptomatic aortic valve stenosis is an unequivocal indication for surgical valve replacement, assuring symptoms relief and increasing survival. About one third of elderly patients is not being operated due to, among others, high peri-procedural risk and comorbidities. Transcatheter aortic valve implantation (TAVI) has recently become a valuable therapeutic option for these patients., Aim: to present early results of first TAVI Edwards-Sapien procedures in our hospital, performed in symptomatic patients with high operational risk or other contraindications for conventional surgery, as well as the results of 6-month follow-up., Method: twelve patients referred for TAVI were included in the analysis. The valve was implanted in 11 patients and in 1 patient the procedure was finished with aortic valve valvuloplasty. Eight (72.7%) patients underwent transapical (TA) and 3 (27.3%) patients transfemoral (TF) TAVI. Seven (63.6%) 26 mm valves and 4 (34.4%) 23 mm valves were implanted., Results: the efficacy of the procedure was 92%: 100% in the TA group, and 75% in the TF group. During the procedure 1 patient developed ventricular fibrillation. Atrial fibrillation and right ventricle perforation by the endocavitary electrode was observed in another patient. Prolonged wound healing occurred in 4 patients and contrast-induced renal failure occurred in 2 patients. There were no deaths at 30-days. Two patients had a pacemaker implanted during hospitalisation. A significant improvement of echocardiographic parameters was observed: maximum gradient across the aortic valve was 104.4 ± 23.9 mm Hg before vs 25.2 ± 6.1 mm Hg after the intervention, p = 0.000001, mean gradient - 63.8 ± 18.3 vs 12.7 ± 3.7 mm Hg, p = 0.000004, and valvular surface - 0.7 ± 0.2 vs 1.5 ± 0.2 cm2, p = 0.000106, respectively. During the 6-month follow-up period 1 patient died of multiorgan failure and 6 patients required another hospitalisation. After 6 months an improvement in physical capacity was observed in all but one patients (NYHA II - 9 patients, NYHA III - 1 patient)., Conclusions: 1. The authors' initial experiences with TAVI Edwards-Sapien procedure confirm its efficacy and safety in patients with symptomatic aortic stenosis and high surgical risk. 2. Echocardiographic parameters of the implanted valves, assessed during hospitalisation and 6 month later, are satisfactory. 3. Due to the risk of complications, patients require careful observation in the postoperative period and during short-term follow-up.

Unlabelled: Renal Angiography and IntraVascular UltraSonography (IVUS), are valuable diagnosis methods for assessment of renovascular hypertension (RVH). Endovascular techniques employing percutaneous transluminal renal angioplasty (PTRA) are effective for therapy of ischaemic nephropathy in patients with RVH. Success of PTRA is limited by a significant rate of restenosis. THE AIM OF STUDY was to compare the assessment of residual stenosis and restenosis with angiography and IVUS., Material and Methods: Residual stenosis after PTRA (combine with intravascular brachyterapy in 33 patients--group I) were assessed in 62 RVH patients with angiography and IVUS techniques. Both baseline and 9-month follow-up quantitative computerized angiography (QCA) and intravascular ultrasound (IVUS) analysis were performed to assess restenosis., Results: Residual stenosis after PTRA of atherosclerotic lesions was slightly lower with QCA than IVUS (in group I 15.49 +/- 4.69% and 18.81 +/- 4.81% and in group II 15.36 +/- 4.68% and 18.43 +/- 4.69%, respectively). The loss of lumen area in QCA assessment was slightly greater than in IVUS measurement (1.2 +/- 0.7 mm vs. 0.9 +/- 0.8 mm in group I i 1.7 +/- 0.7 mm vs. 1.5 +/- 0.8 mm in group II). The angiographic measurements of late lumen loss, diameter stenosis, and minimal lumen diameter correlated well with IVUS measurements (r = 0.81, r = 0.89 and r = 0.89 respectively)., Conclusions: Angiography and IVUS are equally effective methods for diagnosis and assessment of residual stenosis and restenosis after endovascular renal artery revascularisation.

We report a case of a 70-year-old woman admitted with symptoms of decompensated heart failure. Magnetic resonance imaging revealed lipomatous hypertrophy of the interatrial septum with partial upper right atrial inflow obstruction, partial obstruction of the right ventricular outflow tract, and excessive accumulation of adipose tissue in the pericardial space. The patient underwent excision of the septal lipomatous mass, which relieved the right ventricular outflow obstruction.

Introduction: The largest group of patients with secondary hypertension comprises individuals with renovascular hypertension resulting from renal artery stenosis that is a potentially removable condition. It is caused by atherosclerosis in 70-80% of patients., Objectives: The aim of the study was to evaluate the influence of intravascular brachytherapy (IVBT) procedure performed after percutaneous transluminal renal angioplasty (PTRA) on left ventricular (LV) function, mass regression and type of hypertrophy (LVH) determined on echocardiography during long-term follow-up., Patients and Methods: Sixty-two patients with atherosclerotic renal artery stenosis complicated by severe hypertension were treated with PTRA and randomly assigned to group 1 (PTRA alone) or group 2 (PTRA followed by IVBT). Subsequent IVBT was performed with the PARIS catheter and the Microselectron HDR (Nucletron) system for peripheral arteries. Treatment outcomes during follow-up were assessed with quantitative coronary angiography. LV mass and mass index (LVM and LVMI) and functional parameters prior to PTRA and during follow-up were determined by echocardiography with regard to the type of procedure., Results: The degree of renal artery stenosis was significantly different in groups 1 and 2. In both groups elevated LVMI was observed (p = 0.94). There were no significant differences in interventricular septum (IVS) to LV posterior wall (LVPW) ratio, relative LV wall thickness, volumetric parameters and LV ejection fraction between both groups. During follow-up the values of LVMI and IVS to LVPW ratio were significantly lower (p = 0.021 and p = 0.004, respectively) in the PTRA + IVBT group compared to the PTRA group. Analysis of the LV geometry and type of hypertrophy revealed a marked reduction in concentric LVH in the IVBT group during long-term follow-up., Conclusions: Echocardiographic evaluation comparing several LV parameters in the PTRA alone and PTRA + IVBT groups showed that PTRA with subsequent brachytherapy were associated with better control of blood pressure and greater LVM regression, especially concentric hypertrophy, during long-term follow-up.

Background/aim: Scarce data exist concerning the long-term effect of renal balloon angioplasty (PTRA) enhanced by intravascular gamma-brachytherapy (IVBT) in patients with renovascular hypertension. The aim of this randomized study was to evaluate long-term outcome after PTRA with IVBT in patients with renal artery stenosis., Patients and Methods: 71 patients with renovascular hypertension were randomized into group I (PTRA + IVBT) or group II (PTRA). 9 patients who required stent implantation were excluded. Both baseline and 9-month follow-up quantitative computerized angiography and intravascular ultrasound (IVUS) analysis were performed to assess restenosis. During the 9-month follow-up, 3 patients died - 2 from group I and 1 from group II., Results: The restenosis rate was 16.1% in group I and 32.1% in group II. The 9-month lumen loss in angiography was 1.2 +/- 0.7 and 1.7 +/- 0.7 mm (p = 0.004) and the area loss (IVUS) was 6.5 +/- 4.8 and 10.1 +/- 5.6 mm(2) in groups I and II, respectively (p = 0.01). eGFR increased both in group I (from 75 +/- 22 to 84 +/- 31 ml/min/1.73 m(2); p < 0.001) and in group II (from 74 +/- 23 to 77 +/- 23 ml/min/1.73 m(2); p = 0.04). Only the diastolic blood pressure in group I decreased significantly (65 +/- 17 and 77 +/- 18 mm Hg; p = 0.048). The rate of blood pressure normalization was low in both groups (6.1 and 6.9%)., Conclusions: IVBT after PTRA with a self-centering source is a safe and effective method for prevention of restenosis in patients with renovascular hypertension., (Copyright 2008 S. Karger AG, Basel.)

Objectives: The aim of the study was to evaluate the occurence of death and major adverse cardiac events (MACE) in patients with normal (group A) and elevated (group B) plasma bilirubin levels., Patients and Methods: We evaluated 124 patients (83% males, mean age 50.1 +/- 7.7 yrs) in New York Heart Association class II and III with hypertension-related chronic heart failure. We assessed the occurence of death and MACE (death, urgent heart transplantation and readmission to hospital)., Results: Groups A and B comprised 77 and 47 patients respectively. The independent predictors of death in group B were: N-terminal pro-brain natriuretic peptide (NT-proBNP) level (per 100 pg/ml difference; 95% CI: 1.29-4.76; p = 0.005) and physical component summary score (per 10 point difference; 95% CI: 0.66-0.99; p = 0.03). The independent predictors of MACE in group B were: age (per 10 yrs; 95% CI: 0.1-1.8; p = 0.04), NT-proBNP level (per 100 pg/ml difference; 95% CI: 1.02-3.69; p = 0.04) and the symptoms of depression (95% CI: 1.02-2.5; p = 0.01). The independent predictors of MACE in group A were: NT-proBNP level (per 100 pg/ml difference; 95% CI: 1.31-5.32; p = 0.006) and mental component summary (per 10 point difference; 95% CI: 0.85-0.98; p = 0.01). In a two-year follow-up the death rate was 5.2% in group A, and 23.4% in group B (p = 0.002) and frequency of MACE 18.2% and 42.6% in group A and B (p = 0.003), respectively., Conclusions: Elevated bilirubin levels are associated with higher incidence of death and MACE during a two-year follow-up in patients with hypertension-related chronic heart failure. Thus, it may be used as a simple prognostic factor in such of patients.

Background: Early invasive strategy is one of alternative methods for management of acute coronary syndromes (ACS) without persistent ST-segment elevation., Hypothesis: The aim of the study was analysis of clinical characteristics, in-hospital outcome and factors of in-hospital mortality., Methods: The study group comprised 853 patients who were defined as high-risk, based on resting pain episodes within previous 24 hours, changes of ST-T segment in ECG, and elevated serum cardiac markers. All patients underwent coronary angiography followed by PCI (percutaneous coronary interventions) in 73.1% of patients. 16.7% were assigned to CABG (coronary artery bypass graft), 1.6% of patients underwent PCI and CABG and 8.6% of patients were treated conservatively., Results: Overall in-hospital mortality was 3%; 1.4% in the PCI group, 8.4% in the CABG group and 6.8% in conservatively treated patients. The independent risk factors of in-hospital deaths were: Braunwald's IIIC class angina (OR 7.8; 95%CI 3.6-12.37 p=0.004), recurrent angina after revascularization (OR 13.04; 95%CI 7.62-29.23 p=0.002), congestive heart failure (OR 11.45; 95%CI 8.01-18,38 p=0.00001) and evolving myocardial infarction with ST-segment elevation (OR 12.77; 95%CI 8.35-27.35 p=0.0001). Stent implantation was associated with decreased risk of in-hospital death (OR 0.12; 95%CI 0.07-0.41; p=0.003)., Conclusions: Early invasive strategy in patients with ACS without ST-segment elevation is efficacious method of treatment. Independent predictors of in-hospital deaths are: Braunwald's IIIC class angina, congestive heart failure, recurrent angina after revascularization, myocardial infarction complicating hospital course. Stent implantation improves in-hospital prognosis.

Unlabelled: Early invasive strategy is one of two methods of treatment of acute coronary syndromes without ST-segment elevation (NSTEACS). We aimed at assessing 12-month outcomes and quality of life in patients with NSTEACS and multivessel coronary artery disease (CAD) who underwent percutaneous or surgical revascularization. Analyzed group comprised 412 patients (92%) who were qualified for invasive treatment based on coronary angiography performed 24 hours after admission and in whom long-term follow up data was available. The inclusion criteria were: rest angina within 24 hours prior to admission and at least one of the following: ST segment depression (> or = 0.5 mm), transient (< 20 min) ST-segment elevation, negative T-waves (> or = 1 mm)in at least 2 contiguous leads, positive serum cardiac markers. Patients with single-vessel CAD or qualified for conservative treatment were excluded from the study. We analysed the rate of adverse cardiac events (death, non-fatal myocardial infarction, unstable angina, repeated revascularization, cardiovascular hospitalization) at one year. The quality of life was assessed using Short-Form-36 (SF-36) questionnaire. The rate of death was 5.3% vs 9.3% (NS), myocardial infarction 3.4% vs 0% (p = 0.054), unstable angina 20.9% vs 2.8% (p = 0.0000), repeated revascularization 12.6% vs 0% (p = 0.0001) and cardiovascular hospitalization 36% vs 22.7% (p = 0.001) in the PCI and CABG group respectively. Physical Component Summary scores were 38.7 +/- 11.6 vs 43.08 +/- 9.5, p = 0.001 in the PCI and CABG group respectively. Mental Component Summary Scores were similar in both groups (46.34 +/- 13.05 vs 45.97 +/- 11.9, NS)., Conclusions: Overall mortality rate was similar in both groups. PCI patients had more frequent rate of unstable angina, rate of hospitalization and repeat revascularization. This study has shown that there is a significant difference in health-related quality of life 12 months after PCI and CABG. This difference arises from better physical function (Physical Component) for CABG surgery patients compared with PCI patients. Despite impairment of the physical health status, the mental health status (Mental Component) remained similar in both groups.

An intravascular ultrasound (IVUS) is a new cardiological diagnostic technique which provides detailed cross-sectional images of the vessel wall, allows to investigate lumen, as well as structure of the coronary artery. This imaging technique has the unique potential to provide an image of atherosclerotic plaque, characterizes its composition, and severity of stenosis. "Soft" plaque, dense fibrous "hard" plaque, calcification and thrombosis have all been identified using IVUS. Intravascular ultrasound imaging has become a method for supporting interventional decision making by selecting patients who are to undergo Percutaneous Transluminal Coronary Angioplasty, Stent placement, Directional Coronary Atherectomy or Laser Angioplasty. Quality of measurements should allow more widespread use to guide interventional techniques. A series of IVUS imagings could assess the influence of plaque composition on mechanism of immediate lumen enlargement after revascularization. With utilization of IVUS guidance and high pressure balloon inflation--stent implantation could now be performed "optimally" and safely without anticoagulation. This original diagnostic tool is becoming a clinically useful adjunct to angiography in the assessment coronary arteries of heart transplant recipient and patients with higher risk of restenosis.