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Infectious endocarditis is frequently complicated with acute cerebral events. In most cases they represent the consequences of cerebral embolism. In the presented case the first clinical manifestation of aortic valve endocarditis was intracerebral bleeding. After exclusion of intracerebral aneurysm the aortic valve was replaced and the further course was uncomplicated.

Surgical treatment of atrial fibrillation (AF) evolves to less invasive, safer and technically easier procedures mostly due to the electrophysiological studies, technological progress and creativeness in ablation systems construction. We present first clinical experience, mid- and long-term results of AF treatment with new liquid nitrogen cryothermy device for endocardial application. In 26 patients we have proved the feasibility and clinical effectiveness of liquid nitrogen cryocatheter ablation reaching more than 70% of sinus rhythm rate in long follow-up from 3 up to 24 months.

Background: Atrial fibrillation (AF) is the most common arrhythmia, having a strong impact on long-term stroke and heart failure prevalence and mortality. Nowadays, rapid development in the field of minimising the invasiveness of surgical ablation of AF can be observed., Aim: To report on the feasibility and early results of the first Polish experience with a novel technique of minimally invasive video-assisted beating heart bilateral surgical ablation for lone paroxysmal AF using irrigated bipolar radiofrequency technique., Methods: Between February and December 2006, 6 patients with highly symptomatic paroxysmal AF, resistant to pharmacological treatment, underwent video-assisted beating heart bilateral pulmonary vein isolation using irrigated bipolar radiofrequency combined with vein of Marshall dissection and left atrial appendage closure. In 2 patients at least 2 unsuccessful percutaenous ablations had previously been performed., Results: There were no complications. Ablation time was on average 88+/-12.1 seconds. At least one recurrence of AF was observed in 4 patients in the early postoperative period; in 3 of them an electrical cardioversion was performed. All patients were discharged home in stable sinus rhythm. Three patients have exceeded 3 months' observation; one has reached 6 months of observation. All are in stable sinus rhythm and the follow-up course is uneventful., Conclusions: Minimally invasive video-assisted beating heart bilateral surgical ablation for lone paroxysmal AF using irrigated bipolar radiofrequency is effective and safe. These promising results have to be confirmed by larger studies.

Background: Unstable atherosclerotic plaque is a dangerous clinical condition, possibly leading to acute coronary deficiency resulting in cardiac infarction. Questions about the role of inflammatory factors in the formation of pathological lesions in the endothelium of coronary vessels have often been raised. This condition may be caused by bacteria that are able to initiate clot formation in a blood vessel, destabilizing an atherosclerotic plaque that is already present. The sources of these pathogens are chronic inflammatory processes occurring in the host, including periodontal disease, which is one of the most frequent conditions. The aim of this study was to evaluate the incidence of selected anaerobic bacteria in subgingival and atherosclerotic plaque in patients treated surgically because of coronary vessel obliteration., Methods: The study was performed on 20 individuals with chronic periodontitis. Subgingival plaque was collected from periodontal pockets >5 mm. DNA testing was used to identify eight pathogens responsible for periodontal tissue destruction. Material from atherosclerotic plaques was collected from the same patients during bypass surgery, and DNA testing by the same method was performed., Results: In 13 of 20 patients, the pathogens most frequently found in severe chronic periodontitis were also found in coronary vessels. In 10 cases, those species of bacteria were also present in atherosclerotic plaque. The most frequently identified bacteria were Porphyromonas gingivalis and Treponema denticola., Conclusions: In patients with the severe form of chronic periodontitis, it seems that clinical attachment loss is not associated with bacterial permeability into coronary vessels. What is important is the presence of an active inflammatory process expressed by a significantly higher bleeding index in those patients in whom the examined bacterial species were found in atherosclerotic plaque.

Purpose: We evaluated the use of a novel irrigated bipolar radiofrequency system for the treatment of nonmitral paroxysmal atrial fibrillation., Description: Between December 2003 and July 2005, 24 patients with paroxysmal atrial fibrillation underwent nonmitral cardiac procedures (coronary artery bypass grafting, n = 14; aortic valve replacement, n = 6; aortic valve replacement and coronary artery bypass grafting, n = 3; Bentall procedure, n = 1). In 12 of 14 of the coronary artery bypass graft patients, the procedure was performed off pump. All patients additionally underwent pulmonary vein isolation using the Medtronic Cardioblate BP system (Medtronic, Minneapolis, MN). Acute conduction block was evaluated in 16 patients., Evaluation: Patients were followed-up for 6 months. Major adverse events include 1 patient death and 1 patient requiring implantation of a pacemaker. At discharge 19 of 22 patients (86.3%) were in stable sinus rhythm. After 3 months, stable sinus rhythm was found in 15 of 21 patients (71%). After 6 months, 15 of 15 patients (100%) were in stable sinus rhythm. Complete conduction block was accomplished in 29 of 32 pulmonary vein pairs (91%) after a single radiofrequency ablation and in 31 of 32 pairs (97%) after a second application., Conclusions: Pulmonary vein isolation with the use of this irrigated bipolar radiofrequency device is feasible, safe, and gains high experimental and clinical efficacy, including use during off-pump surgery.

A case of a 66-year-old male hospitalised due to heart failure is presented. Echocardiography showed an abnormal structure in the right atrium resembling myxoma or thrombus. Abdominal ultrasonography revealed a right renal tumor. Finally, magnetic resonance imaging showed that the abnormal structure in the right atrium was a neoplasmatic plug continuously extending from renal carcinoma. The renal tumor and it's metastatic plug were successfully removed during surgery.

Background: Ischaemic mitral regurgitation (IMR) may be surgically treated by isolated myocardial revascularisation or in combination with valve repair. Dobutamine stress echocardiography (DSE) may be helpful in selecting an optimal surgical strategy., Aim: To develop the optimal surgical approach to patients (pts) with significant (ERO łO2 cm(2)) IMR on the basis of TEE-DSE. An attempt was undertaken to select patients in whom coronary revascularisation should be performed alone or in combination with reconstruction of mitral apparatus., Methods: The study group comprised 212 pts (M/F--134/78; mean age 65+/-10 years) with a history of Q-wave myocardial infarction qualified to elective surgical revascularisation on the basis of coronary angiography. In 25 pts with significant IMR (ejection fraction <40%, wall motion score index 1.8+/-0.3) TEE-DSE was performed. Based on TEE-DSE results pts were divided into the following groups: Group I--7 pts with significant reduction of MR and improvement of left ventricular contractility following dobutamine infusion and qualified to CABG; and Group II (n=18) without significant changes of IMR (9 pts) or with significant reduction of IMR without significant influence on WMSI (9 pts) who were qualified to CABG with mitral valve surgery., Results: In 4 pts from Group II valve replacement was performed and the remaining 14 pts had mitral annuloplasty. Echocardiographic assessments performed 2-7 days, 6 months and 12 months following the surgical procedure revealed IMR intensity as follows (number of patients is given): Group I--small 5/4/4, moderate 2/2/2, severe 0/0/0, Group II--small 15/14/13, moderate 2/3/3, severe 0/0/0., Conclusions: TEE-DSE seems to be a useful tool for optimal selection of surgical treatment in patients with significant IMR and qualification for CABG.

Background: Unstable atherosclerotic plaque is a dangerous clinical state, possibly leading to acute coronary deficiency resulting in cardiac infarction. Inflammatory factor's role in creating pathological lesions in the endothelium of coronary vessels is frequently raised. This state may be caused by bacteria able to initiate clot formation in blood vessel and destabilizing atherosclerotic plaque already present. Source of these pathogens are chronic inflammatory processes occurring in organism, among them periodontal disease as one of more frequent. Aim of the work was to evaluate incidence of selected anaerobic bacteria in subgingival plaque and in atherosclerotic plaque in patients treated surgically because of coronary vessels' obliteration., Methods: Study was performed on 20 individuals with chronic periodontitis. Subgingival plaque was collected from periodontal pockets deeper than 5 mm DNA test was used for marking eight pathogens responsible for periodontal tissues destruction. In the same patients, as well as in 10 edentulous individuals material from atherosclerotic plaque was collected during by-pass implantation procedure, and identical DNA testing occurred., Results: In 13 of 20 patients pathogens most frequent in severe chronic periodontitis were found in coronary vessels. In 10 cases those bacteria were also present in atherosclerotic plaque. Pathogens linked with periodontal disease were also found in 7 of 10 edentulous individuals. Most frequently marked bacteria were: Porphyromonas gingivalis and Treponema denticola., Conclusions: It seems that advancement of periodontal disease does not have influence on bacteria permeability to coronary vessels. Important is the presence of active inflammatory process expressed by significantly higher bleeding index in patients with marked bacteria in atherosclerotic plaque.