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Implantable loop recorders (ILR) are considered increasingly helpful in diagnosing cardio-neurological conditions, especially if arrhythmic events are of high clinical importance but are unlikely to be captured by standard methods of electrocardiogram recording due to the low frequency of events and short duration of a single event. The compelling evidence from randomized trials and observational studies strongly supports ILR utilization in patients after cryptogenic stroke or transient ischemic attack and in patients with recurrent transient loss of consciousness of unknown origin. These two groups of patients are expected to gain the most from initiating ILR-driven clinically effective management strategies. Stroke or transient ischemic attack survivors with detected subclinical atrial fibrillation can be switched from antiplatelets to anticoagulants, whilst patients with recurrent syncope may avoid severe injuries and/or substantial impairment of their quality of life. This joint opinion of the Heart Rhythm Association of the Polish Cardiac Society and experts from the Polish Neurological Society summarizes the up-to-date rationale for using ILR in everyday clinical practice and describes the road map for implementing this technology in Poland. Special emphasis is placed on the most recent guidelines issued by both cardiological and neurological scientific societies.

Background: It remains a challenge to determine the best time to refer asymptomatic patients for aortic valve replacement (AVR)., Aims: We aimed to determine whether late gadolinium enhancement (LGE) in patients with asymptomatic aortic stenosis (AS) has an independent prognostic significance for adverse postoperative cardiovascular events and changes in left ventricular (LV) hypertrophy (LVH) and LV ejection fraction (LVEF)., Methods: Consecutive patients with severe asymptomatic AS were prospectively enrolled in the study. All patients underwent cardiovascular magnetic resonance with LGE assessment. Patients were followed up every 6 months, and immediately after the onset of symptoms, they were referred for AVR. Early outcomes, as well as LVH and LVEF in the follow-up after AVR, were compared between patients with and without LGE., Results: Ninety-one patients (34 females, 57 males, median [interquartile range] age: 59.2 [56.9-61.6] years) were evaluated, and 68 persons (75%) were treated with AVR. LGE patients (LGE+) developed symptoms earlier than patients without LGE (LGE-, median [interquartile range]: 18 [7-34] months vs. 28 [14-47] months; P = 0.01), but there were no differences in early complications (P = 0.14) and LVEF (P = 0.47) post-AVR between the groups. One year after AVR, no differences were observed between LGE+ and LGE- patients with regard to LV posterior wall thickness (P = 0.26), interventricular septum thickness (P = 0.16), and LVEF (P = 0.9)., Conclusions: The outcome for patients with asymptomatic AS but with LGE was similar to this observed in the non-LGE group. Watchful waiting in this group, with referral to AVR immediately after symptom onset, is associated with comparable results as in LGE- patients.

The aim of the study was to evaluate the prognostic value of red cell distribution width (RDW) for multiple organ dysfunction syndrome (MODS) in the early postoperative period in patients undergoing valve replacement or repair surgery. A prospective study was conducted on a group of 713 patients with haemodynamically significant valvular heart disease who underwent elective valvular surgery. The primary end-point at the 30-day follow-up was postoperative MODS. The secondary end-point was death from all causes in patients with MODS. The postoperative MODS occurred in 72 patients. At multivariate analysis: RDW (OR 1.267; 95% CI 1.113-1.441; P =0.0003), creatinine (OR 1.007; 95% CI 1.001-1.013; P =0.02) and age (OR 1.047; 95% CI 1.019-1.077; P =0.001) remained independent predictors of the primary end-point. Receiver operator characteristics analysis determined a cut-off value of RDW for the prediction of the occurrence of the perioperative MODS at 14.3%. RDW (OR 1.448; 95% CI 1.057-1.984; P =0.02) and age (OR 1.057; 95% CI 1.007-1.117; P =0.04) were associated with an increased risk of death in patients with perioperative MODS. Elevated RDW is associated with a higher risk of MODS and death in patients with MODS following heart valve surgery., Competing Interests: Competing interestsThe authors declare no competing or financial interests., (© 2018. Published by The Company of Biologists Ltd.)

Background: Dual antiplatelet therapy (DAPT) is recommended prophylaxis after transcatheter aortic valve implantation (TAVI). The usefulness of platelet reactivity (PLTR) tests in predicting the safety of periprocedural DAPT in the TAVI population is unknown., Aim: To analyze the value of aspirin/clopidogrel PLTR testing in predicting the risk of in-hospital TAVI-related bleeding., Methods: PLTR, expressed as P2Y 12 /aspirin reaction units (PRU/ARU), was performed using optical aggregometry with the VerifyNow ® device, in the 24h before and on the sixth day after TAVI. Follow-up was by telephone. Bleeding was defined according to VARC-2, and comprised in-hospital, major and life-threatening events., Results: Overall, 100 patients undergoing TAVI were included; 30 (30%) had bleeding. Clopidogrel PLTR before TAVI (area under the curve [AUC] 0.686, 95% confidence interval [CI] 0.542-0.808; P=0.02) and after TAVI (AUC 0.970, 95% CI 0.904-0.995; P<0.001) correlated with bleeding, with PRU cut-off values of ≤204 and ≤124 as bleeding predictors, respectively. A significant periprocedural decrease in clopidogrel PLTR was noted, with a PRU drop of >78 as bleeding predictor (AUC 0.851, 95% CI 0.725-0.935; P<0.001). Only postprocedural aspirin PLTR was associated with bleeding (AUC 0.697, 95% CI 0.585-0.794; P=0.008). Follow-up (359±73 days after TAVI) included 85 patients (85%) (after exclusion for in-hospital death [n=4] and lack of contact [n=11]). Major bleeding was noted in four patients (4.7%), all on combined prophylaxis., Conclusions: TAVI-related bleeding occurs mainly during the procedure or in the early postprocedural period. Testing of periprocedural clopidogrel PLTR, but not aspirin PLTR, seems useful because of its predictive value for TAVI-related bleeding. PLTR testing suggests that premedication with clopidogrel, enhanced response to clopidogrel early after TAVI and significant periprocedural drop in clopidogrel PLTR might increase the risk of TAVI-related bleeding., (Copyright © 2017 Elsevier Masson SAS. All rights reserved.)

Introduction: Transcatheter aortic valve implantation (TAVI) improves prognosis in patients disqualified from surgical valve replacement. Calcifications of the aortic complex can lead to deformation of the prosthesis, resulting in paravalvular leaks (PVL)., Aim: To evaluate the predictive value of quantitative estimation of volume/weight and geometric distribution of calcifications in multislice computed tomography, for the development of PVL., Material and Methods: This was a retrospective, case-control study on patients with a CoreValve aortic prosthesis. The study group consisted of 20 patients with confirmed significant PVL after TAVI. The control group consisted of 20 patients without significant PVL, matched according to valve type and clinical characteristics. The size spatial distribution and shape of calcifications were measured., Results: The average age of patients was 79.9 years (60% women). Cases and controls did not differ in their clinical characteristics. The size of the aortic annulus was significantly larger in cases vs. controls (23.4 ±1.6 vs. 22 ±1.4 mm, p = 0.01). Volume, area and curvature of calcifications were greater in cases vs controls (1.09 ±0.56 vs. 0.59 ±0.41 cm 3 , p = 0.011; 15.26 ±5.46 vs. 9.50 ±5.29 cm 2 , p = 0.008; 1.76 ±0.07 vs. 1.68 ±0.13 cm 3 , p = 0.037). In multivariate analysis, adjusted for aortic annulus size, the area of aortic valve calcifications independently predicted paravalvular regurgitation (OR = 1.41, 95% CI: 0.09-1.92, p < 0.009)., Conclusions: Morphometric analysis of aortic valve calcifications predicted the risk of paravalvular leak following TAVI irrespectively of patients' clinical characteristics.

Background: Numerous studies have shown that elevated red cell distribution width (RDW) is associated with poor outcomes in patients with cardiovascular diseases such as acute myocardial infarction, stroke, and chronic heart failure. The prognostic utility of RDW in patients with valvular disease undergoing heart valve surgery is unknown., Methods: A prospective study was conducted on a group of consecutive patients with hemodynamically significant valvular heart disease that underwent elective valvular surgery. The preoperative complete blood count, data on risk factors, course of operations and the postoperative period were assessed. The primary and secondary endpoints were 30-day mortality and any major adverse event within 30 days. The data were analyzed with Kaplan-Meier survival curves, regression analyses, and receiver operator characteristic (ROC) curves., Results: The study group included 500 consecutive patients who underwent replacement or repair of the valve/valves. Sixteen patients died during the follow up period. On multivariate analysis, creatinine (p = 0.04), red blood cell (RBC) count (p = 0.005) and RDW (p = 0.02) were each associated with an increased risk of death. The composite endpoint occurred in 208 patients. On multivariate analysis, chronic kidney disease (p = 0.003), raised pulmonary blood pressure (p = 0.02) and RDW (p = 0.001) remained independent predictors of the secondary endpoint. The preoperative RDW in patients with valvular disease undergoing valve surgery, combined with EuroSCORE II, predicted 30-day mortality significantly better than did EuroSCORE II alone., Conclusions: An elevated RDW is associated with a worse outcome following valve surgery. The predictive ability of the RDW, when assessed by the area under the ROC curve, improved the predictive ability of the EuroSCORE II calculator.

Introduction: Atrial (ANP) and B-type (BNP) natriuretic peptides are hormones secreted by the heart as a response to volume expansion and pressure overload., Aim: To assess the changes of ANP and BNP after percutaneous balloon mitral valvuloplasty (PBMV) and to investigate factors associated with endpoints., Material and Methods: The study included 96 patients (90.7% females, age 51.6 ±12.2 years) with rheumatic mitral valve stenosis (mitral valve area (MVA) 1.18 (1.01-1.33) cm 2 , mean mitral gradient (MMG) 8.2 (7.1-9.2) mm Hg, NYHA 2.09 (1.9-2.5)). Patients were followed up for 29.1 months for the search of endpoints., Results: The PBMV was successful in all cases. After the procedure MVA increased (1.18-1.78 cm 2 , p < 0.01) and pulmonary capillary wedge pressure (PCWP) decreased (29.8-21.8 mm Hg, p < 0.01). Concentration of ANP significantly rose 30 min after the PBMV (79.2 vs. 134.2 pg/ml, p = 0.012) and dropped significantly after 24 h (134.2 vs. 70.4 pg/ml, p = 0.01). Furthermore, after 36 months concentration of ANP did not differ from the baseline value ( p = NS). BNP concentration at day 1 was lower than at baseline (94.5 vs. 80.2 pg/ml, p = 0.032). Moreover, during the follow-up period BNP continued to fall at all time points. In univariate analysis parameters associated with endpoint occurrence were baseline PAP ( p = 0.023), baseline PCWP ( p = 0.022), baseline NYHA ( p = 0.041) and increase in 6-minute walk test (6MWT) ( p = 0.043). In multivariate analysis the only factor associated with endpoint occurrence was baseline NYHA (HR = 1.52, 95% CI: -1.3-1.91, p = 0.022)., Conclusions: Patients with MS had increased levels of both BNP and ANP. Baseline NYHA class was found to be associated with outcomes after the procedure., Competing Interests: The authors declare no conflict of interest.

Clinical Introduction: An 82-year-old woman suspected of a cardiac tumour was referred for evaluation. Patient's medical history included atrial fibrillation, implantation of a VVI (ventricular stimulation) pacemaker 3 years earlier due to advanced atrioventicular (AV) block, arterial hypertension and hypothyroidism. Patient was adequately anticoagulated with warfarin (international normalized ratio (INR) 3.0 at admission). She reported occasional palpitations and a 2 kg weight loss in the last 2 years, but denied shortness of breath, chest pain, malaise, fever, chills or cough. Blood samples were taken for tests and cultures. Red blood cells, haemoglobin, white blood cells, platelets, C- reactive protein (CRP) and erythrocyte sedimentation rate (ESR) were within normal ranges. Blood cultures were negative. Echocardiogram (figure 1A) (see online supplementary videos 1 and 2) and cardiac CT were performed (figure 1B)., Question: Which of the following is the most likely diagnosis?Caseous calcification of the mitral annulusCoconut left atriumMitral valve myxomaPeriannular abscess., (Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://www.bmj.com/company/products-services/rights-and-licensing/)

Objective: To analyse the impact of postprocedural mitral regurgitation (MR), in an interaction with aortic regurgitation (AR), on mortality following transcatheter aortic valve implantation (TAVI)., Methods: To assess the interaction between MR and AR, we compared the survival rate of patients (i) without both significant MR and AR versus (ii) those with either significant MR or significant AR versus (iii) with significant MR and AR, all postprocedure. 381 participants of the Polish Transcatheter Aortic Valve Implantation Registry (166 males (43.6%) and 215 females (56.4%), age 78.8±7.4 years) were analysed. Follow-up was 94.1±96.5 days., Results: In-hospital and midterm mortality were 6.6% and 10.2%, respectively. Significant MR and AR were present in 16% and 8.1% patients, including 3.1% patients with both significant MR and AR. Patients with significant versus insignificant AR differed with respect to mortality (log rank p=0.009). This difference was not apparent in a subgroup of patients without significant MR (log rank p=0.80). In a subgroup of patients without significant AR, there were no significant differences in mortality between individuals with versus without significant MR (log rank p=0.44). Significant MR and AR had a significant impact on mortality only when associated with each other (log rank p<0.0001). At multivariate Cox regression modelling concomitant significant MR and AR were independently associated with mortality (OR 3.2, 95% CI 1.54 to 5.71, p=0.002)., Conclusions: Significant MR or AR postprocedure, when isolated, had no impact on survival. Combined MR and AR had a significant impact on a patient's prognosis., (Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://www.bmj.com/company/products-services/rights-and-licensing/)

Introduction: Postoperative bleeding is one of the most serious complications of cardiac surgery and requires transfusion of blood or blood products. Acetylsalicylic acid (ASA) and clopidogrel (CLO) are the two most commonly used antiplatelet agents; when used in combination (i.e., as dual antiplatelet therapy [DAPT]), they exert a synergistic effect. Dual antiplatelet therapy, however, significantly increases the risk of postoperative bleeding. The effect of antiplatelet therapy can be monitored by platelet aggregation testing. One of the most commonly methods used for assessing platelet reactivity is multiple electrode aggregometry (MEA) which can be performed with the use of Multiplate analyzer. Although the method has long been used in interventional cardiology to assess the effect of antiplatelet therapy, it is not available at cardiac surgery departments as a standard diagnostic procedure. The aim of the study was to establish the frequency of bleeding complications following coronary artery bypass graft (CABG) surgery in patients on single antiplatelet therapy (SAPT) and patients on DAPT and to determine the usefulness of routine measurement of platelet responsiveness before CABG surgery in patients receiving antiplatelet therapy., Material and Methods: A consecutive cohort of 200 patients referred for elective surgical treatment of stable coronary artery disease was enrolled (100 consecutive patients on SAPT [ASA 75 mg/day] and 100 consecutive patients on DAPT [ASA 75 mg/day + CLO 75 mg/day]). All subjects continued their antiplatelet therapy until the day before surgery. For each subject, platelet aggregation testing in the form of an ASPI test and an ADP test was performed on the Multiplate analyzer. Each subject underwent coronary artery bypass grafting surgery. For the primary and secondary endpoints in our study we adopted the definition provided in 'Standardised Bleeding Definitions for Cardiovascular Clinical Trials: A Consensus Report from the Bleeding Academic Research Consortium' ('Circulation', 2011) for BARC type 4 bleeding (i.e. CABG-related bleeding)., Results: An ROC curve was constructed for the ASPI test and ADP test for a total of 200 patients. No significant correlations were demonstrated between the ASPI test results and either the primary endpoint or the secondary endpoints. A correlation was found between the ADP test results and the composite primary endpoint and each of the secondary endpoints. The primary endpoint of major postoperative bleeding occurred in 16 subjects. From the ROC curve, we established the optimal cut-off value for the ADP test of 26 U at sensitivity of 72%, specificity of 69%, positive predictive value of 69.90%, and negative predictive value of 71.13%., Conclusions: In patients on antiplatelet therapy, an ADP test result of < 26 U is strongly predictive of serious bleeding complications after CABG surgery. The MEA ADP test allows to identify the group of patients at an increased risk of postoperative bleeding.

Introduction: The placement of a Swan-Ganz catheter into the pulmonary artery may lead to a number of complications (2-17%). In less than 0.2% of cases Swan-Ganz catheterization results in serious vascular damage - pulmonary artery rupture (PAR). This paper presents two distinct forms of iatrogenic PAR treated endovascularly using different vascular devices., Aim: To evaluate the effectiveness of endovascular treatment and the application of different types of vascular devices in the management of pulmonary artery rupture caused by Swan-Ganz catheterization., Material and Methods: In this retrospective study we evaluated 2 patients in whom Swan-Ganz catheter application was used for perioperative monitoring and resulted in pulmonary artery rupture. This complication was treated endovascularly by means of interventional cardiology., Results: We report the cases of 2 patients with a pulmonary artery pseudoaneurysm formed in the perioperative period. In case 1, a single, 4-loop, 3 mm diameter coil was implanted. In case 2, a 5 mm Amplatzer Vascular Plug IV was applied. In both cases, the endovascular approach resulted in total occlusion of the feeding artery and reduced further extravasation of the blood., Conclusions: Despite its extremely low incidence, iatrogenic PAR is a serious, life-threatening complication of Swan-Ganz catheterization that requires urgent attention. Among available methods of treatment, percutaneous embolization is a relatively quick, safe, accurate and highly effective alternative to traumatizing surgery.

Background: Whilst echocardiography is currently the 'gold standard' for the diagnosis of infective endocarditis (IE), it has certain limitations and alternative imaging methods are being sought. The study aim was assess the usefulness of cardiac magnetic resonance (CMR) imaging when diagnosing IE., Methods: Twenty consecutive patients with diagnosed IE were included in the study. All patients underwent CMR and transthoracic echocardiography, and 16 (80%) underwent also transesophageal echocardiography., Results: CMR revealed vegetations in 15 patients (75%). Following echocardiography, vegetations were identified in 19 patients (95%) and valve perforation was suspected in seven (35%); vegetations were identified by CMR in six (30%) of these patients. Echocardiography identified two patients suspected of perivalvular abscess; in one patient the abscess was diagnosed also by CMR and intraoperatively, but in the second patient neither CMR nor intraoperative examination confirmed this diagnosis. Late gadolinium enhancement (LGE) was reported at CMR in eight patients (40%), associated with an extension of the inflammatory process and myocardium infiltration. The valve insufficiency fraction allowed the degree of insufficiency of the valves affected by inflammatory processes to be estimated. A positive correlation was found between the degree of valve insufficiency assessed with CMR and echocardiography., Conclusions: CMR may serve as a useful method for diagnosing perivalvular complications in IE patients, although vegetation visualization is limited by the low spatial resolution of the method. CMR may prove superior to echocardiography in evaluating the degree of inflammatory process involvement in the myocardium. The degree of valve insufficiency and its hemodynamic significance can also be assessed.

Introduction: Transcatheter aortic valve implantation (TAVI) is a treatment alternative for the elderly population with severe symptomatic aortic stenosis (AS) at high risk for surgical aortic valve replacement (SAVR)., Aim: To assess the impact of TAVI on echocardiographic parameters of left ventricular (LV) performance and wall thickness in patients subjected to the procedure in a single-centre between 2009 and 2013., Material and Methods: The initial group consisted of 170 consecutive patients with severe AS unsuitable for SAVR. Logistic European System for Cardiac Operative Risk Evaluation (EuroSCORE) was 21.73 ±12.42% and mean age was 79.9 ±7.5 years., Results: The TAVI was performed in 167 (98.2%) patients. Mean aortic gradient decreased significantly more rapidly after the procedure (from 58.6 ±16.7 mm Hg to 11.9 ±4.9 mm Hg, p < 0.001). The LV ejection fraction (LVEF) significantly increased in both short-term and long-term follow-up (57 ±14% vs. 59 ±13%, p < 0.001 and 56 ±14% vs. 60 ±12%, p < 0.001, respectively). Significant regression of interventricular septum diameter at end-diastole (IVSDD) and end-diastolic posterior wall thickness (EDPWth) was noted in early (15.0 ±2.4 mm vs. 14.5 ±2.3 mm, p < 0.001 and 12.7 ±2.1 mm vs. 12.4 ±1.9 mm, p < 0.028, respectively) and late post-TAVI period (15.1 ±2.5 mm to 14.3 ±2.5 mm, p < 0.001 and 12.8 ±2.0 mm to 12.4 ±1.9 mm, p < 0.007, respectively). Significant paravalvular leak (PL) was noted in 21 (13.1%) patients immediately after TAVI and in 13 (9.6%) patients in follow-up (p < 0.001). Moderate or severe mitral regurgitation (msMR) was seen in 24 (14.9%) patients from the initial group and in 19 (11.8%) patients after TAVI (p < 0.001)., Conclusions: The TAVI had an immediate beneficial effect on LVEF, LV walls thickness, and the incidence of msMR. The results of the procedure are comparable with those described in other centres.

Unlabelled: Vascular complications are the main safety limitations of transcatheter aortic valve implantation (TAVI). The aim of the study was to assess the incidents, predictors, and the impact of early vascular complications on prognosis after TAVI. This was a single-center analysis of vascular complications related to TAVI. Early vascular complications were defined as incidents within 30 days after TAVI and comprised complications related to transvascular: transfemoral/transsubclavian ,and transapical bioprosthesis implantation. Evaluated risk factors were: (1) clinical characteristics, (2) TAVI route, and (3) center experience. In patients with transvascular TAVI the impact of: (1) diameters of access arteries, vascular sheathes and difference between them, (2) arterial wall calcification, and (3) ProStar devices used for access site closure were assessed. Arterial wall calcification and arteries diameters were measured by 64-slice computer tomography. Arterial wall calcification was graded according to 5° scale., Results: between 2009-2011; follow-up 1-23 months (12 ± 15.55), 83 consecutive patients, and 62-91 (81.10 ± 7.20) years, underwent TAVI: 67 (80.72%) patients had transvascular, and 16 (19.27%) patients had transapical bioprosthesis implantation. We noted 44 (53.01%) early vascular complications: 17 (20.48%) were major and 27 (32.53%) were minor incidents. Independent predictors of early vascular complications were: history of anaemia (OR 3.497: 95% CI [1.276-9.581]; p = 0.014), diabetes (OR 0.323: 95% CI [0.108-0.962]; p = 0.042), percutaneous coronary intervention performed as preparation for TAVI (OR 4.809: 95 % CI [1.172-19.736]; p = 0.029), and arterial wall calcification (OR 1.945: 95% CI [1.063-3.558]; p = 0.03). Of 6 (7.22%) in-hospital and 10 (12.98%) late deaths: 5 (83.33%) patients and 8 (80%) patients respectively had post-procedural vascular complications. Vascular complications, which occurred in 30-days after TAVI, predict late mortality (p = 0.036). Conclusions derived were: (1) TAVI patients with history of anaemia and diabetes required careful monitoring for early vascular complications. (2) If coronary intervention before TAVI is required, it should be performed in the time allowing vascular injuries to heal. (3) Calcification of access arteries is an independent predictor of post-procedural vascular complications; therefore, its estimation should be a regular element of preceding computer tomography. (4) Vascular complications seem to be predictors of late mortality after TAVI.

Introduction:  Syncope and sudden cardiac arrest are known complications of aortic stenosis (AS)., Objectives:  The aim of the study was to investigate the incidence of these complications in patients with severe symptomatic AS and to analyze whether basic clinical data and electrocardiographic (ECG) and echocardiographic parameters can be the markers of these complications., Patients and Methods:  The incidence of syncope and sudden cardiac arrest and its correlations with clinical and diagnostic data (ECG, echocardiography, Holter monitoring) were analyzed in 514 patients (mean age, 60 ±11 y) with severe symptomatic AS before valve replacement., Results:  Syncope was reported in 167 patients (32%), and aborted cardiac arrest in 14 (2.7%; ventricular fibrillation, 13 patients; third-degree atrioventricular block, 1 patient). None of the analyzed parameters was related to syncope. Patients with a history of sudden cardiac arrest had higher New York Heart Association class (P = 0.01), more frequent history of syncope (P = 0.017), higher left ventricular mass index (P = 0.02), lower ejection fraction (P = 0.004), longer QRS duration (P = 0.048), corrected QT (P = 0.002), QT dispersion (P = 0.007), and a higher number of ventricular arrhythmias in 24-hour Holter monitoring (P = 0.002). A multivariate analysis showed correlations between syncope, ejection fraction of less than 45%, and QTd exceeding 60 ms and aborted cardiac arrest. At least 2 of these parameters were observed in 8 of 14 patients (P <0.001): sensitivity, 57%; specificity, 86%; positive predictive value, 10%; and negative predictive value, 98%., Conclusions:  The incidence of sudden cardiac arrest in severe symptomatic AS is low. It is higher in patients with a history of syncope, prolongation of QTd, and reduced ejection fraction. None of the clinical and diagnostic parameters were associated with a history of syncope in patients with AS.

Background: The development of increasingly accurate immunosuppression and surgical techniques has contributed to transplantology to such an extent that patients who have undergone abdominal organ transplantations account for an increasing group in whom other diseases, including those of the cardiovascular system, have to be treated, also surgically., Case Report: A 61-year-old male patient after liver transplantation was admitted to the Institute of Cardiology to undergo surgical treatment of aortic stenosis. An SJM 23-mm mechanical prosthesis was implanted into the aortic ostium. The postoperative period was without complications. On postoperative day 6, the patient was transferred to the Department of Transplantation Medicine and Nephrology to be treated further., Conclusions: Cardiosurgery procedures in liver transplant recipients involve a higher risk, which results from hemorrhagic complications requiring massive blood and blood components transfusions and repeated thoracotomy. Because of expected complications, the choice of prosthesis is difficult and should be made together by a cardiac surgeon and the patient.

Although coronary computed tomographic angiography has the ability to depict potentially malignant features of anomalous coronary artery originating from the opposite sinus of Valsalva (ACAOS), there are limited data on the significance of ACAOS in the computed tomography population. The aims of this study were to assess the prevalence of ACAOS and to correlate its anatomic features with patients' symptoms among 8,522 consecutive subjects who underwent coronary computed tomographic angiography from February 2008 to May 2012. The ACAOS proximal course was classified into anterior, interarterial, septal, and retroaortic subtypes. Malignant ACAOS was recorded if a slitlike ostium, an acute angle of takeoff, an intramural course, and significant compression between the aorta and pulmonary trunk were present simultaneously. The prevalence of ACAOS was 0.84% (72 of 8,522), including right-sided origins of the left main coronary artery (n = 11), left anterior descending coronary artery (n = 9), and left circumflex coronary artery (n = 33) and left-sided origin of the right coronary artery (n = 20). Of the 24 ACAOS (0.28%) with an interarterial course, 12 (0.14%) showed significant vessel compression, of which 6 (0.07%) were classified as malignant. The presence of significant interarterial compression and malignant ACAOS type were observed in left-sided right coronary arteries only, and interarterial compression correlated with patients' symptoms at a median of 15-month follow-up. In conclusion, the computed tomographic prevalence of ACAOS seems to be comparable with that of previous angiographic studies. The malignant features of ACAOS in the adult computed tomography population might be exclusively associated with left-sided right coronary arteries., (Copyright © 2013 Elsevier Inc. All rights reserved.)

Despite the progress made in diagnosis and treatment of heart valve diseases, the incidence of infective endocarditis (IE) remains constant. It is still associated with high mortality and high rate of embolic complications, including most dangerous one, i.e. stroke. It has a significant impact on further treatment and qualifications for cardiac surgery. In this paper, the authors discuss the epidemiology, mechanisms of stroke and its impact on the qualifications for cardiac surgery. The authors discuss the problem of clinically silent central nervous system embolism in the course of IE and the usefulness of neuroimaging and markers of central nervous system damage in diagnosis of cerebral embolism.

We present the case of a 72-year-old male with chronic phase myeloid leukemia. Elevation of the pulmonary artery pressure due to nilotinib therapy was noted. This effect on pulmonary artery pressure was nilotinib dose dependent.

Background and Aim: To evaluate long-term outcomes of surgical aortic valve replacement (AVR) due to significant aortic stenosis (AS) and assess changes in factors affecting survival during a 10-year period in patients referred for surgery from a single centre., Methods: We evaluated 1143 patients (478 women, 665 men; mean age 61 ± 5 years) treated in the Department of Valvular Heart Disease at the Institute of Cardiology in Warsaw who were referred for AVR due to significant AS in 1998-2008 and survived the surgery and the initial 30-day postoperative period. We assessed long-term survival in relation to preoperative parameters including demographic data (age, gender), clinical variables (New York Heart Association [NYHA] class, presence of a significant coronary artery stenosis, arterial hypertension, reduced left ventricular ejection fraction [LVEF]), and operative parameters (prosthetic valve type: biological vs. mechanical, and the type of the surgery: isolated AVR vs. AVR combined with coronary artery bypass grafting)., Results: Ten-year survival was worse in men compared to women (p = 0.001), with the effect of gender gradually decreasing after 3 years of follow-up. Factors affecting long-term survival included age (p = 0.0001) and NYHA class (p = 0.005) in women, and age (p = 0.0001), NYHA class (p = 0.0001), arterial hypertension (p = 0.01), reduced LVEF (p = 0.03), and the presence of significant coronary artery stenoses (p = 0.0001) in men. Evaluation of factors affecting 1-, 3-, 5-, and 7-year survival showed their variability mostly in men., Conclusions: Long-term surgical outcomes in patients with significant AS are very good, with better survival in women compared to men, although these differences attenuated after 3 years. Factors affecting 10-year survival are different in women and men: a significant effect in women was noted only for age and preoperative NYHA class, while in men for age, NYHA class, hypertension, reduced LVEF, and the presence of significant coronary artery stenoses. During 10-year follow-up, longitudinal changes can be noted in factors affecting survival after AVR.

Background: The rate of significant conduction disturbances requiring permanent pacemaker implantation (PPI) following surgical aortic valve replacement (AVR) is 2-8%. Transcatheter aortic valve implantation (TAVI) is an alternative management approach in patients with severe aortic stenosis who are not considered candidates for AVR. The TAVI using the CoreValve (CV) bioprosthesis is associated with a nearly 30% rate of conduction disturbances requiring postprocedural PPI., Aim: To provide an initial evaluation of the rate of conduction disturbances and the need for PPI, and to analyse factors that increase the risk of this complication in patients undergoing TAVI using CV bioprosthesis. In addition, we evaluated the rate of permanent conduction disturbances in patients who underwent PPI at one year after TAVI., Methods: We studies 22 initial patients in a single centre who underwent CV bioprosthesis implantation in 2009-2010. After exclusion of 6 patients with preprocedural PPI, we ultimately evaluated 16 patients. Uni- and multivariate analyses were performed using χ(2), Fisher, and Wilcoxon tests, and logistic regression analysis was performed using the SAS software., Results: Overall, 8 (50%) patients in our study group required PPI after TAVI (TAVI + PPI), and the remaining 8 patients did not require PPI (TAVI). The most common indication for PPI was complete heart block. The decision to implant a pacemaker was made on average at 9 ± 7 days following TAVI (range 3 to 22 days). When we analysed risk factors for PPI that were unrelated to the TAVI procedure, we found that the TAVI + PPI group was characterised (vs the TAVI group) by a significantly larger diameter of the native aortic valve (p = 0.03) and a larger left ventricular outflow tract (LVOT) dimension in the frontal (p = 0.02) and the corresponding frontal dimension in the transverse view (p = 0.01) by computed tomography angiography. Logistic regression analysis showed that the risk of PPI increased more than 2.5 times for each increase in the aortic annulus diameter by 1 mm (OR 2.64; 95% CI 0.90-7.74). None of the risk factors related to TAVI resulted in a significant increase in the rate of PPI. Among the patients who underwent PPI, we only noted a trend for a larger valvulotomy balloon diameter (p = 0.08), shorter procedure duration (p = 0.06), and deeper CV insertion within LVOT (p = 0.09). In addition, the bioprosthesis was inserted deeper in those patients who developed new LBBB after TAVI (p = 0.06). The ECG analysis at one day after the procedure showed a significant prolongation of PR, QRS, QT, and QTc intervals, and increased left axis deviation in the TAVI + + PPI group. In addition, the TAVI + PPI group showed increased QRS duration (p = 0.03) and increased left axis deviation (p = 0.049) compared to the TAVI group. Each increase in QRS duration by 10 ms was associated with 2.5-fold increase in the risk of PPI (OR 1.10; 95% CI 0.97-1.22), and each increase in PR interval duration by 10 ms with a 23% increase in risk (OR 1.02; 95% CI 0.99-1.05). New LBBB following CV implantation was noted significantly more frequently in the TAVI + PPI group vs the TAVI group (p 〈 0.0003). Pacemaker interrogation at one year after TAVI showed that the mean percentage of ventricular pacing in all patients with a pacemaker (DDD and VVI) pacing was 41%, and it was less than 10% in 2 patients., Conclusions: 1. Transcatheter implantation of a CV bioprosthesis is associated with an increased risk of persistent conduction disturbances and subsequent PPI. 2. New LBBB after TAVI may predict the need for PPI. 3. Careful ECG monitoring is necessary for one week after CV bioprosthesis implantation due to a risk of atrioventricular conduction disturbances and the need for PPI. 4. Patients at an increased risk of postprocedural PPI may be those with deep bioprosthesis insertion in LVOT, larger LVOT diameter, and larger aortic annulus diameter in the frontal view. These observations require confirmation in a larger group of patients.

Background: Coronary computed tomography (CT) angiography is currently the only alternative to invasive angiography in the evaluation of coronary anatomy. In patients referred for valvular or thoracic aortic disease surgery, invasive coronary angiography remains the gold standard required by cardiac surgeons during the preoperative evaluation. According to the current European Society of Cardiology guidelines, evaluation of coronary anatomy is recommended in all patients above 40 years of age, with a history of coronary artery disease (CAD), in postmenopausal women, patients with left ventricular systolic dysfunction, with suspected ischaemic aetiology of mitral regurgitation, and in patients with one or more risk factors for CAD. The possibility to perform coronary CT angiography to exclude CAD before planned non-coronary cardiac surgery was first allowed in the 2010 Report of the American College of Cardiology Foundation Task Force on Expert Consensus., Aim: To evaluate the usefulness of dual-source CT for the evaluation of coronary anatomy in patients before planned cardiac valvular surgery., Methods: We studied 98 consecutive patients with a haemodynamically significant valvular heart disease and guideline-based indications for coronary angiography to exclude CAD before planned valvular surgery. Exclusion criteria included cardiac arrhythmia (atrial fibrillation, frequent ventricular and supraventricular premature beats), estimated glomerular filtration rate < 60 mL/min/1.73 m(2), allergy to iodine contrast agents, and lack of patient consent. Mean patient age was 58.8 (range 30-78) years. Coronary artery calcium score (CACS) was first determined in all patients. Coronary CT angiography was not performed if CACS was > 1000. In the remaining patients, complete CT evaluation was performed with the administration of a contrast agent. Conventional invasive coronary angiography was subsequently performed in patients with at least one > 50% stenosis, artifacts due to calcifications, or motion artifacts., Results: In 79 (80.6%) patients, CT angiography excluded the presence of a significant coronary artery stenosis without the need for invasive angiography. Conventional coronary angiography was required in 19 (19.4%) patients, including 13 (13.3%) patients with a > 50% stenosis in CT angiography, 2 (2%) patients with calcification artifacts, 1 (1%) patient with motion artifacts, 2 (2%) patients with CACS > 1000 in whom CT angiography was nor performed, and 1 (1%) patient with allergic symptoms during administration of a test dose of the contrast agent. Ultimately, significant CAD was diagnosed in 9 (9.2%) patients in whom coronary artery bypass surgery was also performed. In addition, vascular anomalies were diagnosed with cardiac CT angiography in 5 (5.1%) patients. In 14 patients, CT angiography was also used for previously planned evaluation of a coexisting aortic aneurysm., Conclusions: Coronary CT angiography may be useful to exclude significant CAD in patients referred for valvular disease surgery.

The data on cerebral embolism prevalence in the course of infective endocarditis (IE) are most probably underestimated. Part of the cerebral embolism episodes are clinically silent. The objective of this study was to assess the prevalence of clinically silent cerebral embolism in the course of IE and to correlate hematological, inflammatory, and echocardiography parameters with the presence of clinically overt or silent cerebral embolisms. For this purpose, we examined 65 patients with IE by blood test, cultures, echocardiography, and MRI/CT imaging. Clinically overt cerebral embolism was found in 13 patients; 52 patients had no clinically overt cerebral embolism. MRI/CT examinations revealed that among patients with no clinically overt cerebral embolism, 24 had clinically silent cerebral embolism. Thus, 37 patients in all were diagnosed with a cerebral embolism episode (overt + clinically silent). Clinically silent cerebral embolism was diagnosed in 36.9% of all patients, being as high as 64.8% of cerebral embolism cases. Silent or overt embolism development did not depend on the localization of the inflammatory process in either native or artificial valves. The type of cerebral embolism was not found to be influenced by leukocytosis, platelet count, ESR, or hsCRP levels. Neither was the type of embolism found to be influenced by the etiologic factor. Nine patients died. In three patients, the cause of death was hemorrhage from a cerebral apoplectic focus. These results suggest that clinically silent central nervous system embolism is a common complication of infective endocarditis and each patient should undergo a neuroimaging examination.

Background: Trans-catheter aortic valve implantation (TAVI) has recently emerged as an alternative to conventional surgery in high-risk surgical patients with haemodynamically significant aortic valve stenosis. However, patients referred for TAVI are usually elderly individuals (> 80 years) who frequently also suffer from renal impairment. Trans-catheter valve therapies require extensive use of contrast injections with a risk of nephrotoxicity., Aim: To evaluate post-TAVI renal function and to determine whether the exposure to contrast injections might cause reduced kidney function and contrast-induced nephropathy., Methods: From January 2009 to September 2010, TAVI was performed in 39 patients (26 women and 13 men). The mean age of the patients was 81.43 ± 7.39 years, and the mean volume of contrast material administered was 187.95 ± 91.34 mL. Serum creatinine and glomerular filtration rate (GFR, acc. to the MDRD formula) were estimated in all patients prior to and 1, 2, and 5-8 days after TAVI., Results: Two female patients died on postoperative day 1. Other patients did not show clinically significant reduction in renal function following the procedure (mean creatinine concentration 104.46 vs 99.77 vs 94.56 vs 93.64 mmol/L, NS and mean GFR 52.37 vs 56.63 vs 60.18 vs 61.34 mL/min/1.73 m², NS)., Conclusions: 1. The TAVI procedure, which includes contrast injection does not seem to cause a clinically significant decrease of renal function. 2. None of our elderly patients with severe aortic valve stenosis, multiple co-morbidities, and pre- TAVI renal compromise developed contrast-induced nephropathy.

Background: Transcatheter aortic valve implantation (TAVI) is a new method for the treatment of aortic stenosis (AS)., Aim: To evaluate early results of TAVI using transfemoral/transsubclavian approach (TFA/TSA) or transapical approach (TAA) in patients with severe AS and high risk for surgical aortic valve replacement., Methods: Between January 2009 and May 2010, 30 high-risk patients underwent TAVI. The primary treatment option was TFA, and TAA was used if contraindications to TFA were present; one patient underwent the procedure using TSA. Reasons for selecting TAA were as follows: small diameter (<7 mm) and/or severe calcification of the iliofemoral arteries, peripheral atherosclerosis, "porcelain" aorta and a horizontal course of the ascending aorta. Edwards-Sapien or CoreValve devices were used in all cases, and procedures were performed without the use of cardiopulmonary bypass in a cardiac catheterisation laboratory., Results: Mean patient age was 82.46 ± 5.79 years, mean NYHA class was 3.23 ± 0.41, and predicted mean surgical mortality using logistic Euroscore was 29.18 ± 16.9% (22.72 ± 12.07% in the TFA/TSA group vs 34.6 ± 15.4% in the TAA group; p = 0.031). Eleven patients were treated using TAA. The valve was implanted successfully in 96% of patients. Inhospital mortality was 3.3%. Mean 30-day mortality was 6.6% in the entire cohort, 0% in the TFA/TSA group and 18% in the TAA group. There were no cases of periprocedural myocardial infarction (MI), cardiogenic shock, stroke/transient ischaemic attack, or need for cardiopulmonary resuscitation. One patient died suddenly three weeks after the procedure; except for this case, there were no major adverse cardiovascular events (MACCE: MI, cerebrovascular accident, re-do procedure) at 30-day follow-up. The TAVI was associated with a significant reduction in the mean maximal aortic gradient in both groups (from 99.6 ± 22.07 mm Hg to 21.83 ± 9.38 mm Hg post-procedure and to 23.25 ± 9.22 mm Hg at 30-day follow up), with no cases of severe aortic valve regurgitation. The NYHA class at 30 days improved from 3.23 ± 0.41 to 1.72 ± 0.52 (p = 0.03)., Conclusions: Our results demonstrate lower 30-day complication rate and mortality in the TFA/TSA group. The availability of several techniques of valve implantation in the group of non-surgical patients with severe AS potentially broadens the patient population with indications for this treatment.

We present a case of a 61 year-old woman with tachycardia originating close to the His bundle where radiofrequency (RF) ablation may bear potential risk of atrioventricular (AV) block. In this case report we discuss the possibility of a AV nodal reciprocating tachycardia with tendon of Todaro breakthrough. Patient was safely and effectively treated with RF catheter ablation.

Introduction: Despite progress in medicine, the prevalence of infective endocarditis (IE) in patients with prosthetic valves (PVE) has not decreased. Positive blood and valve cultures are one of the most important diagnostic criteria of IE. There are no unambiguous data regarding the influence of pathogenic factors on prognosis., Aim: To analyse blood and valve cultures in patients with PVE and assess their impact on the risk of early and late deaths as well as IE relapse., Methods: The study group consisted of 71 PVE patients. Infective endocarditis was diagnosed based on the Polish Cardiac Society guidelines. Early and late mortality as well as IE relapse were analysed in patients hospitalised between 1988 and 1998., Results: Positive blood cultures were found in 55 (77.5%) patients. Early mortality was 15.5% (11 deaths). Coagulase-negative Staphylococcus infection was an independent risk factor of early death (p=0.02). During long-term follow-up 8 (13.3%) patients died. The risk of late death increased with positive valve culture (p=0.04). Recurrence of IE was diagnosed in 6 (10%) patients. Staphylococcus epidermidis was a risk factor of disease relapse (p=0.03). Six-year survival was 73%., Conclusions: 1. Coagulase-negative Staphylococcus aetiology increases the risk of early death in patients with PVE. 2. Pathogenic factors did not influence the risk of late death. 3. The risk of late death was increased with positive valve culture with negative blood cultures. 4. Staphylococcus epidermidis aetiology increases the risk of PVE relapse.

Introduction: Despite improvement in medical care the incidence of infective endocarditis (IE) has not decreased. Positive blood cultures are one of the most important diagnostic criteria of IE. There are no uniform data regarding the influence of pathogenetic factors on prognosis., Aim: To analyse the results of blood and valve cultures in patients with IE of native valves and evaluate their influence on the risk of early and late deaths as well as recurrence of IE., Methods: The study group consisted of 152 patients with IE of native valves. The IE diagnosis was based on the Duke criteria. Early and late mortality as well as recurrence of IE were analysed in patients hospitalised at the Institute of Cardiology in Warsaw from 1988 to 1998., Results: Positive blood cultures were found in 103 (67.8%) of patients. In-hospital mortality was 5.9% (9 deaths). The incidence of early deaths was significantly lower in surgically treated patients (p=0.01). Late deaths occurred in 23 (16%) patients. Results of blood and valve tissue cultures were not related to mortality. Recurrent IE was observed in 7 (4.9%) patients. Staphylococcus aureus was an independent risk factor for recurrent IE (p=0.04). Six-year survival was 79%., Conclusions: In patients with native valve infective endocarditis: 1. The risk of early and late death is not related to the results of blood and valve cultures. 2. Staphylococcus aureus aetiology increases the risk of disease recurrence. 3. The risk of early death is significantly lower in patients treated with surgery.

Background: The aim of our study was to determine the effect of brief starvation on the level of free radicals and other parameters of oxidative status in the liver., Material/methods: The Wistar male rats used for the experiment were divided into two groups: Group I had free access to water and standard chow, while Group II was subjected to a 36-hour fast. The activity of antioxidant enzymes--catalase (CAT), glutathione peroxidase (GSH-Px) and Cu, Zn-superoxide dysmutase (CuZn-SOD)--was measured in the livers of both control and fasting animals. The hepatic level of free radicals and the concentration of malonyldialdehyde (MDA) were also determined in both groups of animals., Results: Starvation resulted in decreased activity of CAT and CuZn-SOD, while the GSH-Px activity remained unchanged. Food deprivation also increased the level of free radicals. However, this rise was not paralleled by enhanced hepatic lipid peroxidation, measured as a change in MDA content., Conclusions: Since brief starvation causes an increase in the level of free radicals in the liver, it appears to effectively impair the tissue defence system, in part through the decreased activity of antioxidant enzymes, CAT and CuZn-SOD.

Background and Aims of the Study: The study aim was to identify the value of broad-range bacterial PCR in infective endocarditis (IE) of bacterial etiology, and to determine its specificity and sensitivity., Methods: Thirty blood samples were taken for analysis from patients with IE (diagnosed according to Duke criteria) and acquired valvular heart disease. Two control groups of patients with (n = 10) or without (n = 15) urinary tract infection were defined. DNA was isolated, and three different primer pairs for the region of the gene coding for 16S rRNA were tested, to determine the most specific pair. Amplification products were analyzed with gel electrophoresis, stained with ethidium bromide, and located under UV light., Results: Positive blood cultures were found in 25 patients with IE. A typical echocardiography picture with bacterial vegetations was found in all patients with sterile blood cultures, and in 20 patients with positive blood cultures. The highest specificity was found for forward/reverse (F/R) primers, as the relevant amplified PCR product was present in all blood samples with IE, and in four of 10 patients with urinary tract infection., Conclusion: Broad-range PCR in bacterial endocarditis is a rapid, sensitive and inexpensive technique for the detection of bacteria, but is far more prone to contamination than species-specific PCR. However, under controlled conditions, broad-range PCR may be valuable for the identification of non-specific infection, permitting a more rapid clinical diagnosis of endocarditis.

Unlabelled: Infective endocarditis (IE) frequently causes problems in diagnosis, especially where blood cultures are negative and when IE has fungal etiology. The aim of this study was to evaluate the usefulness of broad-range fungal PCR in diagnosis of fungal super-infection of bacterial IE. Twenty five blood samples were taken for analysis from patients with infective endocarditis. IE was diagnosed according to Duke criteria including positive blood cultures. Suspicion of fungal superinfection was established in 5 patients on serological investigation and confirmed by blood culture in 2 patients. Control group consisted of 15 patients without infection. DNA was isolated using the commercially available S.N.A.P. kit. Amplification products were analyzed by gel electrophoresis. Fungal DNA was found in 2 patients with fungal super-infection of bacterial IE confirmed by culture. In the remaining patients with IE and controls no fungal DNA was found., Conclusion: Broad-range fungal PCR is a fast and inexpensive tool for the detection of fungal DNA. The method may be valuable in the diagnosis of fungal super-infection of bacterial IE.

Unlabelled: Serum interleukin-6 (IL-6) level might be used to aid in diagnosis of infective endocarditis (IE), especially when blood cultures are negative. One of typical acute phase proteins is C-reactive protein (CRP), often served as an additional inflammation maker. The aim of the study was to compare serum IL-6 and CRP concentrations assessment in diagnosis and monitoring of IE. The study group consisted of 40 patients with ongoing IE and valvular heart diseases. Two control groups consisted of patients with valvular heart diseases: 15 without infection and another 15 with urinary tract infection. The diagnosis of IE was established according to the Duke University criteria; in 34 patients positive blood cultures were found. Serum IL-6 and CRP were measured on three occasions after diagnosis of IE was established and during antimicrobial treatment (mean period 14 +/- 7 days) by ELISA. Usefulness of both parameters for IE diagnosis were described. Reference values were defined as 0-12.5 pg/ml for IL-6, and 0-10 mg/l for CRP. Mean concentrations of IL-6 and CRP in patients with IE (37 +/- 44.3 pg/ml and 27.1 +/- 23.9 mg/l) were significantly higher than in controls: with urinary tract infection (9.1 +/- 4.42 pg/ml and 6.95 +/- 4.39 mg/l) and without infection (3.95 +/- 1.4 pg/ml and 2.21 +/- 0.96 mg/l). CRP concentration was not significantly correlated with IL-6 (r = 0.51, p = 0.07). The significant tendency of consecutive IL-6 concentrations to decrease (from 37 +/- 44.3 to 8.7 +/- 5.7 pg/ml), without decrease of CRP (from 27.1 +/- 23.9 mg/l to 22 +/- 18.3 mg/l) was found., Conclusions: 1. Elevated serum IL-6 and CRP levels may suggest ongoing IE. 2. Sensitivity, specificity, positive and negative predictive value are nonsignificantly higher for IL-6 than CRP. 3. Combined assessment of serum IL-6 and CRP concentration has no higher value in diagnosis of IE. 4, IL-6 level decrease is faster than CRP during antimicrobial treatment, and it helps better and faster monitoring of treatment.

The quality of life in eighty patients three and twelve months after surgical treatment of acquired heart valve disease was assessed. The significant extension of distance in 6 minute walk test and clinical improvement measured in change of NYHA functional classes after three and twelve months was noticed. However twelve months after valve replacement in comparison to results after three months no further improvement of quality of life in the matter of physical, psychical and social factors was seen.

Surgical treatment of aortic stenosis in patients (pts) with severe heart failure represents high-risk procedure. The aim of this study was to identify prognostic factors and assess the late outcome after aortic valve replacement (AVR) in patients with isolated aortic stenosis and left ventricle ejection fraction (EF) < or = 40%. The study group consisted of 37 pts 25 (67%) men and 12 (33%) women, aged 57 +/- 12 yrs. Mean follow-up period was 18 +/- 17 months (range 6 to 72 months). Before AVR and within follow-up period clinical assessment was based on NYHA classes and echocardiographic study to evaluate left ventricle function. Early mortality rate was 8.3%, late mortality was 5.8%. EF significantly improved from 27 +/- 7% to 59 +/- 15% (p < 0.001) after AVR. It was accompanied by clinical improvement. Left ventricle function improvement did not depend on age, sex of patients, concomitant revascularization and preoperative maximum transaortic gradient. Significant correlation (r = -0.4, p = 0.02) between preoperative left ventricle end-diastolic diameter and postoperative EF improvement was noted.

The aim of this study was to evaluate the usefulness of broad-range bacterial PCR in infective endocarditis of bacterial etiology, and to determine its specificity and sensitivity. Twenty five blood samples were taken for analysis from patients with infective endocarditis and acquired valvular heart disease. Infective endocarditis was diagnosed according to Duke criteria. There were two control groups consisting of patients with acquired valvular heart disease: 10 patients with urinary tract infection and 15 patients without. Three different primer pairs for the region of the gene coding for 16S rRNA were tested, to find the most specific one. The highest specificity was found for F/R primers, as the relevant amplified PCR product was present in every blood sample with infective endocarditis, and also in 4 out of 10 patients with urinary tract infection. Broad-range PCR in bacterial endocarditis is a fast, sensitive and inexpensive tool for the detection of bacteria, but it is far more prone to contamination than species specific-PCR. However, in controlled conditions it may be valuable in the identification of non-specific infection allowing for a more rapid clinical diagnosis of endocarditis.

Unlabelled: Infective endocarditis especially where blood culture is negative frequently causes problems in diagnosis despite of many nonspecific inflammation parameters. Procalcitonin (PCT) concentration is a new marker of severe bacterial and fungal infection. The aim of this study was to evaluate the usefulness of PCT concentration assessment in the diagnosis of uncomplicated infective endocarditis of bacterial etiology. The study group consisted of 30 patients with ongoing infective endocarditis in the course of acquired valvular heart disease. The diagnosis of bacterial endocarditis was established according to the Duke criteria on the basis of: clinical examination, laboratory investigations (inflammatory parameters, transthoracic and transesophageal echocardiography) and positive blood cultures. Patients with sepsis, concomitant infections and in an early postoperative period were excluded. Two control groups consisted of: 10 patients without endocarditis and other infections and another 10 patients without endocarditis and with an urinary tract infection. Serum procalcitonin concentrations were measured by an immunoluminometric assay (LUMItest PCT set). Mean serum PCT concentrations in patients with endocarditis (0.12 +/- 0.13, range 0-0.4 ng/ml) were significantly higher than in control group without infection (0.03 +/- 0.05, range 0-0.1 ng/ml) and higher than in control group with an urinary tract infection (0.02 +/- 0.04, range 0-0.1 ng/ml). However in 12 patients (of 30) were below sensitivity of the method and in the rest were within normal range (< 0.5 ng/ml)., Conclusion: Serum PCT concentration assessment seems to have no value in the diagnosis of uncomplicated infective endocarditis.