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Background: Infective endocarditis (IE) remains major cause of morbidity and mortality in adult congenital heart disease (ACHD). Limited data exists on ACHD with IE in Central and South-Eastern European (CESEE) countries. The aim of this study is to characterize contemporary management and assess outcomes of ACHD with IE in CESEE region. Methods: Data on ACHD patients with IE from 9 tertiary centres in 9 different CESEE countries between 2015 and 2020 was included. Baseline demographics, clinical presentation, indication for surgery, outcomes, hospital and all-cause-1-year mortality were studied. Results: A total of 295 ACHD patients (mean age 40 ± 14 years) with IE were included. Median time from symptoms onset to establishing diagnosis was 25 (11–59) days. The majority of patients (203, 68.8%) received previous empiric oral antibiotic therapy. The highest incidence of IE was observed on native and left sided valves, 194(65.8%) and 204(69.2%), respectively. More than half had a vegetation size ≥10 mm (164, 55.6%); overall 138 (46.8%) had valve complications and 119 (40.3%) had heart failure. In-hospital mortality was 26 (8.8%). Conclusion: There is clear delay in establishing IE diagnosis amongst ACHD patients in CESEE countries. Adequate diagnosis is hampered by common prescription of empiric antibiotics before establishing formal diagnosis. Hence, patients commonly present with associated complications requiring surgery. Hospital treatment and survival are, nevertheless, comparable to other Western European countries. Improved awareness and education of patients and medical profession regarding IE preventive measures, risks, signs, and symptoms are urgently needed. Empiric antibiotic prescription before blood cultures are taken must be omitted.

The prevalence of obesity is growing at alarming rate worldwide. Obesity has reached the proportion of a global epidemic in both developed and developing countries. Growing number of obese patients with atrial fibrillation requires a closer look at how excessive body fat leads to AF. Excessive adipose tissue is the source of many cardiovascular diseases, like hypertension, ischemic heart disease, and arrhythmias such as atrial fibrillation. The prevalence of atrial fibrillation in the general population is estimated at 1-2%. Obesity and overweight occur in 25% of patients with AF. Pathophysiology of obesity and the relationship between atrial fibrillation, diabetes, obstructive sleep apnea and metabolic syndrome are presented in this article as well as the benefit of bariatric surgery in qualifying patients. Paroxysmal AF and its risk factors should be carefully assessed in all patients referred for bariatric surgery. Proper diagnosis allows physicians to introduce appropriate anticoagulant prophylaxis, and significantly lower complication rate. Antiarrhythmic, respiratory, and metabolic therapy should also be considered in preoperative and postoperative care.

OBJECTIVE: Introduction: The work presents a research project carried out in John Paul II Hospital in Cracow in Clinical Department of Cardiac and Vascular Diseases with the Intensive Cardiac Supervision Subdivision, with participation of 100 (50 F, 50 M) patients with congenital heart defects. The purpose of the work is to resolve the issue of personality specifics, and thus the different characteristics of people who suffer from congenital heart defects. Therefore, the following questions should be answered: Is there a relationship between personality traits and the occurrence of a congenital heart defect? What personality traits are characteristic for patients with congenital heart defects? The aim: We aimed to assess personality traits of clients suffering from PFO and ASD. The article also talks about how coronavirus pandemic affects patients with congenital heart disease. PATIENTS AND METHODS: Materials and methods: The research was conducted by psychologist Adrianna Skoczek. We performed a psychological clinical assessment and conducted the psychological tests like Eysenck Personality Questionnaire-Revised Short Version [EPQ-R(S)] and Eysenck's Impulsivity Inventory [IVE] by Hans J. Eysenck and Sybil G. Eysenck, the State-Trait Anxiety Inventory [STAI] by C. D. Spielberger, R. L. Gorsuch, R. E. Lushene describing personality traits of patients. Patients (F=50, M=50), with ASD (n=70) and with PFO (n=30). RESULTS: Results: In people suffering from ASD, the level of declared empathy was statistically significantly higher than the levels of impulsiveness and tendency to risk-taking. In people suffering from PFO, a statistically significant difference was observed only between the level of psychoticism and other variables. The level of declared empathy was statistically significantly higher than the levels of impulsiveness and tendency to risk-taking, a statistically significant difference was found between the analyzed variables - anxiety as a trait and anxiety as a condition. CONCLUSION: Conclusions: The results of the study allowed us to isolate the specific personality traits of patients suffering from congenital heart defects.

Stroke due to paradoxical embolism can be a complication of certain peripheral venous procedures in patients with coexisting patent foramen ovale. There is an established link between venous sclerotherapy and stroke, however there are no known reports of this complication following peripheral arteriovenous embolization.We present a case of a 36-year- old woman who experienced symptoms of disorientation and apraxia following a hypoxic event during percutaneous alcohol embolization of a large arteriovenous malformation in her right gluteal region. An MRI scan revealed multiple foci of restricted diffusion in both cerebral hemispheres corresponding to acute ischemic stroke lesions. As the subsequent work-up revealed patent foramen ovale, we speculate on the pathomechanism of stroke and conclude with a recommendation to screen for patent foramen ovale in patients undergoing peripheral venous procedures including arteriovenous malformation embolization.

BACKGROUND There were gaps between guidelines and practice when surgery was the only treatment for aortic stenosis (AS). OBJECTIVES This study analyzed the decision to intervene in patients with severe AS in the EORP VHD (EURObservational Research Programme Valvular Heart Disease) II survey. METHODS Among 2,152 patients with severe AS, 1,271 patients with high-gradient AS who were symptomatic fulfilled a Class I recommendation for intervention according to the 2012 European Society of Cardiology guidelines; the primary end point was the decision for intervention. RESULTS A decision not to intervene was taken in 262 patients (20.6%). In multivariate analysis, the decision not to intervene was associated with older age (odds ratio [OR]: 1.34 per 10-year increase; 95% CI: 1.11 to 1.61; P = 0.002), New York Heart Association functional classes I and II versus III (OR: 1.63; 95% CI: 1.16 to 2.30; P = 0.005), higher age adjusted Charlson comorbidity index (OR: 1.09 per 1-point increase; 95% CI: 1.01 to 1.17; P = 0.03), and a lower transaortic mean gradient (OR: 0.81 per 10-mm Hg decrease; 95% CI: 0.71 to 0.92; P < 0.001). During the study period, 346 patients (40.2%, median age 84 years, median EuroSCORE II [European System for Cardiac Operative Risk Evaluation II] 3.1%) underwent transcatheter intervention and 515 (59.8%, median age 69 years, median EuroSCORE II 1.5%) underwent surgery. A decision not to intervene versus intervention was associated with lower 6-month survival (87.4%; 95% CI: 82.0 to 91.3 vs 94.6%; 95% CI: 92.8 to 95.9; P < 0.001). CONCLUSIONS A decision not to intervene was taken in 1 in 5 patients with severe symptomatic AS despite a Class I recommendation for intervention and the decision was particularly associated with older age and combined comorbidities. Transcatheter intervention was extensively used in octogenarians. (J Am Coll Cardiol 2021;78:2131-2143) (c) 2021 by the American College of Cardiology Foundation.

Survey to Fabry Research Letter

The presence of patent foramen ovale (PFO) was found to be associated with a number of medical conditions, including embolic stroke and recurrent transient neurological defects. The closure of PFO remains controversial; however, in recently published guidelines from the European Association of Percutaneous Cardiovascular Interventions in collaboration with 7 other European societies, which extensively refer to the latest randomized clinical trials, it is explicitly recommended to perform percutaneous PFO closure in the prevention of recurrent thromboembolic events. In connection with the above facts and expected increasing number of PFO closure procedures, the joint expert group of the Association of Cardiovascular Interventions and the Grown‑Up Congenital Heart Disease Section of the Polish Cardiac Society developed the following consensus opinion in order to standardize the principles of diagnosis, indications, methods of performing procedures, and postoperative care in relation to Polish conditions and experiences.

Objective Closure of the atrial septal defect in the elderly patients is controversial. The aim of the study was to evaluate the outcomes of transcatheter closure of secundum atrial septal defect (ASD) in elderly patients. Methods From a total of 650 pts with ASD who underwent transcatheter closure 120 pts over 60 years (70 F, 50 M) with a mean age of 66.7±18.1 (60–78) were analyzed. All patients had an isolated secundum ASD with a mean Qp:Qs: 2.79±1.8 (1.5–3.9). A symptom-limited treadmill exercise tests with respiratory gas exchange analysis and transthoracic color Doppler echocardiographic study as well as Quality of life (QoL) measured using the SF36 questionnaire (SF36q) were repeated in all pts before procedure and after 12 months of follow-up. Results The device was successfully implanted in all pts (procedure time 30.1±9.9 (10–59) minutes, fluoroscopy time 10.1±7.2 (6–40) minutes). There were no major complications. The defect echo diameter was 19.5±15.4 (12 - 34) mm. The mean balloon stretched diameter of ASD was 22.0±7.8 (14 - 36) mm. The diameter of the implanted devices ranged 16 - 38 mm. After 12 months of ASD closure, all the pts showed a significant improvement of exercise capacity parameters. Seven QoL parameters (except mental health) improved at 12 months follow up compared to their baseline data. The mean SF36q scale increased significantly in 96 (80.2%) pts of mean 41.6±26.1 (4–71). The right ventricular dimension decreased in 101 pts (84.2%) (Table 1). Conclusions Closure of ASD in elderly patients caused a significant clinical and hemodynamic improvement after percutaneous treatment, which is maintained to long-term follow-up what justified this procedure in old age. Funding Acknowledgement Type of funding source: None

To examine the current status of care and needs of adult congenital heart disease (ACHD) services in the Central and South Eastern European (CESEE) region.We obtained data regarding the national ACHD status for 19 CESEE countries from their ACHD representative based on an extensive survey for 2017 and/or 2018. Thirteen countries reported at least one tertiary ACHD centre with a median year of centre establishment in 2007 (interquartile range 2002-2013). ACHD centres reported a median of 2114 patients under active follow-up with an annual cardiac catheter and surgical intervention volume of 49 and 40, respectively. The majority (90%) of catheter or surgical interventions were funded by government reimbursement schemes. However, all 19 countries had financial caps on a hospital level, leading to patient waiting lists and restrictions in the number of procedures that can be performed. The median number of ACHD specialists per country was 3. The majority of centres (75%) did not have ACHD specialist nurses. The six countries with no dedicated ACHD centres had lower Gross Domestic Product per capita compared to the remainder (P = 0.005).The majority of countries in CESEE now have established ACHD services with adequate infrastructure and a patient workload comparable to the rest of Europe, but important gaps still exist. ACHD care is challenged or compromised by limited financial resources, insufficient staffing levels, and reimbursement caps on essential procedures compared to Western Europe. Active advocacy and increased resources are required to address the inequalities of care across the continent.

Atrial septal defect is the most common congenital heart lesion in adults. Although atrial septal defect closure is recommended in those with right heart enlargement or paradoxical embolism, data informing such indications in adults are quite limited. This population has many unique characteristics and needs. In recent years, significant progress has been made with regard to diagnostic modalities that facilitate the diagnostic workup of these patients. However, the decision‑making process, especially in selected adult patients population (advanced age, various concomitant diseases, poor LV function [both systolic and diastolic], pulmonary hypertension, concomitant arrhythmias or multiple defects, or deficient rims) is still not easy. Available data are predominantly focused on imaging endpoints and short‑term morbidity and mortality rather than long‑‑term. The evidence base for outcomes with or without defect closure comes from various studies with different observation periods. Moreover, the clinical experience in diagnosing and treating that subgroup of patients is inhomogeneous between individual physicians (cardiologists, imaging specialists, operators) and between small and large experience centers. In the view of the above, the joint group of experts from the Association of Cardiovascular Interventions and the Grown‑Up Congenital Heart Disease Section of the Polish Cardiac Society developed the following consensus opinion in order to standardize the principles of diagnosis, indications for treatment, methods of performing procedures, and tenets of postoperative care in Poland.

Objective Introduction: Numerous risk factors for cardiovascular disease (CVD) are modifiable, therefore understanding their effects has a significant impact on lowering the incidence and mortality. The "Malopolska Cardiovascular Preventive Intervention Study (M-CARPI)" aims to educate the inhabitants of the voivodeship regarding preventative measures for developing CVD. The aim: To examine the effectiveness of the seminars regarding preventative measures for developing CVD according to the M-CAPRI among the inhabitants of Lesser Poland. Patients and methods Material and methods: The seminars were carried out by a doctor with a specialization in cardiology, in the form of presentations, based on materials prepared by experts in accordance with European and Polish guidelines. Both initially and after the course, participants completed questionnaires regarding the subjects discussed. Results Results: The study covered 558 people (137 men, 411 women). The analysis was based on the sub-populations of retirees and non-retirees. The knowledge of risk factors was checked, the respondents most often indicated incorrect judgment of nutrition, physical activity and smoking (45.9%, 39%, 44.2% for non-retirees and 22.8%, 27.6%, 16.5% for retirees, respectively). A significant increase in the number of people who indicated individual risk factors after the training was found (p=0,047 for HDL level and for others). Conclusion Conclusions: Educating and creating awareness towards the prevention of CVD according to the M-CAPRI survey protocol is an effective tool for prevention. Due to the limited knowledge of cardiovascular risk factors, it is necessary to carry out activities to raise awareness of the importance of cardiological disease prevention. Preventive interventions are equally effective regardless of age or profession.

Background The work presents a research project carried out in hospital with participation of 100 (50 female, 50 male) patients with congenital heart defects [atrial septal defect (ASD) and patent foramen ovale (PFO)]. The aim of the study was to identify specific personality traits of patients with congenital heart defects and to check the psychological functioning of patients by examining: the level of anxiety, impulsiveness, tendency to risk-taking, empathy, neuroticism, extraversion, psychoticism and lying. The presented results and their statistical analyses showed specific personality traits of patients with congenital heart defects. Methods The research was conducted by psychologist Adrianna Skoczek. We performed a psychological clinical assessment and conducted the psychological tests like Eysenck Personality Questionnaire-Revised Short Version [EPQ-R(S)] and Eysenck's Impulsivity Inventory (IVE) by Hans J. Eysenck and Sybil G. Eystenck, the State-Trait Anxiety Inventory (STAI) by C. D. Spielberger, R. L. Gorsuch, R. E. Lushene describing personality traits of patients. Results The level of extraversion was statistically significantly higher than the level of all other variables. The level of lies was significantly different from the level of psychoticism, which in turn was statistically significantly lower than all other. In the case of the examined women, statistically significant differences were found only between the level of psychoticism and all other analyzed variables. Conclusions The conducted research shows that patients suffering from ASD or PFO have specific personality traits what allow to better understanding of suffering patients.

The ongoing pandemic of coronavirus disease 2019 (COVID‑19), caused by severe acute respiratory syndrome coronavirus 2 (SARS‑CoV‑2), represents a major challenge for healthcare. The involvement of cardiovascular system in COVID‑19 has been proven and increased healthcare system resources are redirected towards handling infected patients, which induces major changes in access to services and prioritization in the management of patients with chronic cardiovascular disease unrelated to COVID‑19. In this expert opinion, conceived by the task force involving the Working Groups on Valvular Heart Diseases and Cardiac Surgery as well as the Association of Cardiovascular Intervention of the Polish Cardiac Society, modification of diagnostic pathways, principles of healthcare personnel protection, and treatment guidelines regarding triage and prioritization are suggested. Heart Teams responsible for the treatment of valvular heart disease should continue their work using telemedicine and digital technology. Diagnostic tests must be simplified or deferred to minimize the number of potentially dangerous aerosol‑generating procedures, such as transesophageal echocardiography or exercise imaging. The treatment of aortic stenosis and mitral regurgitation has to be offered particularly due to urgent indications and in patients with advanced disease and poor prognosis. Expert risk stratification is essential for triage and setting the priority lists. In each case, an appropriate level of personal protection must be ensured for the healthcare personnel to prevent spreading infection and preserve specialized manpower, who will supply the continuing need for handling serious chronic cardiovascular disease. Importantly, as soon as the local epidemic situation improves, efforts must be made to restore standard opportunities for elective treatment of valvular heart disease and occluder‑based therapies according to existing guidelines, thus rebuilding the state ‑of ‑the ‑art cardiovascular services.

Objective Introduction: Personality traits of patients suffering from congenital heart defects The work presents a research project carried out in John Paul II Hospital, The Clinical Department of Cardiac and Vascular Diseases with the Intensive Cardiac Surgeon Division Institute of Cardiology, Collegium Medicum of the Jagiellonian University in Cracow, with participation of patients with congenital heart defects. We aimed to assess personality traits of clients suffering from congenital heart defects, in a group of women and men, younger, under 40 years old and older than 40 years old, with PFO and ASD before and after surgery. The aim: identify specific personality traits of patients with congenital heart defects and to check the psychological functioning of patients by examining: the level of anxiety, impulsiveness, tendency to risk-taking, empathy, neuroticism, extraversion, psychoticism and lying. Patients and methods Material and methods: We performed a psychological clinical assessment and conducted the psychological tests like EPQ-R(S) by Hans J. Eysenck and Sybil G. Eysenck, IVE by Hans J. Eysenck and Sybil G. Eystenck, STAI by C. D. Spielberger, R. L. Gorsuch, R. E. Lushene describing personality traits of patients. Results Results: Patients (F=29, M=21), adult, with ASD and with PFO, with the level of education: basic, vocational, secondary, incomplete higher, higher; inhabiting: village, city up to 40 thousand residents, a city with a population of 41-61 thousand, and a city with a population of 60 thousand; civil status: single, married, divorced, widow/widower, separated; being: students, unemployed persons, working persons, pensioners, retirees. Conclusion Conclusions: The presented results and their statistical analyses showed specific personality traits of patients with congenital heart defects.

The size of the right atrium (RA) reduces after transcatheter closure of the atrial septal defect (ASD). Inverse structural and electrical remodeling is observed.The aim of study was to analyze the parameters predisposing to the lack of normalization of enlarged RA after transcatheter closure of ASD during 6-month follow-up.A prospective study included 56 consecutive adult patients (12 men) aged from 23 to 76 years (49.8±13.3 years) with ASD, in whom transcatheter ASD closure was performed. Each patient was assessed before and 6 months after the treatment using standard 12-lead resting electrocardiogram (ECG), 24-hour Holter monitoring and echocardiography.Before the procedure in 37 patients with ASD enlarged RA was observed, while after transcatheter ASD closure in 24 patients normalization of enlarged RA was noted. Patients in whom 6 months after the procedure there was no normalization of the enlarged RA were older, characterized by higher right ventricular systolic pressure (RVSP), pulmonary to systemic blood flow ratio (Qp/Qs), larger size of the occluder, interatrial septal defect, longer fluoroscopy time and lower left ventricular ejection fraction. P-wave dispersion (Pdysp) was found to be a destimulant i.e. increased Pdysp (67 ms, P0.000) decreased the chance of RA normalization after procedure. On the other hand, minimum P-wave duration (Pmin) was a stimulant, therefore, increased Pmin (72ms, P0.000) increased the chance of RA normalization. A significant association was found between the reduction of supraventricular extrasystolic beats and RA area normalization (P0.001), and there was no association between the incidence of atrial fibrillation episodes and RA area normalization.Evaluation of the duration of the P-wave and its dispersion may help to assess the prognosis of the right atrium size normalization in the mid-term follow-up after transcatheter closure of ASD. There is a significant relationship between normalization of the right atrium size and reduction of supraventricular extrasystolic beats.

BACKGROUND Atrial septal defect (ASD) and patent foramen ovale (PFO) are specific types of atrial septal communications (ASC). OBJECTIVES We aimed to assess quality of life (QoL) in patients before and after percutaneous closure of ASC and determine the factors influencing QoL in this group of patients. MATERIAL AND METHODS We performed a clinical assessment and conducted an SF-36 questionnaire, electrocardiography and echocardiography studies in patients before and 6 months after percutaneous ASC closure. RESULTS Patients with ASD (n = 56) had a lower SF-36 total score than those with PFO (n = 73), before and after percutaneous ASC occlusion (both p < 0.001). After the procedure, the improvement of SF-36 total score in patients with ASD or atrial fibrillation was greater (p < 0.001 and p = 0.005, respectively). We observed correlations between improvement of QoL and baseline supraventricular extrasystolic beats (rs = 0.28; p = 0.002), but not ventricular extrasystolic beats (rs = 0.03; p = 0.76). Quality of life improvement was predicted in patients with ASD by higher baseline tricuspid annular plane systolic excursion (TAPSE) and right ventricular longitudinal dimension R2 = 0.38; p < 0.001. However, in patients with PFO, this was predicted by TAPSE, lack of arterial hypertension and usage of angiotensin-converting enzyme inhibitors, R2 = 0.30; p < 0.001. CONCLUSIONS Patients with ASD have lower QoL than those with PFO before and after percutaneous ASC occlusion. Six months after the procedure, the improvement of QoL in patients with ASD was higher than in those with PFO. The change in QoL self-assessed by patients after the procedure was associated with episodes of arrhythmia and was predicted with echocardiographic and clinical parameters.

We present a case report of a 79-year-old woman with permanent atrial fibrillation and Osler-Weber-Rendu disease who underwent percutaneous closure of left atrial appendage. The patient had a history of small bowel resection due to mesenteric embolism and recurrent episodes of gastrointestinal bleeding, epistaxis and hemarthrosis. Bleeding episodes were exacerbated by anticoagulation therapy causing severe anemia that required repeated red blood cells transfusions. Left atrial appendage occlusion with Watchman 30 mm LAA Device was successfully performed. In long-term observation no thromboembolic event, epistaxis or severe bleeding have occurred.

INTRODUCTION Rare cardiovascular diseases and disorders (RCDDs) constitute an important clinical problem, and their proper classification is crucial for expanding knowledge in the field of RCDDs. OBJECTIVES The aim of this paper is to provide an updated classification of rare arrhythmogenic and conduction disorders, and rare arrhythmias (RACDRAs). METHODS We performed a search for RACDRAs using the Orphanet inventory of rare diseases, which includes diseases with a prevalence of no more than 5 per 10 000 in the general population. We supplemented this with a search of PubMed and Scopus databases according to a wider definition proposed by the European Parliament and the Council of the European Union. RESULTS RACDRAs are categorized into 2 groups, primary electrical disorders of the heart and arrhythmias in specific clinical settings. The first group is further divided into subgroups of major clinical presentation: disorders predisposing to supraventricular tachyarrhythmias, ventricular tachyarrhythmias, bradyarrhythmias, and others. The second group includes iatrogenic arrhythmias or heart rhythm disturbances related to medical treatment, arrhythmias associated with metabolic disorders, and others. We provide a classification of RACDRAs and supplement them with respective RCDDs codes. CONCLUSION The clinical classification of RACDRAs may form a basis to facilitate research and progress in clinical practice, both in diagnostic and therapeutic approaches.

This study was conducted in Nowy Wiśnicz, with prisoners sentenced for: murders, sex crimes, theft and robbery, maintenance, bullying. A Polish adaptation of PAI test, made by the author of the study, was used. The study results and its statistical analysis showed characteristic personality features of particular criminal groups can be used in rehabilitation of disturbed people, addicts, and become the basis for preparing actions reducing frequency of committing crimes.

Background: Atrial septal communications (ASCs) include atrial septal defects (ASDs) and patent foramen ovale (PFO). Aim: The purpose of this study was to assess P-wave dispersion (PWD) and the prevalence of arrhythmia in patients before and after ASC closure. Methods: We analysed the clinical history and performed 12-lead electrocardiograms, echocardiograms, and 24-h Holter electrocardiograms in patients with ASC, before and six months after ASC closure. Results: We included patients with ASD (n = 56) and PFO (n = 73). PWD before percutaneous ASC closure was predicted by right ventricular outflow tract (RVOT) proximal diameter, left atrial area, ASD, smoking, and paroxysmal dyspnoea, R2 = 0.67; p < 0.001. RVOT proximal diameter was an independent predictor of PWD, both in patients with ASD and PFO. Six months after successful closure of ASC, a reduction in PWD was observed in the whole group of patients as well as in patients with ASD and PFO considered separately. A decrease in PWD was associated with reduction of maximum P-wave duration. At the same time, in the whole group, we noticed a reduction in the number of supraventricular and ventricular extrasystolic beats and fewer atrial fibrillation (AF) episodes, p < 0.04 for all variables. Postprocedural AF episodes in patients with ASD were predicted by PWD of 80 ms. Conclusions: Percutaneous closure of ASC is associated with a reduction of PWD and fewer arrhythmia episodes six months after the procedure. PWD predicts AF episodes after ASD closure.

The aim of this study is to assess the relationship between autoimmunity and endothelial activation/damage (ICAM-1 and vWF serum levels) and the degree of prothrombotic activity (thrombin-antithrombin complexes-TAT serum levels) in SLE. In 60 clinically stable SLE patients, levels of the following parameters were estimated in their serum: lupus anticoagulant (LA), anticardiolipin antibodies in both IgG and IgM classes (aCL-IgG and aCL-IgM, respectively), antiβ2GPI antibodies in both IgG and IgM classes (antiβ2GPI-IgG and antiβ2GPI-IgM, respectively), ICAM, von Willebrand factor (vWF), TAT, CRP, C3c, C4, and IL-6. ICAM-1 values exceeded the upper reference limit in 9 (15%) patients. vWF levels were increased in 21 (35%) patients. In all patients with elevated ICAM-1 values, vWF were also increased. TAT concentrations were elevated in 12 (20%) people. ICAM-1 were significantly higher in patients with elevated aCL-IgM ( 30 MPL vs ≤ 30 MPL; p 0.05). Similarly, ICAM-1 were significantly higher in patients with elevated antiβ2-GPI-IgM ( 20 SMU vs ≤ 20 SMU; p 0.05). There was no significant difference in ICAM-1 levels in relation to LA-positivity. vWF were not significantly different in relation to antiphospholipid antibodies nor the inflammation marker levels. TAT were significantly higher in patients with elevated aCL-IgM ( 30 MPL vs ≤ 30 MPL; p 0.05). In one third of young patients with stable SLE, signs of endothelial activation/damage were found, as shown by elevated plasma ICAM-1 or vWF. Increased prothrombotic tendency manifested by elevated TAT was found in one fifth of the patients. Elevated anticardiolipin (IgM) and anti-β2-glycoprotein I (IgM) antibodies influence endothelial dysfunction and enhance prothrombotic state.

Background Neurogenic mechanism is believed to contribute to left ventricular (LV) systolic dysfunction in acute coronary syndromes (ACS); its extreme form is known as takotsubo cardiomyopathy. However, the magnitude of neurogenic contribution to LV dysfunction in all-comer first-time ACS remains unknown. Material/Methods In 120 consecutive patients with first-time ACS (age 66.3±12.3years, 40 women) coronary angiograms were individually matched to the echocardiographic left ventricular (LV) segments (17-segment model). Baseline contractility impairment was classified as ischemic (I): confined to the stenotic artery(ies) supply area(s), neurogenic (N): in absence of attributable coronary stenosis, or partially ischemic/partially neurogenic (I&N). Echocardiography was repeated at 6 months to determine LV systolic function recovery. Results Neurogenic component (NC) contribution to myocardial contractility impairment was present in 24.2% of ACS patients, with pure N in 6.7% and I&N in 17.5%. Diabetes/pre-diabetes was present in 38.5% vs. 33.5% vs. 0% (I vs. I&N vs. N; p=0.02). Major stressor preceding symptom onset was reported in 3.3% in I, 9.5% in I&N, and 25.0% in N (p=0.03). The number of LV segments with contractility impairment was 2±4 in I, 17±11 in I&N, and 3±16 in N (p

BACKGROUND The Fontan procedure, performed for univentricular heart, may also include the technique of percutaneous fenestration to create a small atrial septal defect (ASD) and a right-to-left shunt. The aim of this study was to evaluate the long-term effects of fenestration in adult patients who had a Fontan procedure for univentricular heart. MATERIAL AND METHODS Fontan surgery was performed in 39 patients, including 19 (49%) patients with fenestration (Group I), and 20 (51%) patients without the fenestration procedure (Group II). Laboratory tests in both groups included echocardiography, plethysmography, cardiopulmonary exercise testing, and 24-hour Holter monitoring. RESULTS Compared with patients in Group I, patients in Group II had a significantly increased level of N-terminal pro-brain natriuretic peptide (NT-proBNP) (p=0.04), alkaline phosphatase (ALP) (p=0.01) and a significant increase in frequency of atrial fibrillation (p=0.04). Patients in Group I had a significantly increased systemic ventricular ejection fraction (SVEF) (p=0.05) and increased heart rate (HR) (p=0.006), heart rate reserve (HRR) (p=0.02), ventilatory equivalent (VE) (p=0.01), and VO2 peak (p=0.05) on cardiopulmonary exercise testing (CPET). Renal, hematologic, and ventilatory parameters, and incidence of thromboembolism showed no significant differences between the groups. CONCLUSIONS Long-term follow-up of patients who underwent Fontan procedures with percutaneous fenestration had improved single ventricular function, lower NT-proBNP levels, improved exercise capacity, and reduced ALP levels. These findings indicate that percutaneous fenestration closure should be considered for adult patients who have undergone Fontan procedure for univentricular heart.

Sports‑associated sudden cardiac arrest (SCA) constitutes an important problem. Causes of SCA during sport activities include Brugada syndrome (BrS) among others. We describe a 29‑year‑old male, without a history of cardiovascular disease, who suffered from SCA during football training and despite intensive treatment, after almost 4 weeks of hospitalization, unfortunately died. Detailed medical documentation review showed grade I atrioventricular block, intraventricular conduction abnormalities and BrS type 2 morphology of ST-segment elevation on resting 12‑lead electrocardiogram (ECG). The patient had a history of syncope during physical activity. Further echocardiographic study did not reveal significant structural heart disease. Submaximal exercise testing was performed and showed ventricular extrasystoles during physical activity and type 1 BrS morphology of ST-segment elevation during recovery phase. We compared observed ECG changes to those present in a healthy football player and described noticeable similarities. Exercise ECG testing, especially in patients after syncope of probable arrhythmic etiology, may unmask BrS ECG pattern and lead to BrS diagnosis. JRCD 2017; 3 (3): 92–97.

Aortic stenosis is the most common form of congenital left ventricle outflow tract obstruction. It may be a life threatening ductal-dependent condition in newborns and necessitating urgent percutaneous balloon aortic valvuloplasty (BAV). Although early results of valvuloplasty are usually satisfactory, long-term follow-up show frequent incidence of gradually progressing aortic insufficiency that requires valve replacement surgery. The case report presented below concerns a young patient with a history of BAV in childhood who developed severe aortic regurgitation accompanied by combined post- and pre-capillary pulmonary hypertension.

Objective: Closure of the atrial septal defect in the elderly patients is controversial. The aim of the study was to evaluate the outcomes of transcatheter closure of secundum atrial septal defect (ASD) in elderly patients. Methods: From a total of 488 patients with ASD who underwent transcatheter closure 15 pts over 70 years (10 females, 5 males) with a mean age of 75.3 ±12.7 (70–79) were analyzed. All patients had an isolated secundum ASD with a mean Qp:Qs: 3.01 ±1.9 (2.6–3.9). A symptom-limited treadmill exercise tests with respiratory gas exchange analysis and transthoracic color Doppler echocardiographic study as well as Quality of life (QoL) measured using the SF36 questionnaire (SF36q) were repeated in all patients before procedure and after 12 months of follow-up. Results: The atrial septal occluder (ASO) device was successfully implanted in all patients (procedure time 29.7±6.5 (14–59) minutes, fluoroscopy time 13.2 ±9.3(6–40) minutes). There were no major complications. The defect echo diameter was 21.7± 15.8 (18–33) mm. The diameter of the implanted devices ranged 20 – 36 mm. After 12 months of ASD closure, all the patients showed a significant improvement of exercise capacity parameters. Seven QoL parameters (except mental health) improved at 12 months follow up compared to their baseline data. The right ventricular dimension decreased (p

Background: The study aimed to assess the level of plasma Endothelin-1 (ET-1) in patients before and after transcatheter closure of atrial septal defect (ASD) and to evaluate the usefulness of measuring ET-1 levels for the diagnosis and selection of candidates for ASD closure. Methods: 21 patients (11 F, 10 M), mean age 40.2 ± 11.9 years with pulmonary artery hypertension were enrolled for an attempt at ASD closure. A group of 19 healthy volunteers, (12 F, 7 M) mean age 39.2 ± 9.15 served as controls. All ASD patients underwent: clinical and echocardiographic study and cardiopulmonary exercise test. ET-1 levels were measured before and after closure. Whole blood was collected from femoral artery and vein and from pulmonary artery during cardiac catheterization. Results: ET-1 levels at peripheral artery and vein in ASD patients were significantly higher than in the volunteers (p

Patent foramen ovale (PFO) is a residue of the foramen ovale, an integral part of the normal fetal circulation. It closes in most of newborns, however 25–30% of adults may have it patent. Conditions such as crytpogenic stroke, migraine and vascular headaches or decompression sickness are strongly related to the presence of PFO. Less frequently acute myocardial infarction, renal infarction or acute mesenteric ischemia may also occur. We present a case of a 67-year-old man after cerebral ischemic episode, acute myocardial infarction treated with primary coronary intervention and pulmonary embolism, who was eventually diagnosed with PFO and factor V Leiden mutation. Life-long anticoagulation was initiated in this patient as a standard-of-care. He additionally underwent successful percutaneous PFO closure. As a result no subsequent thromboembolic complication occurred in this patient at the follow-up period. JRCD 2015; 2 (2): 18–21

Background Thrombotic complications are common in adult patients who have had a Fontan operation early in life for treatment of congenital heart disease. Objective To characterize platelet function and responsiveness to aspirin in relation to thrombogenesis, systemic inflammation, and markers of endothelial function in adults with Fontan circulation (FC). Methods Thirty-four FC patients (age 18–40years; 62% taking aspirin chronically and 38% not taking aspirin) and 32 age- and sex-matched healthy controls were studied. Platelet function was evaluated by measurement of basal concentrations of thromboxane B2 (TXB2) and sCD40L and ex-vivo generation of TXB2 and sCD40L. Plasma concentrations of thrombin–antithrombin, endothelin-1, vWF, IL-6, IL-8, MCP-1, MIP-1β, TNFα, sVCAM-1, and syndecan-1 also were measured. Results Platelet numbers were significantly lower in FC patients than in controls, but the patients had significantly higher platelet activity, as evidenced by higher TXB2 and sCD40L concentrations and higher ex vivo generation of TXB2. Chronic aspirin treatment had no effect on plasma concentrations of TXB2 and sCD40L in FC, but in 52% of aspirin-treated FC subjects, TXB2 concentrations remained elevated at 60min of TXB2 generation, indicating aspirin resistance. In addition, FC patients had increased levels of thrombin–antithrombin, endothelin-1, vWF, IL-8, MCP-1, MIP-1β, TNFα, sVCAM-1, and syndecan-1 but not of IL-6. Conclusion Adults with FC had lower platelet numbers but increased platelet activity, increased thrombogenesis, systemic inflammation, and endothelial dysfunction. A significant proportion of aspirin-treated FC adults had aspirin resistance, which may be at least in part responsible for their increased incidence of thrombotic complications.

Background The study aimed to assess the level of plasma Endothelin-1 (ET-1) in patients before and after transcatheter closure of atrial septal defect (ASD) and to evaluate the usefulness of measuring ET-1 levels for the diagnosis and selection of candidates for ASD closure. Methods 80 patients (55 F, 25 M), mean age 42,2 ± 11,5 years were enrolled for an attempt at ASD closure. A group of 19 healthy volunteers, (12 F, 7 M) mean age 39.2 ± 9.15 served as controls. All ASD patients underwent: clinical and echocardiographic study and cardiopulmonary exercise test. ET-1 levels were measured before and after closure. Whole blood was collected from femoral artery and vein and from pulmonary artery during cardiac catheterization. Results ET-1 levels at peripheral artery and vein in ASD patients were significantly higher than in the volunteers (p