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Four out of 661 consecutive patients with permanent endocardial VVI pacing had the pacing lead introduced through a persistent left superior vena cava. It was difficult to introduce the lead from the right atrium into the right ventricle because the tip of the lead tended to be deflected away from the tricuspid orifice. This difficulty was overcome by shaping the lead into a pigtail with 3-4 cm wide loop. This avoided the risk of entering a branch of the coronary sinus in order to reach the right atrium. This technique made it easier to position the lead in the right ventricular apex. There were no complications in these four patients during a mean follow up of three years. [ABSTRACT FROM PUBLISHER]

Background: Aortic valve-sparing aortic root replacement (VSARR) David procedure has not been routinely performed via minimally invasive access due to its complexity. Methods: We compared our results for mini-VSARR to sternotomy-VSARR from another excellence center. Results: Eighty-four patients, 62 in the sternotomy-VSARR group and 22 in the mini-VSARR group, were included. A baseline, the aneurysm dimensions were higher in the mini-VSARR group. Propensity matching resulted in 17 pairs with comparable characteristics. Aortic cross-clamp and cardiopulmonary bypass times were significantly longer in the mini-VSARR group, by 60 and 20 min, respectively ( p < 0.001). In-hospital outcomes were comparable between the groups. Drainage volumes were numerically lower, and hospital length of stay was, on average, 3 days shorter ( p < 0.001) in the mini-VSARR group. At a median follow-up of 5.5 years, there was no difference in mortality ( p = 0.230). Survival at 1, 5 and 10 years was 100%, 100%, and 95% and 95%, 87% and 84% in the mini-VSARR and sternotomy-VSARR groups, respectively. No repeat interventions on the aortic valve were documented. Echocardiographic follow-up was complete in 91% with excellent durability of repair regardless of the approach: no cases of moderate/severe aortic regurgitation were reported in the mini-VSARR group. Conclusions: The favorable outcomes, reduced drainage, and shorter hospital stays associated with the mini-sternotomy approach underscore its potential advantages expanding beyond cosmetic outcome.

The main goal of minimally invasive surgery is to reduce the perioperative trauma, accelerate patient mobilization and reduce the length of hospital stay. Due to the development of modern technology, these treatments can be offered to a wider group of patients. For many years, aortic root surgery consisted of mechanical conduit implantation and, therefore, necessitated life-long anticoagulation. At present, in patients with aortic root aneurysm and significant aortic valve regurgitation, it is possible to perform minimal-access valve sparing surgical procedures. The current paper is a brief description of the surgical technique for aortic root aneurysm surgery with preservation of the patient's own valve using the David procedure., Competing Interests: The authors report no conflict of interest., (Copyright: © 2022 Polish Society of Cardiothoracic Surgeons (Polskie Towarzystwo KardioTorakochirurgów) and the editors of the Polish Journal of Cardio-Thoracic Surgery (Kardiochirurgia i Torakochirurgia Polska).)

In SARS-CoV-2 patients with severe acute respiratory distress syndrome (ARDS), Veno-Venous Extracorporeal Membrane Oxygenation (V-V ECMO) was shown to provide valuable treatment with reasonable survival in large multi-centre investigations. However, in some patients, conversion to modified ECMO support forms may be needed. In this single-centre retrospective registry, all consecutive patients receiving V-V ECMO between 1 March 2020 to 1 May 2021 were included and analysed. The patient cohort was divided into two groups: those who remained on V-V ECMO and those who required conversion to other modalities. Seventy-eight patients were included, with fourteen cases (18%) requiring conversions to veno-arterial (V-A) or hybrid ECMO. The reasons for the ECMO mode configuration change were inadequate drainage (35.7%), inadequate perfusion (14.3%), myocardial infarction (7.1%), hypovolemic shock (14.3%), cardiogenic shock (14.3%) and septic shock (7.1%). In multivariable analysis, the use of dobutamine ( p = 0.007) and a shorter ICU duration ( p = 0.047) predicted the conversion. The 30-day mortality was higher in converted patients (log-rank p = 0.029). Overall, only 19 patients (24.4%) survived to discharge or lung transplantation. Adverse events were more common after conversion and included renal, cardiovascular and ECMO-circuit complications. Conversion itself was not associated with mortality in the multivariable analysis. In conclusion, as many as 18% of patients undergoing V-V ECMO for COVID-19 ARDS may require conversion to advanced ECMO support.

Background: Minimally invasive aortic valve (AV) surgery has become widely accepted alternative to standard sternotomy. Despite possible reduction in morbidity, this approach is not routinely performed for aortic surgery. Current report aimed to demonstrate early and mid-term outcomes in patients undergoing minimally invasive aortic root- and ascending aorta-replacement with or without concomitant AV replacement (AVR)., Methods: Between 2011 and 2018, 167 selected low- and intermediate risk patients (mean age: 64.1±11.3; 70% men; EuroSCORE II 2.58±3.26) underwent minimally invasive aortic surgery. The "V" shaped partial upper sternotomy was performed through a 6-cm skin incision. Patients were divided into minimally invasive root reimplantation/replacement/remodelling (root RRR), supracoronary aorta replacements (SCAR) and SCAR+AVR. Kaplan-Meier estimates of survival were used., Results: Mean follow-up was 3.1 year (max 7.7 years). Of 167 patients, 82 (49%) underwent SCAR; 44 (26%) SCAR + AVR. Forty-one patients (25%) underwent minimally invasive root RRR. Average aortic diameter was 6.00±0.46 cm. The cardiopulmonary bypass and aortic cross-clamp time were 152.0±46.8 and 101.8±36.8 minutes. There was one conversion to sternotomy. Median intensive care unit stay was 2.0 (IQR: 1.0-3.0) days. Thirty-day mortality was 1%. Within investigated follow-up, there was one late reoperation due to aortic valve thrombosis; late survival was estimated at 95% without differences between types of surgery: hazard ratio, 0.81; 95% CI: 0.36-1.81; P=0.61., Conclusions: Minimally invasive aortic surgery performed through "V" shaped partial upper sternotomy is feasible and safe in selected patients regardless of the extent of repair, from supracoronary aorta replacements to complex root surgery., Competing Interests: Conflicts of Interest: All authors have completed the ICMJE uniform disclosure form (available at http://dx.doi.org/10.21037/jtd-20-2165). Dr. Kowalewski serves as an unpaid editorial board member of Journal of Thoracic Disease from Sep 2020 to Aug 2022. The other authors have no conflicts of interest to declare., (2020 Journal of Thoracic Disease. All rights reserved.)

Background: This study was conducted to determine the effect of left atrial structural remodeling on heart rhythm after radiofrequency ablation concomitant to mitral valve operation., Methods: Sixty-six consecutive patients with of atrial fibrillation (AF) and mitral valve disease underwent radiofrequency ablation and mitral valve operation. Heart rhythm was evaluated before and at 3, 6, and 12 months postoperatively. Biopsy specimens of the posterior wall of the left atrium were evaluated for the extent of fibrosis, myocyte diameter, intensity of inflammatory infiltrates, degree of myocytolysis, and capillary density., Results: Ten patients died and 1 patient was lost to follow-up. Heart rhythm at 12 months was used to divide the remaining 55 patients into two groups: group I, 34 with sinus rhythm; group II, 21 with AF. Paroxysmal AF preoperatively was more frequent among group I patients, and persistent/long-standing persistent AF in group II (p=0.0006). Groups I and II differed significantly in myocyte diameter (17.9±3.5 vs 20.3±4.6 μm, p=0.04), fibrosis percentage (38.7%±11.2% vs 47.6%±12.3%, p=0.009), inflammatory infiltrates (p=0.02), and preoperative left atrial diameter (5.03±0.7 vs 5.5±0.8 cm, p=0.04). No differences were found in capillary density (797.9±500.6 vs 946.0±373.7/mm2, p=0.3) and myocytolysis (p=0.4). Multivariate analysis showed myocyte diameter (p=0.047) and fibrosis (p=0.014) were independent predictors for an AF persistence at 12 months., Conclusions: Left atrial structural remodeling strongly affects heart rhythm after concomitant radiofrequency ablation and mitral valve operation., (Copyright © 2012 The Society of Thoracic Surgeons. Published by Elsevier Inc. All rights reserved.)

Two cases of large, free-floating right heart thrombi in patients with massive pulmonary embolism and a history of deep vein thrombosis are presented. In a 30-year-old male with prominent obesity and a history of hypertension, disappearance of the thrombus at the end of alteplase infusion coexisted with onset of haemodynamic stabilization. In a 70-year-old female, the thrombus, which persisted despite streptokinase administration, translocated suddenly (during echocardiography) to the pulmonary artery, which resulted in a deterioration in her status. After alteplase administration following heparin infusion, steady clinical and echocardiographic improvement was observed.

A case of a 49-year-old female with acute coronary syndrome is presented. The patient underwent coronary angioplasty with stent implantation. Due to the recurrence of pain and dyspnea a repeated coronary angiography was performed 3 hours later which confirmed good result of angioplasty. For the next 48 hours a local compression on both femoral arteries was maintained and the patient received full anticoagulant and antiplatelet treatment. However, clinical condition of the patient continued to deteriorate. Echocardiography and spiral computerised tomography revealed the presence of a massive pulmonary embolism. The patient underwent surgery and fully recovered.

The aim of this study was to define the value of ear-lobe crease as the marker of potential risk of coronary artery disease on the basis of world's reports and own research. The test group consisted of 92 patients who were classified to coronary-artery bypass graft using coronarography. Patients were divided into 3 groups (A-without ELC, B-ELC on one ear, C-ELC bilateral). Detailed statistical analysis of coronarography results and incidence of coronary disease risk factors in each group was done. Obtained data allowed to evaluate the correlation between existence of the crease and extent of atherosclerotic changes in coronary vessels.

Fistulas connecting coronary arteries with trunk of pulmonary artery are the most common congenital defects of coronary arteries. Depending on the size of fistula they cause IHD symptoms of different intensification (Coronary Steal Phenomenon). The symptoms appear very often in advanced age. In this study two patients with coronary-pulmonary artery fistula accompanied by another heart defects (VSD or stenosis of aortic valve), but with no IHD-symptoms, are presented. To find possible coronary arteries malformations, it seems to be useful to perform the catheterization of coronary arteries in all patients, who are qualified for surgical procedure because of heart's disease. It also concerns younger patients with VSD (under 35) in whom coronarography is not a routine procedure.

Phrenic nerve injury and diaphragmatic dysfunction can be induced by cardiac operation. We evaluated nonconsecutive 34 patients (pts) with elevation of the diaphragma after cardiac operation. 27 pts have coronary artery bypass grafting, 7 pts have prosthetic valve implantation. We have impression that ice/saline slush used along with cold cardioplegia for heart arrest can cause hypothermic damage of phrenic nerve. Palsy of that nerve results in raised hemidiaphragm and delayed recovery of the pts. In our pts normalisation of the diaphragm we observed 6 months after operation in 41% pts and 12 month after in 93% pts. We suggest that results depends on early and well rehabilitation.

In many patients operated on for valvular heart diseases indications are present to digitalis administration in the preoperative period. During extracorporeal circulation fluctuations occur of blood potassium concentration which increase the risk for toxic effect of digitalis. In the work, digoxin concentration was studied in the serum of patients operated on in extracorporeal circulation in whom administration of this drug was discontinued 48 hours before the operation. The first digoxin dose (0.5 mg) was given directly after withdrawal of extracorporeal circulation, and another 0.5 mg was given after 4 hours. Digoxin concentrations were determined by fluorescence-polarization-immunological method using TD* Abbott device. The digoxin concentration increased rapidly and reached its peak after 6 hours (1.9 ng/ml), decreasing after 12 hours to 0.9 ng/ml and persisted at this therapeutic level in further samples. The present studies demonstrated that digoxin administration directly after withdrawal of extracorporeal circulation and within 24 hours after the operation in commonly accepted doses provided therapeutic concentration of the drug and caused no increase of the risk for toxic reaction development.

The report analyzes a rare case of lung cancer presenting as a dissecting aortic aneurysm. A 59-year-old patient was admitted to the Department of Cardiosurgery of the Institute of Cardiology, Poznań Medical School, with a preliminary diagnosis of dissecting aneurysm of ascending aorta. The patient had hypertension treated for 5 years and 3 year history of retrosternal pains. He had smoked 20 cigarettes daily for 20 years. On admission a strong chest pain radiating into the ++inter-scapular region was reported. After two days the radiation extended into the lumbosacral area. Blood pressure was 180/100 mmHg. After 7 days paresis of the lower extremities occurred. Ecg showed only hypertrophy of the left ventricle. Chest X-ray revealed dilatation of the mediastinum and enlargement of the lungs, without focal changes. Echo (M + 2D + Doppler) suggested aortic wall dissection in the ascending part and the arch. The DSA examination did not reveal the dissection, which in turn suggested mediastinal tumor. TC presented an extensive infiltration of the upper-medial part of the right lung and invaded right mediastinum. The final diagnosis, oat cell carcinoma, was established after the histopathological analysis of a biopsy specimen taken in the course of bronchoscopy. The patient died at home after two months of oncological treatment. Autopsy was not performed. In spite of considerable progress of the diagnostic technics both dissecting aortic aneurysm and lung cancer still present a very difficult clinical problem.