[Early complications and their treatment after heart transplantation in Hungary--experience of the first 16 years]. / A szívátültetések korai szövôdményei és kezelésük Magyarországon--az elsô 16 év tapasztalatai.

UNLABELLED: Heart transplantation is the most successful current long-term therapy of end stage cardiac failure. AIM: In order to improve the results of the Hungarian heart transplantation activity, all data from the first 16 years were retrospectively examined and matched with the relevant literature. METHODS: Between January 1992 and December 2007, 127 heart transplantations were performed in 125 patients in Hungary. Above the documentation of the Department of Cardiovascular Surgery, Semmelweis University, the archives of the Institute of Forensic Medicine, Semmelweis University, the Registry of Hungarian National Blood Transfusion Service, Organ Coordination Office and the data of the Gottsegen György National Institute of Cardiology were used. RESULTS: Early mortality has been approaching the international level recently. Graft failure was the primary cause of death in the Hungarian practice as well, followed by infection, uncontrollable bleeding during surgery and multiorgan failure. In one case successful acute retransplantation was performed, but the most effective, ventricular assist device therapy is completely missing from the armamentarium. Excellent results were achieved with medical treatment against acute rejection such as written in the international literature. CONCLUSIONS: For the sake of developing, regular usage of assist device therapy in Hungary is a prominent task. Development and application of standard protocols providing better quality in organ donor treatment and donation management have to be pressed.

[Role of heart transplantation in pediatric heart surgery. The first successful pediatric heart transplantation in Hungary]. / A szívtranszplantáció helye a gyermekszívsebészetben. Az elsô sikeres gyermekszív-átültetés Magyarországon.

7-year-old boy, who underwent aortic valve replacement two years previously, suffered from idiopathic dilated cardiomyopathy. Because of poor condition (NYHA-IV), heart transplantation was performed on 18th October 2007. It was the first pediatric heart transplantation in Hungary. It was an uneventful early postoperative period, 6 months after the operation he is doing well, no biopsy-proven and tissue Doppler echocardiography (TDI-derived velocities measurement) rejection was detected. The immunosuppression was based on triple-drug therapy (tacrolimus+mycophenolate mofetil+corticosteroid) with use of induction therapy with interleukin-2 receptor blocker (basiliximab).

[The first successful combined heart-kidney transplantation in Hungary]. / Az elso sikeres kombinált szív- és veseátültetés Magyarországon.

Combined heart-kidney transplantation has become a new therapeutic solution for patients with coexisting, irreversible heart and kidney failure. Though this combined approach has several theoretical advantages over sequential transplantation, it remains to be established whether it has a jeopardizing impact on patient and graft outcome. The authors report their experience of the first successful combined heart-kidney transplantation in Hungary from a single donor and review the literature in order to clarify this issue. Young male patient candidate for heart transplantation was suffering from concurrent end stage kidney disease. Donor was selected on the basis of weight and size matching, AB0 compatibility and negative T-cell cross-match. The heart was grafted first, and after the hemodynamic stabilization kidney from the same donor was transplanted. The surgical procedure was uneventful. Heart and kidney function recovered quickly, and the patient is doing very well with good cardiac and renal function even a year following the double organ transplantation. The first Hungarian experience showed that combined heart-kidney transplantation is a therapeutic solution for patients with end stage heart and kidney failure. The lower rate of rejection compared to single heart or kidney transplantation, known from the literature as well, supports their current approach to immunosuppression.

[To the margin of the one hundredth Hungarian heart transplantation: an analyzing review]. / A 100. magyar szívátültetés margójára: egy elemzö számvetés.

On the 28th of September, 2006 was performed the one hundredth heart transplantation (HTX) at the Department of Cardiovascular Surgery of Semmelweis University in Budapest, just 15 years after the beginning of the Hungarian HTX project. This fact provides the occasion for this analyzing review. The relatively high (15.68%) hospital mortality was caused mainly by the frequent occurrence of acute graft failure due to the poor recipient's selection possibilities. The Kaplan-Meier method has found a 56% five year and a 46% ten year long survival rate. The vast majority of the 63 surviving patients (95%) is in NYHA I functional class. The late deaths are caused most frequently by malignancy. Authors state that further increase in the HTX activity might be reached only by creating a longer waiting list since at the very moment there are only eight patients on it.

[Hybrid solution in aortic arch surgery]. / Hybrid megoldások az aortaív sebészetben.

Since the introduction of endografts, treatment of vascular diseases has remarkably changed. Due to less surgical trauma patients--those were not amenable to open surgery--now have the chance to be treated with remarkably lower risk. At certain segments of the aorta with life important side branches combination of open surgery is needed to get free segment for deployment of endografts. These "hybrid" interventions have opened new horizon at aortic arch surgery without use of cardiopulmonary bypass and deep hypothermia. In selected types of diseases by debranching of the aortic arch and transposition of the supra-aortic trunks we can achieve suitable landing zones to fix the endografts properly. In this paper we provide an overview of the possible solutions.

[Case of a young woman successfully operated on for acute pulmonary embolism and right ventricular thrombus after urogenital infection]. / Akut tüdoembolia és jobb kamrai thrombus sikeresen operált esete fiatal nobeteg urogenitalis infekciója után.

The authors report a case of a 22-year-old women operated on for pulmonary embolism with success. The venous embolism developed in two phases one week apart. The first clinical sign was a dyspnea of abrupt onset limiting physical activity even after a mild exertion. However, relevant diagnostic tests were performed after one week when the patient fainted, her dyspnea worsened. The results of ECG, echocardiography and pulmonary perfusion scintigraphy indicated the presence of a thrombus residing in the right ventricle and the embolism of the right pulmonary artery. Chest CT and pneumo-angiography findings show the embolus completely blocking the main right branch of the pulmonary artery and partially blocking the left lower lobe artery. On the basis of their experiences published earlier the patient was brought to a stable cardio-respiratory state prior to surgery. Both the adherent right ventricular thrombus and the fresh embolus residing in the right branch of the pulmonary artery were removed under the protection of extracorporeal circulation. After the elapse of an event-free 6-month postoperative period the patient continued to remain symptomless, while being on a long-term anticoagulant regimen. The long-term anticoncipient medication and the urogenital infection 3 months prior to surgery may have been involved in the etiology of the pulmonary embolism. The authors propose the implementation of an antithrombotic prophylaxis in young women after gynecological infections.

[The advantages of axillary artery cannulation in surgical treatment of type A acute aortic dissection]. / Az arteria axillaris kanülálás elonyei az akut "A" típusú aorta dissectio sebészi kezelésében.

There are more alternative cannulation techniques during surgery of type A aortic dissection. The most frequently used femoro-atrial cannulation method provides limited possibility for brain protection during surgery. This theory is confirmed by relatively high frequency of major brain complications in patients operated on while using this cannulation technique. During the last years cannulationis used more often, as it may provide more protection for the brain than other methods. In 2003 seven patients underwent aortic reconstruction because of type A acute aortic dissection using axillary cannulation. All patients except one were discharged after uneventful recovery. There were no postoperative neurological complications following surgery. We lost one patient due to distal progression of the dissection. He was the only patient with clinical evidence of transient postoperative brain damage. We are strongly convinced that the spectacular improvement in our results for the surgery of type A acute aortic dissection is due to the axillary cannulation, the anterograde flow and the isolated cerebral perfusion. We recommend the axillary cannulation technique as the first choice in type A acute aortic dissection.

[Modified Jatene operation for the repair of left ventricle aneurysm]. / Tapasztalataink a bal kamra aneurysma sebészetében--módosított Jatene mútét alkalmazásával.

INTRODUCTION: 134 left ventricle aneurysm operations were performed at our institute between 1993 and 2000. The original Jatene operation was modified by our workgroup: running sutures and abandoning Teflon pledges for faster operation; an additional linear closure of the remnant aneurysm above the patch to eliminate bleeding complications. OBJECT: The aim of this study was to describe our surgical technique, its advantages against other surgical methods in left ventricle aneurysms. METHOD: We divided our patients into three subgroups: linear techniques, such as plication (PL) n = 54, resection (RE) n = 45, and circular technique modified Jatene operation (MJ) n = 35. We performed a I. retrospective study in these subgroup, and a II. long-term clinical follow-up in MJ group. RESULTS: We did not find any technical difficulties in modified Jatene operations (there was no significant difference in operating times and cross clamping times in linear versus circular techniques). On the other hand, we found significantly better left ventricle geometry after circular method with echocardiography. There was no short-term (< 30 days) mortality in RM group. II. In the RM group long-term clinical follow-up we found further improvement in left ventricle geometry. We lost 1 patient (2.94%) because of cardiac death, and 2 patients (5.88%) had heart transplantation. All patients were in NYHA class I or II. CONCLUSIONS: In left ventricle aneurysm surgery circular techniques should be preferred because the better results in left ventricle geometry. We think that our improvements in Jatene's operation significantly decreased surgical difficulties, and through decreasing operating time short and long term outcome can be positively affected.

[Surgical treatment of pulmonary embolism]. / Tüdóembólia sebészi kezelésének lehetóségei.

The authors describe the pathology and the symptoms of pulmonary embolism with possible therapies, including thrombolysis and suction extraction. We performed two successful operations and after the examination of the data of the literature we think that in most patients the conditions for immediate surgery are not present. After the acute period, when the cardio-respiratory status is stabile, pulmonary embolectomy can result in complete recovery. Extracorporeal circulation and cardiac surgical background are necessary for the intervention. The seven Hungarian adult cardiac surgical centers could save the life of many patients.

Aortic coarctation reconstructed by resection and homograft replacement in the 1950s: long-term outcome 40 years after operation.

Since the first successful repair of aortic coarctation by Dr Clarence Crafoord in 1945, there are few data regarding late follow-up of homografts in this position. Between 1957 and 1959, 7 patients underwent surgical correction of aortic coarctation by Professor József Kudász at the Department of Cardiovascular Surgery, Semmelweis University, using freeze-dried aortic homograft. We were able to locate 4 of these patients and found no significant complications due to the operation. We report on this 40-year follow-up of implanted aortic homograft.