Left atrial mechanical remodelling assessed as the velocity of left atrium appendage wall motion during atrial fibrillation is associated with maintenance of sinus rhythm after electrical cardioversion in patients with persistent atrial fibrillation.

The velocity of left atrium appendage (LAA) wall motion during atrial fibrillation (AF) is a potential marker of mechanical remodelling. In this study, we investigated whether the velocity of LAA wall motion during AF predicted the success of electrical cardioversion and long-term sinus rhythm maintenance. Standard echocardiographic data were obtained by transthoracic echocardiography, and LAA wall motion velocities were measured by transoesophageal echocardiography. With logistic regression and receiver operating characteristic curve analyses, we related echocardiographic and clinical data to cardioversion outcomes and sinus rhythm maintenance at 12 months. Of 121 patients prospectively included in the study, electrical cardioversion restored sinus rhythm in 97 (81.2%), and 51 (42%) patients maintained sinus rhythm at 12 months. Patients in whom cardioversion restored sinus rhythm had higher LAA wall motion velocities than did the patients with failed cardioversions (p <0.001). Compared to patients with AF at 12 months, patients who maintained sinus rhythm had lower maximum and end-diastolic left atrial volumes (p ≤ 0.01), lower E/e' ratios (p = 0.005), higher s' values (p = 0.013), and higher LAA motion velocities (p < 0.001). On multivariate logistic regression, only LAA wall motion velocity and E/e' ratios remained significant predictors of sinus rhythm maintenance at 12 months (p ≤ 0.04). LAA wall motion velocity was also a significant predictor of sinus rhythm maintenance when corrected for clinical variables (p = 0.039). Conclusion: LAA wall motion velocity, as a marker of mechanical remodelling, can predict short-term and long-term sinus rhythm maintenance after electrical cardioversion in AF.

[A case of recurrent stent thrombosis in a drug-eluting stent following antiplateled therapy discontinuation]. / Nawracajaca zakrzepica w stencie powlekanym po odstawieniu leków przeciwplytkowych.

Stent thrombosis is one of the major complications that occur in percutaneous coronary interventions with stents. Various factors have been attributed to the development of stent thrombosis and several strategies have been recommended for its management. We report a case of 45 year-old patient with recurrent subacute and late stent thrombosis following antiplateled therapy discontinuation on the 6th day and 11th month after he discharging from hospital.

[Post-traumatic isolated aneurysm of aortic arch surgically repaired]. / Pourazowy tetniak luku aorty leczony operacyjnie.

An aneurysm is a permanent localized dilatation of an artery. A trauma is a rare cause of aortic aneurysm. The prognosis of untreated thoracic aneurysm is poor, with 3-year survival rates as low as 25%. Factors that seem to worsen the prognosis are female gender, size greater than 6cm, and traumatic origin. Because of the poor prognosis for the untreated patient and inability to predict rupture, surgical treatment of thoracic aortic aneurysms that result from trauma, even when asymptomatic is justified. The case of a 29 year-old patient, with post-traumatic aortic arch aneurysm qualified for delayed surgery treatment, is presented.

[Chronic type A aortic dissection incidentally detected in a 71 year-old woman]. / Przewlekle rozwarstwienie aorty typu A przypadkowo wykryte u 71-letniej kobiety.

Aortic dissection is a sudden event when the intimal tear occurs, blood penetrates the aortic wall through and the dissection propagates. Acute aortic dissection presents with chest pain, hemodynamic instability, absent or unequal peripheral pulses, various neurologic complications and aortic regurgitation. Noninvasive testing (echocardiography, computed tomography or magnetic resonance imaging) allows an accurate diagnosis to be made. Ascending aortic dissection often require surgery or stent-grafts, depending on their size and location. We present a case of a 71 year-old woman with an asymptomatic chronic type "A" dissection of aorta of total length, incidentally detected during ultrasonographic imaging, qualified for surgery treatment.

[Recurrent ventricular tachycardia as a late complication of a cardiac stab wound]. / Nawracajace czestoskurcze komorowe jako pózne powiklanie rany klutej serca.

We present a case of a 55-year-old male who suffered from a cardiac stab wound in his youth and 38 years later developed unstable sustained ventricular tachycardia. Imaging showed presence of a scarf of myocardium which probably caused the arrhythmia. Arrhythmia was successfully controlled using combined treatment with pharmacotherapy and cardioverter-defibrillator implantation. Relapses of ventricular tachycardia treated by appropriate interventions of cardioverter-defibrillator occurred when the patient stopped pharmacotherapy and experienced great psychic stress.

[Severe mitral regurgitation following blunt trauma of the chest as a cause of over heart failure]. / Niedomykalnosc zastawki mitralnej po tepym urazie klatki piersiowej przyczyna ciezkiej niewydolnosci serca u 33-letniego mezczyzny.

A case of a 33-year-old previously healthy man who due to a car accident suffered from severe multiorgan injuries, is presented. Two months following the injury, the patient developed symptoms of severe heart failure. A significant mitral regurgitation was confirmed together with a torn chordate tendineae being the main cause of the valve dysfunction. Mitral valve plasty was performed using a Carpentier Edwards mitral ring. After 14 months, the patient was selected for reoperation due to the endocarditis process which also affected the mitral ring. The patient had a St. Jude Medical 27-mm mitral valve implanted.

Myocarditis - clinical course and 2-year outcome in 32 patients.

BACKGROUND: Acute myocarditis is one of the most challenging diagnoses in cardiology. It is a disease with variable clinical presentation, progression and outcome. AIM: To assess clinical characteristics and outcome of patients hospitalised with diagnosis of acute myocarditis from year 2006 to 2008. METHODS: We analysed hospital files of consecutive 32 patients admitted to our hospital due to myocarditis. All demographic, clinical and laboratory data were analysed and compared between patients with acute or subacute myocarditis. After discharge the patients were followed for 8-24 months. RESULTS: The majority of patients were males (84%) in a mean age of 33 years. Clinical and echocardiographic parameters improved in 25 (78%) of patients during hospital stay. During follow-up decreased left ventricular ejection fraction (LVEF) was observed more often in patients with subacute than acute myocarditis (mean LVEF values of 49 vs. 61%, respectively). Patients with a subacute form of the disease more frequently required chronic pharmacological therapy and more often retired from occupational activities. CONCLUSIONS: Diagnosis of myocarditis is still challenging. Careful history taking, serial laboratory, ECG and echocardiographic examinations are helpful in therapeutic decisions making and assessing prognosis. Patient with subacute myocarditis are more symptomatic than patients with acute myocarditis.

Cognitive disorders in elderly patients with permanent atrial fibrillation.

BACKGROUND: Atrial fibrillation (AF) is a risk factor for development of thromboembolic events with an annual stroke rate of 4.5%. In subjects over 80 years AF is the single leading cause of major stroke. Moreover, about 25% of patients with AF in the absence of neurological deficits have tomographic signs of one or more silent cerebral infarcts. AIM: To investigate whether cognitive function in patients with permanent AF is significantly worse than in patients with sinus rhythm. METHODS: We included subjects aged > 65 years, without previous cerebrovascular events or dementia, with permanent arrhythmia lasting > 12 months. The AF group comprised 51 patients, aged 75.8 years. The control group consisted of 43 patients with sinus rhythm. The main points of the study protocol were: clinical history recording, physical examination, biochemical analyses, standard 12-lead ECG and transthoracic echocardiography. Cognitive status was assessed by Mini Mental State Examination (MMSE). RESULTS: Patients had established AF with a median duration of 4.9 years (range 1-21 years). Of the 51 patients, 51% had hypertension, 37% coronary artery disease, 12% presented sick sinus syndrome or atrioventricular advanced block with a VVI pacemaker implanted. There were no significant differences between the two groups though AF patients presented left ventricular hypertrophy and history of myocardial infarction more frequently. Patients in the sinus group had a lower-risk profile and received antithrombotic therapy less frequently than the AF group. However, a significant proportion of patients, particularly in the AF group received less than optimal thromboembolic prophylactic treatment with anticoagulants. Cognitive status was found to be significantly lower in the AF group, compared with the sinus rhythm group: 24.8 +/- 3.1 vs. 27.1 +/- 2.6 (p < 0.05). There were 43% patients with cognitive impairment in the AF group and 14% in the sinus rhythm group. CONCLUSIONS: Permanent AF in patients aged over 65 years seems to be associated with lower MMSE score compared with subjects with sinus rhythm. Cognitive impairment in older patients is a multifactorial disorder. One of the causes of low cognitive function in these patients appears to be permanent AF. Further prospective clinical trials should help determine the possible role of inadequate anticoagulant treatment, and its association with the deterioration of cognitive function in AF patients.