Cardiopulmonary exercise test and bioimpedance as prediction tools to predict the outcomes of obesity treatment.

INTRODUCTION Obesity impacts the global population. Bioelectrical impedance analysis (BIA) and cardiopulmonary exercise test [CPET]) may help modify the treatment. OBJECTIVES We aimed to compare BIA and CPET results in obese and lean indivisuals, assess changes in BIA and CPET during obesity treatment, and indentify parameters predicting treatment outcome. PATIENTS AND METHODS We enrolled 200 obese patients, of whom 45 underwent a lifestyle modification treatment, and 32 lean individuals (controls). Lifestyle modifications included diet, rehabilitation, education, and behavioral therapy. The diet was based on body composition assessed by BIA and fat metabolism assessed by CPET. The intensity of exercise in the rehabilitation program was based on CPET, mainly peak oxygen uptake (VO2peak), fat metabolism (FAT), and fat heart rate (FAT HR). The protocol duration was 12 weeks. RESULTS Obese patients differed from lean controls with regard to VO2peak (P <0.0001), oxygen uptake at anaerobic threshold (P <0.0002), respiratory exchange ratio (P <0.014), oxygen uptake to work rate slope (P <0.0004), FAT (P <0.001), FAT HR (P <0.0008), anaerobic threshold heart rate (P <0.0003), as well as fat mass (P = 0.01), fat­free mass (P = 0.007), resting metabolic rate (RMR) (P = 0.007), total body water (P = 0.01), and extracellular water (P = 0.004). The treatment resulted in increased RMR (P <0.02) and VO2peak (P <0.002), as well as reduced fat tissue (P <0.006) and resting heart rate (P <0.017). The prediction model based on FAT HR, resting heart rate, and FAT enabled the prediction of treatment outcomes in 92% of patients. CONCLUSIONS Obese patients had pathological FAT and impaired exercise tolerance. Changes in BIA and CPET prove the metabolic impact of lifestyle modification treatment.

Assessment of cardiac function in donor and recipient fetuses during a 7-day follow-up after selective laser photocoagulation of communicating vessels due to TTTS.

OBJECTIVES: The aim of the study was to analyze the changes in cardiac function and myocardial contractility of donor and recipient fetuses with twin-to-twin transfusion syndrome (TTTS) subjected to selective laser photocoagulation of the communicating vessels (SLPCV), between and after the procedure. Finally, we verified if fetuses with Quintero's stage I TTTS presented with early impairment of myocardial contractility. MATERIAL AND METHODS: We selected 77 consecutive women with twin pregnancies, whose both fetuses survived at least seven days post-SLPCV. Myocardial contractility of both fetuses was evaluated ultrasonographically, and their myocardial performance indices (Tei-Index values) and shortening fractions (SF) were determined. RESULTS: In donor fetuses, the Tei-Index values for both right and left ventricle remained within the respective reference ranges both before the procedure and during a 7-day follow-up. A significant change in shortening fraction values for the left ventricle in recipient fetuses and the right ventricle of in the donors was observed during a 7-day follow-up. CONCLUSIONS: Comparison of the cardiac parameters of donors and recipients revealed significant differences in Tei-indices during the entire follow-up period. The group with Quintero's I stage TTTS included 74% of recipient fetuses with abnormal Tei-Index values for the right ventricle (mean 0.53).

Differences in gene expression related to the outcomes of obesity treatment, peak oxygen uptake, and fatty acid metabolism measured in a cardiopulmonary exercise test.

INTRODUCTION The obesity pandemic requires development of methods that could be used on a large scale, such as the cardiopulmonary exercise test (CPET). Gene expression may explain CPET results on the molecular level. OBJECTIVES The aim of this study was to compare gene expression in obesity, depending on CPET results. PATIENTS AND METHODS The study group consisted of 9 obese patients and 7 controls. The treatment encompassed diet, rehabilitation, and behavioral therapy. Diet was based on the body composition analyzed by bioelectrical impedance, resting metabolic rate, and subjective patient preferences. The rehabilitation depended on the CPET results: maximal oxygen uptake and fatty acid metabolism. Behavioral intervention focused on the diagnosis of health problems leading to obesity, lifestyle modification, training in self­assessment, and development of healthy habits. The intensive treatment lasted for 12 weeks and consisted of consultations with a physician, dietitian, and medical rehabilitation specialist. RNA was isolated from the whole blood. A total of 47 323 transcripts were analyzed, of which 32 379 entities were confirmed to have high quality of RNA. RESULTS We observed differences in gene expression related to the CPET results indicating abnormalities in fat oxidation and maximal oxygen uptake. The genes with major differences in expression were: CLEC12A, HLA­DRB1, HLA­DRB4, HLA­A29.1, IFIT1, and LOC100133662. CONCLUSIONS The differences in gene expression may account for the outcomes of treatment related to inflammation caused by obesity, which affects the muscles, fat tissue, and fatty acid metabolism.

Postoperative kinetics of common inflammatory biomarkers after congenital heart defect procedures with extracorporeal circulation in children.

BACKGROUND: Extracorporeal circulation is associated with systemic inflammatory response syndrome. Therefore, the diagnosis of infection should be differentiated from a typical postoperative course. AIM: The aim of the study was to evaluate the kinetics of inflammatory biomarkers in children in the first days after cardiac surgery with extracorporeal circulation. METHODS: Prospective data were collected from 51 consecutive children referred for surgical treatment in Department of Paediatric Cardiac Surgery, St. Adalbertus Hospital in Gdansk, between February and August 2015. Blood samples were collected on the first, second, and third postoperative days and sent to the institutional laboratory for routine investigations: white blood cell count, serum C-reactive protein (CRP) and procalcitonin concentrations. RESULTS: The highest levels of procalcitonin were on the first postoperative day (median 3.53 ng/mL), although the peak values of CRP concentration and white blood cell count were on the second postoperative day (96 mg/L and 17.3 G/L). In the group of patients with foreign material implantation (Contegra® or Gore-Tex®), the higher values of procalcitonin concentration and white blood cell count were measured in the subsequent postoperative days. CONCLUSIONS: The kinetics of analysed inflammatory biomarkers on the first days after cardiac surgery for congenital heart disease in children have different characteristics. The knowledge about the kinetics of inflammatory biomarkers could be useful in determining the possibility of evolving infections in the early postoperative period.

Symptomatic cardiac hemangioma resected on the first day of life.

Cardiac tumors are extremely rare in neonates. We describe the case of a right atrial hemangioma in a neonate diagnosed prenatally and successfully operated on the first day of life.

Paediatric Melody® mitral valve replacement in acute endocarditis - alternative surgical-hybrid technique.

BACKGROUND AND AIM: Acute endocarditis (AE) is still rare disease in the paediatric population; nevertheless, the children suffering from AE usually need heart valve repair or replacement in emergency settings. METHODS: We present a case of emergency mitral valve replacement with the use of Melody balloon expandable stented bioprosthesis in a two-year-old patient with AE and subsequent mitral (bicuspid) valve incompetence after aggressive infective destruction with the symptoms of critical multi-organ failure. RESULTS: The patient, with a history of rapid deterioration after two-week-long septicaemia in the course of AE, was operated urgently after initial antibiotic treatment because of huge vegetations into the mitral valve orifice. A Melody TVP 22 valve was expanded over a 16-mm TyShak balloon and implanted into a mitral position (Melody-MVR) with good result. CONCLUSIONS: Based on current knowledge concerning heart valve reconstructions and institutional experience, we conclude that infected mitral valve in children should be primarily repaired; nevertheless, the Melody valve could be reasonably con-sidered as a mitral prosthesis in such conditions.

Department of Pediatric Cardiac Surgery in Gdansk in its new location - previous activity and perspectives for development.

The Department of Pediatric Cardiac Surgery in Gdansk is the only pediatric cardiac surgery center in northern Poland providing comprehensive treatment to children with congenital heart defects. The Department of Pediatric Cardiac Surgery in Gdansk currently offers a full spectrum of advanced procedures of modern cardiac surgery and interventional cardiology dedicated to patients from infancy to adolescence. January 19, 2016 marked the official opening of its new location.

Mountain climbing of the grown-up patient with non-corrected congenital heart defect.

Congenital heart defects (CHD) are the cause of reduced physical performance. The presence of congenital abnormalities in the heart of grown-up patients contributes to excessive hypo-kinesia. We present endurance parameters and a personalized comprehensive cardiac rehabilitation program before an extreme mountain climbing of a 27-year-old patient with an uncorrected ventricular septal defect (VSD). A 26-year-old female patient with an uncorrected congenital VSD was admitted to the department of cardiac rehabilitation before the planned high-mountain expedition. Professional preparation and assessment of actual exercise capacity was performed before scheduled extreme climbing. We conclude that physical activity associated with a heavy load in people with uncorrected CHD who have not developed pulmonary hypertension and reverse right-to-left flow seems to be safe, while participation of grown-up patients with congenital heart disease (GUCH) in extreme mountain climbing requires special preparation, individually designed endurance training and education program, conducted by the team of professionals in specialist centers.

Right Ventricle Mass Removal from Tricuspid Valve Apparatus: An Unusual Thromboembolic Complication of Severe Ketoacidosis.

The presence of a pathologic mass in the right ventricle (RV) may lead to hemodynamic consequences and to a life-threatening incident of pulmonary embolism. The diagnosis of an unstable thrombus in the right heart chamber usually necessitates intensive treatment to dissolve or remove the pathology. We present a report of an unusual complication of severe ketoacidosis: thrombus in the right ventricle, removed from the tricuspid valve (TV) apparatus. A four-year-old boy was diagnosed with diabetes mellitus (DM) type I de novo. During hospitalization, a 13.9 × 8.4 mm tumor in the RV was found in a routine cardiac ultrasound. The patient was referred for surgical removal of the floating lesion from the RV. The procedure was performed via midline sternotomy with extracorporeal circulation (ECC) and mild hypothermia. Control echocardiography showed complete tumor excision with normal atrioventricular valves and heart function. Surgical removal of the thrombus from the tricuspid valve apparatus was effective, safe, and a definitive therapy for thromboembolic complication of pediatric severe ketoacidosis.

Alternative hybrid and staged interventional treatment of congenital heart defects in critically ill children with complex and non-cardiac problems.

INTRODUCTION: An individually designed strategy of comprehensive alternative hybrid and staged interventional treatment (AHASIT) can be a reasonable alternative to conventional treatment of congenital heart defects, reduce the risk of cardiac surgery or interventions performed separately, and give an additional chance for critically ill children. AIM: To present our experience and the results of AHASIT of severely ill or borderline children referred for surgery with the diagnosis of congenital heart defects. MATERIAL AND METHODS: A group of 22 patients with complex cardiac and non-cardiac pathologies was retrospectively selected and analyzed. An individual preoperative severity scale was established for AHASIT patients, with one point for each of the following preoperative complications: prematurity, low body weight, cyanosis, intolerance to drug therapy, failed interventional treatment prior to admission, mechanical ventilation prior to the procedure, chronic respiratory failure and non-cardiac, mainly congenital malformations (congenital diaphragmatic hernia, lower extremity agenesia, duodenal atresia) and acquired problems (newborn edema, necrotic enterocolitis, intracranial hemorrhage, liver and renal failure, anemia and thrombocytopenia, infections or colonization with drug-resistant pathogens). RESULTS: The analysis of the postoperative course showed that the patients with 5 AHASIT points or more had a more complicated postoperative course than the patients with 1 to 4 AHASIT points. CONCLUSIONS: The AHASIT of pediatric congenital heart defects with complex and non-cardiac problems appeared to be an attractive option for selected severely ill patients. The strategy was found to be effective in selected neonates suffering from complex and accompanying non-cardiac pathologies, with positive final results of both cardiological intervention and planned surgery.

The impact of professional status on the effects of and adherence to the outpatient followed by home-based telemonitored cardiac rehabilitation in patients referred by a social insurance institution.

OBJECTIVES: Legislators and policymakers have expressed strong interest in intervention programs to reduce dependence on social disability benefits. Hybrid: ambulatory followed by home-based cardiac telerehabilitation--hybrid cardiac rehabilitation (HCR) seems to be a novel alternative for standard cardiac rehabilitation for patients with cardiovascular diseases (CVD) as a form of pension prevention paid by the Social Insurance Institution (SII). The kind of professional status may bias the motivation to return to work after HCR. The aim of our study was to evaluate whether the professional status can affect the effects of HCR. MATERIAL AND METHODS: One hundred fifty-two patients with CVD referred by the SII for a 5-week HCR were qualified for the study. Patients (87.7% males), aged 57.31 ± 5.61 years, were divided into 2 subgroups: W) white-collar employees (N = 22) and B) blue-collar employees (N = 130). To evaluate functional capacity, an exercise test on a treadmill was used. RESULTS: The number of days of absence in the cardiac rehabilitation program did not differ between the groups (mean ± standard deviation--B: 1.09 ± 3.10 days, W: 1.95 ± 3.64 days). There were significant improvements (p < 0.05) in measured variables after HCR in both (W and B) groups (max workload: 8.21 ± 2.88 METs (measured in metabolic equivalents) vs. 9.6 ± 2.49 METs, 7.76 ± 2.51 METs vs. 8.73 ± 2.7 METs, resting heart rate (RHR): 77 ± 16.22 bpm vs. 69.94 ± 12.93 bpm, 79.59 ± 14 bpm vs. 75.24 ± 11.87 bpm; double product, i.e., product of heart rate and systolic BP (DP rest) 10 815.22 ± 2968.24 vs. 9242.94 ± 1923.08, 10 927.62 ± 2508.47 vs. 9929.7 ± 2304.94). In group B, a decrease in systolic blood pressure (BP syst. - 137.03 ± 17.14 mm Hg vs. 131.82 ± 21.13 mm Hg), heart rate recovery in the 1st minute after the end of peak exercise (HRR1) (99.38 ± 19.25 vs. 93.9 ± 19.48) and New York Heart Association (NYHA) class (1.22 ± 0.53 vs. 1.11 ± 0.36) was observed. In group W, a decrease in diastolic blood pressure (BP diast.) at rest was observed (88.28 ± 9.79 mm Hg vs. 83.39 ± 8.95 mm Hg). The decrease in resting HR was significantly greater in group W (69.94 ± 12.93 vs. 75.24 ± 11.87, p = 0.034). CONCLUSIONS: Hybrid cardiac rehabilitation is feasible and safe with high adherence to the program regardless of the patient's professional status. Professional status did not influence the beneficial effect of HCR on exercise tolerance.

[Analysis of pregnancy, labor and neonatal course in babies with prenatally-diagnosed complete atrioventricular heart block]. / Analiza przebiegu ciazy, porodu i losów noworodków z prenatalnie diagnozowanym calkowitym blokiem przedsionkowo--komorowym.

INTRODUCTION: Complete heart block (third-degree atrioventricular block) is a defect of the conduction system of the heart, in which the impulse generated in the sinoatrial node does not propagate to the ventricles, and thus the latter contract independently of the atria. A third-degree atrioventricular block can be either congenital or acquired. In 60-70% of the cases, the congenital heart block results from destruction of the conduction system of the fetal heart by anti-Ro/SSA and anti-La/SSB antibodies present in maternal serum. The antibodies are synthesized in the course of autoimmune maternal conditions, most often systemic lupus erythematosus or rarer rheumatoid arthritis, dermatomyositis or Sjögren's syndrome. The complete block can occur as an isolated defect or be associated with structural anomalies of the fetal heart. MATERIAL AND METHODS: A total of five patients whose fetuses were diagnosed with the third-degree atrioventricular block have been hospitalized at the Department of Obstetrics, Medical University of Gdansk between 2012 and 2014. RESULTS: We present the data of the five patients, hospitalized at the Department of Obstetrics, Medical University of Gdansk, whose fetuses were diagnosed prenatally with the complete heart block. The cases differ in terms of etiology clinical outcome, and postnatal treatment. All data are presented in Table I. CONCLUSIONS: We emphasize the role of appropriate pregnancy management and careful monitoring of the fetal condition. From obstetrical perspective, it is important to monitor the condition of fetuses with the third-degree atrioventricular block ultrasonographically and echocardiographically; in turn, cardiotocography is less useful in this setting. Therefore, a non-reactive cardiotocographic tracing should not constitute an indication for a preterm delivery. An affected fetus should be delivered in a tertiary center for perinatal care that cooperates with a pediatric cardiology center. An efficient program for cardologic prenatal care and close cooperation between obstetricians, neonatologists, pediatric cardiologists, and cardiac surgeons constitute the key to a successful outcome.