[Midterm results aortic valve replacement with allograft]. / Strednedobé výsledky implantací aortálního alograftu.

INTRODUCTION: Aortic allograft implantation into the aortic position in adults is standard procedure with some controversary. The most popular indication is bacterial endocarditis. We would like to present our midterm results. RESULTS: We implanted 61 allografts in 60 patients (between 10/2002 and 04/2008). Men were 46 (76.8%) and average age was 57 +/- 10.76 year. 30 days mortality was 9 people (15.0%, all with bacterial endocarditis). Late mortality 1 man (1.6%). Follow up 1-66 months, average 39.18 SD +/- 14.3 months, median 42 months. CONCLUSION: Implantation of aortic allograft into the aortic position is standard procedure with good midterm results. Relative high early mortality is dependent on preoperative status in patiens with acute bacterial endocarditis--all early death people were people with acute bacterial endocarditis and minimally one vital organ severe dysfunction.

[Aortic allograft (homograft) for the treatment of valvular disorders in adults with focus on treatment of infective aortic valve endocarditis]. / Aortální alograft (homograft) v lécbe chlopennich srdecních vad dospelých s durazem na lécbu infekiní endokarditidy aortální chlopne.

Still after 40 years of heart valve prostheses intensive development ideal valve substitute still does not exist. Aortic allograft represents one alternative which could be used for aortic and/or pulmonary valve replacement. This type of biological heart valve prosthesis is being currently discussed from the point of view of Tissue Banking, as well as from clinical aspects--e.g. surgical implantation technique and long term results. Live issue remains particularly the aortic allograft implantation into the aortic position. The authors discuss the aortic allograft role in the aortic valve infectious endocarditis treatment, which was widespread worldwide and accepted. Aortic allograft implantation is considered as a method of choice in that particular indication, especially in prosthetic aortic valve endocarditis and in left ventricle outlet tract destruction cases. The method is considered to be more technically demanding than routine heart valve surgery (heart valve replacement by means of mechanical or commercial biological prostheses), but literary and authors own experience in that particular group of patients looks encouraging. Aortic allografts permanent supply in our country is secured.

Implantation of cryopreserved mitral allograft into the tricuspid position in an experimental study in sheep: technical aspects of implantation and immediate results evaluated by epicardial echocardiography.

AIMS: Cryopreserved mitral allograft valve (MAV) offers theoretical advantages over conventional mechanical or biological prostheses in tricuspid position, especially in infectious endocarditis patients. MAV processing and tricuspid valve (TV) replacement in a sheep model is described. METHODS AND RESULTS: In 20 adult sheep, MAV were harvested, processed and cryopreserved. One month later, recipient's TV were excised and the MAVs were transplanted into the tricuspid position in 13 sheep, under general anaesthesia, via a right thoracotomy, with an extracorporeal circulation (ECC) and cardioplegic heart arrest. Both MAV papillary muscles were anchored into the right ventricular wall by transmural stitches and the MAV anulus was sewn into the recipient's tricuspid anulus. After weaning from ECC, the anatomy and function of the MAV in the tricuspid position was assessed by epicardial echocardiography. The average duration of the ECC was 58 minutes (42-88), the cardioplegic heart arrest was 36 minutes (28-45). Weaning from EEC was always uneventful. Right atrial & pulmonary artery pressure measurements and epicardial echocardiography documented good function of all MAVs. CONCLUSION: MAV remained mechanically strong enough for implantation into the tricuspid position. Reproducible technique of MAV transplantation into the tricuspid position with excellent early postoperative haemodynamic performance was developed.

[Case description of the abnormally big pseudoaneurysm in a patient after myocardial infarction]. / Popis prípadu neobvykle velkého pseudoaneuryzmatu u pacientky po infarktu myokardu.

Authors present a case of a 72 years old woman with an abnormally big left ventricular pseudoaneurysm as a consequence of a rupture of the left ventricular wall during myocardial infarction. Pseudoaneurysm threatens its carrier with both sudden death as a result of the rupture and a progressing heart failure. The patient mentioned has undergone an infero-lateral myocardial infarction complicated with beginning cardiogenic shock in July 2001. Based on coronarography examination which proved only peripheral stenoses in coronary bed a conservative procedure was indicated. In June 2002 the patient was admitted to a hospital for progressive dyspnoea, nonspecific chest and epigastric pain, and dyspeptic complaints. Transtoracal echocardiography examination proved a large pseudoaneurysm coming from periapical bottom wall of the left ventricle. Diagnosis was further confirmed and specified by ventriculography and the patient was indicated for surgery. Authors present a range of clinical signs of pseudoaneurysm, an approach to an examination, differential diagnostics and treatment procedure in patients with this unusual complication.

[What are indications for surgery in patients with chronic mitral regurgitation?]. / Kdy indikovat k operaci nemocného s chronickou mitrální regurgitací?

This review has been aimed at the presentation of present etiological spectrum of mitral regurgitation and its natural course. A basal survey of pathophysiology of this complicated and insidious defect, which should help to understand its clinical and hemodynamic classification, is presented. The developmental phases, characterized by very long asymptomatic period, when the heart function is compensated and the prognosis is good, are outlined. However, as a paradox of this defect, the contractile function of the left ventricle is damaged as early as in the compensation phase in spite of normal value of the ejection fraction. In the advanced phase the defect threatens that the carrier may suddenly die. Basic methods of quantification are presented as well as their principles. The development cardiosurgical techniques, which enable reconstruction of the mitral valve, and very good long-term and short-term results in large cohorts significantly influenced indication criteria. The causes of increasing interest in surgical treatment of mitral regurgitation, which is aimed at maintaining the inotropic function of myocardium and improvement of quality and duration of life, are presented. A successful mitral reconstruction, often connected with modification of the left atrium function, is associated with lower post-operation mortality, higher resistance of the native valve against infectious endocarditis and very frequently maintaining sinus rhythm as well. The review draws attention of wider medical audience, especially general physicians and general internal physicians, to the present possibilities of cardiosurgical treatment of mitral regurgitation. The therapy of mitral regurgitation is dramatically changing and the indication shift to markedly earlier stages.

[Cardiac damage in a young woman with Hodgkin's disease and long term survival after combination therapy and bone marrow transplantation]. / Poskození srdce u mladé zeny s Hodgkinovou chorobou dlouhodobe prezívající po kombinované lécbe a transplantaci kostní drene.

The authors describe the disease of a 22-year-old woman treated from the age of 13 years on account of Hodgkin's lymphoma by irradiation and cytostatic treatment. On account of a relapse of lymphoma at the age of 14 years megachemotherapy with subsequent transplantation of autologous bone marrow. In the course of eight years of the follow up gradual development of constrictive pericarditis with exsudate. Concurrently progression of mitral insufficiency based on valvular prolapse resulting from radiation. During the last two years refractory systemic hypertension resistant to treatment. At the peak of the disease development of cardiac tamponade and cardiac cachexia with anasarca. After anamnestic, clinical and haemodynamic analysis total pericardetomy was indicated and mitral valve replacement performed. The operation led to improvement of the patient's condition, systemic hypertension receded completely. The patient is in permanent remission.

[Is a bioprosthesis with a rigid stent a good choice for aortic valve replacement in elderly patients?]. / Je bioprotéza s rigidním stentem dobrou volbou pro náhradu aortální chlopne u starsích pacientu?

BACKGROUND: Either stented or stentless bioprostheses can be used for aortic valve replacement (AVR) in aged patients. However the choice of the valve type remains controversial. The implantation technique of the stentless valves is more complex but the haemodynamic performance supposed to be superficial to the stented ones. The aim of the study was to review our experience with stented bioprostheses implanted in the last year. MATERIAL AND METHODS: The study reviews retrospectively 35 patients who underwent AVR with Biocor fy St Jude Medical from May 2000 to May 2001. The mean age was 73 years (65-81). Associated procedures were CABG in 17, aortoplasty in 3 and Bentall procedure in 1. Thirty-two patients had aortic stenosis, the mean preoperative gradient was 44.2 mmHg. Nineteen implanted valves were 23 mm and smaller in diameter. All patients were examined by a cardiologist (including ECHO) one month after surgery. RESULTS: There was no early mortality (30 days) and no sign of structural valve deterioration or valve thrombosis. Mean hospital stay was 10.2 days (5-30). Mean postoperative gradient one month after surgery was 14.1 mmHg (6-24). CONCLUSIONS: The AVR with a stented bioprosthesis is a standard procedure with excellent results, the postoperative gradient is comparable to the gradient of the stentless valves.

[Lactic acidosis as a complication of treatment with biguanides]. / Laktátová acidóza jako komplikace lécby biguanidy.

In the course of two and a half years we treated six diabetic women on account of lactate acidosis during concurrent biguanide administration. The patients were given an average dose of 290 mg Buformin/24 hours. Their mean age was 71 years. Three patients died, i.e. the mortality was 50%. All patients reported nausea, vomiting and abdominal pain. Two suffered from diarrhoea. Two patients suffered from renal failure and one from cardiac weakness. One patient was in coma. The mean lactate concentration was 14.7 mmol/l, pH on admission was 6.84. The patients were given on average 550 mmol bicarbonate. In two instances bicarbonate dialysis was used. The authors discuss the pathophysiology, clinical aspects and importance for treatment and prevention of lactate acidosis during biguanide treatment.

[Acute ischemia of the extremities in the puerperal period]. / Akutní ischémie koncetin v poporodním období.

The development of pharmacotherapy implies great advantages for patients, at the same time it is, however, also the source of more frequent side-effects of drugs, which may result also from mutual interactions of commonly used drugs. The authors describe a case of ergotism which developed as a result of drug interaction between the ergot uterotonic Cornutamine and the marcolid antibiotic Erythromycin. This interaction could have seriously damaged the health of the young woman. At the same time the authors remind of the clinical picture of ergotism and the possible way of its treatment. In the Czechoslovak literature no report on this interaction was published during the past three years.