Relationship Between Satisfaction With Social Support and Self-Efficacy and the Occurrence of Depressive Symptoms and Stress in Heart Transplant Recipients.

Heart transplantation is a recognized and effective therapeutic method for treating end-stage circulatory failure. Physical factors and psychosocial issues among heart transplant recipients have been addressed in an increasing number of studies. According to the transactional model of stress, social support is one of the resources that facilitate coping with stress. The use of social support is related to a lower severity of depression and stress. The research objective was to assess the relationship between satisfaction with social support and self-efficacy and the occurrence of depressive symptoms and stress in heart transplant recipients. MATERIAL AND METHODOLOGY: The study involved 123 participants, including 30 women and 93 men with mean age of 54.8 years (SD = 13.25). Berlin Social Support Scales, Beck Depression Inventory, and General Self-Efficacy Scale were used in the study. RESULTS: According to the analysis, the degree of depression decreased with increased emotional social support (r = -34; P < .001), instrumental social support (r = -378; P < .01), and perceived support (r=-387; P < .001); the degree of stress decreased with an increase in the application of instrumental support (r= 0.36; P<.001), emotional support (r=-0.31; P<.001), and perceived support (r=0,363; P<.001). The level of self-efficacy had a positive impact on emotional and instrumental support as well as on the perceived and actually received support. A regression analysis proved the level of (instrumental) social support and self-efficacy act as predictors of the incidence of depression (R2 = 0.43; P < .05) and stress (R2 = 0.36; P < .05) among heart transplant recipients. CONCLUSION: The obtained results support the positive impact of social support and self-efficacy on the occurrence of depressive symptoms and stress.

Atrial natriuretic peptide and brain natriuretic peptide changes after epicardial percutaneous left atrial appendage suture ligation using LARIAT device.

Percutaneous left atrial appendage closure is an alternative treatment for stroke and systemic thromboembolism risk reduction in non-valvular atrial fibrillation (AF). However, the neurohormonal impact of epicardial exclusion of the left atrial appendage (LAA) with the LARIAT procedure is unknown. Evaluation of changes in atrial natriuretic peptide (ANP) and brain natriuretic peptide (BNP) levels in AF patients underwent percutaneous LAA suture ligation. Sixty six patients underwent successfully percutaneous LAA suture ligation using LARIAT device. The level of ANP and BNP was measured before and 3 months after procedure. Mean ANP level before procedure was 249 ± 77 pg/mL (range from 95 pg/mL to 503 pg/mL) and mean BNP level was 481 ± 517 pg/mL (range from 34 pg/mL to 2508 pg/mL). Three months after procedure mean ANP level was 249 ± 79 pg/mL (range from 98 pg/mL to 492 pg/mL) and mean BNP level was 495 ± 526 pg/mL (range from 52 pg/mL to 2420 pg/mL). At 3 months follow up after percutaneous LAA suture ligation there were no significant differences in ANP and BNP levels.

Evaluation of the Motivation to Consent to and to Refuse Organ Donation Among Participants of Educational Meetings Concerning Organ Transplantation.

BACKGROUND: Improvement of the consent rate for solid organ donation from deceased donors is a key component of strategies applied in many countries aiming to increase the availability of organs for transplantation. Attitudes toward living and posthumous donation are favorable. Research shows that the outlook on organ donation and the degree of the willingness to become an organ donor are associated with a wide range of variables. The main objective of this study was to identify factors that influence the willingness to donate organs and the reasons for refusing consent. MATERIALS AND METHODS: The study included 191 participants (135 female and 56 male) aged 16 to 61 years (mean age 26.86 ± 12.88). A cross-sectional study was conducted during educational meetings concerning organ donation that was addressed to students, teachers, and nurses. Survey tools included the Individual Questionnaire: Study of attitudes toward transplantation, consisting of 26 closed questions (with the consent of the Statistical Office in Krakow). RESULTS: In all, 97.4% of the respondents accepted transplantation from living donors, and 95.8% accepted deceased donations. Of the respondents, 78.5% agreed to posthumous life-saving organ donation. There was a significant difference between the respondents' sex, age, social group, place of living, and the reasons for their willingness to donate organs both posthumously and during their lifetime, as well as reasons for refusal. CONCLUSIONS: Our findings showed that the study group in general had favorable views on treatment involving transplantation and declared willingness to make a posthumous organ donation. These views vary depending on demographic variables. The education on the subject of organ and tissue donation has a positive impact on donation and transplantation rates.

Role of Personal Resources in Depression and Stress in Heart Transplant Recipients.

BACKGROUND: Heart transplantation is the primary option for heart failure treatment and increases the survival rate and the quality of life for recipients. However, this surgical intervention induces numerous psychological problems, such as depression and anxiety. Protective factors and personal recourses are a significant force behind healthy adjustment to life stresses. The aim of this study was to assess the role of personal recourses in terms of depression and stress in heart transplant recipients. METHODS: The study involved a sample of 131 post-heart transplant patients. Standardized instruments were used to measure the key constructs: Beck Depression Inventory Short Form for prevalence of depression, Perceived Stress Scale for prevalence distress, and Sense of Coherence (SOC-29), Life Orientation Test, and General Self-Efficacy Scale for measuring personal resources. RESULTS: We found that sense of coherence, optimism, and self-efficacy proved to be significant predictors for the prevalence of both depression and stress. CONCLUSIONS: These result suggest that the assessment of coping strategies and sense of coherence in heart transplant recipients requires exploration. Evaluating coping strategies and sense of coherence before surgery seems significant and begins with developing skills in this domain.

The increased plasma C-reactive protein and interleukin-6 levels in patients undergoing coronary artery bypass grafting surgery are associated with the interleukin-6-174G > C gene polymorphism.

BACKGROUND: The interleukin-6 (IL-6) promoter -174G/C polymorphism (rs1800795) is associated with enhanced systemic inflammatory response to injury. However, data on the effect of this polymorphism on inflammatory markers in patients undergoing coronary artery bypass grafting surgery (CABG) are inconsistent. The aim of our study was to investigate whether -174G/C IL-6 polymorphism affects plasma IL-6 and C-reactive protein (CRP) concentrations in patients undergoing CABG. METHODS: A total of 179 consecutive white patients (77% men, aged 65 +/- 8.6 standard deviation [SD] y) scheduled for elective isolated CABG were studied. Pre- and postoperative CRP and IL-6 levels were analysed in relation to the 174G/C IL-6 polymorphism determined by using TaqMan single-nucleotide polymorphism genotyping technique. RESULTS: The genotype distribution was as follows: GG -46 (26%), GC -93 (52%) and CC -40 (22%). The C allele carriers had higher baseline CRP (4.1 +/- 0.35 versus 2.4 +/- 0.59 mg/L, P = 0.02) and IL-6 levels (3.0 +/- 0.17 versus 2.2 +/- 0.3 pg/mL, P = 0.02) than GG patients. Five to seven days after CABG, CRP levels rose by 54% (P = 0.03), and IL-6 levels tended to be higher (P = 0.07) in -174C allele carriers than the non-carriers. There were no associations between -174G/C IL-6 polymorphism and any demographic-, clinical- or procedure-related variables as well as major adverse cardiovascular events. Multivariate regression analysis, including sex, age, body mass index, hypercholesterolaemia, smoking, hypertension diabetes, identified CG + CC genotype as the only independent predictor of preoperative CRP and IL-6 levels. CONCLUSIONS: The presence of the -174C allele determines to some extent higher plasma CRP and IL-6 concentrations pre- and postoperatively in CABG patients.

Allogenic heart valve bank in the Department of Cardiovascular Surgery and Transplantology of Jagiellonian University in Cracow - 23 years experience in the treatment of aortic valve or aortic root diseases.

Allogenic aortic valves are widely used in case of native aortic valve or root disease as well as failed prosthetic valves with great success. At the Department of Cardiovascular Surgery and Transplantology of the Jagiellonian University in Cracow, aortic valve or aortic root replacement with allogenic aortic valve has been performed for 23 years. Allogenic heart valve bank was founded in 1980. In the bank we prepare both aortic allografts for adult cardiac surgical procedures and pulmonary allografts that are mostly used for repair of congenital heart disease.Allogenic aortic valves implantation was usually considered in our clinic for older patients, patients with infective endocarditis of the native or prosthetic valve, young women in reproductive age and patients with Marfan syndrome. Allografts exhibit excellent clinical performance and acceptable durability with no early failure if properly inserted. Between 1980 and 1992, allografts were obtained only from cadavers during routine autopsies. More than 10% of prepared allografts were exported to other cardiac surgery centres in Poland and foreign countries. Aortic valve replacement using allogenic aortic valves can be performed with acceptable mortality and good long-term results. The procedure although surgically more challenging has the advantage of not requiring anticoagulation therapy, hemodynamic performance of the allogenic valve is excellent, it demonstrates freedom from thromboembolism and infective endocarditis. We would like to emphasize the importance and advantages of the fact that allogenic heart valve bank is placed in the department of cardiovascular surgery and it is able to supply the department in heart valve allografts 24 h a day.

Superoxide dismutase activity and expression in human venous and arterial bypass graft vessels.

UNLABELLED: Venous bypass grafts are more prone to accelerated atherosclerosis than arterial grafts, which is partly related to increased oxidative stress and diminished nitric oxide bioavailability. In veins superoxide production is dependent primarily on nox2 NAD(P)H oxidase expression, while in arteries nox4 appears to play an important role. This may in part explain differences in susceptibility to graft failure. Net levels of oxidative stress are however determined in parallel by the production as well as by degradation of free radicals (eg. by superoxide dismutases, catalases, thioredoxins etc). The differences in superoxide dismutase (SOD) expression and activity in human bypass conduit vessels remain unclear. Accordingly, we aimed to compare SOD activity and protein levels as well as its functional effects on superoxide production in segments of human internal mammary arteries (IMA) and saphenous veins (HSV) from patients undergoing bypass graft surgery (n=24). SOD activity was assessed by inhibition of pyrogallol autoxidation, Cu-Zn SOD and Mn SOD protein levels were studied by immunoblotting. Basal superoxide release was detected by lucigenin (5 microM) enhanced chemiluminescence. Total SOD activity did not differ significantly between HSV and IMA. Similarly, no difference was observed in SOD activity in the presence of KCN (Mn-SOD). Human bypass conduit vessels show amounts of Cu-Zn SOD or Mn-SOD protein levels. In both HSV and IMA segments superoxide production was more than doubled in the presence of SOD inhibitor-DETC. CONCLUSIONS: These studies suggest that the differences in oxidative stress between human arteries and veins are unlikely to be caused by SOD activity. However SOD plays and important role in amelioration of oxidative stress in both types of vessels.

[QT dispersion in DDD and VVI paced patients after myocardial infarction or with left ventricular hypertrophy]. / Dyspersja odstepu QT w dlugotrwalej stymulacji dwujamowej typu DDD i komorowej VVI u chorych po zawale miesnia serca lub z jego przerostem.

The aim of this study was to assess the alterations of stroke volume (SV) on the QT dispersion (QTD) as a result of different pacing modes and programmed AV delays in patients (pts) after myocardial infarction (MI) or with left ventricular hypertrophy (LVH). We studied 14 MI pts (9 M, 5 F) in mean age 72.3 +/- 3.7 yrs (Group I) and 12 pts with LVH (7 M, 5 F) in mean age 67.3 +/- 5.9 yrs (Group II), in whom DDD pacemakers were implanted due to complete atrioventricular block. The control group (Group III) consisted of 9 pts without MI or LVH. In all cases basic rate of the pacemaker was programmed at 70/min. Resting ECG showed all atrial and ventricular complexes captured. AV delay optimization was based on the measurements of SV by Doppler echocardiography. QT intervals (QTi) were measured from 12-lead ECG at 50 mm/s speed. QTD was calculated as the difference between maximal and minimal QTi. It was measured at optimal (opt. DDD, with highest SV) and "unoptimal" (unopt. DDD) programmed AV intervals and then in VVI mode (with lowest SV) after following reprogramming of the pacemaker. In Group I and II, a strong correlation between SV and QTD was found (R = 0.816 and -0.897, respectively). In control group, it was insignificant (R = -0.339). In VVI mode SV was significantly lower than in unopt. DDD (in Mi pts: 56.1 ml vs 71.1 ml, respectively, p < 0.01; in LVH pts: 64.1 ml vs 96.7 ml, respectively, p < 0.005) and QTD was significantly greater (74.8 ms vs 66.8 ms, respectively, p < 0.005 and 70.0 ms vs 53.5 ms, respectively, p < 0.005). In LVH pts or MI pts programming of different AV intervals and pacing modes significantly influences QTD.

[Risk of hypertension after heart transplantation in the follow-up period]. / Ryzyko nadcisnienia tetniczego po przeszczepieniu serca w obserwacji odleglej.

From October 1988 to March 2000, 58 patients underwent orthotopic heart transplantation (HTX). Data of 220 heart recipients with the follow up > or = 3 months after HTX were analyzed using the average values of blood pressure measured with the sphigmo-manometer. 65% of patients were diagnosed with the hypertension (HA). 39.9% of those patients (NTA group) had the systolic blood pressure < or = 140 mmHg and diastolic blood pressure < or = 90 mmHg during pharmacotherapy. 60.1% of hypertensive patients (NTB group) had the systolic pressure > 140 mmHg and/or diastolic pressure > 90 mmHg despite pharmacotherapy. 35% of all patients had normal blood pressure after HTX (HNA group). Patients with hypertension were older and the end stage ischemic cardiomyopathy was more frequently indication for HTX. Significantly more females were in NTA group. We observed no influence of the daily dose of cyclosporine or other immunosuppressive drugs on HA. The average blood concentration of cyclosporine A and mycophenolate mofetil was similar in all groups. The calcium channel blockers and inhibitors of angiotensin converting enzyme were main tool of pharmacotherapy used. In NTA group calcium channels blockers were used more frequently. In NTB group there was a statistically significant higher blood level of creatinine. After HTX there is a high risk of HA, which: increases with age, with the ischemic cardiomyopathy as indication to HTX, is significantly higher in males, there is no correlation between HA and the dosage and blood level of cyclosporine, increases with kidney insufficiency. In monotherapy calcium channel blockers seem to be especially effective.

[Use of the internal thoracic artery in repeat myocardial revascularization surgery]. / Upotreba unutrasnje torakalne arterije u ponovnoj operaciji revaskularizacije miokarda.

The incidence of redo myocardial revascularization is increasing lately. These procedures are accompanied by the higher operative risk, and the use of internal thoracic artery graft may have additional negative impact on early-rization. Mortality and morbidity in this group did not differ significantly compared to a group where only venous grafts were used. Independent predictors of the unfavorable outcome (for both groups) were the presence of the chronic pulmonary disease, age over 65 and NYHA functional class IV. In the group with internal thoracic graft it was the age over 65, while in the group with only vein grafts it was chronic pulmonary disease. We have discussed potential problems during the redo procedure in patients in whom internal thoracic graft was used during the first procedure.

[Assisted circulation. I. Systems with short-term mechanical circulatory support]. / Asistirana cirkulacija I--sistemi za kratkotrajnu mehanicku potporu cirkulacije.

The concept of artificial circulatory support has been established almost 200 years ago. It has only been within the last four decades that physicians and engineers have developed mechanical assist devices that can temporarily support the circulation until the native heart recovers from a reversible injury. If the heart does not recover sufficient function to maintain adequate hemodynamics, long-term circulatory support or permanent replace (biologically--heart transplant or permanent mechanical circulatory support) is needed. In this paper we describe the devices (intraaortic balloon pump, roller, centrifugal and axial pumps), that are in current clinical use for temporary (short-term) mechanical circulatory support.

[Clinical outcome in patients after single vessel PTCA with multiple stent implantation]. / Ocena chorych leczonych angioplastyka wiencowa i implantacja dwóch i wiecej stentów do jednej tetnicy.

Multiple stenting in a coronary artery may improve the angiographic result of unsatisfactory percutaneous coronary angioplasty (PTCA) but little is known about its clinical outcome. We evaluated 42 patients who underwent multiple contiguous stent implantation (2-4 stents) within a single coronary artery in order to achieve optimal vessel reconstruction. Procedural success rate was 95%. In-hospital events included myocardial infarction in 2 patients (5%) and acute stent thrombosis in 2 patients (5%). Acute stent thrombosis was successfully treated with repeated PTCA and abciximab infusion. The mean stented segment length was 33.5 +/- 9.9 mm. In 23 patients (54.8%) stents were implanted due to abrupt or threatened artery closure (bailout), in 9 (21.4%) following total chronic artery occlusion and in 10 (23.8%) due to a suboptimal result of angioplasty (i.e. provisional stenting). The bailout stent implantation was most frequent in the left anterior descending artery (15 out of 23 patients, i.e. 65.2%). Long-segment multiple stenting was performed mainly in the right coronary artery to maintain recanalization after the chronic artery occlusion (6 out of 9 patients, i.e. 66.7%). Mean data for all studied patients revealed a significant improvement in the exercise stress test parameters after the procedure (exercise time: 8.5 +/- 3.9 vs. 11.4 +/- 3.5 min, maximal load: 5.4 + 3.0 vs. 7.6 +/- 2.9 METS, percent of the maximal predicted effort 75.5 +/- 10.3 vs. 83.2 +/- 9.2%, p < 0.01 for all). Although the sub-group analysis showed a significant increase in exercise test parameters in patients treated with stent implantation due to the bailout (p < 0.05), the increase did not reach statistical significance in the group of patients who underwent multiple stent implantation to maintain recanalization after chronic artery occlusion or to improve the result of angioplasty. At 14.9 +/- 8.3 months follow-up restenosis was found in 14 (33%) patients. It was successfully treated either with re-PTCA (10 patients, i.e. 23%) or with bypass surgery (4 patients, i.e. 10%). Interestingly, the length of the stented segment was not significantly higher in those patients who developed restenosis. No patient died sustained myocardial infarction or subacute stent thrombosis. We conclude that multiple stent implantation is a safe procedure, with an insignificant complication rate. Best outcome is seen when multiple stent implantation is performed for the left anterior descending artery bailout. Reconstruction of the right coronary artery due to chronic total occlusion usually requires multiple stent implantation. When multiple contiguous stent implantation is performed due to the suboptimal PTCA result, it does not seem to improve the clinical outcome as evaluated by exercise stress test. Although the risk of restenosis is increased, subacute stent thrombosis seems rare with multiple one-vessel stenting.

[The internal thoracic artery in myocardial revascularization in patients with severely depressed left ventricular function]. / Unutrasnja torakalna arterija u revaskularizaciji miokarda kod bolesnika s tesko ostecenom funkcijom leve komore srca.

INTRODUCTION: In most prospective, randomized studies, severely depressed left ventricular function is found to be the independent predictor of increased morbidity and mortality after myocardial revascularization [3]. Surgical treatment in this particular group of patients results in superior long-term results [1, 2]. Internal thoracic artery (ITA) is considered to be superior compared to venous grafts in myocardial revascularization for the majority of patients with ischaemic heart disease. However, its value in patients with already severely depressed left ventricular function (EF < or = 30%) is still a matter of debate. There are no prospective, randomized studies, so far. In some studies it was shown that revascularization with ITA graft resulted in superior long-term results (10- and 15-year follow-up) in all subgroups of patients, including those with severely depressed left ventricular function [4, 5]. Some authors find it still unacceptable, if this result would be possible at the expense of higher early mortality (due to use of ITA). The purpose of this study is to analyze the early and long-term results of myocardial revascularization using ITA graft in patients with severely depressed left ventricular function (EF < 30%). MATERIAL AND METHODS: Over the period from November 1986 through March 1999, 2860 pts have received ITA (alone or with additional vein grafts) for myocardial revascularization. In 431 pts EF was < or = 30% (15.1%), average EF being 25.7% (by echocardiography); 33 were women, 29 were diabetics, while average age was 56.7 +/- 8.4 years. The control group consisted of 430 pts, with similar preoperative characteristics, who received vein grafts alone. RESULTS: Operative mortality in the ITA group was 2.55% (11/431), and postoperative morbidity was 7.4% (32/431). In the group with vein grafts only the mortality was 3.25% (14/430) and morbidity 6.7% (29/430)--Table 2. The average postoperative hospital stay was 9.1 days (range 7-32). There was no difference in operative and postoperative parameters (extracorporeal time, ischaemic time, duration of mechanical ventilation, need for inotropic support, mortality, morbidity and hospital stay) compared to the group with vein grafts alone, except for the blood drainage--significantly higher in the ITA group--p < 0.00001)--Table 3. Multivariate analysis showed that independent predictors of unfavorable outcome were the presence of peripheral vascular disease (beta--0.9; p = 0.02) and aortic cross-clamp time (beta--0.02; p = 0.01). Long-term results in 14 pts with ITA graft operated on from 1986 to 1992 (6-12 years of follow-up) showed the survival of 92.7%. DISCUSSION: Superior long-term patency of ITA graft resulted in its practically routine use in myocardial revascularization. However, in some studies it was shown that ITA flow might be insufficient during the maximal effort [6]. This may result in hypoperfusion, low cardiac output syndrome and cardiac arrest. This frequently happens at the end of the operation, and may be accentuated with the use of vasopressors that can further decrease the ITA flow [9]. In patients with already severely depressed left ventricular function preoperatively, the use of vasopressors at the end of procedure when the myocardium may be quite vulnerable, is to be expected. Friesewinkel et al., [18] showed that there was an impairment of the regional contractility of the left ventricle early (up to 4 hours) after myocardial revascularization, when one or both ITA grafts were used. Since this was not the case if vein grafts were used, they advised to be careful in patients with "depressed left ventricular function". However, Elefteriades et al., [1] found no higher mortality in patients with "bad left ventricle" in whom ITA was used, but point out that patients with elective operation and without need for intensive care treatment preoperatively had much better outcome. Jagaden et al., [19] found very good results in these patients, after the routine use of ITA, during a 20-year follow-up. In our study EF < or = 30% was present in 861 patients, 431 with ITA graft and 430 with vein grafts only. There was no difference between groups considering all possible preoperative and operative factors of importance for the outcome. We found no increased early morbidity and mortality in patients in whom ITA was used compared to patients with vein grafts only. In patients operated on from 1986-1992 (follow-up of 6-12 years), we noted the survival of 92.7%. This was not statistically different compared to patients with vein grafts (survival of 88.9%). Despite the small number of patients, we found these long-term results very encouraging. CONCLUSION: ITA graft is a very good and absolutely acceptable choice in patients with severely damaged left ventricular function, particularly if we consider its long-term superiority. These pts should not be deprived of the long-term benefit of ITA graft, since early results are very good.

[Levels of troponin I, tropoinin T, isoenzyme MB creatine kinase and myoglobins in blood serum for perioperative diagnosis of myocardial infarction in patients after coronary artery bypass graft surgery with extracorporeal circulation]. / Poziomy troponiny I, troponiny T, izoenzymu MB kinazy kreatyny oraz mioglobiny w surowicy krwi w diagnostyce okolooperacyjnego zawalu miesnia sercowego u chorych po operacjach naczyn wiencowych z uzyciem krazenia pozaustrojowego.

UNLABELLED: We studied plasma levels of troponin I (cTnI), troponin T (cTnT), creatine kinase MB (CKMBmass) and myoglobin (MB) in patients undergoing coronary artery bypass surgery with extracorporeal circulation and cardioplegia. In group 1 (25 patients without perioperative myocardial infarction) plasma levels of all markers studied were elevated after operation. In group 2 (24 patients with perioperative myocardial infarction) plasma concentrations of all markers exceeded several times levels observed in patients without myocardial infarction with maximal value for MB at 12 hours after operation; for cTnI and CKMBmass at 16 hours after surgery and for cTnT at 32 hours after the end of operation. ROC curves show cut-off value for CKMBmass 20.3 ng/ml (sensitivity 79% and specificity 89%); for cTnI cut-off value was 0.8 ng/ml (sensitivity 80% and specificity 94%) for cTnT the cut-off value was 0.41 ng/ml (sensitivity 86% and specificity 88%) and for MB the cut-off value was 419 ng/ml (sensitivity 85% and specificity 70%). CONCLUSION: All markers studied are reliable biochemical tests for perioperative myocardial infarction, however, the analysis of ROC curves suggested that cTnI and cTnT might be more useful for diagnosis of perioperative myocardial infarction after conventional coronary artery bypass surgery.

[Stents for treatment of transluminal percutaneous coronary angioplasty (PTCA) complications]. / Stenty w leczeniu powiklanej angioplastyki wiencowej (PTCA).

UNLABELLED: This study describes initial results of stent implantation in bailout situations in 38 patients with obstructive dissection after percutaneous transluminal coronary angioplasty (PTCA). Before stent introduction 1.8% of all patients after PTCA required emergency bypass grafting (CABG) because of postprocedural complications. In 1997 the rate of such emergency operations decreased to only 0.5% (p < 0.05). The success rate of stent deployment in patients included in the study was 95%. Mean final inflation pressure used for stent deployment was 12.0 +/- 2.3 atm. After stent implantation average residual stenosis was -0.81 +/- 5.75%. Of the 38 patients, 15 (40%) were treated before stent implantation with prolonged inflations with perfusion catheter. Bailout stenting was performed in 10 (25%) patients undergoing PTCA for restenotic lesions. The stents were placed in the left anterior descending coronary artery in 26 patients (69%), left circumflex coronary artery in 3 patients (8%), and in the right coronary artery in 9 patients (23%). Before bailout stenting 28 patients (75%) presented with type C and D dissection. One patient (2.5%) developed acute stent thrombosis. No episodes of subacute stent thrombosis were noted. During six-months clinical follow up no death and no Q-MI were observed. Angiographic follow up restenosis rate was 13/30 (43%), predominantly in patients treated with prolonged perfusion balloon inflations before stent implantation. The incidence of repeated PTCA and elective CABG due to restenosis was 12/30 (40%) and 1/30 (3%), respectively. There were no vascular complication at the puncture site. IN CONCLUSION: the introduction of coronary stenting has provided an excellent non-surgical modality for treatment of imminent or acute vascular closure complicating coronary angioplasty.

[Coronary bypass grafting after failed percutaneous angioplasty (PTCA)]. / Pilne pomostowanie tetnic wiencowych po powiklanych angioplastykach wiencowych (PTCA).

Between January 1991 and September 1997, in the Cardiovascular Surgery Department of the Institute of Cardiology of Jagiellonian University Medical School, 23 patients underwent emergency CABG due to acute myocardial ischaemia in result of failed PTCA. Over the same period of time invasive cardiologists performed 1883 PTCAs out of which 23 (1.2%) were emergency cardiosurgical procedures, and in 38 patients, stents were implanted in the damaged coronary arteries. The patients' age ranged from 37 to 67 years (median 52.2). In all patients good left ventricular function was preserved, median ejection fraction being 64%. Two patients required IABP to support left ventricular function. 1-4 bypass grafts were implanted (median 1.9 per patient). In one patient, internal mammary artery was collected and then implanted into anterior interventricular branch. The most common complication was myocardial infarction which occurred in 12 patients (52%). In ten patients low output was observed postoperatively. One operated patient (a female died (4.3%). The mean time of hospitalization was 11 days. Emergency myocardial revascularisation procedures performed after failed PTCA, bring higher risk of mortality and dangerous postoperative complications.

Measurement of radial bone mineral density in patients after heart transplantation.

Limited physical activity, steroidotherapy and immunosuppression are known risk factors for the development of osteoporosis. The purpose of our current work was to investigate whether patients after heart transplantation (Htx) have an increased incidence of osteoporosis. We compared bone mineral density (BMD) in 32 post-transplant patients with a reference group of 1548 healthy age-matched males. Measurement of BMD was carried out with a Dtx 100 Osteometer on the distal and ultradistal segment of the non-dominant radius. Our results revealed a decreased BMD in HTx patients ranging from 6.9 to 10% in the ultradistal (p = 0.0446) and from 0.4 to 3.5% in the distal segment (p = 0.0593).

Successful full-term pregnancy in a patient three and a half years after a heart transplant.

The patient is a 28 year old woman who received a heart transplant in 1992 secondary to hypertrophic cardiomyopathy with unremarkable post-operative course. In the period immediately post transplantation the patient was on a four-drug immunosuppressive regimen which was subsequently changed to standard three-agent therapy. This therapy was continued until the patient became pregnant. In the first trimester only Cyclosporine (CsA) was used, and thereafter, the patient was continued on the previous three agent regimen. Toward the end of pregnancy a rise in systolic pressure was observed, but the child was delivered by spontaneous vaginal delivery without complications in the 38th week of pregnancy. The newborn weighed 3320 g and was in good health. A sharp fall in the newborn CsA blood levels was observed post delivery reaching zero level on the third day of life. At the present time, both mother and baby are in good health, 6 weeks after delivery.