The Impact of Age on the Physiological Assessment of Borderline Coronary Stenoses.

Background and Objectives: Coronary angiography is the gold standard for diagnosing coronary artery disease (CAD). In the case of borderline changes, patients require further diagnosis through ischemia assessment via one of the recommended methods of invasive evaluation. This study aimed to assess whether clinical factors influence the risk of a positive result in invasive myocardial ischemia assessment and if these potential factors change with the patient's age and the consistency of ischemia assessment. Materials and Methods: Data were collected retrospectively on all consecutive patients hospitalized in the University Hospital in Krakow between 2020 and 2021, on whom physiological assessments of coronary circulation were performed. Patients were divided into two groups: patients aged 60 or younger and patients older than 60. Results: Despite the older patients having more risk factors for CAD, their physiological assessment results of borderline lesions were similar to those of the younger patients. Positive fractional flow reserve (FFR) assessments were obtained from almost 50% of vessels. In the younger patients, cigarette use and type 2 diabetes mellitus increased the risk of a positive FFR result by 3.5 and 2.5 times, respectively. In the older patients, male gender and peripheral vascular disease significantly increased the risk of a positive FFR by 2.5 and 2 times, respectively. Conclusions: Clinical characteristics of patients undergoing physiological assessment of borderline coronary stenosis varied significantly by age. Refining the definition of borderline lesions to include age, gender, and other factors may improve the identification of patients who would benefit from physiological assessment and coronary revascularization.

A 3D map of the lingual artery-The perfect tool for transoral robotic surgeries on the base of tongue.

BACKGROUND: Knowledge about the anatomy of the lingual artery (LA) is of immense importance when performing procedures on the base of tongue (BOT). METHODS: A retrospective analysis was performed to establish morphometric data of the LA. The measurements were performed on 55 consecutive patients who underwent head and neck computed tomography angiographies (CTA). RESULTS: A total of 96 LAs were analyzed. Additionally, a three-dimensional heat map (showing the oropharyngeal region from the lateral, anterior, and superior point of view) of the occurrence of the LA and its branches was created. CONCLUSION: The length of the main trunk of the LA was measured to be 31.94 ± 11.44 mm. This reported distance is thought to be a surgical safe zone when performing transoral robotic surgery (TORS) on the BOT because it represents the area where the LA does not give off any major branches.

The thoracoacromial trunk: a detailed analysis.

PURPOSE: The thoracoacromial trunk (TAT) originates from the second part of the axillary artery and curls around the superomedial border of the pectoralis minor, subsequently piercing the costocoracoid membrane. Knowledge about the location, morphology, and variations of the TAT and its branches is of great surgical importance due to its frequent use in various reconstructive flaps. METHODS: A retrospective study was conducted to establish anatomical variations, their prevalence, and morphometric data on TAT and its branches. The results of 55 consecutive patients who underwent neck and thoracic computed tomography angiography were analyzed. A qualitative evaluation of each TAT was performed. RESULTS: A total of 15 morphologically different TAT variants were initially established. The median length of the TAT was set at 7.74 mm (LQ 3.50; HQ 13.65). The median maximum diameter of the TAT was established at 4.19 mm (LQ 3.86; HQ 4.90). The median TAT ostial area was set to 13.97 mm (LQ 11.70; HQ 18.86). To create a heat map of the most frequent location of the TAT, measurements of the relating structures were made. CONCLUSION: In this study, the morphology and variations of the branching pattern of the TAT were presented, proposing a new classification system based on the four most commonly prevalent types. The prevalence of each branch arising directly from the TAT was also analyzed. It is hoped that the results of the present anatomical analysis can help to minimize potential complications when performing plastic or reconstructive procedures associated with TAT.

Assessment of the implementation level of the guidelines for secondary prevention of cardiovascular disease in everyday clinical practice.

BACKGROUND: The goal of secondary prevention is to hinder the recurrence of cardiovascular events in patients already diagnosed with cardiovascular diseases. AIMS: We aimed to assess the level of adherence to guidelines for secondary prevention of cardiovascular disease in everyday clinical practice. METHODS: This was a single­center retrospective analysis of 460 consecutive rehospitalized patients previously diagnosed with coronary artery disease. The presence of main risk factors for cardiovascular disease was analyzed in this cohort. RESULTS: Overall, 80.7% of patients did not comply with the body mass index recommendations. Among nondiabetic patients, 43.5% exceeded the recommended blood glucose level and 55.5% of diabetic patients exceeded the recommended level of glycated hemoglobin. Total cholesterol level was higher than recommended in 13.5% of patients, the level of low­density lipoprotein (LDL) cholesterol was exceeded in 78.7% individuals, and the level of triglycerides was over the limit in 30.2% of patients. Systolic and / or diastolic blood pressure higher than or equal to 140/90 mm Hg was recorded in 41.3% of patients. Low level of physical activity was declared by 56.7% of the studied patients and 14.6% of them admitted to being current tobacco smokers. No patient fulfilled all of the main prevention goals (body weight, no smoking, LDL cholesterol level, glucose level, systolic and / or diastolic blood pressure) and in 10.2% of cases none of the above­mentioned criteria were achieved. Significant difference in the implementation level of the guidelines was found between the sexes, with men showing lower adherence than women. CONCLUSIONS: The level of adherence to the guidelines for secondary prevention of coronary artery disease was extremely low, with men being worse responders than women.

Anatomy of the mitral subvalvular apparatus.

OBJECTIVES: To characterize morphologic variations in the papillary muscles and tendinous cords of the left ventricle and ventricular zones of the mitral valve leaflets. METHODS: A total of 100 autopsied human hearts from healthy donors with classical mitral valve type were investigated. RESULTS: In 1 heart, only 1 group of papillary muscles was found, and in the remaining 99%, we could distinguish 2 groups of muscles: Superolateral (SLPM) and inferoseptal papillary muscle (ISPM) groups. The SLPM group had 1 papillary muscle (75.8%), 2 in 20.2%, and >3 in 4.0%. In the ISPM group, the muscle percentages were 38.4%, 36.4%, and 25.2%, respectively. The apex of at least 1 papillary muscle was situated higher than the plane of the opened anterior leaflet (AML) in 47.5% and 50.5% for the SLPM and ISPM groups, respectively. The number of strut cords arising from the SLPM group was 0 (2.0%), 1 (50.5%), 2 (33.3%), 3 (12.1%), and 4 (2.0%), and from the ISPM group was 0 (6.1%), 1 (52.5%), 2 (35.4%), or 3 (6.1%). Cords to left ventricular outflow tract were present in 14 specimens. Muscular cords were found in eight hearts. In all hearts specimens AML had rough and clear zones. The classical zones (rough, clear, and basal) in the posterior mitral leaflet were observed in 38.4%. CONCLUSIONS: There is a high variability in the papillary muscles and tendinous cords in the mitral valve complex. Proper nomenclature, simple classification, and the most common variants for papillary muscle groups and tendinous cords were presented.

In-hospital and long-term outcomes of percutaneous balloon aortic valvuloplasty with concomitant percutaneous coronary intervention in patients with severe aortic stenosis.

BACKGROUND: Severe aortic stenosis (AS) often coexists with significant coronary artery disease. OBJECTIVE: To evaluate procedural complications and long-term outcomes of patients with severe AS undergoing balloon aortic valvuloplasty (BAV) and percutaneous coronary intervention (PCI). METHODS: A total of 97 patients with severe AS underwent 104 BAVs as palliative procedure, bridge to definitive treatment, or before urgent non-cardiac surgery. Patients were followed-up for at least 12 months. RESULTS: Of the 97 patients, 34 (35.0%) underwent standalone BAV, 45 (46.4%) underwent BAV with coronary angiography, and 18 (18.6%) BAV with PCI. There were no differences in baseline characteristics and indications for BAV among the groups (P > 0.05). No higher risk of complications after BAV performed with concomitant coronary angiography/PCI was observed. Transcatheter aortic valve implantation was performed after BAV in 13 (13.4%) patients and surgical aortic valve replacement in three (3.1%) patients. In spite of no difference in in-hospital mortality (5.6% vs. 8.9%; P = 0.76), patients with BAV and concomitant PCI had lower long-term mortality than patients with BAV and concomitant coronary angiography (28.5% vs. 51.0%; P = 0.03). In multivariable Cox analysis adjusted for age, sex, and body mass index, the Society of Thoracic Surgeons Predicted Risk of Mortality score was identified as the only independent predictor of long-term mortality for all patients (HR: 1.09, 95%CI: 1.04-1.15, P = 0.0006). CONCLUSIONS: Concomitant PCI or coronary angiography performed with BAV may not increase the risk of major and vascular complications. Patients with BAV and concomitant PCI may have better survival than patients with BAV and concomitant coronary angiography.

"Heart without smoke" educational campaign - the role of patient education in secondary prevention of cardiovascular disease.

BACKGROUND: Nicotine addiction is the strongest factor in the increase of the risk of recurrent ischaemic events. AIM: The aim of the study was to analyse the effectiveness of a smoking cessation educational programme in a population of patients hospitalised with acute myocardial infarction within the "Heart without smoke" campaign. METHODS: In this study, we included 100 consecutive patients, active smokers, hospitalised with acute myocardial infarction (STEMI or NSTEMI) at the Centre for Invasive Cardiology, Angiology, and Electrotherapy in Pinczow, Poland in the period from January to December 2015 (12 months). Patients were participants in the educational campaign about tobacco addiction "Heart without smoke". RESULTS: At one-month follow-up observation: 61 patients had quit smoking and an additional 35 had decreased the number of cigarettes smoked per day. During six-month follow-up interview: 51 patients did not smoke cigarettes (13 had returned to smoking, three had additionally stopped smoking, one person had died). There were no statistically significant correlations between smoking cessation and gender (p = 0.4; p = 0.2), age (p = 0.8; p = 0.8) and length of prior smoking habit (p = 0.8; p = 0.5) and daily cigarette consumption before myocardial infarctions (p = 0.3; p = 0.3), one month, and six months after hospital discharge, respectively. CONCLUSIONS: Constant education of patients after myocardial infarction was an effective method for smoking cessation in over 50% of smokers six months after myocardial infarction.

Morphologic variability of the mitral valve leaflets.

OBJECTIVES: The rapid development of surgical and less-invasive percutaneous mitral valve repair procedures has increased interest in mitral valve anatomy. We characterize the morphologic variability of the mitral valve leaflets and provide the size of their particular parts. METHODS: We studied 200 autopsied human hearts from white individuals without any valvar diseases. We measured the intercommissural and aorto-mural diameters of the mitral annulus and identified the leaflets and their scallops. We also noted the base and the height of the inferoseptal commissure, superolateral commissure, anterior mitral leaflet, and posterior mitral leaflet with their scallops. RESULTS: Variations in posterior mitral leaflet were found in 55 specimens (27.5%), and variations in anterior mitral leaflet were found in 5 hearts (2.5%). The most common variations included valves with 1 accessory scallop between P3 and inferoseptal commissure (7%), accessory scallop between P1 and superolateral commissure (4%), connections of P2 and P3 scallops (4%), connections of P1 and P2 scallops (3%), and accessory scallop in anterior mitral leaflet (2.5%). CONCLUSIONS: In all cases, the mitral valve is built by 2 main leaflets with possible variants in scallops (29.5%). The variations are largely associated with posterior mitral leaflet and are mostly related to the presence of accessory scallop. Anatomically, the anterior mitral leaflet is not divided into scallops, but could have an accessory scallop (2.5%). Understanding the anatomy of the mitral valve leaflets helps with the planning and performing of mitral valve repair procedures. Variations in scallops may affect repair procedures, but unfortunately cannot be predicted by any of the annular sizes.