[The use of echocardiography in visualisation of thoracic aorta. The role of intraoperative transoesophageal echocardiography (TEE)]. / Zastosowanie echokardiografii w obrazowaniu aorty piersiowej ze szczególnym uwzglednieniem sródoperacyjnego badania przezprzelykowego (TEE).

Transoesophageal echocardiography is an effective tool in visualisation of intrathoracic aorta. It is highly sensitive in diagnosis of aneurysms, atheromas, posttraumatic ruptures, abnormalities of aortic valve, and complications of bacterial endocarditis. It is superior to other methods in diagnosis of aortic dissection. It is rapid, cheap and can be done at the bedside. TEE is especially helpful in patients undergoing cardiac operations. It makes possible the detection of atheromatosis and assessment of plaque morphology in thoracic aorta. In cases with high risk of peripheral embolisation the surgical strategy is changed.

Early results of coronary artery bypass graft surgery in women.

BACKGROUND: Coronary artery disease is one of the leading causes of death among women in developed countries all over the world. Coronary artery bypass grafting (CABG) is a well established therapeutic modality to treat diffuse coronary artery atherosclerosis. AIM: In this study we focused on the retrospective assessment of the early results of CABG in women as compared to the results of such treatment in men. METHODS: This analysis involved 2881 patients (677 women and 2204 men) who underwent CABG between 2003 and 2005. An operative technique (conventional on-pump or off-pump) was applied in a similar proportion of patients in both groups (on-pump: 59.4% of women and 59.6% of men; NS). Women were older than men and had higher body mass index. Concomitant disorders such as diabetes mellitus, hypertension and hypercholesterolaemia were noted more frequently in female patients. RESULTS: In the perioperative period, left ventricular failure requiring intra-aortic balloon pump insertion and administration of high doses of catecholamines was observed significantly more often in women than in men (22.1 vs. 16.1%, respectively; p <0.001). Perioperative myocardial infarction was diagnosed more frequently in women (5.5 vs. 2.9%; p <0.001). In female patients, the rate of repeat operation was higher (8.9 versus 5.1%; p <0.001) and more subjects required blood transfusions (45.5 vs. 27.5%; p <0.001). Female gender featured a higher rate of postoperative acute renal failure requiring renal replacement therapy (8.5 vs. 0.95%; p <0.001). Mechanical ventilation was longer, and women stayed longer in the postoperative intensive care unit as well as in hospital. Early postoperative mortality among women was 3.6%, i.e. significantly higher than in male patients (1.6%) (p <0.01). CONCLUSIONS: The analysis performed herein suggests that mortality and morbidity after CABG is higher in women than in men.

[Acute renal failure as a complication of cardiac surgery]. / Ostra niewydolnosc nerek wymagajaca terapii nerkozastepczej jako powiklanie operacji serca.

We observed acute, postoperative renal failure requiring dialysis in 33 patients from the entire group of adult patients who received cardiac surgery in 2004 in The Silesian Center for Heart Diseases in Zabrze. Over 50% of these were qualified for emergency operation. During the early postoperative period all of the examined patients had cardiac failure and circulatory insufficiency requiring high doses of catecholamine and intraaortic balloon pump support. In the analyzed group of patients the frequency of multi-organ failure was high (neurologic dysfunction, the need for prolonged mechanical ventilation, mesenteric ischemia). Hemodiafiltration was used as a renal replacement therapy with the dialisate volume not exceeding 11/h. The volume of ultrafiltrate was regulated on the basis of fluid overload and directed to optimize intravascular filling. The average start of hemofiltration was the 3rd postoperative day and was continued for 5 days. The mortality rate in the analyzed group was 81.8%. The renal function substitution based on hemodiafiltration performed in the way described above is easy to start, easy to manage, generates low costs, nevertheless its efficacy is low.

Effect of leukocyte-depleted blood cardioplegia on the early outcome in patients with preserved left ventricular function undergoing surgical revascularisation.

BACKGROUND: It has been shown that leukocytes play one of the key roles in the myocardial reperfusion injury. AIM: To examine the effects of cardiac protection with leukocyte-depleted blood cardioplegia on the early outcome of patients with preserved left ventricular function who undergo surgical revascularisation. METHODS: The study group consisted of 58 patients with coronary artery disease (CAD) undergoing coronary artery bypass grafting (CABG) who were randomised to receive leukocyte-depleted blood cardioplegia (leukocyte filter Pall BC1B) (group A, n=29) or to receive standard blood cardioplegia (group B, n=29). Peri-operative mortality and morbidity as well as haemodynamical and biochemical parameters were compared between these two groups. RESULTS: No early death occurred. There were no statistical differences in clinical data between the groups. Only cardiac index measured 24 hours after declamping of aorta was significantly higher in group A than in group B (3.6+/-0.6 l/min/m(2) vs 2.95+/-0.45 l/min/m(2), p<0.05). Group B showed significant higher release of creatine kinase (CK) 6 and 12 hours, and CK-MB 6, 12, and 24 hours after unclumping the aorta whereas troponin I level was similar in both groups. CONCLUSIONS: The use of leukocyte-depleted blood cardioplegia during elective CABG did not improve the early outcome.

[Role of the hemostatic system in pathogenesis of atherosclerosis as the main etiology of coronary ischemia] [corrected]. / Rola ukladu hemostazy w patogenezie glównej przyczyny choroby niedokrwiennej serca w patogenezie miazdzycy [corrected]

Coronary artery disease is a leading cause of mortality in highly developed societies. This occurs in spite of growing therapeutic opportunities. Atherosclerosis begins as a functional or/and structural damage of endothelium, which in turn causes its discontinuation and impairs humoral and secreting function. Haemostasis plays an important role in the progression of atherosclerosis and development of cardiac complications--acute coronary syndromes. Research still continues to determine precisely role of each of haemostasis disorders in increased risk of coronary artery disease and its complications. The aim of this paper is to review the literature data concerning haemostatic risk factors and their role of development of coronary artery disease. Fibrinogen, thrombocytes, factor VII, factor VIII, von Willebrand factor (vWF), thrombomodulin (TM), plasminogen activator inhibitor--type 1 (PAI-1), tissue-plasminogen activator (t-PA) and other haemostatic factors, were described as more or less helpful in estimation of risk of occurrence of coronary artery disease and its cardiovascular complications. Only some of the described hematologic factors were verified so far in large prospective studies, and were recognized as independent risk factors of cardiovascular diseases.

[Role of the hemostasis in unstable angina pectoris]. / Rola ukladu hemostazy w niestabilnej chorobie wiencowej.

Haemostasis plays an important role in the development of cardiac complications--acute coronary syndromes. The thrombus formation in coronary arteries, related to unstable atherosclerotic plaque rupture is the basic pathogenesis of acute coronary syndromes. The balance between coagulation and fibrinolytic system influences on ruptured atherosclerotic plaque and following acute coronary syndrome. Critical narrow or total occlusion of the coronary artery could be a consequence of this interaction. Researches are continued to determine precisely role of haemostasis disorders in unstable angina pectoris. The aim of this paper is to review the literature data concerning haemostatic risk factors in unstable angina pectoris. Fibrinogen, thrombocytes, factor VIII, von Willebrand factor (vWF), thrombomodulin (TM), plasminogen activator inhibitor--type 1 (PAI-1), tissue-plasminogen activator (t-PA) and other haemostatic factors, play more or less essential role in unstable angina pectoris. However further investigations are needed to determine their utility and to search for new and better haemostatic factors of acute coronary syndromes.

[Role of inflammation and infection in the etiopathogenesis of atheromatosis--literature review]. / Rola procesów zapalnych i mikroorganizmów w etiopatogenezie miazdzycy--przeglad literatury.

The investigation of etiopathology of arteriosclerosis shows close relationship between inflammatory processes and evolution of sclerotic lesions. In many patients acute coronary syndromes are caused by the rupture of hemodynamically insignificant sclerotic lesion and consequently thrombosis of coronary artery. The reason of instability of sclerotic plaque may be on going inflammation inside it. This paper reviews literature on the subject of relationship of atheromatosis, inflammation and infection.

[Coronary artery bypass grafting in the elderly: early results]. / Pomostowanie tetnic wiencowych u chorych w wieku starszym--wczesne wyniki leczenia operacyjnego.

Indications for CABG (coronary artery bypass grafting) procedures are on the rise with ageing population. Because in the world literature there is not consensus on the elderly patients operative risk estimation we have conducted a retrospective analysis of 300 consecutive patients treated at Cardiac Surgery Department of Bialystok University Centre. The postoperative mortality and morbidity rates were assessed in an each case. 103 patients over 65 and 197 younger patients were included to the study. An operative risk was assessed according to EuroSCORE protocol and was higher in the elderly group. Strangely enough, this was not accompanied by higher mortality and morbidity rates, which were rather similar in the two groups. A female gender and an inclination to gastrointestinal bleeding were the independent risk factors in the elderly group. Probably diabetes mellitus is to be held for the higher mortality rate amongst them. In conclusion, the results of the presented investigation suggest that a biological and not a chronological age is essential in the qualification for CABG procedures.

[Neuropsychiatric complication after surgical procedures--literature review]. / Neuropsychiatryczne powiklania u chorych po operacjach serca z uzyciem krazenia pozaustrojowego--przeglad pismiennictwa.

2-3% of patients after cardiac procedures with the use of cardiopulmonary by-pass develop neurological complications with focal symptoms. Also to there may be mental, emotional and intellectual disturbances. This kind of complications occurs in 33-83% of patients. The post-cardiopulmonary by-pass delirium is a syndrome with diverse symptoms. Confusion, hallucinations, paranoid illusions, psycho-motoric excitation, fear may also occur. A high level of serotonin and overstimulation of 5-HT2 receptors in the central nervous system are the reason of delirium. The relief of symptoms may be achieved by intravenous administration of Ondansetron, an antagonist of 5-HT2 receptors.

[Acute normovolemic hemodilution together with aprotinin applied as a scheme of blood saving in cardiac surgery]. / Ostra normowolemiczna hemodylucja w polaczeniu z podawaniem aprotyniny jako schemat oszczedzania krwi w kardiochirurgii.

The risk of blood loss in open heart surgery procedures is related to a high level of homologous blood transfusion. Due to numerous possible complications connected with transfusion, as well as the increase in prices of blood preparations, methods of blood saving are of great interest. The aim of the study was to assess acute normovolemic hemo-dilution (ANH) efficacy and aprotinin administration in homologous blood usage limitations. The study was conducted in the group of 265 patients operated on during the period of 12 months. The control group consisted of patients operated on during the period 6 months. The scheme of ANH with the administration of aprotinin was applied in the second half-year period. A statistically significant reduction in the percentage of patients who required blood transfusions was observed (77.2%/53%). The scheme applied enabled to reduce procedure costs in regard to blood preparation purchase. The results have shown that ANH together with antifibrinolytic drug administration is not only an efficient but also profitable strategy of blood saving.