Inhaled corticosteroid improves bronchial reactivity and decreases symptoms in patients with mitral stenosis.

STUDY OBJECTIVE: To determine if treatment with inhaled budesonide forte can diminish increased bronchial hyperreactivity and improve symptoms in patients with mitral valve stenosis. DESIGN: The study was randomized, double blind, and placebo controlled. SETTING: Outpatient/university hospital. PATIENTS: Twelve subjects, 8 female and 4 male, who qualified for mitral valve replacement. All subjects presented with increased bronchial reactivity to histamine at the time of the study. INTERVENTIONS: Patients received placebo or budesonide forte twice a day (1,200 mg/d) for 6 weeks. During the study, patients were treated with the same doses of diuretics and other medications that could affect bronchial reactivity. MEASUREMENTS: Spirometry, provocative concentration of histamine causing a 20% fall in the FEV1 (PC20H), symptom scores. RESULTS: In the treated group, the initial PC20H was 0.82+/-0.72 mg/mL; in the placebo group 1.39+/-1.3 mg/mL. After 6 weeks of treatment, PC20H was significantly higher (3.07+/-2.28 mg/mL; p > 0.01) in the budesonide-treated group and remained unchanged in the placebo group (1.49+/-0.91). Symptom scores were significantly lower after administration of budesonide forte (mean change, 4.0+/-2.6). CONCLUSIONS: Six weeks of treatment with budesonide forte significantly decreased bronchial reactivity to histamine and improved symptoms in patients with mitral valve stenosis.

Electrophysiologic properties of transplanted human heart with and without rejection.

Twelve male heart transplant recipients underwent routine electrophysiologic evaluation. None were taking cardioactive drugs, and only two had symptoms of arrhythmia. Two patients had endocardial VVI pacemakers because of previous early sinus node dysfunction. With simultaneous endomyocardial biopsy, we found seven patients with no evidence of rejection (group 1) and five patients with mild rejection (group 2; three initial or mild; two definite rejection). In two group 1 patients with presyncope, corrected sinus node recovery time was prolonged, and pacemakers were implanted into the endocardium. In all patients atrioventricular conduction was normal. One patient had evidence of functional duality of anterograde atrioventricular nodal conduction. In group 2 patients prolongation of effective refractory period of the donor atrium, functional refractory period of the atrioventricular node, and effective refractory period of the right ventricle were observed. This prolongation of refractoriness may be one of the earliest markers of rejection.

Protective influence of pretreatment with allopurinol on myocardial function in patients undergoing coronary artery surgery.

Xanthine oxidase is responsible for the release of free oxygen radicals during myocardial reperfusion. Allopurinol was shown to be an effective inhibitor of this reaction in the laboratory experiments, but not in patients. Thirteen male patients undergoing routine coronary artery bypass graft surgery were treated with allopurinol in doses of 15 mg/kg per day for 4 days before the operation. Haemodynamic function in the early period after cardiopulmonary bypass, ECG, enzyme release and ultrastructural findings in this group were compared with those in a control group of 13 male patients matched for age distribution and stage of coronary disease. Left ventricular stroke work index was higher in the treatment group 10 min (P less than 0.001) and 15 min after termination of cardiopulmonary bypass (P less than 0.01) and also 2 h later (P less than 0.02). In the early post-operative recovery phase fewer episodes of arrhythmia were observed in this group of patients (P less than 0.001). Electron microscopy studies of the myocardium and CK and CK-MB release showed no significant differences between groups. Thus, allopurinol may have a protective effect on the human ischaemic myocardium in the early period of reperfusion.

Biocompatibility of extracorporeal circulation with autooxygenation.

Platelet damage, complement activation and neutropenia during cardiopulmonary bypass are the result of blood contact with artificial surfaces, mainly in the oxygenator. To evaluate biocompatibility of this kind of bypass we compared two techniques of extracorporeal circulation in 40 patients undergoing elective coronary bypass operations. In 20, a standard technique with a bubble oxygenator was used (group 1), and in the remaining 20 patients with autooxygenation, the patients' own lungs were included in the perfusion circuit (group 2). Several blood samples were taken before, during and after perfusion to estimate the corrected platelet numbers and pulmonary leucocyte sequestration in all patients, and additionally in 6 patients from each group, complement C3a and C5a anaphylatoxins were measured (radioimmunoassay). At the end of cardiopulmonary bypass, the decline of platelet number corrected to haematocrit platelet number in group 1 was significantly higher than in group 2 (P less than 0.01). There was a significant increase in circulating white blood cells when compared to pre-bypass time in both groups (P less than 0.05). However, comparison of differences between leucocyte counts in the blood of the patients' right and left atria showed enhanced leucocyte sequestration in group 1, 1.46 +/- 0.5 x 10(3)/mm3 vs only 0.34 +/- 0.2 x 10(3)/mm3 in group 2. The C3a rose progressively during extracorporeal circulation: in group 1 from 268 +/- 46 ng/l to 521 +/- 65 ng/l, and in group 2 from 244 +/- 46 ng/l to 418 +/- 34 ng/l (P less than 0.05). No characteristic changes in C5a activation were observed in either group.(ABSTRACT TRUNCATED AT 250 WORDS)

Follow-up of infants after systemic-pulmonary shunts, performed with fresh frozen vein homografts. Postoperative angiographic assessment.

Ten of twenty-six modified Blalock-Taussig shunts performed with fresh frozen vein homograft were studied angiographically. In two of them the shunt was stenosed. The remaining eight shunts were satisfactory. Among them in four irregularities of the inner surface and in four spindle shape of the shunt were observed. The diameter ratio between subclavian artery and homograft at the time of operation and later as seen on the angiograms did not change. This suggests that spindle shape of homograft is caused by growth rather than by aneurysm formation.

Serum beta-2-microglobulin (beta-2-M) levels in heart transplant patients (HTP).

UNLABELLED: The present paper aim to answer following questions: 1. What is serum beta-2-M levels in HTP? 2. Does significant correlations between serum beta-2-M levels and serum creatinine levels or creatinine clearance (inulin clearance) exit? 3. Does any significant correlation between serum beta-2-M levels and blood cyclosporine A concentration exit? Three groups of subjects were studied. The first group consisted of 33 heart transplant patients (HTP), the second group consisted of 12 patients with small decline kidney function, and the third one consisted of 36 healthy subjects. In all examined subjects serum beta-2-M (RIA) creatinine, creatinine and inulin (steady state dosis method) clearance were assessed. CONCLUSION: 1. In observed HTP serum beta-2-M level is significantly higher then in controls and patients with small decline kidney function; 2. A significant correlation between kidney function and -2-M level in HTP as well as in other examined groups subjects exit; 3. Presence a significant positive correlation between serum beta-2-M level and blood cyclosporine A concentration suggest that beta-2-M level can be a good parametr to define cyclosporine A tubular toxicity.

Robin Heart 2003--present state of the Polish telemanipulator project for cardiac surgery assistance.

The Polish telemanipulator (Robin Heart), for use in cardiac surgery, has been realized by the Foundation of Cardiac Surgery Development in Zabrze, Poland, in cooperation with specialists from the Technical University of Lodz and Warsaw University of Technology. The brief history of robotic surgery and fundamental advantages of employing robots in this field--safe, reliable and repeatable operative results with less patient pain, trauma and recovery time--follow the assumptions of the Polish Cardio-Robot project. The cardiac surgery robot, Robin Heart, is an original construction with a segment type structure which allows the various combination of its parts for different types of surgery. The telemanipulator for cardiac surgery will consist of two arms equipped with tools and one arm holding the camera. Several models suitable for surgeon contact systems, using the experience of centers designing the artificial hand and haptic systems have been worked out. The detailed mechanical analysis and original construction of main parts of the robot and development of the surgical planning system are presented in further sections.

Atrial natriuretic peptide secretion in heart transplant patients.

Plasma atrial natriuretic peptide (ANP), plasma renin activity (PRA), aldosterone (ALD) and vasopressin (VP) were assessed in six heart transplant patients (HTP) and ten healthy subjects under bed rest conditions and 60 and 120 minutes after head-out water immersion (WI). Bed rest had no significant influence on these parameters. WI raised plasma volume (PV) to the same extent in both groups. This increase of PV was accompanied by significant suppression of PRA, ALD and VP and an increase of plasma ANP. In HTP basal plasma ANP was significantly elevated and the ANP response to central hypervolemia reduced. Significantly elevated VP plasma levels were also found in HTP. These endocrine abnormalities in HTP seem to be caused by latent failure of the transplanted heart. No direct correlation was found between plasma ANP and PRA, ALD and VP under basal conditions and after WI in either HTP or normals.

Coarctation of the aorta with right aortic arch. A rare case and atypical clinical picture.

We report the case of a 13-year-old girl with a diffusely hypoplastic right aortic arch, anomalous origin of the left subclavian artery, and a small, insignificant ventricular septal defect. The patient's pulse was forceful at the carotid arteries, but it was markedly weaker at all extremities. Catheterization revealed that both common carotid arteries arose from the dilated ascending aorta; the right subclavian and vertebral arteries arose from the hypoplastic posterior segment of the aortic arch, and the left subclavian artery arose from the normally developed descending aorta. The pressure gradient between the ascending and descending aorta was 80 mmHg. A bypass grafting procedure was performed to connect the ascending and the upper abdominal aorta. No pressure gradient remained after the operation, nor was a gradient detected during 2 years of follow-up. The origin of both subclavian arteries distal to the area of coarctation resulted in an atypical clinical picture and delayed diagnosis. Ten previously reported cases of coarctation of the aorta with right aortic arch are reviewed.

[Effect of water immersion on the cortisol, glucose, growth hormone and prolactin levels in patients with transplanted heart]. / Kortyzol, glukoza, hormon wzrostu i prolaktyna u chorych z przeszczepionym sercem w warunkach immersji wodnej.

In 6 heart transplant patients (HTP) and in ten healthy subjects the influence of head out water immersion (WI) on blood levels of glucose, cortisol, somatotropic hormone (HGH) and prolactin was examined. Under baseline conditions. HTP showed similar blood levels of the above mentioned parameters as normals. After WI a significant increase of blood HGH but decrease of blood cortisol and prolactin were found in both examined groups. HTP differed from healthy subjects only by a less marked decline of blood cortisol induced by WI. Data obtained in this study suggest presence of a preserved physiological endocrine response of HTP to WI.

[Effect of water immersion on glucose, insulin and atrial natriuretic factor levels in patients with transplanted heart]. / Glukoza, insulina i przedsionkowy czynnik natriuretyczny u chorych z przeszczepionym sercem w warunkach immersji wodnej.

In 6 heart transplant patients [HTP] and in 10 healthy subjects the influence of water immersion [WI] on blood levels of glucose, insulin and atrial natriuretic peptide [ANP] were studied. HTP showed significantly higher baseline ANP levels and a reduced response of ANP to water immersion as compared with normals. HTP did not differ from normals by baseline plasma levels of glucose and insulin. WI induced significant decline of blood glucose and increase of insulin in both examined groups. A significant correlation was found between WI induced increase of blood insulin and ANP and between the increase of ANP and decline of blood glucose both in HTP and in healthy subjects. Data presented in this paper suggest existence of a significant relationship between ANP and insulin secretion and participation of ANP in the carbohydrate metabolism both in normals and HTP.

[Cardiogenic shock. Surgical reperfusion and myocardial revascularization]. / Wstrzas kardiogenny. Chirurgiczna reperfuzja i rewaskularyzacja miesnia sercowego.

Emergency coronary bypass for cardiogenic shock has been associated with a high operative mortality. From February 1986 through October 1989, 40 patients with acute myocardial infarction were operated. Ten pts (25%) were in shock despite intensive treatment (intra-aortic balloon pump in 4, catecholamines in 10). Seven pts. required cardiopulmonary resuscitation before operations. After operations 66% of the patients required catecholamine support and 60% were treated with intra-aortic balloon pump. There were three (30%) hospital deaths (one in the operating room due to acute cardiac failure). Follow-up (100%),(mean 26 months) revealed one late death--39 months after operations. In functional class I were 2 patients, II--one, and III--two pts. One pt is in group IV (transplant candidate). Myocardial infarction complicated by cardiogenic shock can produce a mortality rate in excess of 85%. Contemporary medical management has had little effect on mortality, hence effective surgical therapy has evolved for this lesion.

[A case of direct right pulmonary artery-left atrium fistula]. / Przypadek bezposredniej przetoki prawej tetnicy plucnej do lewego przedsionka.

An unusual case of cyanotic heart disease in a 20-year-old male has been presented. Cyanosis was due to right to left shunt through direct right pulmonary artery--left atrium fistula. After successful operative ligation of the fistula, the patient got rid of cyanosis and is doing well.

[Implantation of an automatic cardioverter-defibrillator--case report]. / Wszczepienie automatycznego defibrylatora-kardiowertera serca--opis przypadku.

Authors present a case of a female patient with abundant attacks of rapid ventricular tachycardia and ventricular fibrillation, frequently resuscitated, who received an automatic cardioverter--defibrillator (AICD)--Ventak 1520 (CPI). Sooner 5-month pharmacotherapy with attainable drugs was deceptive. Operative and postoperative period was uncomplicated. During late 24-month follow-up 27 times a shock was delivered by the implanted cardioverter. Full patient's recovery was observed.

[Surgical treatment of paroxysmal ventricular tachycardia (personal observations)]. / Chirurgiczne leczenie napadowego czestoskurczu komorowego (doswiadczenia wlasne).

Five patients with recurrent VT/VF resistant to medical treatment were successfully treated surgically. In 3 patients excision of the altered endocardium by Harken's method (endocardial peeling) was done; in 2 of the patients it was preceded by intraoperative electrophysiological study. Two other patients were treated alternatively: a 45-year old patients with post-MI cardiomyopathy had a cardiac transplantation and a 57-year old patient with good left ventricular function an implantation of a automatic cardioverter-defibrillator (AICD). No patient had VT and/or VF during the 14-35 month follow-up. Exercise tolerance improved in all patients. Good short- and longterm results of surgical treatment show that these methods can be effective in treating patients with life-threatening arrhythmias resistant to pharmacological therapy.

[Personal observations with application of auto-oxygenation techniques in the surgical management of coronary disease]. / Doswiadczenia wlasne z zastosowaniem techniki autooksygenacji w chirurgicznym leczeniu choroby wiencowej.

There were presented operative technique and clinical results of extracorporeal circulation (ECG) with patients lungs utilization, instead of routinely applied artificial blood oxygenators. Auto-oxygenation method was applied in 12 patients with coronary artery disease treated by coronary artery bypass grafting (CABG). Operative procedure differs from the traditional one in two additional cannulations of pulmonary artery and left atrium. Two peristaltic pumps and incorporated in circulation blood reservoirs. Polystan 892910 allows for temporary substitution of cardiac function without lung disconnection. Lungs functioning during surgery do not render it difficult. Hypothermia enables to decrease respiration rate and tidal volume with no effect on physiological blood oxygenation and CO2 exhalation. Method assessment was based on results comparison with those obtained in patients treated by traditional method using bubble oxygenators-Venotherm 5,000. PO2, PCO2, platelets number and hemolysis extent were assessed before, in 10, 30, 60 min of ECG and just after it. Platelets activity and influence of the method on hemostatic disorders were evaluated based on clotting time by Ivy. Additionally hemostatic disorders were assessed by thoracic blood drainage volume calculated from the moment of protamine administration to drainage tubes withdrawal in average 18 hours after surgery. Laboratory parameters characteristically changing during ECG were also estimated. It was proved, that auto-oxygenation diminished negative effects of ECG. Increased platelets number, faster normalization of clotting time and decreased postoperative drainage were stated in the auto-oxygenation group. Postoperative drainage in this group was 260 +/- 60 ml in comparison with 800 +/- 100 ml of the control group. Authors consider that pulmonary function remaining during ECG positively affects on postoperative hemostasis. This method can be helpful in surgical management of coronary artery disease, especially in patients with primary coagulation disorders.

[Angioplasty of the ostium of the left coronary artery using a venous patch]. / Plastyka ujscia lewej tetnicy wiencowej przy uzyciu laty zylnej.

Isolated critical ostial stenosis of the left main coronary artery (LMCA) without narrowing in the distal parts of coronary vessels is rather rare cause of angina. It was observed in 7 our patients: 5F and 2M aged 42-55 yrs (mean 47.5). Five of them were in unstable condition. In all of them a direct surgical angioplasty of the LMCA was performed. Cardiopulmonary bypass with moderate hypothermia were used in all patients. The LMCA was approached from behind. A curved incision was made into the right lateral aortic wall toward the LMCA. Care was taken to stay away from the commissure between the noncoronary and the left coronary cusp. The posterior aspect of the LMCA was incised across the stenosis and prolonged through bifurcation. A venous onlay patch was used to enlarge not only the LMCA but also the adjacent 2 cm of aortic incision, so as to give the LMCA ostium a funnel shape, which favors a homogeneous blood flow. The mean aortic cross clamping time was 46 min. The patients were easily weaned from cardiopulmonary bypass. The early and late results are good--all patients were discharged from the hospital free of symptoms. In 6 patients a perfect patency of the left main stem was documented during control coronarography. In our opinion direct surgical angioplasty of LMCA is better then the conventional surgical treatment because normal geometry of LMCA ostium and normal blood flow can be restored using this method.

[Use of cardiopulmonary bypass decreases leukocyte count and activation of the complement system]. / Zastapienie utleniania pozaustrojowego plucami chorego w krazeniu pozaustrojowym--zmniejsza aktywacje leukocytów i ukladu dopelniacza.

Platelet damage, complement activation and neutropenia during extracorporeal circulation are the result of blood contact with artificial surfaces, mainly in the oxygenator. To evaluate the biocompatibility of the ++auto-oxygenation technique of cardiopulmonary bypass (CPB) 2 techniques of extracorporeal circulation were compared in 40 patients undergoing elective coronary bypass surgery. Patients were studied in 2 groups, 20 patients in each: I (++auto-oxygenation --patients lungs used in CPB) and II (conventional technique of CPB with bubble oxygenator). Several blood samples were taken before, during and after perfusion to estimate pulmonary leukocytes sequestration in all patients and additionally complement C3a and C5a anaphylatoxins + were measured (radioimmunoassays) in 6 patients of each group. During cardiopulmonary bypass the decline in leukocyte number was observed in both groups, but leukocyte count was higher in group I then II, due to the transpulmonary leukocyte sequestration which was higher in group II. The difference between leukocytes count in group II was 1.46 +/- 0.5 x 10(3)/mm3 vs only 0.34 +/- 0.2 x 10(3)/mm3 in group I, p less than 0.001. In postoperative period an increase in circulating white blood cells was observed in both groups when compared to pre-bypass time, but the difference between groups was non significant. The level of C3a increased in group I from 244 +/- 46 ng/ml to 418 +/- 34 ng/ml, in group II from 268 +/- 46 ng/ml to 521 +/- 65 ng/ml, p less than 0.001, but in group I the levels were significantly lower, p less than 0.001. The current study confirms that cardiopulmonary bypass results in significant leukocyte and complement activation and supports the theoreticaly better biocompatibility of CPB with lung over oxygenator.

[Anatomical correction of transposition of the great arteries in 7 newborn infants]. / Korekcja anatomiczna przelozenia wielkich pni tetniczych u siedmiu noworodków.

In the presented article, the course and results of anatomical correction of transposition of great arteries (TGA) in 7 neonates (2 females and 5 males) with mean body mass of 3250 g and 2 to 5 days old (mean 3 days) are reviewed. Surgery was performed in moderate hypothermia. St. Thomas cold cardioplegia was used. Mean aortic clamping time was 70 min (55-115), and the time of extracorporeal circulation was 165 min (117-210). Low cardiac output in all patients in the postoperative period required prolonged mechanical ventilation and positive inotropic drugs. Out of 7 patients operated, two died (29%). The cause of death in both cases was myocardial ischemia of right ventricle. The other 5 patients were discharged after healing of operational wound. In the control echocardiographic examination performed 3 to 12 months postoperatively, apart from one case of moderate pulmonary artery stenosis, no other haemodynamically significant complications were noted.

[Concentration of myoglobin in serum in patients with heart transplantation]. / Stezenie mioglobiny w surowicy krwi u chorych z przeszczepionym sercem.

The studies were carried out, the aim of which was the answer to question what are the changes of myoglobin concentration in patients after heart transplantation. For this purpose, 31 healthy persons being the control group (C) and 15 patients after heart transplantation (HTP) were studied. In both groups myoglobin concentration was determined by the RIA method, finding no statistically significant differences in changes of this parameter between the two studied groups. However, the nephrotoxic effect was confirmed of cyclosporin A which was continuously taken by the patients after heart transplantation, expressed as the decrease of creatinine clearance.