[Vascular rings as a cause of the respiratory disturbances in children]. / Pierscienie naczyniowe jako przyczyna zaburzen oddychania u dzieci.

Vascular rings are an infrequent cause of tracheal and/or oesophageal compression in infants and children. The authors present 11 cases of vascular rings in children from 3 months to 15 years of age. There were: double aortic arch in 5 cases, right aortic arch with left arterial ligament in 1 case, aberrant right subclavian artery in 2 subjects and pulmonary artery sling in 3 patients. The diagnosis was established on the basis of chest X-ray examination, echocardiographic examination, bronchoscopy, angiography and magnetic resonance imaging. Surgical correction was performed in all patients with good primary results. One infant died after several months after operation because of respiratoty system complications. As many as ten subjects were sent to paediatric cardiology unit from pulmonary departments where for the first time a suspicion of vascular ring existance was undertaken. All of them were previously diagnosed and treated in paediatric hospitals, usually as bronchial asthma. It is stressed that in every case of unexplained chronic coughing it is necessary to perform at least lateral X-ray examination of the chest with contrast in oesophagus.

Minimally invasive saphenous vein harvesting for coronary artery bypass grafting--comparison of three less invasive methods.

INTRODUCTION: Saphenous vein is routinely harvested using one or a few long continuous skin incisions. This method is associated with typical healing complications such as oedemas, pain, necrosis, what often restricts proper rehabilitation. An alternative minimally invasive techniques may decrease these complications. MATERIAL AND METHODS: This prospective randomised trial compared outcomes associated with saphenous vein harvested using three minimally invasive techniques versus a traditional longitudinal incision. RESULTS: In the less invasive group we observed statistically significant improvement in all estimated parameters of wound healing, oedemas and pain. We present also costs analysis between the groups. CONCLUSIONS: We conclude that less invasive techniques of saphenous vein harvesting may be alternatively introduced in coronary bypass surgery.

[Pulmonary artery sling--diagnostic difficulties]. / Sling tetnicy plucnej--trudnosci diagnostyczne.

The pulmonary artery sling is a very rare vascular anomaly which consists in improper branching off and course of the left pulmonary artery. This artery presses on the trachea causing significant symptoms on the part of the respiratory system such as dyspnea, stridor or cyanosis. The authors present the case of a 17-month-old boy who had dyspnea incidents for several times while the reason was unknown. It was only after the X-ray examination of the chest with barium in the esophagus was carried out alongside the bronchoscopy, followed by the echocardigraphic and angiocardiographic examinations that the pulmonary artery sling was found to be reason for those incidences.

A congenital defect of the pericardium.

Ten patients with congenital defects of the pericardium were treated in Departments of Cardiac Surgery, Silesian School of Medicine in Zabrze and Katowice between 1989 and 1998. There were eight children and two adults, eight males and two females. In each case the pericardial defect was discovered intraoperatively during surgery for congenital heart defect. There were no cases with clinical symptoms that could be clearly related to the defect of the pericardial sac. In the case of a child with a complete absence of the left pericardial wall the heart was significantly rotated contrary to the defect. The final outcome of the congenital heart defect surgery was satisfactory in each case. An abbreviated historical review of the diagnosis and treatment of the pericardial defects is presented with special attention placed on therapeutic management. Surgical correction of pericardial defects is concluded to be justified in patients with clinical symptoms. In most cases pericardial defects are discovered intraoperatively, but when they are large the said defects do not require any treatment.

[Collagen metabolism disturbances with experimentally increased pulmonary flow--experimental model of left to right shunt with congenital heart defects in children]. / Zaburzenia metabolizmu kolagenu w doswiadczalnie wywolanym zwiekszonym przeplywie plucnym--model eksperymentalny przeciekowych wad wrodzonych serca u dzieci.

The studies carried out on young piglets were to demonstrate that experimentally increased pulmonary flow resulted in collagen hyperproduction in the pulmonary tissue. In 14 piglets a modified Blalock-Taussig anastomosis was performed, 9 animals constituted the controls. The survivors included 9 experimental and 8 control piglets. In direct lung biopsies the biochemical collagen content was assessed, whereas histopathology confirmed the development of vascular lesions characteristic for pulmonary hypertension. A significant increase of collagen level in the pulmonary tissue was demonstrated in experimental animals. Determinations were also made of serum and urine hydroxyproline values. A significant increase was observed in serum and urine hydroxyproline values in experimental animals in comparison to the controls when determinations were made 7 days to 3 months after the anastomosis had been performed (p < 0.01). The authors showed that an increase of pulmonary flow in piglets results in collagen metabolism disturbances which are seen both in an increased collagen level in the tissue and in increased serum and hydroxyproline levels.

[Hydroxyproline in serum and urine in children with pulmonary hypertension in the course of congenital heart defects]. / Hydroksyprolina w surowicy i moczu u dzieci z nadcisnieniem plucnym w przebiegu przeciekowych wad wrodzonych serca.

In accordance to contemporary views on the pathology of biochemical changes in the fibrotic process at pulmonary hypertension, the authors took a trial to investigate the convection of excessive blood flow through lungs and changes of collagen metabolism in lungs. The possibility of following the metabolism of collagen through naming its metabolites (hydroxyproline-Hp) made us to connect the intended surveys with practical trail of its use, and diagnostic methods at children with congenital shunt cardiac defects. The survey was taken up in three groups of children with different levels of pulmonary advancement hypertension process: 39 children with dynamic elevation of pulmonary artery pressure (I st and II nd group age range: 12 months to 2 years), and 17 children with marks of pulmonary vascular obstructive disease. III rd group age range: 12 months to 6 years. It was stated, that between children from the first and second group before operational treatment, clear growth of Hp contents in serum and in urine returned to its correct value within the 1 to 6 months observation period since the cardiac defect has been corrected. In the third group, in spite of surgical treatment, the increased Hp content remained in the post operative period, therefore testifying the non-retreated fibrotic changes. It was stated, that Hp content control in serum and excretion in urine can possess clinical usage as an auxiliary exam estimating the advancement of pulmonary hypertension before surgical treatment and at the post-operative monitoring of the lungs.

Improved biocompatibility of extracorporeal circulation by the use of auto-oxygenation instead of artificial oxygenator in perfusion circuit.

The aim of this study was to determine the biocompatibility of an auto-oxygenation technique of cardiopulmonary bypass. Forty patients undergoing coronary bypass surgery were studied in two groups: A (auto-oxygenation, patients' lungs used in cardiopulmonary bypass) and B (conventional technique of cardiopulmonary bypass with bubble oxygenator). The platelet count decreased to -73% of initial value in group B vs only -27% in group A, P less than 0.001. Platelet aggregation to ADP decreased slightly in group A and hardly at all in group B, P less than 0.001. A transpulmonary leukocyte sequestration was greater in group B: 1.46 +/- 0.5 x 10(3)/mm3 vs only 0.34 +/- 0.2 x 10(3)/mm3 in group A, P less than 0.001. The level of C3a increased in group A from 244 +/- 46 ng/ml to 418 +/- 34 ng/ml and in group B from 268 +/- 46 ng/ml to 521 +/- 65 ng/ml, P less than 0.001, but in group A the levels were significantly less, P less than 0.001. The current study clearly confirms the superior biocompatibility of cardiopulmonary bypass with lung over oxygenator.