Toll-like Receptor 4 Single-Nucleotide Polymorphisms and Heart Transplant Rejection.

BACKGROUND: Transplant rejection is one of the major problems after heart transplantation (HTx). The aim of the study was to find possible links between chosen single-nucleotide polymorphisms (SNPs) of Toll-like receptor 4 (TLR4) and heart transplant rejection. MATERIAL AND METHODS: Blood samples were taken from 24 patients subjected to HTx between 2010 and 2016 at the Clinic of Cardiac Surgery and Transplantation and under the control of I Clinic of Cardiology. All the patients were permanently controlled and had therapeutic levels of immunosuppressants in their blood. Their DNA was isolated and analyzed using the high-resolution melting method according to the Toll-like receptor 4 SNPs rs10983755 A/G, rs4986791 C/T, rs4986790 A/G, rs10759932 C/T, rs1927911 C/T, rs11536889 C/G, and rs12377632 C/T. The analysis of the clinical data of biopsies according to International Society for Heart and Lung Transplantation classification was derived from the patients' medical history, divided into two groups: 0-1b and 2-4. A statistical analysis was then performed. RESULTS: The results obtained showed no association between analyzed SNPs and rejection. For rs10983755 A/G, P = .85; rs4986791 C/T, rs4986790 A/G, and rs1927911 C/T had P = .35; and rs10759932 C/T, rs11536889 C/G, and rs12377632 C/T had P = 1. CONCLUSIONS: No association between the SNPs rs10983755 A/G, rs4986791 C/T, rs4986790 A/G, rs10759932 C/T, rs1927911 C/T, rs11536889 C/G, and rs12377632 C/T and heart transplant rejection was found, but further investigation is suggested for TLR4 SNPs with P < .5.

Predictors of Tricuspid Valve Anulus Dilation in a Heart Recipient Population.

BACKGROUND: Tricuspid valve regurgitation in reported in >20% of heart recipients. It severity has not only clinical impact, but it is also associated with increased mortality. Risk factors for developing tricuspid valve dysfunction include allograft rejection, donor/recipient pericardial cavity mismatch, preoperative transpulmonary gradient and vascular resistance, biatrial anastomosis technique, and biopsy-induced injury. Tricuspid valve annulus distention is reported to causative factor for most common type of tricuspid valve dysfunction after heart transplantation. The aim of the study was to estimate possible early predictors for tricuspid valve regurgitation after orthotopic heart transplantation performed with standard Lower-Shumway technique on magnetic resonance imaging studies. METHODS: A total of 20 patients (18 men and 2 women) with a mean age of 45 ± 12 years were enrolled into the study. Echocardiographic evaluation followed by magnetic resonance studies were performed. The mean duration from time of transplantation was 34 ± 12 months. Magnetic resonance and echocardiographic imaging focused on tricuspid valve annulus diameter and atrium dimensions. RESULTS: The was a progressive distension of tricuspid valve annulus observed during the follow-up period. Mean tricuspid valve diameter increased from 3.0 ± 0.3 to 3.34 ± 0.3 mm (P < .05). There was a positive correlation observed between recipient native right atrium and overall right atrium diameter and tricuspid valve diameter distension. CONCLUSIONS: Overall right atrium diameter and native recipient right atrium diameter were found to be a risk factor for tricuspid valve annulus distension.

Association between high on-treatment platelet reactivity and occurrence of cerebral ischemic events in patients undergoing percutaneous coronary intervention.

INTRODUCTION: Percutaneous coronary angioplasty (PCI) has become a routine treatment in symptomatic patients with coronary artery disease. The use of new generation drug eluting stents (DES) and dual antiplatelet therapy has significantly improved treatment outcomes and increased patients' safety by reducing the risk of stent thrombosis. AIMS: The goal of this study was to assess whether high on treatment platelet reactivity (HTPR), despite clopidogrel treatment, measured with Multiplate Electrode Aggregometer (MEA) is associated with the risk of adverse ischemic cerebral events. METHODS: Symptomatic patients with coronary artery disease admitted for coronary angiography and angioplasty (PCI) were consecutively enrolled in this study. 249 consecutive patients underwent coronary artery stenting for stable angina (n=215) or non-ST-elevation acute coronary syndrome (n=34). Inhibition of platelet aggregation was assessed by MEA. Genetic polymorphism of CYP2C19 was tested by HRM Real-Time PCR method in 150 patients. RESULTS: Patients with HTPR were more frequently diagnosed with ischemic stroke (p=0.0351, OR=16.818, 95% CI [1.464-193.23]) and other ischemic cerebral events (stroke or TIA, p=0.0339, OR=6.5, 95% CI [1.36-31.07]). Cumulative assessment of all ischemic and hemorrhagic events showed no statistical significance. Cerebral ischemic event was the only adverse event that correlated with CYP2C19 (*2/*2) allele (p=0.0489, OR=10; 95% CI [1.39-71.80]). CONCLUSIONS: HTPR assessed by MEA, in patients treated with clopidogrel after coronary artery stenting was found to be an important risk factor of ischemic cerebral events. In concordance, the carriers of CYP2C19*2/*2 allele showed an increased rate of ischemic cerebral events.

Novel Method of Infection Prophylaxis in Heart Transplantation by Retrosternal Gentamycin Sponge Application.

BACKGROUND: Surgical wound infections are more frequent in patients undergoing heart transplantation than in other heart surgery patients. There is a wide spread of sternal wound infection incidence in transplant patients ranging from 4% to 40%. It is first study describing local gentamicin sponge application during heart transplantation procedure. MATERIALS AND METHODS: We enrolled 75 patients in a retrospective, single-center study, including 25 patients who underwent orthotopic heart transplantation (heart transplant group) and 50 in the cardiac surgery group. They were in mean age of 49 ± 12 years and 51 ± 13 years in heart transplantation and cardiac surgery group, respectively. A gentamicin sponge was inserted intraoperatively between sternal borders before chest closure in all heart transplantation patients. RESULTS: There was 1 early death (4%) on postoperative day 7 owing to Clostridium difficile infection in the heart transplant group. There was 1 death (2%) in the cardiac surgery group owing to multiorgan failure secondary to perioperative heart ischemia. There was neither bacterial sternal wound infection nor sternal instability in the heart transplant group. None of the patients who had gentamicin sponge applied had wound healing problems. Two patients (4%) had a deep sternal wound infection in the cardiac surgery group, who had no sponge application; 1 (2%) was treated by surgical debridement and active drainage and 1 (2%) by vacuum therapy. There were 11 patients (44%) discharged on insulin therapy in the heart transplant group and 21 (21%) in the cardiac surgery group. Mean overall postoperative hospital stay was 35 ± 19 days in the heart transplant group and 10 ± 4 days in the cardiac surgery group. CONCLUSIONS: Gentamicin sponge is an effective local infection prophylaxis in heart transplant patients.

Left atrial appendage closure - new choice for no-option patients with atrial fibrillation.

AIM: Remodeling and impaired blood flow in left atrial appendage (LAA), which occurs in patients with atrial fibrillation (AF), may lead to thrombus formation and possible thromboembolic complications. Although there are several pharmacological antithrombotic possibilities, some patients with several co-morbidities and contraindications to such treatment cannot be offered any of them. Therefore LAA closure systems may be an attractive alternative. We present our early experience with two currently available different LAA transcatheter closure systems (Watchman and Amplatzer Cardiac Plug). METHODS: Twenty three patients (mean age 69.1±6.8 years, 12 male) with non-rheumatic AF and high risk of thromboembolic complications (CHA2DS2-VASc score ≥2 (mean 4.5±1.5), who could not be treated with the long-term oral anticoagulation because of contraindications or significant side effects, were qualified to the LAA closure. RESULTS: The Amplatzer Cardiac Plug (St Jude Medical, St Paul, MN, USA) was implanted in 7 patients and Watchman Occluder (Boston Scientific, Boston, MA, USA) in the other 15 patients. The implantation was not performed in one patient as the transoesophageal echocardiography during the procedure revealed a new thrombus in LAA. The procedural details and follow-up data are presented. Neither severe pericardial effusion nor device related thrombus were observed. In long term follow-up transient ischemic attack was noted only in one patient (diagnosed with thrombophilia). One patient died 14 months after the procedure due to non-cardiac reason. CONCLUSION: The LAA occluder implantation seems to be a safe and reasonable alternative for oral anticoagulation and should be considered in patients with AF who have contraindications or complications of pharmacological treatment.

Comparison of the antiplatelet effect of two clopidogrel bisulfate formulations: Plavix and generic-Egitromb.

Due to expansion of the pharmaceutical market it seems necessary to prove the efficacy of the generic drugs. The aim of this study is to compare the effects of two clopidogrel formulations: brand-name-Plavix and generic drug - Egitromb. This is a prospective, randomized study comparing two groups of patients treated with two clopidogrel: brand-name Plavix and generic drug- Egitromb. The 53 consecutive patients with stable coronary artery disease qualifying for coronary angiography and PCI were enrolled in this trial. They were randomized into two groups. In the group A (n = 28) patients received Egitromb 300 mg at admission followed by 8 days of 75 mg Egitromb daily. In the group B (n = 25) patients received Plavix 300 mg on the admission followed by 8 days of 75 mg Plavix maintenance therapy. Blood samples for multiple electrode aggregometry testing were drawn at baseline, 5 hours and 8 days after taking the loading dose. Median values of platelet aggregation inhibition did not differ between the Plavix and Egitromb groups when assessed at baseline: 239AU/min (IQR:329) vs. 209 (IQR:406; p = 0.894), 5 hours after loading: 183 AU/min (IQR:107) vs. 165 (IQR:171; p = 0.831) or at day 8: 174 AU/min (IQR:133) vs. 211 (IQR:133; p = 0.332. The study showed no difference in the therapeutic effect of two clopidogrel formulations (Egitromb and Plavix).

Prognostic usefulness of IL-6 and VEGF for the occurrence of changes in coronary arteries of patients with stable angina and implanted stents.

AIM: The aim of this study was to determine the prognostic significance of interleukin 6 (IL-6) and vascular endothelial growth factor (VEGF) in patients with chronic coronary artery disease treated who underwent percutaneous coronary intervention with stent implantation, for assessing the risk of restenosis and the occurrence of de novo lesions. PATIENTS AND METHODS: 498 patients with stable angina were examined during 18 months. 50 patients with significant (> 70%) stenosis of one coronary artery, eligible for the implantation of one stent, were enrolled to the study. Il-6 and VEGF level was measured using ELISA immunoassays during the initial coronary angiography with simultaneous angioplasty and stent implantation and 4 weeks after stent implantation. Coronary angiography was carried out 8-12 months after stent implantation. RESULTS: Statistically significant increase in IL-6 (from 4.02 ± 4.40 to 10.90 ± 8.23) and VEGF (from 310.13 ± 50.90 to 392.32 ± 106.84) level was observed 4 weeks after stent implantation in the group with restenosis. CONCLUSIONS: Increased levels of IL-6 and VEGF in the peripheral blood of patients with chronic stable angina pectoris, measured 4 weeks after coronary angioplasty with stent implantation, may indicate an increased risk of angiographic restenosis and de novo coronary artery lesions.

The BNP concentrations and exercise capacity assessment with cardiopulmonary stress test in cyanotic adult patients with congenital heart diseases.

Cyanosis is observed in patients with complex congenital heart disease (CHD) and pulmonary hypertension, heart failure represents an important clinical problem in such patients. The aim of this study was to evaluate the exercise capacity in patients with cyanotic CHDs using cardiopulmonary exercise test, measuring serum BNP levels as well as to seek correlation between BNP levels and cardiopulmonary exercise test parameters and identify the effects of blood oxygen desaturation and pulmonary hypertension on these indices. The study group consisted of 53 patients (21 males) at the mean age of 39.4 ± 14.3 years, of whom 19 were operated on at the mean age of 9.6 ± 8.6 years. Mean blood oxygen saturation (SO(2)) in patients was 81.2 ± 6.2%. Twenty four patients presented with Eisenmenger syndrome, 16--univentricular hearts, 4--transposition of the great arteries, 6--Fallot's tetralogy, and 3--Ebstein anomaly. The control group comprised 32 healthy individuals (16 males) at the mean age of 40.7 ± 9.9 years. Cardiopulmonary stress test showed significantly lower exercise capacity in patients with cyanosis than in controls: maximal oxygen uptake (VO(2max)) 15.5 ± 4.9 vs. 31.6 ± 7.1 ml/kg/min (p=0.00001), maximum heart rate at peak exercise (HR max): 139.5 ± 22.5 bpm vs. 176.6 ± 12.1 (p=0.0001), VE/VCO(2) slope: 46.4 ± 10.1 vs. 27.3 ± 2.9 (p=0.00001), forced vital capacity FVC: 3.1 ± 1.1 l vs. 4.4 ± 0.8 l (p=0.00001). Subjects with the evidence of pulmonary hypertension (PH+) had lower exercise capacity than those without (PH-): VO(2max): 17.2 ± 4.2 vs. 12.8 ± 4.8 ml/kg/min (p=0.002), VE/VCO(2): 43.7 ± 11.1 vs. 50.9 ± 6.4 (p=0.01), FVC: 3.46 ± 1.05 l vs. 2.37 ± 0.91 l (p=0.0002). Plasma BNP levels in the study group were higher than in controls: 122.4 ± 106.7 vs. 21.1 ± 20.2 pg/ml p=0.00001 and did not differ between PH+ and PH- groups (115.7 ± 99.0 vs. 127.9 ± 114.1 pg/ml p=0.78). Negative correlations between BNP levels and VO(2max) (r=-0.389, p=0.006), FVC (r=-0.395 p=0.005), FEV1 (r=-0.386 p=0.006), SO(2) (r=-0.445 p=0.00001), and positive correlation between BNP level and VE/VCO(2) (r=0.369 p=0.009) were found.

QT interval dispersion as a new marker of restenosis after percutaneous transluminal coronary angioplasty of isolated single-vessel coronary artery stenosis.

BACKGROUND: There are no reliable non-invasive markers of restenosis after percutaneous transluminal coronary angioplasty (PTCA). The aim of our study was to measure changes in QT interval dispersion after PTCA and to determine whether restenosis subsequently affects QT interval dispersion. METHODS AND RESULTS: Fifty-six consecutive patients - 41 men and 15 women (mean age: 56.2 +/-8.3 years) - with isolated stenosis of the left anterior descending artery who underwent successful PTCA were studied. A symptom-limited treadmill exercise test was performed within 7 days after PTCA and then again before repeated angiography. Repeated coronary angiography revealed restenosis in 15 patients (26.8%) and no signs of significant stenosis in 41 patients (73.2%). QT interval dispersion in the group of patients with restenosis measured before exercise increased from baseline 34 +/- 7 to 49 +/- 15 ms after 6 months (p < 0.01) and QT interval dispersion measured immediately after exercise increased from baseline 38 +/- 4 to 68 +/- 21 ms after 6 months (p < 0.001). In contrast, patients without restenosis showed no significant changes in QT interval dispersion measured before (baseline: 34 +/- 9 ms; after 6 months 33 +/- 12 ms; p = NS) and immediately after exercise (baseline: 34 +/- 12 ms; after 6 months: 33 +/- 10; p = NS). When QT interval dispersion > or =60 ms (measured 6 months after PTCA procedure) was considered as a potential marker of restenosis, this indicator had very high sensitivity and specificity when measured immediately after exercise (80 and 95% respectively). CONCLUSIONS: QT interval dispersion significantly increases in the group of patients with documented restenosis and may be a simple, non-invasive marker of restenosis. However, further studies are needed to confirm this observation.

Cardiac arrest related to coronary spasm in patients with variant angina: a three-case study.

We present three patients with variant angina pectoris and episodes of cardiac arrest. All of them had typical clinical symptoms, ST-segment changes in electrocardiogram, and coronary artery spasm confirmed by arteriography. They were treated with high doses of calcium antagonists and nitrates. An automatic cardioverter-defibrillator was implanted in the patient who developed ventricular fibrillation despite therapy with calcium antagonists. In another patient a DDD pacemaker was implanted because of high-degree atrioventricular block.

Mycotic aneurysm of the ascending aorta following CABG.

Mycotic aneurysm of the thoracic aorta is a rare and life threatening condition. Two patients are presented (both male, aged 66 and 59 years) in whom coronary artery bypass surgery was complicated by the development of a mycotic aneurysm. Fever preceded the radiological and echocardiographic signs of the aneurysm by at least several months in both cases. Blood cultures were negative for one patient and the source of Corynebacterium sp infection in the other was not determined for several months. Both patients died before surgery could correct the aneurysm.

[Survival of women and men after myocardial infarction does not differ. Results of several years' observation]. / Przezywalnosc kobiet i mezczyzn po zawale serca nie rózni sie. Wyniki kilkuletniej obserwacji.

The contention that female gender is an independent factor that affects survival after acute myocardial infarction (AMI) is still controversial. The aim of this retrospective study was to assess whether or not early and late mortality after AMI is greater in women than in men. Data of 464 consecutive patients (130 women and 334 men) who had a documented acute myocardial infarction in our Department of Cardiology between 1990 and 1993 were eligible for the study. We excluded 48 patients from the study for the following reasons: the location of infarct could not be determined in 18 patients: 16 patients refused to take part in the study and we were not able to contact 14 patients. The remaining 416 patients were analyzed in the study. The mean follow-up period was 36 months (from 1 to 72 months). Women were significantly older than men (62.1 +/- 11.2 vs 58.1 +/- 11.6; p < 0.001), especially those who died in hospital (70.7 +/- 9.3 vs 64.4 +/- 8.7; p < 0.01). In hospital died 26 women (20%) and 39 men (11.7%)--p < 0.05. However, age-adjusted in-hospital mortality did not differ between women and men (p = 0.256). We did not find any significant difference in 3-year survival after AMI between women and men (22% vs 20.7%; NS). Total mortality was also similar (38% vs 30.2%; NS). QMI was diagnosed in 85 women and 234 men (73% vs 78%; NS), NQMI in 31 women and 66 men (27% vs 22%; NS). The rate complications of acute phase of AMI (acute heart failure and/or rhythm disturbances) was similar in women and men. Fibrinolytic treatment was introduced in 27.2% of women and in 26.4% of men. Hypercholesterolemia and hypertension were more often associated with female gender. In multivariate analysis we found that age, acute heart failure, previous MI, hypercholesterolemia and diabetes mellitus were significant factors which affects survival after AMI. Of these only age and diabetes mellitus appeared to be significant in women.

Evaluating IAIMS at Yale: information access.

OBJECTIVE: To evaluate use of information resources during the first year of IAIMS implementation at the Yale-New Haven Medical Center. The evaluation asked: (1) Which information resources are being used? (2) Who uses information resources? (3) Where are information resources used? (4) Are multiple sources of information being integrated? DESIGN: Measures included monthly usage data for resources delivered network-wide, in the Medical Library, and in the Hospital; online surveys of library workstation users; an annual survey of a random, stratified sample of Medical Center faculty, postdoctoral trainees, students, nurses, residents, and managerial and professional staff; and user comments. RESULTS: Eighty-three percent of the Medical Center community use networked information resources, and use of resources is increasing. Both status (faculty, student, nurse, etc.) and mission (teaching, research, patient care) affect use of individual resources. Eighty-eight percent of people use computers in more than one location, and increases in usage of traditional library resources such as MEDLINE are due to increased access from outside the Library. Both survey and usage data suggest that people are using multiple resources during the same information seeking session. CONCLUSIONS: Almost all of the Medical Center community is using networked information resources in more settings. It is necessary to support increased demand for information access from remote locations and to specific populations, such as nurses. People are integrating information from multiple sources, but true integration within information systems is just beginning. Other institutions are advised to incorporate pragmatic evaluation into their IAIMS activities and to share evaluation results with decision-makers.

[Analysis of hemodynamic changes in patients with essential arterial hypertension at rest and during exercise]. / Analiza zmian hemodynamicznych u chorych z nadcisnieniem tetniczym samoistnym w spoczynku i w czasie próby wysilkowej.

Arterial hypertension is a hemodynamic changeable process. The haemodynamic parameters also change when the disease develops. The changes of main haemodynamic parameters according to the intensity of hypertensive disease at rest and during exercise have been presented. The haemodynamic changes observed during short-term physical exercise, may be the indication for evaluation and foreseeing the changes in patients with essential arterial hypertension. Simultaneously the authors draw the attention to a permanent and slow increase in total peripheral resistance (TPR) form the earliest stages of the disease.

The MEDLINE experience at Yale: 1986-1996.

The Cushing/Whitney Medical Library began providing end-user access to MEDLINE in 1986 and switched to the OVID system in 1993. MEDLINE is a core service of the library, and the choice of delivery systems has had a significant impact throughout the Yale-New Haven Medical Center. This paper describes the user response to MEDLINE, discusses the effects of MEDLINE on other library services, and suggests ways in which technology, policy, and funding have influenced use. Yale's experience suggests that removing barriers in all three areas can dramatically expand the points of access, the number of users, and the amount of use with manageable effects on other library services.

[Right atrial thrombosis--a difficult diagnostic and therapeutic problem]. / Skrzepliny prawego przedsionka--trudny problem diagnostyczny i terapeutyczny.

Right atrial thrombi have been diagnosed more frequently since the widespread use of two-dimensional echocardiography. The authors present current opinions on etiology of right heart thrombi. They can originate from two sources: type A thrombi originate in deep peripheral veins; they have worm-shape and they are extremely mobile or they develop within the right heart chambers-type B-they are then parietal and immobile. Clinical significance, prognosis in both types of thrombi is discussed and the guidelines for treatment are presented. Type A patients are a high risk group because of frequent incidence of severe pulmonary embolism and excessive mortality rate so aggressive therapy is required (surgery or fibrinolysis when surgery is contraindicated). Type B thrombi are much more benign, usually they do not lead to the death and treatment with anticoagulants seems to be sufficient.

[Beta-adrenergic receptor blockers in the treatment of chronic heart failure]. / Leki blokujace receptory beta-adrenergiczne w leczeniu przewleklej niewydolnosci krazenia.

We present a current opinion about the management of chronic heart failure with beta-blocking agents. Pathophysiologic rationales for such treatment and clinical experience were analyzed. Most of the studies showed that long-term treatment of heart failure with beta-blockade produces improvement in symptoms, exercise tolerance, ejection fraction and central hemodynamics (CI, PCWP, MPAP, LVSWI, SVI). Treatment must be started at an extremely low dose and then must be increased gradually to therapeutic levels over several weeks. The titration phase must take place in the hospital. It was emphasized that the management of chronic heart failure with beta-blockers is not the routine management yet. Ongoing multicenters trials should finally determine the place of beta-blockers in the treatment of chronic heart failure.

[Evaluation of arterial blood pressure and heart rate during exercise tests in patients with essential hypertension in different stages of hypertension]. / Ocena cisnienia tetniczego i czestosci pracy serca podczas prób wysilkowych u chorych z nadcisnieniem tetniczym samoistnym, w róznych okresach choroby nadcisnieniowej.

This article analyses the changes of arterial blood pressure and heart rate (HR) in 120 patients with essential hypertension during two successive exercise tests. Before and during the tests, the patients did not take any hypertensive drugs. The obtained measuring results at exercise tests and restitution were the basis for the calculating regression equations. Then the results were analyzed statistically (p < 0.05) and clinically (drop or increase of arterial systolic blood pressure value (SAP) or/and diastolic (DAP) by 5 mmHg, and HR by 5 beats per minute). The HR response was comparable in both test for all tested groups both in exercise and restitution periods. For the additional sex division the HR value in all subgroups women was lower in the second test and satisfies the condition of statistic and clinical significance. In the second test SAP was lower only in the group of mild pressure and in the group without organ changes (stage I WHO) during exercise. At restitution periods the SAP values were lower in all the tested groups with the exception of the group with borderline hypertension. DAP was lower in the second test in all the tested groups both in exercise test and in the restitution period. It is also shown that the quantity of DAP difference in the second test is the greater, the higher value of DAP at restitution is.

[A case of primary hepatocellular carcinoma with tumor thrombus in the right atrium and massive pulmonary embolism]. / Przypadek pierwotnego raka watroby powiklanego skrzeplina w prawym przedsionku i masywna zatorowoscia plucna.

We present a case report of primary hepatocellular carcinoma with tumor thrombus extending into the right atrium complicated by pulmonary embolism. A 49-year-old man was admitted to our hospital for searching a cause of thrombus in the right atrium. The patient complained of shortness of breath and oedema of the lower extremities. He had a history of hepatitis B. Abdominal sonography and computed tomography revealed a tumor of the liver. A needle biopsy confirmed the diagnosis of hepatocellular carcinoma. Magnetic resonance showed a tumor thrombus also in the inferior vena cava. The diagnosis of pulmonary embolism was confirmed by pulmonary perfusion scintigraphy. This case stresses that clinicians should include hepatocellular carcinoma among the possible causes of intracardiac thrombus and pulmonary embolism.

[Arterial hypertension complicated by aortic dissection. Clinical analysis, results of conservative treatment]. / Nadcisnienie tetnicze powiklane tetniakiem rozwarstwiajacym aorty. Analiza kliniczna, wyniki leczenia zachowawczego.

Detailed analysis of 21 patients suffering from arterial hypertension complicated by aortic dissection, who were treated non-surgically was performed. Signs and symptoms of aortic dissection appeared the most frequently in the age between 50 and 69. In 14 (66.7%) cases proximal (type A) and in 7 (33.3%) distal (type B) dissection were diagnosed. During acute phase 15 patients complained of pain and 6 did not. Smoking and family history of arterial hypertension were the commonest risk factors in this group. Proximal dissection was more frequently connected with painful course of the dissection whereas distal with painless. Detailed analysis of clinical data and non-invasive treatment during acute phase (first 14 days since onset of pain) was performed. During ambulatory observation which lasted 3-75 month (mean 34.3 month) 5 (25%) patients died, 15 (75%) are still alive.