Potential of herbal products in prevention and treatment of COVID-19. Literature review.

The COVID-19 epidemic is the greatest pandemic that human kind experienced for decades, with high morbidity and mortality. Despite recent development of vaccines there is still many severe cases of COVID-19. Unfortunately there is still no standardized therapies and treatment of severe cases is very challenging. The aim of this study is to indicate if herbs administered alone or as a complementary therapy could be used as prophylaxis or treatment of SARS-CoV-2 infection. Over 85% of patients with COVID-19 in China used Traditional Chinese Medicine (TCM), and a most common herb is Glycyrrhiza glabra, which in vitro inhibits replication of different enveloped viruses, including coronaviruses. Glycyrrhizin in vitro connects and changes conformation of ACE2 receptors, which are vital for SARS-CoV-2 penetration into host cells. Pelargonium sidoides show immunomodulatory and antiviral properties in clinical and in vitro studies, and it inhibits replication of HCo-229E coronavirus. Glycyrrhiza glabra in combination with standard therapies significantly reduces the hospitalization rate and occurrence of COVID-19 symptoms. As complementary therapies lianhuaqingwen capsules and jinhua qinggan granules reduces hospitalization rates, time to symptoms recovery and improve patient psychological comfort. In view of SARS-CoV-2 other herbs are not effective, e.g. maxingshigan-yinqiaosan, or therapeutic concentration would be impossible to achieve, e.g. ephedra herb, or there is simply no proper data. Therefore, Liquorice and Pelargonium sidoides are effective against coronaviruses and could be possibly used as prophylaxis and treatment of COVID-19, while lianhuaqingwen capsules and jinhua qinggan granules can be useful as a complementary therapy to conventional treatment.

Artificial aortic valve dysfunction due to pannus and thrombus - different methods of cardiac surgical management.

INTRODUCTION: Approximately 60 000 prosthetic valves are implanted annually in the USA. The risk of prosthesis dysfunction ranges from 0.1% to 4% per year. Prosthesis valve dysfunction is usually caused by a thrombus obstructing the prosthetic discs. However, 10% of prosthetic valves are dysfunctional due to pannus formation, and 12% of prostheses are damaged by both fibrinous and thrombotic components. The authors present two patients with dysfunctional aortic prostheses who were referred for cardiac surgery. Different surgical solutions were used in the treatment of each case. CASE STUDY 1: The first patient was a 71-year-old woman whose medical history included arterial hypertension, stable coronary artery disease, diabetes mellitus, chronic obstructive pulmonary disease (COPD), and hypercholesterolemia; she had previously undergone left-sided mastectomy and radiotherapy. The patient was admitted to the Cardiac Surgery Department due to aortic prosthesis dysfunction. Transthoracic echocardiography revealed complete obstruction of one disc and a severe reduction in the mobility of the second. The mean transvalvular gradient was very high. During the operation, pannus covering the discs' surface was found. A biological aortic prosthesis was reimplanted without complications. CASE STUDY 2: The second patient was an 87-year-old woman with arterial hypertension, persistent atrial fibrillation, and COPD, whose past medical history included gastric ulcer disease and ischemic stroke. As in the case of the first patient, she was admitted due to valvular prosthesis dysfunction. Preoperative transthoracic echocardiography revealed an obstruction of the posterior prosthetic disc and significant aortic regurgitation. Transesophageal echocardiography and fluoroscopy confirmed the prosthetic dysfunction. During the operation, a thrombus growing around a minor pannus was found. The thrombus and pannus were removed, and normal functionality of the prosthetic valve was restored. CONCLUSIONS: Precise and modern diagnostic methods facilitated selection of the treatment method. However, the intraoperative view also seems to be crucial in individualizing the surgical approach.

Sarcomas of the heart as a difficult interdisciplinary problem.

Cardiac tumors are assumed to be a rare entity. Metastases to the heart are more frequent than primary lesions. Sarcomas make up the majority of cardiac malignant neoplasms. Among them angiosarcoma is the most common and associated with the worst prognosis. Malignant fibrous histiocytoma comprises the minority of cardiac sarcomas and has uncertain etiology as well as pathogenesis. Transthoracic echocardiography remains the widely available screening examination for the initial diagnosis of a cardiac tumor. The clinical presentation is non-specific and the diagnosis is established usually at an advanced stage of the disease. Sarcomas spread preferentially through blood due to their immature vessels without endothelial lining. Surgery remains the method of choice for treatment. Radicalness of the excision is still the most valuable prognostic factor. Adjuvant therapy is unlikely to be effective. The management of cardiac sarcomas must be individualized due to their rarity and significant differences in the course of disease.

Urgent splenectomy in the course of prosthetic valve endocarditis.

We present a case of a 51-year-old male patient hospitalized due to acute coronary syndrome requiring stent implantation to the left main stem. Double antiplatelet therapy was commenced. After 2-3 days, the patient presented with high fever, dyspnea on exertion, pain in the chest, myalgia, and general weakness. Transthoracic (TTE) and transesophageal (TEE) echocardiography revealed abnormal, turbulent flow across the aortic prosthesis, which was probably caused by the presence of a pathological smooth and mobile structure (10 × 9 × 5 mm) in front of the aortic annulus. Blood cultures were positive and staphylococcal prosthetic valve endocarditis (PVE) was diagnosed. Despite antibiotic treatment, the patient's condition deteriorated, and he was referred for prosthesis reimplantation. After being transferred to the Cardiac Surgery Clinic, he presented with nausea, vomiting, and abdominal pain. The results of imaging examinations suggested spleen hematoma. The patient underwent an urgent splenectomy. Histopathological examination revealed a spleen infarction consequent to an embolic event and subscapular hematoma. On the 10(th) day after the laparotomy, cardiac surgery was performed. No large vegetations were found on the aortic prosthesis. The mechanical valve, implanted 20 years earlier, was functioning properly; it was intact and well healed. Several fragments of a thrombus and fibrous tissue, resembling a pannus and covered with minor calcifications, were removed from the ventricular surface of the discs. A decision was reached to leave the aortic prosthesis in situ. The valvular material culture revealed the presence of Streptococcus anginosus, and the antibiotic scheme was modified. The postoperative period was uneventful.

23-year experience on diagnosis and surgical treatment of benign and malignant cardiac tumors.

INTRODUCTION: Although myxoma is the most frequent cardiac tumor, other conditions should be taken into consideration in the differential diagnosis. Transthoracic echocardiography (TTE), followed by transesophageal echocardiography (TEE) remain the principal methods for cardiac tumor screening and visualizing. The aim of the study was to compare the diagnostics, surgical treatment and prognosis of malignant and benign cardiac tumors. MATERIAL AND METHODS: From 1986 to 2009 there were 121 patients with cardiac tumors operated on in the Cardiac Surgery Clinic of the Medical University in Lodz. Patients were referred to surgery mainly on the basis of the TTE and TEE image. In 4 cases valvular prosthesis implantation or valve repair were carried out. Patients remained under long-term observation in the Cardiac Surgery Outpatient Clinic. RESULTS: Myxoma was diagnosed in 114 cases. Malignancies were discovered in 7 cases. The left atrium was the most frequent localization. The echocardiographic image differed significantly in benign and malignant tumors. The postoperative period was complicated by embolic events or myocardial infarctions. Only malignant tumors were associated with mortality due to cardiovascular events. The survival for malignant tumors was significantly shorter. CONCLUSIONS: Short and long-term results of operative treatment are very good for benign tumors in contrast to cardiac malignancies. The TTE and TEE image can be very significant in the final diagnosis.

Early and long term coronary artery bypass grafting outcomes in patients under 45 years of age.

BACKGROUND: In Poland, mortality and morbidity rates due to ischaemic heart disease (IHD) remain high and concern the whole population. An interesting issue is rapid development of IHD in some younger subjects and uncertain treatment outcomes in this patient subset. Premature cessation of professional activity, along with worsening of quality of life due to IHD in the population under 45 years of age is a huge medical, economic, and social problem. Only few studies evaluated early and long-term outcomes of coronary artery bypass grafting (CABG) used for the treatment of IHD in young patients, especially in premenopausal women. AIM: The purpose of the study was to analyse early and long-term outcomes of CABG in patients under 45 years of age. METHODS: We studied 125 patients under 45 years of age who underwent a CABG procedure. The study group included 65 women aged 27-45 (mean 41.5 ± 3.5) years operated upon in 1990-1999, and 60 men aged 33-45 (mean 41 ± 3.2) years operated upon in 1993. We evaluated early postoperative outcomes. The two genders were compared in regard to survival free from death, recurrent angina, and repeated myocardial during long-term follow-up. We also evaluated other variables such as education level, professional activity, and exposure to IHD risk factors before and after the operation. RESULTS: Seven women and two men died in hospital after CABG (p = 0.2). Analysis of major postoperative outcomes like myocardial infarction, low cardiac output syndrome requiring support with intra-aortic balloon pump (IABP), a lower limb amputation following the use of IABP, ischaemic stroke, and respiratory failure showed that these complications were significantly more frequent in women than in men (p < 0.01). Differences between the two groups regarding other adverse outcomes including atrial fibrillation, sternal instability, haemothorax, and pneumothorax were not significant. Analysis of long-term survival curves did not show any significant differences between men and women in regard to rates of death, recurrent angina, and the need for repeated myocardial revascularisation (p = 0.64, p = 0.93, and p = 0.13, respectively). CONCLUSIONS: Young women who underwent CABG were burdened with higher early postoperative morbidity and mortality than young men. However, long-term outcomes (mortality, recurrent angina, and repeated myocardial revascularisation rates) did not differ significantly between the two groups. Regardless of gender, repeated myocardial revascularisation rate was significantly higher among those patients who continued to smoke after the surgery (p < 0.01).

Removal of the left atrium and left ventricle tumour: a case report.

The heart is the rarest site for neoplasms to be localized. Despite modern diagnostic techniques, cardiac tumours continue to among those discovered latest and with the worst prognoses. We present the case of a 62-year-old woman with a heart tumour and mediastinal lymphadenopathy, who was admitted to the Department of Cardiac Surgery. The patient underwent surgical removal of the tumour with extracorporeal circulation. The left atrium, mitral valve and the left ventricle were occupied by the infiltration. A radical resection appeared to be impossible. A valvular prosthesis was not implanted. The perioperative period was uncomplicated. On the 9(th) day a local recurrence was confirmed in the transthoracic echocardiography. Further oncological diagnostics revealed the spread of the malignant neoplasm to bones of the pelvis and spine. Chemotherapy was initiated. The authors discuss the most appropriate diagnostic and treatment procedures employed in the above case.

[Aortic valve replacement in patients with heart failure]. / Wymiana zastawki aortalnej u chorych z niewydolnoscia miesnia serca.

UNLABELLED: Severe aortic regurgitation and stenosis are urgent indication for aortic valve replacement in patients with left ventricular dysfunction, however the effect of cardiac surgery may differ in both groups. The aim of the study was to evaluate the early changes of haemodynamic parameters of heart: ejection fraction, endsystolic and enddiastolic left ventricle diameters, endsystolic and enddiastolic left ventricular wall thickness and left atrium diameter, depending on ejection fraction value (EF), in patients undergoing aortic valve replacement due to isolated aortic stenosis or regurgitation. MATERIALS AND METHODS: 250 patients engaged to the study were subjected to the mechanical aortic valve replacement in Cardiac Surgery Department in Lodz. All patients were divided into two groups--patients operated due to aortic regurgitation and aortic stenosis. Then each group, depending on EF volume before operation, was divided into two subgroups (A - EF between 35 and 50%; B - EF below 35%). RESULTS: Comparing the pre- and early postoperative period, ejection fraction rose markedly in both subgroups of patients with aortic stenosis and the highest increase was ascertained in subgroups A. Analyzing endsystolic and enddiastolic left ventricle diameters we observed the reduction of left ventricle diameters in all groups. Evaluating endsystolic left ventricular wall thickness we observed the increase of wall thickness in both subgroups B. Analogically enddiastolic left ventricular wall thickness increased in all analyzing groups, whereas in groups with lowest fraction the rise was essential. CONCLUSIONS: Aortic valve replacement both due to aortic stenosis and regurgitation is associated with improved haemodynamic status in early postoperative period.

[Early and subsequent results of operation of trivalvular diseases]. / Wyniki wczesne i odlegle operacji wad trójzastawkowych.

UNLABELLED: The aim of the thesis is the evaluation of efficacy of surgical treatment for complex valvular heart diseases. An inclusion criterion to this analysis was the performance of a mitral valve replacement (MVR) and aortic valve replacement (AVR) for an artificial valve and a tricuspid valve replacement or plastic operation (TVR or pl. TV). Such operative procedures were carried out simultaneously. Twenty five operations were performed from 1995 to 1999. TVR was carried out in 2 patients, pl. TV in 21 patients and the Revuelt method was adopted for this purpose, whereas in two cases a tricuspid valve plastic operation was performed sewing in the annulus. In the two cases the revascularization of the right coronary artery was carried out simultaneously. In another case a myxoma removal from the left atrium was additionally carried out. One patient died due to renal failure during hospitalization on the 9th day after the operation. Three patients died subsequently in the first, second and third year after operation. The causes of subsequent deaths among the patients examined in the period of five years after the operation were thrombotic-embolic complications. CONCLUSIONS: Early and subsequent results of simultaneous tri-valvular operations are good. The most frequent and difficult postoperative complication in this group of patients is a low output syndrome. Subsequent complications and deaths are most often due to thromboembolic complications, therefore a particular attention should be paid to the anticoagulant treatment in this group of patients.