Nonsurgical treatment of a patient with decompensated right ventricular failure due to chronic thromboembolic pulmonary hypertension with proximal clot location-A case report.

Chronic thromboembolic pulmonary hypertension (CTEPH) is a disease resulting from impaired patency of the pulmonary arteries by a clot, and the treatment method of choice is pulmonary endarterectomy (PEA). In inoperable patients, balloon pulmonary angioplasty (BPA) is recommended, but we need to implement pharmacological bridge therapy to BPA in some cases. We report a case of a 38-year-old male diagnosed with CTEPH, disqualified from PEA due to comorbidity, who developed right ventricular (RV) failure. The case shows a complex pharmacological treatment method that can be successfully used as an effective bridge therapy to BPA in patients with CTEPH and severe RV dysfunction, disqualified from surgery.

Obtaining N-Enriched Mesoporous Carbon-Based by Means of Gamma Radiation.

In this paper, we present the results of the gamma irradiation method to obtain N-doped mesoporous activated carbons. Nitrogen-enriched mesoporous carbons were prepared from three chosen commercial activated carbons such as Carbon Black OMCARB C-140, KETJENBLACK EC-600JD and PK 1-3 Norit. HRTEM, SEM, Raman spectra, elemental analysis, XPS studies and widely approved N2 adsorption-desorption measurements allowed us to evaluate the effectiveness of N atom insertion and its influence on the BET surface area and the pore structure of modified carbons. The obtained materials have an exceptionally high N content of up to 3.2 wt.%. Additionally, selected N-doped activated carbons were fully characterized to evaluate their applicability as carbon electrode materials with particular emphasis on Oxygen Reduction Reaction (ORR). The proposed method is a relatively facile, efficient and universal option that can be added to the already known methods of introducing heteroatoms to different carbons.

Multidisciplinary aortic arch procedures within the "Aortic Team".

Introduction and aim: The European societies EACTS (European Association for Cardio-Thoracic Surgery) and ESVS (European Society for Vascular Surgery) recommend the establishment of "Aortic Teams" from 2019. In Poland, the first such team was officially established in Specialist University Hospital no. 2 in Szczecin in 2021. Material and methods: Sixty-four patients were treated for aortic arch pathology using frozen elephant trunk (n = 3), branch custom made devices (n = 12), physician-modified endo-grafts (PMEG; n = 30) and the thoracic endovascular aortic repair "plus" technique (n = 19). Results: Among thoracic endovascular aortic repair (TEVAR) plus (chimneys/periscopes, n = 7, extra-anatomical bypasses, n = 12) there was 100% technical success and 4% bad outcomes (stroke or death). Among "customized" stent grafts there were Bolton Relay (n = 8), Brail Endo-Branch (n = 1) and Castor branched stent graft (n = 3) with 91% technical success and 18% bad outcomes. In the group of PMEG there were 14 cases with one fenestration, 5 cases with two fenestrations and 11 cases with triple fenestration to all vessels of the aortic arch. In this group, technical success was achieved in 91% and poor outcome ended treatment in 11%. In total we noted a 91% technical success rate and a good treatment outcome was achieved in 89%. The cooperation of cardiac surgeons and vascular surgeons in one team brought competence benefits for both specialties. It allowed for good clinical and economic results despite new logistical complexities and fits into the currently changing perspective of cardiac surgery development worldwide. Conclusions: Implementation of the recommendation to create aortic teams within cardiac surgery departments is possible and may be cost-effective in Polish conditions.

Balloon pulmonary angioplasty in chronic thromboembolic pulmonary hypertension: a multicentre registry.

BACKGROUND: Balloon pulmonary angioplasty (BPA) is a promising therapy for patients with chronic thromboembolic pulmonary hypertension (CTEPH) who are ineligible for pulmonary endarterectomy. AIMS: The present study aimed to evaluate the safety and efficacy of BPA for CTEPH using the first multicentre registry of a single European country. METHODS: Data were obtained from the Database of Pulmonary Hypertension in the Polish Population (NCT03959748), a prospective, multicentre registry of adult and paediatric pulmonary arterial hypertension (PAH) and CTEPH, for a total of 236 patients with confirmed CTEPH (124 women; mean age 67 years) who underwent 1,056 BPA procedures at eight institutions in Poland. RESULTS: In 156 patients who underwent follow-up assessments after a median of 5.9 (IQR: 3.0-8.0) months after final BPA, the mean pulmonary arterial pressure decreased from 45.1±10.7 to 30.2±10.2 mmHg (p<0.001) and pulmonary vascular resistance from 642±341 to 324±183 dynes (p<0.001), and the six-minute walking test (6MWT) improved from 341±129 to 423±136 m (p<0.001). Pulmonary injury related to the BPA procedure occurred in 6.4% of all sessions. Eighteen patients (7.6%) died during follow-up, including 4 (1.7%) who died within 30 days after BPA. Overall survival was 92.4% (95% confidence interval [CI]: 87.6%-94.9%) three years after the initial BPA procedure. CONCLUSIONS: This multicentre registry confirmed significant improvement of haemodynamic, functional, and biochemical parameters after BPA. Complication rates were low and overall survival comparable to the results of another registry. Therefore, BPA may be an important therapeutic option in patients with CTEPH in Poland.

Externalized transapical guidewire technique after artificial aortic valve replacement during complete endovascular aortic arch repair.

An externalized transapical guidewire (ETAG) technique has been used for safe delivery of high-profile devices through a tortuous aorta to zone 0, which is currently precluded after mechanical artificial aortic valve replacement (AVR). The aim of the study was to report one center's experience (based on 3 cases) of a unique modification to the ETAG technique used for the first time during total endovascular aortic arch repair after AVR. This report contains technical notes regarding a new method of steering the guidewire from the apex inside the artificial aortic valve during total endovascular aortic arch repair after AVR and the details crucial in preparation for this mini-invasive procedure. As a conclusion, the ETAG technique could be performed after mechanical AVR with active positioning of the guidewire carried out under the control of transesophageal echocardiography.

Treatment of chronic thromboembolic pulmonary hypertension in a multidisciplinary team.

BACKGROUND: Chronic thromboembolic pulmonary hypertension (CTEPH) may be treated with pulmonary endarterectomy (PEA), balloon pulmonary angioplasty (BPA) and medical therapy (MT). Assessment in a multidisciplinary team of experts (CTEPH team) is currently recommended for treatment decision making. The aim of the present study was to report the effects of such an interdisciplinary concept. METHODS AND RESULTS: A total of 160 patients were consulted by the CTEPH team between December 2015 and September 2018. Patient baseline characteristics, CTEPH team decisions and implementation rates of diagnostic and therapeutic procedures were analysed. Change in World Health Organization (WHO) functional class and survival rates were evaluated by treatment strategy. A total of 51 (32%) patients were assessed as operable and 109 (68%) were deemed inoperable. Thirty-one (61% of operable patients) underwent PEA. Patients treated with PEA, BPA(+MT) and MT alone were 50.9 ± 14.7, 62.9 ± 15.1 and 68.9 ± 12.7 years old, respectively. At the follow-up, PEA patients had the highest WHO functional class improvement. Patients treated with BPA(+MT) had significantly better survival than PEA (p = 0.04) and MT patients (p = 0.04; 2-year survival of 92%, 79% and 79%, respectively). CONCLUSIONS: The CTEPH team ensures that necessary diagnostic procedures are performed. A relatively low proportion of patients was assessed by the CTEPH team as operable and underwent surgery, which in survivors resulted in the best functional improvement. Although patients undergoing BPA(+MT) were older than patients treated with PEA, their survival was better than patients subjected to PEA or MT alone. The reviews of this paper are available via the supplemental material section.

Angiographic severity of coronary artery disease and cardiovascular risk in acute coronary syndrome in patients with metabolic syndrome.

BACKGROUND: The extent of angiographic lesions, size of infarct, and in-hospital and long-term prognosis in patients with metabolic syndrome (MS) have not been clearly determined. AIM: The aim of the study was to investigate the effect of MS on the severity of coronary artery disease (CAD) and cardio-vascular risk evaluated using the GRACE 2.0 risk score and left ventricular ejection fraction (LVEF) in patients with first acute coronary syndrome (ACS) treated with coronary angioplasty. METHODS: The study was conducted in a group of 160 consecutive patients hospitalised for their first ACS. Coronary angiogra-phy was assessed and an echocardiographic evaluation of LVEF was performed. MS was diagnosed according to the National Cholesterol Education Programme-Adult Treatment Panel III criteria. Cardiovascular risk was evaluated using the GRACE 2.0 score. Statistical analysis was performed using the STATISTICA software version 12.0. RESULTS: Diagnostic criteria for MS were met by 53.5% of the patients. Patients with and without MS did not differ in angio-graphic severity of CAD and cardiovascular risk as evaluated with the GRACE 2.0 score. LVEF was significantly elevated in patients with MS. In the examined group the angiographic severity of CAD correlated positively with age, body mass index (BMI) and the homeostatic model assessment for insulin resistance (HOMA-IR) index. The cardiovascular risk correlated positively with age, BMI, fasting insulin levels, and HOMA-IR, and inversely with blood pressure and triglyceride levels. The multivariable regression model for predicting the LVEF value indicated that the strongest prognostic factor was the type of ACS. CONCLUSIONS: The associations between the angiographic severity of CAD and age, BMI, and insulin resistance (IR) confirm the involvement of these parameters in coronary atherosclerosis. The correlations between the estimated cardiovascular risk and IR indicate the prognostic value of metabolic parameters in patients after first ACS. The type of ACS is the strongest predictor of LVEF at discharge in this population.

Scuba diving, patent foramen ovale and heart rhythm disturbances: The role of underwater Holter monitoring-Case report.

Patent foramen ovale (PFO) is thought to be a risk factor for decompression illness (DCI). Catheter-based closure procedure reduces the risk of DCI in selected scuba divers with PFO. Major complication of invasive approach are rare, minor, especially heart rhythm disturbances are reported relatively often. We describe a case of 41-year-old diver, who underwent PFO closure due to recurrent DCI events. Afterward, he experienced no DCI symptoms; however, he complained about feeling of the heart beating during a submersion. Arrhythmia should be considered as a life-threatening for scuba diver, thus we performed underwater ECG monitoring and exclude the arrhythmia.

[Is stress-induced cardiomyopathy always benign? The patient with long QT and torsade de pointes]. / Kardiomiopatia stresowa - czy zawsze lagodna? Wydluzenie QT i czestoskurcz torsade de pointes u pacjentki z zespolem balotujacego koniuszka.

Stress-induced cardiomyopathy is usually described as syndrome with good prognosis. Although the QT prolongation is usually associated with this cardiomyopathy, the life threatening arrhythmias are less frequent than expected. We present middle age woman with torsade de pointes caused by significant QTc interval prolongation on the basis of tako-tsubo cardiomyopathy, which could suggest not always mild course of this syndrome.

Microvolt T-wave alternans for the risk stratification of dangerous ventricular arrhythmias in patients with previously implanted automatic cardioverter-defibrillator.

BACKGROUND: Sudden cardiac death (SCD) is the main cause of death in patients with reduced left ventricular ejection fraction (LVEF). Implantation of an automatic cardioverter-defibrillator (ICD) significantly reduces mortality of these patients. T-wave alternans (TWA) analysis is a relatively new method of SCD risk stratification. However, it's prognostic role in patients with ICD has not yet been fully established. AIM: To assess the predictive value of TWA in patients with previously implanted ICD. METHODS: The study included 67 patients with properly functioning ICD (54 men and 13 women, aged 62.2 ± 8.4 years). All patients underwent TWA analysis on the treadmill using the Cambridge Heart 2000 system. Results were considered as positive, negative or indeterminate. Each patient had at least 1 clinical control visit with ICD interrogation during the 12 ± ± 6 months of follow-up. The recurrence of sustained ventricular arrhythmias: ventricular tachycardia (VT) or ventricular fibrillation (VF) was analysed. RESULTS: No significant relationship was found between previous infarction (p = 0.810), aetiology (p = 0.768), LVEF (p = 0.413) or age (p = 0.562) and the incidence of arrhythmia during follow-up. The results of TWA were not significantly different between patients with or without VT or VF. The TWA analysis identified patients with arrhythmia recurrences with a sensitivity of 62%, specificity of 49%, negative predictive value of 81%, and positive predictive value of 28%. The TWA performance was better in patients with non-ischaemic than ischaemic cardiomyopathy (negative predictive value: 100%, positive predictive value: 75%). CONCLUSIONS: The TWA alternans was moderately effective for identification of patients with ICD and ventricular arrhythmia recurrences. The test was most useful for identification of patients with non-ischaemic cardiomyopathy who are of low arrhythmic risk.