Recoarctation of the aorta after the Norwood procedure may be treated during the second stage of the surgical palliation.

OBJECTIVES: Recoarctation of the aorta (re-CoA) after the Norwood procedure is traditionally treated during catheter-based aortoplasty (CB-A) performed as a separate procedure preceding stage II surgical palliation (S II SP). Our goal was to determine the efficacy of the protocol according to which re-CoA after the Norwood procedure in patients with hypoplastic left heart syndrome is treated during S II SP using hybrid catheter-based aortoplasty. METHODS: We compared 2 groups of infants who developed re-CoA after the Norwood procedure and were treated at the same institution: In group I (n = 18), CB-A was traditionally performed before S II SP; in group II (n = 15), CB-A was performed during S II SP using a hybrid procedure (catheter access was through an aortic cannula routinely used for cardiopulmonary bypass). The right ventricular fractional area change was analysed. RESULTS: The CB-A was performed effectively in both groups. S II SP was performed at a younger age in group II (5.4 ± 0.3 vs 6.0 ± 0.4 months; P = 0.003), with lower body weight (5.6 ± 0.5 vs 6.0 ± 0.4; P = 0.03, respectively). The duration of hospital stay did not differ between the groups (10.6 ± 6.2 vs 11.6 ± 6.4 days; P = 0.91). The right ventricular fractional area change measured before S II SP was higher in group I (39.7 ± 4.2% vs 36.8 ± 3.6%, respectively; P = 0.009), but the difference was not seen 1 month after S II SP (41.0 ± 5.6 vs 39.8 ± 4.1; P > 0.05). The total radiation dose was significantly lower in group II. CONCLUSIONS: re-CoA after the Norwood procedure in patients with hypoplastic left heart syndrome can be treated effectively during S II SP using a hybrid procedure. The strategy allows for reduction of the total radiation dose and of the number of procedures and does not prolong the postoperative course, even in patients with decreased right ventricular systolic function.

The effect of prenatal diagnosis on antibiotic therapy in neonates with hypoplastic left heart syndrome. Antibiotics in prenatally diagnosed patients with HLHS.

INTRODUCTION: Hypoplastic left heart syndrome (HLHS) is a congenital heart anomaly that is diagnosed prenatally or postnatally. The prenatal diagnosis leads to limiting the rate of systemic complications in the preoperative period due to optimization of the early therapeutic management. OBJECTIVE: The objective of the study is to determine the effect of prenatal diagnostic management of HLHS on the condition of newborns and the frequency of antibiotherapy employment prior to the first stage of surgical treatment. METHODOLOGY: The study included 95 children with HLHS operated on in the years 2014-2016. The cohort was divided into two groups: newborns with a prenatally diagnosed heart defect (50 children - 52.6%) and neonates with the defect diagnosed after birth (45 children - 47.4%). The data of the patients were analyzed based on their medical records. RESULTS: The mean age of the children upon admission was 3.86 days in the group of patients with the prenatally diagnosed heart defect (PreHLHS) and 7.41 days in the group of newborns without the prenatal diagnosis (PostHLHS) (p = 0.001). In 60% of the PreHLHS group patients (30/50), at least one antibiotic was administered, while in the PostHLHS group, antibiotherapy was employed in 93.3% (42/45) cases (p = 0.001). Bacteriological tests demonstrated pathogen growth in 33 children (36% and 33.3%, respectively), what accounted for 34.7% of the entire cohort. On the average, the first antibiotic was introduced on the 6.55th day of life in the PreHLHS group and on the 2.73th day in the PostHLHS group (p = 0.005). The most profound differences in antibiotic employment involved aminoglycosides. The aforementioned type of antibiotic medications was administered to 6% of the children with the prenatal diagnosis and to 17.8% of the children diagnosed postnatally (p = 0.042). CONCLUSIONS: Preoperative antibiotherapy in children with HLHS was employed more frequently than it would be indicated by microbiology tests results. Antibiotics were observed to be introduced more commonly and earlier in the newborns with the postnatally diagnosed congenital heart defect.

Risk factors for recoarctation of aorta after Norwood procedure in patients with hypoplastic left heart syndrome.

BACKGROUND: Recoarctation (reCoA) of the aorta is a common complication afer the Norwood procedure. Untreated, it can lead to failure of the systemic ventricle and death. The main goal of the study is to define risk factors of reCoA after the Norwood procedure in hypoplastic left heart syndrome (HLHS). METHODS: We retrospectively analyzed the pre-, intra- and postoperative data of 96 successive patients who underwent the Norwood procedure between 2007 and 2011. In case of reCoA balloon angioplasty was performed. We analyzed and compared the data of the patients with reCoA and without reCoA using the StatSo STATISTICA TM 10 software. RESULTS: ReCoA was noted in 23 patients (33.3%). This complication was diagnosed 95.1 days (49-156 days) on the average a er the Norwood procedure. Balloon angioplasty successfully allowed for decreasing the mean gradient across the site of the narrowing from the average 27.5 mmHg to the average 9.7 mmHg (p = 0.008) and enlarged the neo-isthmus by the average of 2 mm (p <0.05). The risks factors seemed to be the diameter of the ascending aorta OR = 7.82 (p = 0.001), atresia of the mitral valve OR = 7.00 (p = 0.003) and atresia of the aortic valve - OR = 6.22 (p = 0.002). CONCLUSION: Balloon angioplasty seems to be an effective intervention in case of reCoA. A low diameter of the native ascending aorta (<=3mm) and the presence of atresia of the mitral and/or aortic valve should intensify the vigilance of a cardiologist in the search for signs of reCoA of the aorta.

The "double dunk" technique for a right ventricle to pulmonary artery conduit implantation during the Norwood procedure reduces unintended shunt-related events.

BACKGROUND: The introduction of a right ventricle to pulmonary artery conduit (RVPAc) during the Norwood procedure (NP) for hypoplastic left heart syndrome (HLHS) resulted in a higher survival rate, but also in an increased number of unintended pulmonary and shunt-related interventions. AIM: To analyse how several modifications employed in RVPAc implantation during NP may influence the interstage course, unintended surgical or catheter-based interventions, and pulmonary artery development in a cohort of patients with HLHS. METHODS: We retrospectively analysed three groups of non-selected, consecutive neonates who underwent the NP between 2011 and 2014, with different RVPAc surgical techniques employed: Group I (n = 32) - left RVPAc with distal homograft cuff, Group II (n = 28) - right RVPAc with distal homograft cuff, and Group III (n = 41) - "double dunk," right reinforced RVPAc (n = 41). RESULTS: There were no intergroup differences in terms of age, weight, prevalence of aortic atresia, diameter of the ascending aorta, deep hypothermic circulatory arrest time, and hospital mortality rate (9.3% vs. 14.2% vs. 7.3%, respectively). There was a significant difference between the groups in the number of catheter-based interventions during the interstage period (34% vs. 25% vs. 0%, respectively, p < 0.05) and/or concomitant surgical interventions (17.2% vs. 4.1% vs. 2.6%, respectively). The diameter of the pulmonary arteries was most homogenous in the third group. CONCLUSIONS: The modified strategy of using the "double dunk," right reinforced RVPAc during the NP for HLHS significantly reduces the number of unintended catheter-based and surgical shunt-related reinterventions during the interstage period. This technique allows a more homogenous development of pulmonary arteries before the second, surgical stage.

Effect of acid-base balance on postoperative course in children with hypoplastic left heart syndrome after the modified Norwood procedure.

Hypoplastic left heart syndrome (HLHS) is a congenital heart defect that requires 3-stage cardiac surgical treatment and multidirectional specialist care. The condition of newborns in the first postoperative days following the modified Norwood procedure is characterized by considerable hemodynamic instability that may result in a sudden cardiac arrest. It is believed that the most important cause of hemodynamic instability is the fluctuations in redistribution between pulmonary and systemic blood flow.The paper analyzes the postoperative course in 40 neonates with HLHS following the modified Norwood procedure performed under deep hypothermic cardiopulmonary bypass hospitalized in Cardiac Surgical Intensive Care Unit (CSICU) in the years 2014-2015. For all hospitalized children, the arterial blood acid-base balance (ABB) parameters (pH, pO2, pCO2, HCO3, base excess (BE), and lactic acid) were measured 2 times a day during the first 5 postoperative days. The main goal of the studies is to analysis of ABB parameters and their influence on the clinical state of newborns with HLHS. Several descriptors were concerned to describe the neonates clinical state: the date of the surgery (the day of life when the child was operated on), the duration (number of days) of mechanical ventilation employment, the time of hospitalization in intensive care unit, and the total duration of treatment in CSICU.The statistical analysis of the particular ABB parameters revealed a significant dependence (P < .001) between the values of pH, pO2, pCO2, HCO3, BE, lactic acid, and all concerned descriptors of the newborn clinical state.The article shows that monitoring the ABB parameters, proper interpretation of the results, and appropriate modification of pharmacotherapy and respiratory treatment are crucial for therapeutic results and survival rates in neonates with HLHS after the modified Norwood procedure.

Myocardial infarction and angina pectoris in the history of Polish medicine. Part 1. Discovery and understanding of the disease.

This review presents the most important achievements associated with the understanding of angina pectoris and myocardial infarction in Poland. The author describes the contribution of physicians living on Polish soil to scientific knowledge in this field. The beginning of Polish interest in cardiac diseases are associated with an eminent medieval physician, Thomas of Wroclaw. In Part 1, a history of studies on myocardial infarction ends with establishing the first diagnosis of myocardial infarction as the cause of death in patients with angina in the mid-19th century. While discussing the contribution of Polish physicians to the worldwide knowledge about myocardial infarction, crucial facts associated with understanding of angina pectoris in other countries have been presented. The discovery of the pathomorphological features of ischemic heart disease and its relation to clinical signs or symptoms has been reminded to the readers. Eminent and well or less known Polish forefathers of medicine are recalled, including Adam Christian Thebesius, Józef Chrzczonowicz, Jan Cenner, Andrzej Janikowski, Józef Rompalski, Józef Pawinski and Edward Korczynski.

Myocardial infarction and angina pectoris in the history of Polish medicine. Part 2. Diagnosis and early attempts at treatment: the 19th and 20th centuries.

In the second part of the article, developments following the "discovery" of ischemic heart disease and gaining understanding of its nature have been presented starting from the first intravital diagnoses of myocardial infarction in the history of the world medicine established by Adam Hammer in Austria (1878) and Edward Korczynski in Krakow (1887). The contribution of Polish clinicians at the turn of the XX century to the first modern attempts at elucidating the nature of myocardial infarction based on the knowledge of anatomopathology and physiology prevalent at the end of the 19th and the beginning of the 20th century has been described. A special role in understanding pathological mechanisms of myocardial infarction was played by such Polish researchers as Wladyslaw Bieganski, Józef Pawinski, Zdzislaw Dmochowski, Wladyslaw Antoni Gluzinski and Marian Franke. The author has described the beginnings of introducing electrocardiography to the diagnostic evaluation of cardiovascular diseases advocated by Napoleon Cybulski and Józef Latkowski. The discovery of adrenaline by Cybulski and Szymonowicz, an event of great importance in the history of cardiology, as well as the introduction of nitroglycerine to clinical practice by Korczynski soon after the preparation was employed for the first time in the world has been presented. The paper further discusses the rapid development of medical knowledge and therapeutic progress in symptomatic treatment of myocardial infarction within the past fifty years--pharmacotherapy and also early attempts at interventions aiming at restoring blood flow in the occluded infarct-related artery. While presenting the role of Polish physicians in the history of cardiology, the author recalls the most important world discoveries associated with understanding the nature of myocardial infarction, initial diagnostic and therapeutic attempts.

[The celebrity of Polish and French medicine--Józef Julian Franciszek Feliks Babinski (1857-1932)]. / Józef Julian Franciszek Feliks Babinski (1857-1932) --wielki uczony, chluba polskiej i francuskiej medycyny.

The paper presents a biography of Polish and French medical scientist, Józef Julian Franciszek Feliks Babinski (1857-1932), a son of Polish exiles to France after the unsuccessful insurrection against the Russian occupants. Born in Paris, Babinski considered Poland as his own home-country, being faithful and grateful citizen of France, his adopted country. He made his neurological department in Paris a world famous medical centre at the turn of the 20th century. Currently for every student of medicine or physician practitioner, the name of Babinski immediately associates with the "toe phenomenon" (phénomène des orteils). The discovery of this "sign" (1896) is the crowning point of Babinski's work in semiology. He was a co-author of discoveries known under eponym names of syndromes: Babinski-Nageotte, Babinski-Fröhlich, Anton-Babinski and many others. Babinski emphasized his Polish origins, expressing his feeling towards two home countries (1922): "I am proud to have two countries--to one, I owe the knowledge, to the other, the country of my ancestors, the elements of my Polish soul...".

[Newborn life threatening respiratory failure treatment with extracorporeal membrane oxygenation]. / Leczenie skrajnej niewydolnosci oddechowej noworodków z zastosowaniem natleniania pozaustrojowego.

UNLABELLED: THE AIM of the study was to show first results of newborn life threatening respiratory failure treatment with extracorporeal membrane oxygenation (ECMO) in Poland. MATERIAL: Nine newborns were treated with extracorporeal membrane oxygenation in Silesian Center for Heart Diseases. Newborns were born in 38 week of gestational age (36-41 weeks) with mean birth weight of 3490 g. Reasons for the referral were: meconium aspiration syndrome, infection, and pulmonary hypertension. Each newborn fulfilled an Extracorporeal Life Support Organization (ELSO) criteria for extracorporeal membrane oxygenation. RESULTS: seven out of nine of patients treated with extracorporeal membrane oxygenation survived. Full clinical stabilization was reached about 6th hour of treatment. Mean extracorporeal oxygenation time was 162 hours. For eight newborns veno-venous method was applied and for one newborn veno-arterial method. Roller pump was used in 7 cases and centrifugal pomp in one case. Five newborns had uneventful treatment. During extracorporeal membrane oxygenation therapy we have observed several complications: PDA, hemorrhagic complications, renal failure, arterial hypertension, septicemia, tubing rupture. CONCLUSIONS: extracorporeal oxygenation is an effective method of treatment for newborn life threatening respiratory failure. Obtained results do not differ much from Extracorporeal Life Support Organization register results. The most essential problem for extracorporeal membrane oxygenation therapy is correct qualification, early referral, safe transportation as well as the development of centers providing ECMO treatment.

Albert Wojciech Adamkiewicz: the discoverer of the variable vascularity of the spinal cord.

The present article contains a brief biography as well as a discussion of the more significant contributions of Albert Wojciech Adamkiewicz, Head of General and Experimental Pathology at the Jagiellonian University in Cracow in the years 1879 to 1892, and who is now primarily remembered as the discoverer of the major radicular artery eponymically named "Adamkiewicz's artery." His work as an investigator of the variability of the vasculature of the spinal cord led to his major contributions to present clinical practice in such areas as vascular surgery, neurosurgery, pediatric surgery, and the surgery of the aorta, providing a permanent Polish eponymic accent in major textbooks in these specialties. This article also deals with Adamkiewicz's contributions in other fields, mostly involving the nervous system, such as the development of a new and original method for staining neuronal tissue (double staining of the spinal cord) and his extensive studies of spinal cord degeneration. The authors also present aspects of his career that brought ill fame to Adamkiewicz. These were his claims to have discovered the so-called nervous bodies and anticancer antitoxin, which were both severely criticized by his faculty peers at the Jagiellonian University. The biography is supplemented with an attempt at evaluating Adamkiewicz's entire scientific output, wherein unquestionable achievements and pointed discoveries prevail in comparison with failures.

[Coronary disease in the past. An attempt at evaluating the dissertation by Jan Cenner "De angor pectoris" (1820) in the context of contemporary knowledge]. / Choroba wiencowa dawniej. Próba oceny wartosci pracy "De angore" pectoris Jana Cennera z 1820 roku, w realiach wiedzy wspólczesnej.

Following an abbreviated historical review of literature related to angina pectoris spanning the period from olden days to the beginning of the XIX th century, this paper analyses Jan Cenner's doctoral dissertation entitled "Dissertation inauguralis medica de angor pectoris", written in Cracow, Poland in 1820. A conciliation of the information regarding coronary artery disease with the current state of medical understanding is made in a tabular form and an attempt at an assessment of treatment rules (including prevention, general non-specific therapy, local treatment, dietary management and the use of pharmacological agents) according to updated medical criteria follows. The authors' goal is an objective evaluation of the real scientific value of Cenner's work in light of nearly two centuries of progress in medical knowledge. Emphasis is placed on those diagnostic findings and therapeutic paths relating to coronary artery disease that are currently used in medical practice.

[New possibilities in the postoperative measures to prevent bleeding in cardiac surgery. Will the recombinant activated factor VII improve surgical results?]. / Nowe mozliwosci w walce z krwawieniem pooperacyjnym w kardiochirurgii. Czy rekombinowany aktywowany czynnik VII jest w stanie poprawic wyniki leczenia?

The authors present the diagnostic and therapeutic management in bleeding episodes associated with cardiosurgical operations, which constitutes the policy that is employed at Department of Cardiac Surgery and Transplantology, Silesian Academy of Medicine, Zabrze, Poland. The paper also presents a compendium of information on the pathophysiology of coagulation processes, most significant from the standpoint of cardiosurgical practice. Separate issues associated with providing optimal hemostasis in patients operated on using cardiopulmonary bypass are discussed, along with the effect of cardiac procedures on coagulation processes. Further, the authors present their clinical observations and experience in the utilization of the recombinant activated factor VII (NovoSeven, NovoNordisk) in two patients with severe perioperative bleeding. In the first case bleeding was associated heart transplantation procedure in a 37-year old woman, who had previously been twice subjected to operations for valvular heart disease. A dysfunction of two artificial valves implanted 15 years previously resulted in considerable heart muscle damage and an extremenally severe form of cardiac insufficiency. Two months after the heart transplant the patient unfortunately died due to infectious complications. In the second patient the recombinant activated factor VII was employed in an attempt at controlling severe bleeding encountered in a 15-year old boy in the course of reoperation in surgical treatment of a complex congenital heart defect. In this case the treatment was successful. In both described patients who were characterized by a high risk of surgical bleeding, the employment of the recombinant activated factor VII led to significant improvement in coagulation system indices and the hemostatic outcome was regarded positive. The authors state that the introduction of the recombinant activated factor VII to clinical practice in a selected group of patients presenting with most serious coagulation abnormalities and difficult to control perioperational bleeding allows for improving therapeutic results and decreasing mortality in cardiac surgery patients. In view of the significant economic barrier associated with a high cost of the preparation, the authors propose a consistent approach of employing at all times the classic, well-balanced hemostatic management, based primarily on extended knowledge of the pathophysiology of the clotting system and on very thorough surgical hemostasis, with the recombinant activated factor VII being reserved for exceptional situations only.