[Prevention of bacterial endocarditis in patients with prosthetic heart valves]. / Prevence bakteriální endokarditidy u nemocných s chlopenní náhradou.

American Heart Association published in 1997 new version of recommendations for prevention of bacterial endocarditis in risk patients. Postoperative stadium in patients with prosthetic valve belongs to the highest risk. Infection can develop during bacteremia, which occurs most frequently at stomatologic and urologic interventions. The whole scale of medical interventions can be covered by two universal antibiotical regimes--one for the mouth, respiratory and upper GI tract, second for urogenital and lower GI tract. In the first case 2 g of Amoxicillin are administered p.o. 2 hours before the intervention. Interventions are individually listed, and cases where antibiotical prophylaxis is not recommended are separately given. Special situations are discussed.

Aneurysm of the common carotid artery as a sequel of puncture angiography.

The case of a 60-year-old man with a large aneurysm of the common carotid artery, which manifested five months after puncture angiography, is described. This was successfully managed by aneurysm exclusion and aortocarotid bypass. The etiology of the aneurysm is discussed.

Do preoperative branched-chain amino acids have a beneficial effect on the heart after cardiac surgery?

To verify the hypothesis, formulated on the basis of data emerging from animal experiments, that branched-chain amino acids (BCAA) exert a protective effect on the heart during ischaemia, eight patients immediately before aortocoronary reconstruction were provided 400 ml of a 3% BCAA solution. A control group comprised another eight patients. Per- and postoperative myocardial status and myocardial enzyme levels were assessed. Myocardial biopsy was performed during surgery to determine glycogen levels. Creatine kinase (CK) levels were invariably higher in the BCAA group, with statistically significant differences in samples obtained immediately after surgery (10.6 +/- 3.35 mu kat/l vs. 4.07 +/- 0.59, p < 0.0004), in the evening after surgery (14.2 +/- 5.92 vs. 5.91 +/- 2.21, p < 0.06) and in the morning of the first postoperative day (18.0 +/- 10.1 vs. 7.5 +/- 4.76, p < 0.025) when aspartate aminotransferase (AST) levels were likewise higher (1.35 +/- 0.28 vs. 1.00 +/- 0.26, p < 0.035). There were no differences between the groups in the number of defibrillations after ischaemia, myocardial glycogen content, peroperative ischaemia, incidence of arrhythmia and catecholamine support. We conclude that BCAA at the above indicated doses did not raise myocardial glycogen content or improve myocardial status after cardiac surgery. Their administration resulted in a rise in CK and AST in the postoperative period.

[Catabolism after direct myocardial revascularization]. / Katabolismus po prímé revaskularizaci myokardu.

The objective of the investigation was to assemble more knowledge of catabolic processes after cardiosurgery. In 14 patients after 6-hour intervals following an aortocoronary bypass the total production of urea nitrogen, Bistrian's catabolic index and the sodium:potassium ratio in urine was assessed. The urea nitrogen production varied within a range of 5.4-9.5 g per 12 hours. These values when calculated per 24 hours are 94-108 g of protein. The catabolic index was in the range of 5.8-11.2, i.e. within the zone of intense stress. Also the values of the Na/K ratio (1.0-1.9) suggested intense stress. The authors discuss the causes and possibilities to relieve the stress response.