Emergency caesarean section delivery and puerperium in a patient with severe idiopathic pulmonary arterial hypertension - a case report.

BACKGROUND: The aim of this paper is to describe the third pregnancy trimester, delivery and puerperium in patient with idiopathic pulmonary hypertension. CASE REPORT: a 30-year-old primigravida with idiopathic pulmonary hypertension was qualified for emergency Caesarean section. In the post partum period no improvement in managing pulmonary arterial hypertension was achieved. Because of progressive respiratory and circulatory failure as well as the pulmonary artery pressure exceeding the systemic pressure the AV ECMO was applied on postoperative day 6. During the ECMO period the emergency laparotomy due to bleeding was necessary. The further course of ICU treatment was uneventful. CONCLUSION: In described case things are left to chance or goodwill of specialists and final outcome depend on happy coincidences.

Left ventricular diverticulum mimicking cardiac tumor.

Left ventricular (LV) diverticulum represents a rare and frequently asymptomatic congenital anomaly, which is incidentally discovered during routine transthoracic echocardiography. We present a case of a 66-year-old female patient who was admitted to the cardiology department due to incidental finding of a tumor-like mass associated with the posterior mitral leaflet. Preliminary echocardiographic evaluation revealed a solid structure, suspected of mitral annulus calcification or LV malignancy. However, cardiac contrast-enhanced computed tomography confirmed the presence of LV diverticulum, partially filled with calcified thrombus. Conservative management was recommended. This case underscores the importance of multimodality imaging for differentiation of LV tumor-like structures.

Impact of atherosclerotic changes of carotid vessels on long-term outcome in relatively young patients with acute coronary syndrome.

BACKGROUND: Complex stenoses of coronary vessels as well as unstable plaques are part of the widespread atherosclerotic process. AIM: The possible association between the incidence of unstable coronary artery disease (CAD) and the morphology of carotid artery wall and cardiovascular events (MACE) was assessed prospectively in a two-year follow-up study. METHODS AND RESULTS: Ninety-seven consecutive patients, aged under 60, admitted to hospital with suspected acute coronary syndrome (ACS) were included. Angiography was performed in all patients. Coronary artery disease was confirmed in 78 patients. This was the CAD(+) group. In 19 patients, coronary arteries were normal. This was the CAD(-) group. In all cases, carotid ultrasound was performed before discharge and at two-year follow-up, with evaluation of carotid arteries wall morphology: carotid intima-media thickness (CIMT) in far distal wall of common carotid artery and the presence of plaques. Carotid atherosclerosis was defined as CIMT > 0.9 mm or incidence of plaques; MACE was defined as death, ACS, stroke or need for urgent coronary revascularisation. Sixty patients from the CAD(+) group met the carotid atherosclerosis criteria. This was named the CAR(+) subgroup; 18 patients with normal carotid morphology comprised the CAR(-) subgroup. During the two years, MACE occurred only in the CAD(+) group (22 events). There was no statistical difference in the MACE-free survival curve of the CAR(+) and CAR(-) subgroups (p = 0.91). CONCLUSIONS: The presence of atherosclerotic process in carotid region coexists well with the incidence of CAD; however, it does not determine prognosis after ACS.

Impact of left ventricular remodeling on ventricular repolarization and heart rate variability in patients after myocardial infarction treated with primary PCI: prospective 6 months follow-up.

BACKGROUND: The relation between postinfarction left ventricle remodeling (LVR), autonomic nervous system and repolarization process is unclear. Purpose of the study was to assess the influence of LVR on the early (QTpeak) and late (TpeakTend) repolarization periods in patients after myocardial infarction (MI) treated with primary PCI. The day-to-night differences of repolarization parameters and the relation between QT and heart rate variability (HRV) indices, as well left ventricle function were also assessed. METHODS: The study cohort of 104 pts was examined 6 months after acute MI. HRV and QT indices (corrected to the heart rate) were obtained from the entire 24-hour Holter recording, daytime and nighttime periods. RESULTS: LVR was found in 33 patients (31.7%). The study groups (LVR+ vs LVR-) did not differ in age, the extent of coronary artery lesions and treatment. Left ventricle ejection fraction (LVEF) was lower (38%+/- 11% vs 55%+/- 11%, P < 0.001), both QTc (443 +/- 26 ms vs 420 +/- 20 ms, P < 0.001) and TpeakTendc (98 +/- 11 ms vs 84 +/- 12 ms, P < 0.005) were longer in LVR + patients, with no differences for QTpeakc. Trends toward lower values of time-domain (SDRR, rMSSD) HRV parameters were found in LVR+ pts. Day-to-night difference was observed only for SDRR, more marked in LVR-group. Remarkable relations between delta LVEF (6 months minus baseline), delta LVEDV and TpeakTendc were found, with no such relationships for QTpeakc. CONCLUSIONS: The patients with LVR have longer repolarization time, especially the late phase-TpeakTend, which represents transmural dispersion of repolarization. Its prolongation seems to be related to local attributes of myocardium and global function of the left ventricle but unrelated to the autonomic nervous influences. Remodeling with moderate LV systolic dysfunction is associated with insignificant decrease in HRV indices and preserved circadian variability.

Influence of coronary artery bypass grafting on QT dispersion.

BACKGROUND: Abnormal dispersion of the QT interval (QTd), measured as the interlead variability of QT, reflects an inhomogeneity of ventricular action potentials. In this study we observed both short- and long-term influences of coronary artery bypass grafting (CABG) on rest and exercise QTd in 64 male patients, having a mean age of 54+/-10 years, with coronary heart disease. MATERIAL/METHODS: QTd was measured as the difference between QT maximum and minimum from 12 leads on an averaged ECG (25 mm/s). QTd and QTdc were measured at rest and at peak exercise during symptom-limited treadmill exercise (ET), which was performed before, 6 months after, and 2 years after CABG. RESULTS: There was a significant reduction in rest QTd from before CABG to 6 months and 2 years after (60+/-20 ms vs. 43+/-14 ms and 45+/-13 ms, respectively; p<0.001). Similarly, there was a significant reduction in peak QTd from before CABG to 6 months and 2 years after (66+/-22 ms vs. 38+/-11 ms and 36+/-11 ms, respectively; p<0.001). Two years after CABG, 17 patients had a recurrence of angina and ET provoked chest pain and/or >2 mm ST depression. The resting values did not distinguish patients with ischemia from nonischemic ones. In patients with ischemia, ET provoked an increase in QTdc. CONCLUSIONS: Rest and exercise QTd is significantly reduced after CABG. It seems that the measurement of QT dispersion during ET can be helpful in distinguishing patients with a recurrence of ischemia.