[Biochemical parameters in the blood of patients during open-heart surgery. I. Monitoring changes in energy metabolism]. / Sledovanie niektorých biochemických parametrov v krvi pacientov pocas operácie na otvorenom srdci. I. Monitorovanie zmien energetického metabolizmu.

Levels of lactate, inorganic phosphate and uric acid in arterial, mixed venous and coronary sinus blood were studied in patients during open-heart surgery. It was found that the determination of mentioned biochemical parameters can provide information regarding the energetic metabolism status of the whole organism, but selectively, also of the patient's myocardium. The results of biochemical analyses demonstrate a significant loading of the organism manifested by metabolic alterations, especially after long-term cardiopulmonary bypass. The study of mentioned biochemical parameters can be employed for investigation of a more efficient protection of myocardium against ischemia-reperfusion injury. (Fig. 6, Ref. 18).

[Biochemical parameters in the blood in patients during open-heart surgery. II. Malondialdehyde, superoxide dismutase and catalase as indicators of formation and elimination of free oxygen radicals]. / Sledovanie niektorých biochemických parametrov v krvi pacientov pocas operácie na otvorenom srdci. II. Malóndialdehyd, superoxiddismutáza a kataláza ako indikátory tvorby a odstranovania vol'ných kyslíkových radikálov.

Investigation of cardiosurgical patients have provided evidence for the generation of free oxygen radicals during open heart surgery. The finding of increased plasma malondialdehyde concentrations, considered to be an indicator of lipid peroxidation in cell membranes, is suggestive of this process. Simultaneously, the antiradical capacity of tissue was found to exhibit a decreasing trend, as established by the levels of superoxide dismutase and catalase in erythrocytes of peripheral blood which tended to diminish. The funding that no changes in the studied parameters were observed in the blood from the coronary sinus taken before and after interruption of coronary blood flow demonstrates that the commonly applied protection of the myocardium by hypothermic cardioplegic solution and topical cooling of the heart is effective in suppressing radical formation. (Fig. 5, Ref. 36.)

[Surgical treatment of supravalvular aortic stenosis]. / Operacná liecba supravalvulárnej aortálnej stenózy.

Over the last 22 years, two children were operated on for supraventricular aortic stenosis at the Institute of Cardiovascular Diseases in Bratislava. Both cases presented a localized form of supravalvular aortic stenosis. Simple elipsoid flaps were used without extended aortoplasty. One of the two children, a 12-year-old boy with Williams' syndrome died of endocarditis in the early postoperative period. In the 10-year-old girl with familial supravalvular aortic stenosis the operation was successful, although the defect was combined with supravalvular muscular obstruction. The authors emphasize the possibility of choice between two surgical procedures according to the localization of the stenosis with respect to the valvular apparatus.

[Mechanisms of the effect of allopurinol on the metabolism of adenine nucleotides]. / Mechanizmy pôsobenia alopurinolu na metabolizmus adenínových nukleotidov.

The effect of repeated administration of allopurinol (50 mg.kg-1 48, 24, and 4 hours before analysis) on the activity of enzymes of degradation and resynthesis of adenine nucleotides was studied. The activity of xanthine dehydrogenase and xanthine oxidase was inhibited in the heart, liver and kidney and the activity of membrane-bound 5'-nucleotidase was particularly elevated in the heart and brain, suggesting that membrane transport processes may be affected. The increase in the activity of hypoxanthine guanine phosphoribosyl transferase in the liver is indicative of a potential mechanism of positive action of allopurinol upon restoring the purine nucleotide store. The authors present their hypothesis on the mechanism of allopurinol action upon the metabolism of adenine nucleotides. The suggested mechanisms might become operative in protecting tissues against ischemia and reperfusion induced damage.

Protective effect of alpha-tocopherol and L-ascorbic acid against the ischemic-reperfusion injury in patients during open-heart surgery.

The purpose of the investigation was: 1. to examine the effect of cardiopulmonary bypass (CPB) on the generation of cytotoxic oxygen-derived radicals and 2. to determine if the pretreatment of patients with vitamins E and C will combat generation of such radicals. Twenty patients undergoing CPB for treatment of cardiac disease were entered into the study and randomized to one of two groups. Group 1 (n = 9) served as control. Group 2 (n = 11) consisted of patients pretreated with 2000 IU of vitamin E 12 h prior to surgical intervention and 2 g of vitamin C given in the morning on the day of operation. Blood samples from arterial and mixed venous blood for analysis were obtained at the following intervals: 1. before anesthesia, 2. before sternotomy, 3. at the start of CPB, 4. at the end of CPB, 5. at the time of skin closure, 6. in the morning of the following day. Blood specimens from the coronary sinus were withdrawn A--before aortic cross-clamping, B--immediately after aortic declamping, C--in the 5th min, and D--in the 15th min of reperfusion. The concentration of inorganic phosphate as well as of uric acid was significantly higher in the control group what might indicate that vitamins E and C attenuate the degradation of adenine nucleotides. The most important difference between treated and control groups was observed in plasma concentration of malondialdehyde--a marker of lipid peroxidation--which was significantly lower in pretreated patients. A similar pattern of changes was found in the level of the lysosomal enzyme N-acetyl-glucosaminidase. Finally, pretreatment with vitamins E and C inhibited the decrease of catalase, observed in controls.

[Surgery of congenital heart defects in adulthood]. / Operácie niektorých vrodených srdcových chýb v dospelosti.

During the period between 1983-1989 the authors operated 165 patients with the diagnosis of coarctation of the aorta, 197 cases of patent ductus arteriosus and 360 atrial septal defects. In all diagnostic groups they operated a large number of patients above 10 years of age whereby the oldest patient with a septal defect was 57 years old, patients with coarctation of the aorta or a patent ductus arteriosus 35 years old. The authors discuss the reasons why the patients were indicated for operation so late.

[Tumors of the heart and arterial embolisms]. / Tumory srdca a arteriálne embólie.

Tumors of the heart are a rare cause of embolism of the peripheral arterial system. A series of 26 patients operated on for heart tumor in the Institute of Cardiovascular Diseases in Bratislava over the years 1979-1988 was analyzed. Pseudomyxoma was histologically verified in 24 patients and rhabdomyoma and rhabdomyosarcoma in the other two patients. A total of 12 embolic events was recorded in 9 patients (34.6%). There were 8 instances of embolism in the central nervous system and 4 in the extremities. In all cases pseudomyxoma of the left parts of the heart was the source of embolism. In 21 cases diagnosis was established and operation indicated on the basis of ultrasonographic evidence. The authors recommend the biatrial transseptal approach. Early surgical removal of a heart tumor is the therapy of choice which prevents the development of potential complications from the heart and peripheral arteries.

Septic complications in patients with permanent pacemakers.

Nine patients with implanted pacemakers had the diagnosis of septicaemia to endocarditis. The diagnosis was established on the basis of a repeatedly positive haemoculture. The interval since the first pacemaker implantation to the onset of sepsis to endocarditis was about 5 years. All nine patients had previous reoperation either of the pacemaker or its lead due to decubitus. While, in four patients, the route of infection was a pacemaker lead in its extravascular couse, in 5 patients the source of infection was a lead placed right in the venous system. All patients were treated with ATB according to the antibioticogram. 4 patients had the pacemaker lead extracted. In the remaining five, the pacemaker lead was removed by catheterization. All patients recovered. There is only one way of eliminating infection that caused the sepsis, that is, to remove the foreign body present in the patient - the pacemaker leas in this particular case.

Influence of moderate hypothermia and deep local hypothermia with or without cardioplegia on intramyocardial oxygen tension during ischemic cardiac arrest.

The effect of ischemic cardiac arrest on intramyocardial oxygen tension (MpO2) in hearts of dogs under normothermia, moderate hypothermia as well as in heart in deep local hypothermia and in hearts subjected to deep local hypothermia combined with Bretschneider cardioplegia was examined. In the last mentioned condition the myocardial oxygen depletion was slowest and even at the end of 30 minutes of anoxia MpO2 was significantly higher in comparison with the other groups. Release of myocardial ischemia resulted in an immediate rise of MpO2 to overshoot levels in animals in normothermia and with deep local hypothermia alone, while in animals in moderate hypothermia and with combination of local hypothermia with cardioplegia reversed only to preanoxic values. On the basis of MpO2 measurements and of postischemic recovery of cardiac function the authors conclude that the combination of deep local hypothermia with cardioplegia is superior for myocardial protection to other used techniques.