[Various technics in the surgical treatment of dissection of the thoracic aorta]. / Diferencovaná taktika chirurgické lécby disekce hrudní aorty.

During 1994-1996 at the Clinic of Cardiovascular and Transplantation Surgery of IKEM 17 patients were operated with acute dissection of the thoracic aorta type A. Based on the applied surgical tactics the patients were retrospectively divided into two groups. The first included 8 patients where surgical reconstruction of the ascending aorta was implemented in the standard way, the second group comprised 9 patients where the method of deep hypothermia and circulatory arrest were used. Three operated patients died, all from the group with deep hypothermia. The cause of death was twice multiorgan failure and once haemorrhage in a female patient with cardiac tamponade before surgery. The authors discuss the advantages and some pitfalls of surgery in deep hypothermia and circulatory arrest and maintain that neurological disorders are most serious. In the conclusion they draw attention to some possible ways how to improve hitherto achieved results. They include e.g. reduction of the time interval between the development of symptoms of dissection and surgery, careful checking of the cooling and heating when using deep hypothermia, as well as better prevention of cerebral embolic attacks.

[Techniques and tactics in multiorgan harvesting]. / Technika a taktika multiorgánového odberu.

The eighties and nineties are characterized by potent development of transplantology. Despite this the number of patients with organ failures waiting for a suitable organ is steadily increasing. Due to the permanent shortage of donors transplantation surgery tries to implement the maximum possible multiple organ collection. In the conclusion the authors emphasize the importance of satisfactory cooperation of the anaesthesiologist attending donors and the organ collection teams.

[Causes of failure in surgical treatment of acute dissection of the ascending aorta (type A)]. / Príciny neúspechu pri chirurgickém lécení akutní disekce vzestupné aorty (type A).

In 27 patients with acute dissection of the ascending aorta where during 1988-1995 for reconstruction of the affected portion of the aorta an intraluminal prosthesis was used, a retrospective analysis of some factors was made to evaluate their importance for the final result of the operation. The analysis proved the fundamental importance of complications present before operation. Among them, in association with the extent of the dissection, the most important one proved to be cardiac tamponade, impaired renal function and a state of shock. More detailed analysis revealed the unequivocal relationship of the development of these complications with the protracting time interval between the development of the dissection and the surgical operation. Because symptoms of dissection of the thoracic aorta are very closed to clinical manifestations of AIM, it is useful, if the latter is ruled out, to consider this possibility and focus the further procedures on the most rapid possible confirmation or at least justified suspicion of this disease and to contact without delay a cardiosurgical department. Only in this way we can improve the results which so far do not correspond the possibilities of surgical and anaesthesiological care.

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.

[Transseptal approach to the left atrium]. / Transseptální prístup do levé síne.

The authors present their first experience with trans-septal access to the left atrium, employed in 22 procedures of mitral valve surgery and in 4 myxoma extirpations. The majority of cases were re-operations or combined procedures, performed most often in connection with tricuspid valve annuloplasty. There were two deaths (7.6%), serious arrhythmias or signs of an intra-atrial shunt were not seen in any of the patients undergoing surgery. Trans-septal access allows thorough orientation in the left atrium, and the authors find it useful especially in re-operations or combined procedures.

[Surgical problems in heart transplantation]. / Chirurgické problémy transplantace srdce.

Today, heart transplantation is a generally recognized method for managing an otherwise uncontrollable heart failure. The surgical technique of transplantation has become standardized in recent years. There are no substantial differences in postoperative care and the rate of surgical complications between a heart transplant recipient and a patient undergoing routine cardiac surgery. The only problem to be handled is the recipient's elevated pulmonary resistance. Late complications are caused by infection related to immunosuppression and/or antirejection therapy.

[Coronary surgery at the Institute of Clinical and Experimental Medicine]. / Koronární chirurgie v IKEM.

In 1971-1991 in the Institute of Clinical and Experimental Medicine 2386 operations on account of IHD were performed. 2154 aortocoronary bypasses, 6 Vineberg operations, 51 valvular prostheses and aortocoronary bypasses, 128 resections of left ventricular aneurysms and 47 closures of post-infarction perforations of the interventricular septum. The mortality from aortocoronary bypasses during the entire period was 6.9%. The authors discuss different periods, changes of the operative technique and contemporary views on surgical treatment of IHD.

[Personal experience with heart transplantation]. / Nase zkusenosti s transplantacemi srdce.

During the period from 1984-1991 in the Institute of Clinical and Experimental Medicine 72 orthotopic transplantations of the heart were performed in 71 patients with irreversible cardiac failure. Indication for transplantation in 39 patients was IHD, in 28 cardiomyopathy, in 3 RHD and in one instance a tumour. The mean age of the patients was 41 years, the youngest patient was 17 and the oldest 62 years old. Immunosuppression involved a combination of three preparations Azathioprine, corticoids and Cyclosporine A. Nineteen patients died within one month after operation. The most frequent cause of death was cardiac failure. As to postoperative complications, renal failure was most frequent. Fifty patients were followed-up on a long-term basis. The longest survival period was 8 years and 2 months. The most frequent cause of death in the long-term follow-up was sudden death caused in the majority most probably by rapid development of coronary disease.

[A fistula between the aorta and esophagus--an uncommon sequela of dissection of the thoracic aorta]. / Pístel mezi aortou a jícnem--méne bezný následek disekce hrudní aorty.

In a patient with repeated dissection of the ascendent aorta where the first episode was resolved surgically by an intraluminal prosthesis the authors describe the rare consequence of the development of a new dissection manifested by an aorto-oesophageal fistula. In the described case an inoperable episode was involved which fully confirmed the clinical validity of the pathognomic Chiari triad.

Long-term results of tricuspid annuloplasty according to DeVega.

The long-term results on 36 patients undergoing tricuspid annuloplasty according to DeVega over the years 1981-1990 were analyzed. All had mitral valve replacement or repair in addition to the above procedure. Moreover, three patients had aortic valve replacement while aortocoronary bypass and interatrial septal defect closure was performed in two cases each. Duration of follow-up ranged between 6 to 72 months (mean 36 months). All patients were examined by echocardiography. Significant tricuspid regurgitation was found in three of the patients operated on, manifest clinical signs of the condition were present in one female patient only. Functional evaluation reassigned 72% of the operated patients from Class III and IV to Class I and II, and apparent subjective improvement was reported by 81% of patients. The analysis showed that indication of patients for simultaneous management of tricuspid regurgitation associated with mitral valve disease is justified, and that the surgical technique employed is appropriate.

The mobilized omentum and muscle flaps in the treatment of infectious complications in cardiovascular surgery.

Infection in cardiovascular surgery invariably constitutes a very serious complication that cannot be controlled by antibiotics in all cases. Improved blood supply to the tissue affected by infection largely helps to control these complications. The article reports on three cases in which mobilized muscle and omental flaps helped essentially to heal infectious complications following heart transplantation, aortic valve replacement, and reconstruction of arteries of the lower limb.

[Surgical treatment of heart valve defects in infectious endocarditis]. / Chirurgická lécba chlopenních srdecních vad pri infekcní endokarditide.

The study makes an assessment of the results of surgical treatment of infectious endocarditis in 25 patients operated in 1982-1988 at the Institute of Experimental and Clinical Medicine. At the active stage of the disease, surgery was performed on 15 patients (60%), while prior to the operation, 16 persons' condition (64%) corresponded to the IIIrd and IVth degree of the NYHA functional classification. In infectious endocarditis, early mortality after valve replacement was 8%, late mortality--9% with an average of two-year post operative follow-up. Re-infection occurred in 12% patients, paravalvular regurgitation was found in 20 percento, out of whom 8% were haemodynamically significant and associated with the infection. Clinical post-operative improvement was observed in 76% patients, out of whom one half was totally asymptomatic and one third resumed their jobs. The results show that early surgical treatment of infectious endocarditis helps to reduce mortality. The post-operative risk of re-infection or of other complications was not high and the long-term post-operative functional effect was favourable in most patients.

[Metabolic and ultrastructural changes in the myocardium during heart arrest in patients undergoing surgery for ischemic heart disease]. / Metabolické a ultrastrukturální zmeny v myokardu pri srdecní zástave u nemocných operovaných pro ischemickou chorobu srdecní.

The authors give an account of metabolic changes in the ultrastructure of the myocardium which develop during cardioplegic arrest of the heart muscle by cold during aortocoronary reconstruction operations. Using the technique of arteriovenous differences before myocardial ischemia and after its termination, the assessed differences in arterial blood and blood from the sinus coronarius as regards the blood sugar level, lactate, pyruvate, potassium, phosphorus, unsaturated fatty acids and triglycerides. The results revealed a marked disorder of the carbohydrate and ion metabolism and severe impairment of the ultrastructure of the heart muscle during cardiac arrest.

Perforated mycotic aneurysm of the aortic arch: surgical management by deep hypothermia with circulatory arrest.

The case of a ruptured mycotic aneurysm of the aortic arch in a 40-year-old patient is reported. Successful surgery was performed using deep hypothermia with circulatory arrest. Reconstruction was carried out using an intraluminal ringed vascular prosthesis. The postoperative course was uncomplicated and 10 months after surgery the patient is symptomless and back at his original job.

Cardiac valve surgery combined with aortocoronary bypass.

An analysis of the experience obtained in combined cardiac valve and coronary artery surgery in 23 patients was performed. The dominant feature of their clinical symptomatology was valvular disease in the majority of patients, even though angina pectoris was present in 14 of them. In all patients, cardiac valve surgery was carried out together with coronary reconstruction in the form of a single to triple bypass. The procedure involved, in two cases, simultaneous removal of a left ventricular aneurysm and, in one patient, closure of a postinfarction lesion of the interventricular septum. One patient died in the postoperative period displaying signs of the low cardiac output syndrome. Long-term follow-up included 20 patients operated on. Improvement of a varying degree was observed in 19 patients.