[Concurrent coronary artery disease and acquired rheumatic mitral valve disease]. / Wspólistnienie choroby wiencowej z nabyta, poreumatyczna wada zastawki mitralnej.

The aim of this study was to estimate coincidence of coronary artery disease (CAD) and rheumatic mitral valve disease in 264 patients treated in the National Institute of Cardiology (1976-1990). Severity of stenoses on coronary angiography with respect to age, sex, symptoms and risk factors were also estimated. Stenoses over 70% of artery lumen in relation to artery diameter before lesion and over 50% for left main coronary artery were stated as severe. There were 180 (68%) females and 84 (32%) males in the studied group; mean age was 52.5 year. Patients were divided into two groups: with angina--126 pts and without CAD symptoms--138 pts. 8 females (4%) had severe stenoses and 45 (25%) non-severe. Respectively 14 males (16.7%) had severe stenoses and 14 non-severe. Severe lesions were present in a group of females older than 50 years and in a group of males older than 45 years. Both in group with or without angina prevalence of coronary artery lesions was similar. Sensitivity and specificity of CAD clinical symptoms was low (less than 50%). Significantly more risk factors were present in pts with coronary stenoses than in pts free of CAD. No correlation between high pulmonary artery pressure and angina in patients without coronary stenoses occurred.

[Propionibacterium acnes in the etiology of endocarditis]. / Propionibacterium acnes w etiologii zapalenia wsierdzia.

Propionibacterium acnes is the gram positive anaerobic bacteria belongs to the normal skin and oral microbial flora. The participation of this microorganism in the infective endocarditis is still controversial. The aim of the study was to perform the diagnostic and therapeutic difficulties in 5 patients with infective endocarditis caused by Propionibacterium acnes. In 3 out of 5 patients the infective endocarditis developed after prosthesis valve replacement, in 2 others on the native valves. The inserted prostheses were mechanical ones, propionibacterium acnes was identified as causative organisms in all of the causes (two positive blood and/or valve culture). The bacterial strains were sensitive to the antibiotics as: penicillins, cephalosporins, clindamycin, and vancomycin, however cephalosporins used at the beginning of the treatment in 3 patients and clindamycin in 1 patient had limited clinical efficacy. Later treatment with timentin, augmentin and tienamycin was successful in 3 patients; one patient was cured with vancomycin. One patient died because of septic, embolic complication in early stage of illness. We conclude the effectiveness of penicillins in combination with clavulanic acid and tienamycin in therapy of infective endocarditis due to Propionibacterium acnes. The treatment should be lasted during 4-6 weeks.

[Analysis of remission of pulmonary hypertension after mitral valve replacement]. / Analiza odwracalnosci nadcisnienia plucnego po leczeniu operacyjnym wady zastawki mitralnej.

In a group of 32 patients with mitral valve disease and extreme pulmonary hypertension, the efficacy of mitral valve replacement (MVR) was analysed. In all patients hemodynamic and clinical data were obtained and compared before and after operation. After surgery a statistically significant differences (p < 0.01) of the pressure was observed in right atrium and ventricle, pulmonary artery and capillaries, the pulmonary resistance was decreased, the cardiac index was increased. The improvement of hemodynamic parameters correlated well with clinical data. But it has not influenced for return to the job.

[Consequences of late diagnosis and long-term conservative treatment of patients with congenital heart defects]. / Konsekwencje póznych rozpoznan oraz wieloletniego zachowawczego leczenia chorych z wrodzonymi wadami serca.

Of adult patients of the Cardiac Defects Clinic, National Institute of Cardiology (in Warsaw) we can distinguish several groups of patients with congenital heart defects among which those who were diagnosed after the age of 18 or those who despite of early and correct diagnosis, not underwent surgery on the childhood due to many reasons. In this paper we analyzed the group of 218 patients treated in our clinic between 1981-1987; 103 women aged 13-64 (mean-32 years) and 115 men aged 15-58 (mean-28 years). We classified congenital heart defects into 6 group: ASD, VSD, Tetralogy of Fallot, Persistent Ductus Arteriosus, Coarctation of Aorta and others (19.2%). We classified the range of health care before admission to our Department into the following categories: cardiosurgery (palliative or total correction); no therapy after congenital heart defects diagnosis; medical treatment after diagnosis; admission to our clinic immediately after the diagnosis of a heart defect. We compared that range of health care with qualifications of our Institute-(1. qualification for operation, 2. contraindication for operation, 3. operation unnecessary as the defect is not significant). We conclude basing on our results that, late diagnosis of a congenital heart defect does not finally effect on cardiosurgery possibilities. the majority of patients with C.H.D. have been waiting for many years for a specialist diagnosis and optimal therapeutic decision. long term conservative therapy of the patients with C.H.D. significantly reduces the changes of surgical correction.