Blockage of extracorporeal circulation during emergency surgery for fulminant infective endocarditis.

A 37-years-old man with a history of alcohol abuse and pancreatitis, presented to the emergency department with a 1-week history of progressively worsening dyspnoea with a fever up to 39°C. Echocardiography revealed bicuspid aortic valve with additional mobile structure and perforation of leaflet with acute aortic regurgitation. Due to rapidly deteriorating condition of the patient, a decision about immediate surgery was made. In the operating room, cardiac arrest in the asystole mechanism occurred. Extracorporeal circulation was turned on during direct heart massage. After opening of the aorta, the circulation was blocked by total clogging of the arterial line filter by fibrine deposits. The oxygenator was replaced which resulted a break in extracorporeal circulation lasting about 10 min. Patients survived surgery and was discharged after 6 week antibiotic therapy.

[Infective endocarditis in intensive cardiac care unit - clinical and biochemical differences of blood-culture negative infective endocarditis]. / Infekcyjne zapalenie wsierdzia w oddziale intensywnej terapii kardiologicznej ­ róznice kliniczne i biochemiczne w grupie z ujemnym posiewem krwi.

Diagnosis and treatment of infective endocarditis (IE) is still a challenge for physicians. Group of patients with the worst prognosis is treated in Intensive Cardiac Care Unit (ICCU). Etiologic agent can not be identified in a substantial number of patients. AIM: The aim of study is to find differences between patients with blood culture negative infective endocarditis (BCNIE) and blood culture positive infective endocarditis (BCPIE) treated in ICCU by comparing their clinical course and laboratory parameters. MATERIALS AND METHODS: Retrospective analysis of 30 patients with IE hospitalized in ICCU Swietokrzyskie Cardiac Centre between 2010 and 2016. This group consist of 26 men (86,67%) and 4 women (13,3%). Mean age was 58 years ±13. Most of the cases were new disease, recurrence of the disease was observed in 2 cases (6,7%). 8 patients (26,7%) required artificial ventilation, 11 (36,7%) received inotropes and 6 (20%) vasopresors. In 14 (46,7%) cases blood cultures was negative (BCNIE), the rest of patients (16, 53,3%) was blood cultures - positive infective endocarditis (BCIE). RESULTS: Both of the groups were clinically similar. There were no statistically significant differences in incidence of cardiac implants, localization of bacterial vegetations, administered catecholamines, antibiotic therapy, artificial ventilation, surgical treatment, complication and in-hospital mortality. Incidence of cardiac complications in all of BCNIE cases and in 81,3% cases of BCPIE draws attention, but it is not statistically significant difference (p=0,08). There was statistically significant difference in mean BNP blood concentration (3005,17 ng/ml ±2045,2 vs 1013,42 ng/ml ±1087,6; p=0,01), but there were no statistically significant differences in rest of laboratory parameters. CONCLUSIONS: BCNIE group has got higher mean BNP blood concentration than BCPIE group. There were no statistically significant differences between these groups in others laboratory parameters, clinical course and administered antibiotic therapy. In our endemic region major cause of BCNIE seems to be early antibiotic therapy prior to collection of blood samples, but further studies are necessary.

[Early invasive strategy in patients with myocardial infarction and intraventricular conduction disturbances and plasma B-type natriuretic peptide levels assessed 6 months after myocardial infarction]. / Wczesna strategia inwazyjna u chorych z zawalem serca i zaburzeniami przewodzenia sródkomorowego a stezenie peptydu natriuretycznego typu B w surowicy oceniany 6 miesiecy po zawale serca.

UNLABELLED: The aim of the study was to assess plasma B-type natriuretic peptide (BNP) levels in patients after myocardial infarction (MI) with intraventricular conduction defects (IVCD) and to define relationship between BNP level, treatment strategy and left ventricular performance. MATERIAL AND METHODS: Four types of IVCD were noted: left bundle branch block (LBBB), right bundle branch block (RBBB), left anterior hemiblock (LAH) and left posterior hemiblock (LPH). A total of 158 patients six months after MI treated either invasively or conservatively were included. Of them 126 had IVCD (group A): LBBB-31, RBBB-36, LAH-130, LPH-29, whereas 32 patients without IVCD served as controls (group B). Plasma BNP levels were measured using an immunoenzymatic method. All subjects underwent echocardiography to evaluate left ventricular function. RESULTS: In group A significantly lower plasma BNP levels (186.3 vs 355.3 pg/mL; p < 0.01) and significantly higher left ventricular ejection fraction (EF) (48.4 vs 42.4%; p < 0.05) were noted in favour of invasive treatment. In group B differences between plasma BNP level and echocardiographic parameters of left ventricle function were insignificant. In patients with LBBB plasma BNP levels were significantly lower in those treated invasively (163.9 vs 528.9; p < 0.01). Also, left ventricular EF and myocardial performance index (MPI) were comparable, whereas E/A value was lower as compared with patients treated conservatively (p < 0.05). There were no significant differences in BNP levels in groups with RBBB, LAH and LPH. Multifactorial regression analysis showed that BNP levels were most strongly correlated with magnitude of the ejection fraction EF (p < 0.001). Other parameters which affect significantly BNP level were MPI: OR 9.07 (95% CI 1.03-79.58; p < 0.05) and E/A: OR 6.58 (95% CI 1.01-42.76; p < 0.05). CONCLUSIONS: Invasive strategy in MI with IVCD, especially with LBBB, correlates with lower plasma BNP levels six months after index procedure. In patients with IVCD post MI plasma BNP level is better marker of dysfunction of the left ventricle than its ejection fraction.

Plasma B-type natriuretic peptide as a marker of myocardial asynchrony.

OBJECTIVES: Myocardial asynchrony in postinfarction patients with intraventricular conduction defects (IVCD) may influence plasma levels of B-type natriuretic peptide (BNP). The aim of the study is to evaluate asynchrony parameters in postinfarction patients with IVCD and to define the relationship between plasma levels of BNP and echocardiographic parameters of asynchrony. METHODS: The study included 158 patients 6 months after myocardial infarction (MI): 126 patients with IVCD and 32 patients without IVCD. Plasma levels of BNP were measured using an immunoenzymatic method. Left ventricular (LV) function was evaluated in echocardiography. RESULTS: In patients with post-MI IVCD, the mean plasma level of BNP was 280.2 +/- 340.2 versus 181.7 +/- 270.4 pg/ml (p < 0.001) and they had significantly higher parameters of interventricular asynchrony as compared with subjects without postinfarction IVCD. Multifactorial regression analysis showed that in patients with an ejection fraction (EF) > or =50%, interventricular asynchrony and intraventricular delay significantly influenced the BNP level. In patients with an EF <50%, BNP levels were correlated with the magnitude of the EF. CONCLUSION: Plasma levels of BNP 6 months after MI depend not only on parameters of LV function but also on LV asynchrony and may serve as its marker in patients with IVCD and preserved LV systolic function.

[Myocardial infarction after carbon monoxide poisoning]. / Zawal serca u mezczyzny zatrutego tlenkiem wegla.

Carbon monoxide (CO) exposure is a common cause of unintentional poisoning. Clinical manifestation usually involve central nervous and cardio-vascular systems as brain and heart are very sensitive to hypoxia. Myocardial infarction pathogenesis during CO intoxication is complex. Generalised tissue hypoxia and increased thrombotic tendency may play an important role. A case of ST-segment elevation myocardial infarction following CO poisoning in a 58-year-old male is presented.

Sepsis complicating giant cardiac myxoma.

Myxomas, as other primary cardiac tumors, appear rarely. The most common symptoms are typical of mitral stenosis or peripheral embolism. The rarity of infected cardiac myxomas leads to numerous diagnostic and therapeutic difficulties. We present a case of a 67-year-old man with fever of unknown origin. Laboratory results disclosed signs of sepsis, disseminated intravascular coagulation, acute renal failure, and neuroinfection. Blood cultures were positive for methicillin-resistant Staphylococcus aureus. Transthoracic echocardiogram revealed enlarged left atrium filled with tumor with mobile structure protruding into the left ventricle during diastole. Abnormal intra-atrial mass were also apparent in chest computed tomography (CT). Because of sepsis complicated by coagulation disorders, surgical treatment was postponed. On the 11th day, a large retroperitoneal hematoma occurred, and it was punctured under ultrasonography (USG) control. After 37 days of intensive medical therapy, a stable patient was operated. A giant tumor fixed to the atrial wall between the pulmonary veins' orifices was excised and confirmed as myxoma in histological tests. The patient was discharged in good condition and was followed up for several months with no further complications.

[Acute aortic dissection in a 34 year old pregnant woman--a case report]. / Ostre rozwarstwienie aorty piersiowej u 34-letniej kobiety w 38. tygodniu ciazy.

A case of a 34 year old pregnant woman at 38 weeks gestation, who was admitted to the hospital with acute chest pain, is presented. Electrocardiogram showed ST segment changes suggestive of acute myocardial infarction. Echocardiography, however, revealed acute aortic dissection. The patient was transferred to another hospital where caesarean section followed by cardiac surgery were successfully performed. A subsequent one-year follow-up period was uneventful, both for mother and child. Diagnosis and treatment of acute aortic dissection during pregnancy are discussed.

[Acute pulmonary embolism--four case reports]. / Ostry zator tetnicy plucnej potwierdzony bezposrednim uwidocznieniem materialu zatorowego.

Four patients with acute pulmonary embolism are presented. The diagnostic role of transesophageal echocardiography and spiral computerised tomography is underlined.

[Acute pulmonary embolism following cardiac arrest in a 31 year-old female with long QT syndrome]. / Zatorowosc plucna po naglym zatrzymaniu krazenia u 31-letniej kobiety z zespolem wydluzonego QT.

A case of a young female with acute pulmonary embolism following cardiac arrest due to ventricular fibrillation as a result of long QT syndrome is presented. A differential diagnosis has been discussed.

Post-myocardial infarction intraventricular conduction defects and B-type natriuretic peptide levels.

BACKGROUND: Levels of B-type natriuretic peptide (BNP), a significant marker of left ventricular (LV) dysfunction, may provide information on the severity of heart failure in patients with intraventricular conduction defects (IVCD).The aim of this study was to measure serum BNP levels in post-myocardial infarction (MI) patients with IVCD. METHODS: In 2004-2005 during standard follow-up at 6 mo after acute MI in 158 subjects, BNP was measured using an immunoenzymatic method. Of them, 126 patients had IVCD: 31, left bundle branch block (LBBB); 36, right bundle branch block (RBBB); 30, left anterior hemiblock (LAH); and 29, left posterior hemiblock (LPH). Thirty two patients with a previous MI, but without IVCD, served as controls, whereas 15 healthy subjects entered the comparative group. RESULTS: In post-MI patients with IVCD, the mean BNP level was significantly higher than in their counterparts without IVCD (p < 0.001) and in healthy subjects (p < 0.001). The highest BNP level was found in patients with LBBB and RBBB. In patients with LAH and LPH, levels of BNP were insignificantly higher than in patients without IVCD. CONCLUSIONS: Significantly higher BNP levels in patients with previous MI and IVCD suggest more severe heart failure than in their counterparts without IVCD with comparable LV ejection fraction.

Correlation analysis of atrial natriuretic peptide concentration, echocardiographic left atrial and left ventricular dimensions, and renal function parameters in patients after permanent pacemaker implantation.

BACKGROUND: Atrial endocrine function was established in the second half of the 20th century, confirming the role of atrial natriuretic peptide (ANP) and brain natriuretic peptide (BNP) in the physiology of the cardiovascular system. The present study was undertaken to evaluate changes in ANP and echocardiographic parameters within the first month after VVI and DDD pacemaker implantation and to evaluate correlations between the parameters. METHODS: The study population consisted of group I--20 VVI patients aged 71-90 years (mean age 77.5 +/- 5.9) and group II--20 DDD/VDD patients aged 49-81 years (mean age 68.9 +/- 11). Fifteen healthy volunteers aged 58-80 years (mean age 72.7 +/- 2.8) served as controls. Correlations between ANP levels and cardiac cavity dimensions and between ANP and parameters of renal function were studied. RESULTS: Blood levels of ANP decreased after pacemaker implantation: in the VVI group from 168.61 +/- 81.95 pg/1000 microL to 118.04 +/- 61.06 pg/1000 microL at 7 days and to 121.4 +/- 71.90 pg/1000 microL at 30 days; and in the DDD/VDD group from 134.89 +/- 83.11 pg/1000 microL to 104.96 +/- +/- 57.09 pg/1000 microL at 7 days and to 110.82 +/- 53.32 pg/1000 microL at 30 days. There was a significant correlation between ANP levels and left atrial size in the DDD/VDD group--0.598 (p = 0.005) and 0.593 (p = 0.005) and left ventricular dimensions--0.499 (p = 0.024) and 0.485 (p = 0.030). CONCLUSIONS: ANP decreases significantly after pacing implementation in patients selected for implantation of VVI and DDD/VDD pacemakers. ANP correlates significantly with echocardiographic measurements in patients selected for DDD/VDD pacemakers, but no significant correlation is observed in VVI patients qualifying for permanent pacemaker due to atrioventricular block.

Does permanent cardiac stimulation through atrial natriuretic peptide secretion influence the basic parameters of renal function?

BACKGROUND: The aim of this study was to evaluate atrial humoral function and renal function after pacemaker implantation due to atrioventricular conduction disturbances. We analyzed blood atrial natriuretic peptide (ANP) concentration and basic parameters of renal function within 1 month of implantation of VVI and DDD pacemakers. We evaluated correlations between blood ANP values and basic renal function parameters. METHODS: We studied two groups of patients with atrioventricular (AV) conduction disturbances: second-degree AV block and third-degree AV block. Group I comprised 20 patients aged 71-90 years (median 77.5 +/- 5.9 years) in whom permanent VVI pacing was applied, and group II consisted of 20 subjects aged 49-81 years (median 68.9 +/- 11.9 years) in whom DDD/ /VDD pacemakers were implanted. The control group consisted of 15 healthy volunteers aged 58-80 years (median 72.7 +/- 2.8 years). Plasma concentration of ANP was determined by radioimmunoassay. The parameters of renal function we analyzed with Jaffe's colorimetric and kinetic test. RESULTS: Patients in group I showed a significant decrease in blood concentration of ANP from 168.1 +/- 81.9 pg/1000 mL to 118.0 +/- 61.1 pg/1000 mL (p < 0.01) 7 days after implantation. At 30 days, ANP was 121.4 +/- 71.9 pg/1000 mL. In group II, plasma concentration of ANP decreased significantly from 134.9 +/- 8.1 pg/1000 mL to 104.9 +/- 6.1 pg/1000 mL (p < 0.01) 7 days after implantation and to 110.8 +/- 53.3 pg/1000 mL at 30 days. Patients in group I had elevated, albeit insignificantly, clearance of creatinine to 76.1 +/- 17.8 ml/min at 7 days (p > 0.05) which increased significantly to 85.0 +/- 17.9 ml/min at 30 days. In group II, clearance of creatinine increased insignificantly to 84.6 +/- 13.2 ml/min (p < 0.05) at 7 days and was significantly elevated to 96.9 +/- 18.2 ml/min (p < 0.05) at 30 days. In group I, plasma concentration of creatinine decreased significantly (p < 0.05) to 1.15 +/- 0.30 mg/dl at 7 days and to 1.01 +/- +/- 0.21 mg/dl at 30 days. In group II, there was a significant decrease (p < 0.05) to 1.15 +/- 0.24 mg/dl at 7 days and to 1.08 +/- 0.27 mg/dl at 30 days. There was a positive correlation between creatinine clearance and plasma ANP concentration in groups I and II (r = 0.301; p < 0.05). CONCLUSIONS: In patients with a pacemaker implanted due to atrioventricular disturbances, blood concentration of ANP was decreased. Renal function was improved after pacemaker implantation. (Cardiol J 2007; 14: 568-572).

Myocardial asynchrony in patients with postinfarction intraventricular conduction defects.

BACKGROUND: Postinfarction intraventricular conduction defects lead to asynchronous activation of the myocardium. HYPOTHESIS: The aim of the current study is to evaluate contraction asynchrony in postinfarction patients with intraventricular conduction defects. METHODS: A total of 158 patients 6 months postmyocardial infarction and 15 healthy subjects underwent echocardiography to evaluate atrioventricular, interventricular, intraventricular asynchrony, and myocardial performance index (MPI). A subgroup of 126 patients had intraventricular conduction defects in ECG, whereas 32 with normal QRS complex served as controls. RESULTS: All patients postmyocardial infarction showed intraventricular asynchrony and markedly higher MPI. Comparing groups with and without intraventricular conduction defects postmyocardial infarction, those with left bundle branch block (BBB) had significantly higher parameters of all asynchrony types; those with right BBB and left posterior hemiblock (LPH) had significantly higher interventricular asynchrony parameters; those with left anterior hemiblock did not show significant differences in asynchrony parameters as compared with subjects without postinfarction conduction defects. CONCLUSIONS: (1) Patients 6 months postmyocardial infarction show intraventricular asynchrony and markedly higher MPI. (2) Postinfarction patients with LBBB have the highest parameters of atrioventricular, interventricular and intraventricular asynchrony as compared with postinfarction patients with other and without conduction defects. (3) In postinfarction patients with RBBB or LPH parameters of interventricular asynchrony are significantly higher as compared with postinfarction patients without intraventricular conduction defects.

Dispersion of P wave duration and P wave vector in patients with atrial septal aneurysm.

AIMS: Atrial septal aneurysm (ASA) may be involved in the genesis of atrial arrhythmias as a consequence of disturbances in the propagation of depolarization, which may be easily assessed by P wave dispersion measurement. The aim of this study is to assess the dispersion of P wave duration and P wave vector in patients with ASA and to determine the effect of associated interatrial shunt on the magnitude of P wave dispersion. METHODS AND RESULTS: The study population consisted of 23 healthy volunteers and 88 patients with ASA base more than 15 mm and protrusion more than 7.5 mm. The size of aneurysms and atria was determined by echocardiography and P wave dispersion was measured on the surface ECG. In ASA patients, dispersion of P wave duration was significantly increased when compared with healthy controls (7.8 +/- 12.1 vs. 3.7 +/- 3.5 ms; P < 0.01). Dispersion of P wave vector was also significantly increased (8.5 +/- 10.1 degrees vs. 4.6 +/- 3.6 degrees ; P < 0.005). In healthy volunteers, the mean values of both parameters were below the cutoff points. CONCLUSION: In patients with ASA, there was a significant dispersion of P wave duration and P wave vector. Variation in P wave duration was significantly correlated with the dispersion of P wave vector and age of these patients. Dispersion of P wave vector was significantly decreased in ASA patients with interatrial shunt. P wave dispersion in ASA patients may predispose to the development of atrial arrhythmias.