[Aortointestinal fistula--a serious complication of surgery on aortic and pelvic arteries]. / Aorto-intestinální pístel--závazná komplikace chirurgie aorty a pánevních tepen.

Aortoenteral fistula (AEF) is a rare, but a serious complication in the vascular surgery. It may occur as a primary or a secondary fistula. The principal sign of the condition is bleeding from the gastrointestinal tract (GIT), which, depending on its severity, may present with various symptoms (anemia, melena, hematemesis). The authors describe three cases of patients who experienced AEF. In all the cases, signs of massive GIT bleeding were present with a rapid development of hemorrhagic shock. In a single case, the primary fistula was concerned, in two cases the fistula was secondary. The perioperative mortality rate reached 66%. The surgical management approach is discussed in the article, and early diagnosis and prevention of the complication is emphasized.

Phagocyte-induced oxidative stress in patients with haemodialysis treatment and organ transplantation.

The aim of the study was to examine the phagocyte-derived production of reactive oxygen species (ROS), lipoperoxidation and the total radical-trapping antioxidant parameter (TRAP) in patients undergoing regular haemodialysis (HD) followed by kidney transplantation (n = 13). A significant increase in both spontaneous and activated ROS generation was found during the post-transplantation period in days 1-3. This effect was caused mainly by an increased number of neutrophils. On the other hand, the TRAP parameter was decreased in HD patients. After kidney transplantation, the TRAP parameter increased, reaching the level of healthy controls at the end of the first week after surgery. Increase in MDA level was determined after HD and kidney transplantation. It can be concluded from the results obtained that phagocyte mobilisation and increased oxidative stress after HD and kidney transplantation were associated with the insufficient activity of extracellular antioxidant mechanisms resulting in increased lipid peroxidation.

[Replacement of the aortic valve in patients over 60 years of age]. / Náhrady aortálních chlopní u nemocných starsích 60 let.

The authors evaluated a group of operated patients above 60 years of age where the main cardiosurgical operation was a aortic valve replacement. The early mortality in the group comprising 49 patients was 4.1%. (Of 33 patients where the replacement of the aortic valve was an isolated operation none of the patients died. From another 16 patients where also the mitral valve had to be replaced or IHD had to be resolved by revascularization of the heart muscle by aortocoronary bypasses, two patients died.) During a check-up examination one year after operation 92% of the checked patients where in functional group I or II according to NYHA classification (before operation all were in group III or IV). Prostheses of aortic valves do not only considerably prolong the life even in older patients but also improve its quality. Advanced age alone is no contraindication for operation and the surgical risk is not greater than in younger age groups. The authors recommend to implant in advanced age bioprostheses because of the markedly lower risk of serious haemorrhagic complications in the long-term postoperative course.

[Results of surgical treatment of Fallot's disease during a 5-year period (1986-1990)]. / Výsledky chirurgické lécby Fallotovy choroby za petileté obdobi (1986-1990).

The authors treated in the Centre for cardiovascular and transplantation surgery in Brno between January 1986 and September 1990 84 children with the tetralogy of Fallot. In 77 children a radical correction was made, in 7 children a modified B-T anastomosis was established. Soon after the radical operation four children died (5.1%), soon after the palliative operation 2 children (28%). When selecting the type of surgery the authors take into account the clinical status of the child, the frequency of hypoxic episodes and anatomical conditions of the heart. In the authors opinion the optimal time for operation is toddler and preschool age. For diagnosis of the defect and postoperative evaluation in the majority of patients echocardiographic examination suffices, in extreme forms of the defect with associated defects and in patients where examination is difficult catheterization of the heart is necessary. In children before radical surgery selective coronagraphy is performed. In 87% of radically operated children the haemodynamic results are very good, 5% of the children have a medium severe residual defect and 3% of the children must undergo another operation.

[Aortopulmonary window in 10 children]. / Aortopulmonální okénko u 10 detí.

The authors present their diagnostic and therapeutic experience with aortopulmonary window in 10 children. As it threatens, in particular if combined with other heart diseases, the majority of children with development of early irreparable changes in the pulmonary circulation it is important to diagnose the defect, preferably by echocardiography and treat it already in childhood.

[Coronary fistulas, their diagnosis and treatment]. / Koronární pístele, jejich diagnostika a lécení.

Congenital coronary fistulas diagnosed from systolic-diastolic murmurs were detected in 10 patients. They were verified and located by coronarography in six patients between the right coronary artery and right atrium, right ventricle and pulmonary artery; in four patients between the left coronary artery and pulmonary artery and sinus coronarius cordis. In five patients followed marked left-right shunt the fistula was surgically eliminated by a very favourable postoperative course.

[Cardiac pacing therapy of late intermittent AV block after surgery for tetralogy of Fallot]. / Pozdní intermitentní kompletní A-V blokáda po operaci Fallotovy tetralogie lécená kardiostimulací.

Postoperative atrioventricular block may be the cause of early or late death unless diagnosed and treated in time. The authors describe the development of late intermittent complete intraventricular block in an 11-year-old girl with syncope nine years after radical correction of the tetralogy of Fallot. Incomplete trifascicular block was diagnosed by electrophysiological examination of the conduction system four years before the development of complete trifascicular block. With regard to the serious character of an intermittent block cardiac pacing therapy was used.

[Pericardial teratoma in an infant]. / Teratom perikardu u kojence.

In a four-month-old neonate a pericardial teratoma was diagnosed which exerted pressure on the airways, right atrium and large blood vessels. The tumour was removed by operation. It was a simple, mature pericardial teratoma. Supporting cytostatic treatment was administered. Three years after operation the patient is free of signs of relapse of the tumour.

[Severance of the accessory bundle of Kent in a 13-year-old boy with Ebstein's anomaly of the tricuspid valve]. / Prerusení akcesorního Kentova svazku u 13-letého chlapce s Ebsteinovou anomalií trikuspidální chlopne.

In patients with Ebstein's anomaly of the tricuspid valve combined with WPW syndrome, possibly other cardiac disease, in particular with the repeated occurrence of severe tachydysrhythmias we can foresee cure or at least elimination of complaints by simultaneous surgical treatment of all defects. The author presents experience with the surgical treatment, the first of its kind in this country, in a boy aged 13 years. By better diagnosis it proved possible to locate correctly and to severe by surgery the abnormal accessory bundle between the right atrium and right ventricle, simultaneously with a plastic operation of the insufficient tricuspid valve with closure of the atrial septal defect. Since the operation the patient has no signs of ventricular preexcitation and has no tachydysrhythmias.

[Results of surgical treatment of incomplete forms of atrioventricular septal defects in adults]. / Výsledky chirurgické lécby nekompletní formy defektu sínokomorového septa v dospelosti.

At a cardiosurgical department in Brno in 1978-1987 244 patients above 15 years of age were operated for the first ++time on account of inborn heart disease. This number comprised 21 patients (8.6%) with incomplete defects of the atrioventricular septum. Two patients died in the early postoperative period, two patients were lost from the records and 17 patients were subjected to clinical and echocardiographic examination two to 11 years after operation. All patients were in the 1st or 2nd functional class of the NYHA classification, signs of recanalization were found in one patient and progressing mitral regurgitation in two patients. Consistent with data in the literature, the authors consider it important, to check the patients regularly, incl. clinical and echocardiographic examination, after operations of incomplete defects of the atrioventricular septum and to focus special attention of progressing mitral regurgitation.

[Long-term results of radical operations on the ventricular septum with organic pulmonary hypertension]. / Dlouhodobé výsledky radikální operace komorového septa s organickou plicní hypertenzí.

From a total group of 189 children with a ventricular septal defect operated in 1978-1985 at the Cardiosurgical and Transplantation Department in Brno the authors followed up 60 patients with pulmonary hypertension. In addition to catheterization and echocardiographic examination, they made in 28 patients (46%) a preoperative pulmonary biopsy. In the majority of children before and after operation by catheterization the pulmonary tension Rp/Rs was measured and in some also pulmonary vascular resistance. During the echocardiographic examination attention was focused on the possibility to as the pulmonary tension by pulsed Doppler and continuous technique, on the detection of left-to-right shunt, pulmonary or tricuspid insufficiency. Of 60 patients 5 children (8.3%) died soon after operation, one patient died six years after operation. Long-term postoperative follow up made is possible to define more accurate indication criteria for operation as well as for pulmonary biopsy.

[Type II atrial septal defects in adulthood]. / Defekty sínového septa II. typu v dospelosti.

Indication criteria of adult patients with atrial septal defects type II for surgery are not uniform so far. In a group of 150 adult patients with atrial septal defects type II operated in 1978-1987 at the cardiosurgical department in Brno the authors report the following results: a mortality on operation of 0.7% and a very satisfactory postoperative condition in almost all patients. In a group of 16 patients examined in 1978-1987 but not operated because of a defect of the atrial septum type II of minor haemodynamic impact the authors observed after long-term follow up a deterioration of the health status in four patients and they express therefore doubts on the rigorous criterium for operation a 1.5:1 left-to-right shunt in adult patients and assume that in some instances the defect is indicated for surgery even when the shunt is small.

[Ebstein's anomaly of the tricuspid valve with the WPW syndrome]. / Ebsteinova anomálie trikuspidální chlopne s WPW-syndromem.

Case-history of a four-year-old boy with Ebstein's anomaly of the tricuspid valve with WPW syndrome. Severe tricuspid insufficiency and repeatedly occurring tachydysrhythmias soon led to cardiac decompensation and death before the intended cardiac operation. Non-invasive clinical, ECG, X-ray and ECHO examinations correlated with catheterization, electrophysiological and pathological findings. In addition to the dislocated, malformed tricuspid valve the septal cusp of which was fused with the ventricular septum the authors found another additional atrioventricular muscular connection between the lower part of the septum of the right atrium and right ventricle.

[Atrial-triggered and ventricular-inhibited ventricular VDD pacing with atrial and ventricular single catheter electrodes--the Phymos MPS pacemaker]. / Sínemi spoustená komorami inhibovaná stimulace komor VDD se sínovou a komorovou elektrodou na monokatetru--Phymos MPS.

Optimal treatment from the haemodynamic aspect in complete atrioventricular block is dual-chamber DDD pacing. It makes possible atrioventricular sequence and adaptability of the frequency of ventricular pacing to the load under the control of the sinoatrial node. DDD pacing calls, however, for an atrial and ventricular electrode on two leads. Italian authors developed in 1984 a pacemaker (PM) PHYMOS (MEDICO ITALIA) which makes possible atrial triggered ventricular VDD pacing by means of a single pass lead with a tripolar electrode. As the first ones in the post-communist countries the authors implanted to six patients a PM PHYMOS MPS. They confirmed that the advantages of the VDD system, as compared with DDD, are the use of a single pass lead. This makes the implantation quicker, simpler and safer and reduces the time of X-ray irradiation and the incidence of electrodes dislocations. Another advantage is the lower incidence of atrial fibrillation and probably also pacemaker mediated tachycardias. The disadvantages of the VDD system are that atrial stimulation is impossible and that the diameter of the single pass lead is somewhat larger. According to data in the literature and the so far small experience of the authors, when the indication is correct--atrioventricular block grade III or II with intact function of the sinoatrial node--the advantages of VDD pacing with a single pass lead, as compared with DDD pacing, predominate over disadvantages.

[Use of drains in the biliary tract in liver transplantation]. / Pouzití drénu do zlucových cest pri transplantaci jater.

Between January 1995 and December 1997 42 liver transplantations were performed in Centre for cardiovascular surgery and transplantation's in Brno. The patients were divided into two groups. The first group consist of 27 transplantations, where the biliary reconstruction was performed by means of choledochocholedochostomy or choledochojejunostomy over a drain. The drain was used on the first 20 patients for initial irrigation and for the decompression of the biliary tree later on. It was used only for the decompression in the last 7 patients of this group. The second group consist of 14 patients, where the choledochocholedochostomy was performed without any drain. The rate of the biliary complications was significantly higher in the first group. Nine biliary obstructions, 6 leaks a and 6 cholangitis occurred. Four patients died in consequence of the biliary complications. There was no biliary complication in the second group. Choledochocholedochostomy without a drain is considered as a method of choice for biliary tract reconstruction in liver transplantation.

[The piggyback technique in venous outflow tract reconstruction in liver transplantation]. / Význam piggyback techniky pri rekonstrukci venózního odtoku pri transplantaci jater.

Nowadays, the piggyback technique of venous outflow tract reconstruction has been adopted by an increasing number of transplant teams. From January 1996 to August 2000, we used it in 73 of 84 liver transplantations (86.9%) in our institution. We observed one postoperative complication (1.4%) in direct relation to this technique. The main advantages of the piggyback are 1. maintaining of the haemodynamic stability during the anhepatic phase, 2. avoiding of the veno-venous bypass, 3. diminution of blood loss, 4. easier solution of the graft size mismatch problem, 5. shorter manipulation time and 6. easier retransplantation. Disadvantages of the piggyback technique include 1. more technically demanding recipient's hepatectomy, 2. the potential for venous outflow tract obstruction and 3. possible thrombosis in a blind caval pouch. According to our results and experience in the literature, we consider the piggyback technique as a method of choice for venous outflow tract reconstruction in liver transplantation. It can be used in the majority of patients after gaining some experience.

[Reconstruction of the venous outflow in liver transplantation using the "piggyback" technique]. / Rekonstrukce venózního odtoku pri transplantaci jater "piggyback" technikou.

The piggyback technique in venous outflow tract reconstruction has been proposed as an alternative to the conventional technique in liver transplantation. Between November 1994 and November 1997 this technique was used in 29 patients in our institute. Most of the patients were operated on without veno-venous bypass and we observed no complications concerning venous outflow tract reconstruction and no renal failure. Hemodynamic measurements during the operation showed only an insignificant decrease in cardiac index during the partial clamp on the inferior vena cava. The piggyback technique proved to be a convenient and safe approach to the venous outflow tract reconstruction in a majority of liver transplantations and has been used routinely in our institute.