[Pre-operative care for cardiac surgery patients with cold antibody disorder, cryoglobulinaemia and cryofibrinogenemia]. / Péce a pacienty s nemocí chladovych protilátek, kryoglobulinemií a kryofibrinogenemií pred kardiochirurgickými zákroky.

We present an example of a patient with confirmed cold agglutinin disease who underwent cardiac surgery in hypothermia to illustrate a known fact that, when exposed to cold, cold agglutinins induce haemolysis of erythrocytes and that cryoglobulins and cryofibrinogens may, upon exposition to cold during a surgery under hypothermia, precipitate or gelify and thus increase plasma viscosity and damage microcirculation. Detailed immunological and haematological investigations in all patients awaiting cardiac surgery with a risk of developing hypothermia is not advantageous considering the low number of patients with clinical and laboratory signs of cold agglutinin disease, autoimmune haemolytic anaemia or paroxysmal cold haemoglobinuria and considering that these investigations, in addition, might not detect cryoglobulinaemia and cryofibrinogenemia. Identification of in-risk patients from the warning signs in the medical history, physical or basal laboratory testing who would subsequently undergo confirmatory investigations to verify the presence of these entities and define them accurately might be a potential solution to this clinical issue. Cardiac surgery strategy and peri-operative care should be tailored to the results of these investigations. Well-structured, practiced and functional cooperation between clinicians and laboratory personnel is a prerequisite for success in these circumstances.

[Pericardiocentesis afrer heart surgery--our experience]. / Perikardiocentéza po srdecní [corrected] operaci--nase zkusenosti.

UNLABELLED: Pericardial effusion after cardiac surgery is common, but only in a small part of patients it has progressive character and cardiac tamponade occurs. Accurate diagnosis and well-timed pericardiocentesis are necessary to effective management of this life threatening complication. The study aimed at presentation of our centre outcomes of echocardiographically-guided pericardiocentesis in patients after cardiac surgery. METHODS: Between December 2005 and November 2007, 2,232 patients underwent open-heart surgery in our centre. At 48 (2.2%) of them pericardiocentesis for clinically significant pericardial effusion was performed. RESULTS: Pericardiocentesis was significantly more frequent after valve surgery (7.1%, p < 0.001), aortic root surgery (8.2%, p < 0.001) and surgical ablation of atrial fibrillation (6.6%, p < 0.001), i.e. in patients who had received postoperative anticoagulation therapy. Echo-guided pericardiocentesis was technically and therapeutically successful in 100% of cases and no complications were registered. The time elapsed between surgery and puncture was in range 6 to 80 days (median, 13 days). The median volume initially aspirated was 450 ml (range, 50 to 1,550 ml). Forty five patients (93.8%) had extended catheter drainage with active suction, the median duration of the drainage was 1 day (range, 1 to 6 days), the mean volume of catheter drainage was 328 ml (median, 145 ml; range, 20 to 2,950 ml). Four patients (8.3%) required repeated pericardiocenteses because of recurrence of significant pericadial effusion. Extended pericardial catheter drainage (after initial evacuation of the effusion) was associated with a significant reduction of recurrence of significant pericadial effusion and with lower probability of repeated pericardiocentesis. We can conclude, echo-guided pericardiocentesis was effective and safe method for primary treatment of postoperative pericardial effusions.

A step towards understanding the beneficial influence of a LIPON-based artificial SEI on silicon thin film anodes in lithium-ion batteries.

In this work, we present a comprehensive study on the influence of lithium phosphorus oxynitride (LIPON) as a possible "artificial SEI layer" on the electrochemical performance of pure silicon (Si) thin film electrodes for a possible application in microbatteries or on-chip batteries. Si thin film anodes (140 nm) with and without an additional amorphous LIPON surface layer of different thicknesses (100-300 nm) were prepared by magnetron sputter deposition. The LIPON surface coating was characterized thoroughly by means of electrochemical impedance spectroscopy, Raman spectroscopy, X-ray photoelectron spectroscopy and atomic force microscopy. In situ electrochemical dilatometry and ex situ cross-section analysis of the electrodes after cycling could prove that the LIPON coating greatly diminishes the volume expansion of the Si electrode and, therefore, significantly improves the cycling stability and capacity retention. Furthermore, the LIPON coating remarkably reduces parasitic electrolyte decomposition reactions that originate from the Si volume expansion and contribute to the overall electrode volume expansion, as observed by the enhanced Coulombic efficiency over ongoing charge/discharge cycling. Overall, this article focuses on the preparation of optimized Si-based thin film electrodes in combination with LIPON solid electrolyte coatings for use in high-energy lithium ion batteries.

[Effect of surgical treatment of atrial fibrillation on the attainment and maintenance of sinus rhythm in patients undergoing concomitant cardiac surgery--short-term results]. / Efekt chirurgické lécby fibrilace síní na dosazení a udrzení sinusového rytmu u nemocných podstupujících sdruzený kardiochirurgický výkon--krátkodobé výsledky.

BACKGROUND: Atrial fibrillation is the most frequent sustained arrhythmia. It is associated with higher morbidity and mortality of patients. Cryoablation was introduced to the current practise in cardiac surgery as a non-pharmacological method of therapy of atrial fibrillation. The aim of the study was to assess the effect of surgical ablation of atrial fibrillation on the attainment and maintenance of sinus rhythm in patients undergoing concomitant cardiac surgery. METHODS AND RESULTS: Ninety four consecutive patients with atrial fibrillation (paroxysmal, persistent or permanent) were followed up prospectivelly. The mean age was 67.8 years; there were 39 (41.5%) women in the study group. Forty two patients (44.7%) had paroxysmal or persistent atrial fibrillation and 52 (55.3%) of them had permanent atrial fibrillation before surgery. Patients with permanent atrial fibrillation had significantly bigger preoperative left atrial diameter (51.2 versus 46.6 mm) and more severe tricuspid regurgitation (grade 2.3/4 versus grade 1.4/4) compared to the group with paroxysmal and persistent atrial fibrillation. Mitral valve surgery was significantly more frequent in patients with permanent atrial fibrillation too. Operations were performed between January 2005 and July 2006 using flexible argon-based cryoablative device. Sinus rhythm was achieved statistically significantly more frequently in patients with preoperative paroxysmal and persistent atrial fibrillation in comparison with patients with permanent atrial fibrillation--at discharge, 1, 3.5 and 6 months after operation (90.5-96.3 % versus 50-65.9%). At 12 months it was only statistical trend (84.6% versus 63.3%). Kaplan-Meier analysis demonstrated a 79.4% freedom from atrial fibrillation at 12 months. Preoperative atrial size and duration of atrial fibrillation were the most significant negative predictors of maintenance of sinus rhythm. Four patients (9.3%) required postoperative permanent pacemaker placement. Ischemic stroke occured in 5 (5.3%) patients. Thirty-day motality was 12.9% (12 patients). CONCLUSIONS: Perioperative ablation of atrial fibrillation using cryoenergy is effective therapeutic method for restoring and maintenance of sinus rhythm in relatively high proportion of patients. The most significant predictors of late recurrence are preoperative atrial size and duration of atrial fibrillation. This non-pharmacological method should be routinely used in patients undergoing concomitant cardiac surgery.

[Atrial transport function after surgical ablation of atrial fibrillation using cryoenergy]. / Transportní funkce síní po chirurgické ablaci fibrilace síní pomocí kryoenergie.

BACKGROUND: Surgical ablation is one of the most effective techniques for treatment of atrial fibrillation. Stable sinus rhythm is achieved and effective atrial contractions are restored in the majority of patients. The aim of the prospective study is to assess the presence of atrial transport function after surgical ablation of atrial fibrillation using cryoenergy and to evaluate predictors of the procedural success. METHODS AND RESULTS: Between January 2005 and September 2006, 100 consecutive patients underwent left atrium cryoablation as a concomitant cardiac procedure. Their mean age was 67.6 years (range 50 to 82 years), there were 41 (41 %) women. Forty six patients (46 %) suffered from paroxysmal or persistent atrial fibrillation and 54 (54 %) of them from permanent atrial fibrillation before surgery. Atrial mechanical function was assessed by echocardiography (pulsed Doppler examination of the mitral and tricuspidal inflow, presence of the atrial filling [A] wave) after 3.5, 6, 12 and 18 months postoperatively. 79.6 % of patients, who have had sinus rhythm at 3.5 months, were free from atrial fibrillation at 18 months after surgery. The effective left atrial contractions were present at 3.5, 6, 12 and 18 months postoperatively in 70.2 %, 71.9 %, 81.4 % and 73.5 % of patients and we found right atrial transport function in 97 %, 95.3 %, 97.7 % and 97.1 % of patients. There was no significant difference between group with paroxysmal or persistent atrial fibrillation and permanent fibrillation. Negative predictors for restoration of the left atrial transport function were: preoperative mitral stenosis (at 3.5 and 6 months, p=0.02 and p=0.03 respectively), bigger left atrial dimension prior to procedure (only at 3.5 months, p=0.01) and severity of tricuspid regurgitation before surgery (only at 18 months, p=0.01). An ischaemic stroke occured in 7 %. Thirty-day motality was 12 % (12 patients). CONCLUSIONS: Left atrial mechanical funtion was detected in 70-80 % of patients and right atrial function in 95-98 % of patients with sinus rhythm during follow-up of 18 months. Preoperative left atrial dimension, presence of mitral stenosis and severity of tricuspid regurgitation were the most significant predictors for postoperative restoration of the left atrial transport function. Significant reduction in occurence of ischaemic stroke by surgical ablation was not achieved.

[Surgical treatment of infective endocarditis: 8 year experience]. / Chirurgická lécba aktivní infekcní endokarditidy: 8leté zkusenosti.

BACKGROUND: A retrospective study analysing effects of surgical treatment of active infective endocarditis was performed in our centre between January 1998 and December 2005. METHODS AND RESULTS: 57 consecutive patients with infective endocarditis underwent surgical intervention in active phase of infection (fulfilment of Durack diagnostic criteria, persisting elevation CRP at the time of cardiac surgery, indications for surgery according to actual guidelines of the Czech Society of Cardiology). Male to female ratio was 38:19. The patients' mean age was 52.5 years without any significant differences among men and women. The most frequent causative agents were staphylococci--28.1 % and streptococci--19.3 %. 26 cases of aortic valve involvement were the most frequent, followed by 21 cases of mitral endocarditis, and 7 cases were both aortic and mitral valve endocarditis. 3 cases of tricuspid endocarditis were also observed. Native valve endocarditis prevailed over the prosthetic ones--49 versus 8. Surgery was most often performed using a mechanical prosthesis (45 cases), bioprostheses were implanted in 13 patients and 6 patients underwent mitral or tricuspid valve repair operation. In 1 patient, the procedure was complemented with mitral valve annuloplasty, and in 5 patients, the operation was completed with tricuspid annuloplasty--because of significant regurgitation of other aetiology. Coronary artery bypass surgery (at the same time) was necessary in 9 patients. Surgery was followed by a significant shift from classes III and IV to classes I and II of NYHA classification. Relapsing or recurrent endocarditis developed in 7 %. Thirty-day mortality of patients who had undergone surgery for active infective endocarditis was 15.8 %, 9 patients died. During follow up period 7 patients died, the overall mortality was 28.1 %. Survivors were followed up for 0.5-90 (median 40) months. CONCLUSIONS: Operation for active infective endocarditis carries a relatively higher mortality in comparison with elective surgery. Nevertheless, this is acceptable because the operation in active phase is enforced by life-threatening complications and it also reduces assumed mortality at conservative therapy. Our results are comparable with data from other studies.

[Is obesity a real risk factor in cardiosurgical procedures?]. / Je obezita skutecne rizikovým faktorem u kardiochirurgických operací?

AIM: Obesity is generally presented to be a risk factor in surgical procedures including the cardiac ones. The aim of this work was to conduct a retrospective study comparing surgical results of the cardiosurgical procedures depending on each patient's body mass index data (BMI). METHODOLOGY: All 4266 patients operated by our team during 1998-2002 have been included in the study. The patient subjects were allocated in 5 groups according to their individual BMIs. Preoperative, peroperative and postoperative data of all groups were compared. RESULTS: There were no significant differences in the preoperative and peroperative data between the groups. The postoperative results showed no statistical differences between the individual groups, indicating a trend towards better results in the groups with higher BMIs. On the contrary, the results of the group with the BMI of less than 20 kg/m2 were the worst, however they were also of no statistical significance. CONCLUSION: The restrospective study did not prove the obesity to be a risk factor in cardiosurgical procedures. On the contrary, it suggested the BMI of less than 20 kg/m2 to be a risk factor.

[Cardiac manifestations of Friedreich's ataxia]. / Kardiální manifestace Friedreichovy ataxie.

Friedreich's ataxia is one of the most frequent ataxias of childhood. The disease is inherited in autosomal recessive mode. It is caused by deficiency of mitochondrial protein frataxin, which is responsible for the degenerative impairment of the spinocerebellar and corticospinal tracts and posterior columns of the spinal cord and for the heart damage. We present a case report of a patient with a complete clinical syndrome. Patient experienced slowly progressive neurological symptomatology from the age of 6 years, which consisted of instability, gait abnormalities, tremor and ataxia. Adult patient became immobile with severe quadruparesis and dysarthria. Cardiac involvement presented in adulthood with multifocal atrial tachycardia became the chief symptom. Hypertrophic cardiomyopathy was diagnosed. Diagnosis of Friedreich's ataxia was confirmed by genetic analysis. Pharmacotherapy with coenzyme Q10 and carnitine was introduced with effort to slow down progression of cardiac impairment. Causal treatment is still impossible.