[Recurrent prosthetic endocarditis in a 21-year old patient with renal transplantation treated with allogeneic homograft]. / Recidivujúca protetická endokarditída u 21-rocného pacienta s transplantovanou oblickou riesená alogénnym homograftom.

Prosthetic infective endocarditis is a possible complication of implantation of a prosthetic cardiac valve. Without early and effective treatment, it can have fatal consequences. One treatment option is use of an allogeneic cryopreserved homograft. This case report presents a 21-year old patient after kidney transplantation due to hereditary nephrotic syndrome and aortic valve replacement with aortic conduits. After fever was noted in the patient, prosthetic infective endocarditis was diagnosed by echocardiography and also confirmed by CT-3D examination. The cryopreserved aortic homograft was implanted at the Department of Cardiac Surgery. This along with additional conservative management effectively treated the infection. Based on literature data and our own experience, we believe that the treatment of prosthetic endocarditis after aortic valve replacement with cryopreserved homograft can be a method of choice.

[An overview of the results of renal transplantation in the Czech Republic]. / Piehled výsledku transplantací ledvin v Ceské republice.

Renal (kidney) transplantation is now a routine and the most successful form of renal replacement therapy. There is a long tradition of renal transplantation in the Czech Republic, The first was performed as early as 1961 in Hradec Kralove, and the programme as such was launched in 1966 with the first successful transplantation at the Institute of Experimental Surgery (later Institute for Clinical and Experimental Medicine, Prague). At present, transplantations are being performed at 7 transplantation centres (IKEM Prague, Centre for Cardiovascular and Transplantation Surgery Brno, Faculty Hospitals Hradec Kralove, Plzen, Olomouc and Ostrava and Faculty Hospital Motol for children). From the programme launch until the end of 2010, 8,761 renal transplantations were performed, 364 in 2010 alone. One-year patient and cadaver renal allograft survival, transplanted in the CR between 2000 and 2009, is around 95% and 92%, respectively, and 5-year survival is 87% and 81%, respectively. As of 31st December 2009, a total of 3,771 patients lived with functional renal allograft in the Czech Republic and the proportion of patients with irreversible renal failure treated with transplantation has recently been around 40%.

[Midterm results aortic valve replacement with allograft]. / Strednedobé výsledky implantací aortálního alograftu.

INTRODUCTION: Aortic allograft implantation into the aortic position in adults is standard procedure with some controversary. The most popular indication is bacterial endocarditis. We would like to present our midterm results. RESULTS: We implanted 61 allografts in 60 patients (between 10/2002 and 04/2008). Men were 46 (76.8%) and average age was 57 +/- 10.76 year. 30 days mortality was 9 people (15.0%, all with bacterial endocarditis). Late mortality 1 man (1.6%). Follow up 1-66 months, average 39.18 SD +/- 14.3 months, median 42 months. CONCLUSION: Implantation of aortic allograft into the aortic position is standard procedure with good midterm results. Relative high early mortality is dependent on preoperative status in patiens with acute bacterial endocarditis--all early death people were people with acute bacterial endocarditis and minimally one vital organ severe dysfunction.

[Aortic allograft (homograft) for the treatment of valvular disorders in adults with focus on treatment of infective aortic valve endocarditis]. / Aortální alograft (homograft) v lécbe chlopennich srdecních vad dospelých s durazem na lécbu infekiní endokarditidy aortální chlopne.

Still after 40 years of heart valve prostheses intensive development ideal valve substitute still does not exist. Aortic allograft represents one alternative which could be used for aortic and/or pulmonary valve replacement. This type of biological heart valve prosthesis is being currently discussed from the point of view of Tissue Banking, as well as from clinical aspects--e.g. surgical implantation technique and long term results. Live issue remains particularly the aortic allograft implantation into the aortic position. The authors discuss the aortic allograft role in the aortic valve infectious endocarditis treatment, which was widespread worldwide and accepted. Aortic allograft implantation is considered as a method of choice in that particular indication, especially in prosthetic aortic valve endocarditis and in left ventricle outlet tract destruction cases. The method is considered to be more technically demanding than routine heart valve surgery (heart valve replacement by means of mechanical or commercial biological prostheses), but literary and authors own experience in that particular group of patients looks encouraging. Aortic allografts permanent supply in our country is secured.

[Resection of metastatic nondifferentiated carcinoma of sternum with thoracic wall reconstruction and simultaneous myocardial revascularization for ischemic heart disease--case report]. / Resekce sterna s rekonstrukcí hrudní steny pro metastázu nediferencovaného karcinomu v kombinaci s revaskularizací myokardu pro ischemickou chorobu srdecní--kazuistika.

Authors offer the case report of a patient with metastatic non differentiated carcinoma of sternum simultaneously suffering from ischemic heart disease. The patient underwent actinotherapy & hyperthermia followed by resection of sternum and coronary artery bypass grafting in one session. Chest wall defect was closed by means of latissimus dorsi muscle rotation. Postoperative palliative chemotherapy started 16 weeks postoperatively. Primary tumor was not found, neither preoperatively nor during the 36 months' postoperative remission.

[Ischemic mitral regurgitation. Clinical review emphasizing the surgical treatment]. / Ischemická mitrální regurgitace Klinické review s durazem na chirurgickou lécbu.

Ischemic mitral regurgitation represents comparatively frequent complication of the myocardial infarction. Presence of the ischemic mitral regurgitation has a negative effect on the immediate mortality after the myocardial infarction and on the long-term survival. Ischemic mitral regurgitation is a functional, not structural impairment of the mitral valve and it is caused by altered geometry of the left ventricle. The article deals with the development and pathophysiology namely of the chronic ischemic mitral regurgitation and with the contemporary potential of surgical treatment of that serious complication of the ischemic heart disease.

[Resection of the trachea with extracorporeal circulation as a simultaneous procedure during coronary artery bypass grafting--a case report]. / Resekce trachey s mimotelním obehem jako simultánní výkon pri chirurgické revaskularizaci myokardu--kazuistika.

The authors describe their surgical management of a female patient with a symptomatic coronary artery disease, who had developed a postintubation stenosis of the trachea. The patient sufferred from a rest dyspnoea with stridor. The unusual combination of the both cardiac and tracheal disorders were managed employing a one-step cardio-thoracic surgical procedure. The tracheal resection was conducted in the extracorporeal circulation condition together with the myocardial revascularization. The case shows how, in indicated cases, availability of the extracorporeal circulation can widen a spectrum and limits of the standard chest surgery.

One-year results from cryopreserved mitral allograft transplantation into the tricuspid position in a sheep experimental model.

Mitral allografts are still used only exceptionally in the mitral or tricuspid position. The main indication remains infectious endocarditis of atrioventricular valves for its flexibility and low risk of infection. The aim of our study was to evaluate 1-year results of mitral allografts transplantation into the tricuspid position in a sheep model. Mitral allografts were processed, cryopreserved, and transplanted into the tricuspid position anatomically (Group I - 11 animals) or antianatomically (Group II - 8 animals). All survivors (4 from Group I, and 3 from Group II) were checked at 3, 6, and 12 months by echocardiography with the exception of one survivor from Group II (which was examinated only visually). Examination throughout follow-up included for mitral allograft regurgitation and annuli dilatation. At postmortem, the papillary muscles were healed and firmly anchored to the right ventricular wall in all subjects. Transventricular fixation of the papillary muscles with buttressed sutures was proven to be a stable, reproducible, and safe method for anchoring mitral allograft leaflets. There were no significant differences between the two implantation methods. Annulus support of mitral allografts might be very useful in this type of operation and could prevent annular dilatation.

Gianturco self-expanding metallic stents in treatment of tracheobronchial stenosis after single lung and heart and lung transplantation.

Three patients with recurrent bronchial stenosis following single lung transplant (SLTx), and one patient with tracheal stenosis following heart-lung transplantation (HLTx), not responding to repeated dilatations (3 patients) and prolonged use of silastic stents (patient with tracheal stenosis), have been treated by the endoscopic insertion of Gianturco self-expanding metallic stents under fluoroscopic control. The stent resulted in immediate improvement in respiratory function in all four patients. One patient (SLTx) had early bronchial re-stenosis due to growth of granulation tissue within the stent which was successfully treated by cryotherapy. In one patient (HLTx), a left lower lobe bronchial stenosis developed 14 months after tracheal stenting. The metallic stent appears to be a promising device in the management of recurrent or resistant bronchial stenosis following SLTx or tracheal stenosis after HLTx.

Atrial septal defect in adults.

BACKGROUND: The value of operation of atrial septal defect (ASD) in adults, especially after 40 years, is still discussed. METHODS AND RESULTS: In 1994-95 57 adults with unoperated ASD were examined clinically, echocardiographically and in 75% by catheterization. Type primum was present in 11%, type secundum in 77% and sinus venosus in 11%. Group A comprised 28 patients aged 20 to 40 years (average 29), group B comprised 29 patients aged 40 to 62 years (average 51). The groups (B:A) did not differ in pulmonary to systemic flow (Qp/Qs) (2.4:2.2) or pulmonary arteriolar resistance (PAR) (group B 2 U.m2, group A 1.7 U.m2), the older patients had worse New York Heart Association (NYHA) classification, more frequent tricuspid regurgitation (group B 96%, group A 45%), significantly larger right ventricles and pulmonary arteries, higher mean pulmonary artery pressure (group B 26 mmHg, group A 17 mmHg) and right ventricle end-diastolic pressure (RVEDP group B 10, group A 8.8 mmHg). All defects larger than 10 mm by transesophageal echocardiography (TEE) had Qp/Qs 1.5 or more. Forty patients were operated with zero mortality, in three cases by minithoracothomy. Postoperatively, 50% of group A and 63% of group B felt better, NYHA classification was significantly better in both groups. Tricuspid regurgitation decreased in both groups as well as the size of right ventricle. The size of the left ventricle enlarged after operation in group A. CONCLUSION: This study suggests to operate adults with ASD larger than 10 mm by TEE with signs of right ventricle overload and/or Qp/Qs 1.5 or more, who have normal PAR. Operative mortality was zero in both age groups, the functional repair was better in younger patients (under 40 years).

[Thromboelastography--an instrument for the researcher or clinician?]. / Tromboelastografie--nástroj výzkumníka nebo klinika?

Thromboelastography is a method which is used experimentally since 1948. Since the end of the eighties it is experiencing a certain revival also in clinical medicine. The submitted case-record presents this technique as a very useful aid in the differential diagnosis of postoperative haemorrhagic conditions in cardiosurgery. Its application can facilitate aimed treatment of some typical disorders of haemocoagulation.

[Congenital heart defects in adults from the viewpoint of the surgeon]. / Vrozené srdecní vady dospelých ocima chirurga.

The adolescent generation of patients operated in childhood on account of congenital heart disease is a new health and social problem. Kardiocentrum for children in Motol started its activities in 1977. A concept of care for children with congenital heart disease was elaborated and gradually all surgical methods used worldwide were introduced. The advances in cardiosurgery along with the development of diagnostic methods and intervention catheterization in particular balloon valvuloplasty and angioplasty make high standard and effective treatment of practically the entire spectrum of congenital heart disease in children of all age groups possible. The cardiac surgeon tries nowadays to resolve problems of inborn heart disease already in early childhood. Before a possible re-operation in adult age he must take into account how the result of the first operation affected the patient's growth and development. He is interested in particular in the fate of implants, surgically induced pathology and the influence of growth on the reconstruction. Despite intensive research, so far the long-term prognosis of patients after some types of surgery is not clear (e.g. transposition of the great arteries, Fontan's operation and its modifications). An adult patient congenital hearth disease should receive care of a specialized cardiologist who has personal experience with the diagnosis and treatment of congenital heart disease. If surgery is necessary it should be performed in a specialised department equipped as regards staff, technical devices and funds for these special operations.

[The effect of electrostimulation with the Rebox apparatus on ischemic renal injury in rats]. / Vliv elektrostimulátoru Rebox na prubeh ischemického poskození ledvin u krys.

BACKGROUND: With developing transplantation programmes the problem of protection against ischaemic renal damage had become important. The results of experimental pharmacological protection of the kidneys are not quite conclusive. The objective of the presented paper was to assess the effect of electrostimulation by means of a Rebox apparatus (generator of direct rectangular impulses at a frequency of 1 to 10 kHz), on the development of ischaemic damage of the renal parenchyma induced experimentally in rats. METHODS AND RESULTS: The experiments were made on Wistar strains rats (n = 15) which were subjected to dextrolateral nephrectomy and the left renal artery was closed by a clamp which was released in the tested and the control group after 30 minutes. In the rebox group electrostimulation with the Rebox apparatus was implemented immediately after release of the clamp. In rats which were in metabolic cages the following parameters were assessed: diuresis, period of survival, endogenous creatinine clearance, plasma creatinine level, urea level and excretion, as well as sodium and potassium urinary excretion. No significant difference in the survival time of the rats was found nor in the plasma levels of creatinine, urea and urinary excretion of potassium and urea between the control and the Rebox group. In the Rebox group, as compared with the control group, a significantly higher diuresis was found 22.8 vs 5.6 (p < 0.001) and natriuresis 0.44 vs 0.11 (p < 0.01). CONCLUSIONS: Electrostimulation by rebox currents in rats increases significantly the diuresis and natriuresis of the solitary kidney exposed to 30-minute ischaemia but has no impact on other parameters. The mechanism of action is not quite clear, apparently the reabsorption of sodium in the proximal tubule is inhibited.

[The nomenclature and concept of care of children and adolescents with renal insufficiency]. / Nomenklatura a koncepce péce o deti a mladistvé s renální insuficiencí.

The standard of care of children and adolescents with chronic renal failure and chronic renal insufficiency in the CSR does not correspond to the european average so far. Dialysis- treatment, contrary to treatment of adults, was started at the beginning of the eighties. The reason was that equipment for dialysis was not readily available. At presents the basic prerequisites have been created for dialysis and transplantation in the mentioned age groups. Rapid improvement will be helped also by organizational provisions the concept of which outlined in the paper.

[Treatment of dilated cardiomyopathy in childhood]. / Moznosti lécby dilatacní kardiomyopatie v detském veku.

Authors reviewed available information concerning etiology and pathophysiology of dilated cardiomyopathy. Diagnostic criteria and current poor results of conservative treatment are discussed. Between August 1984 and August 1991 67 children with various types of cardiomyopathy underwent heart and heart and lung transplantation at Harefield Hospital, U.K. Dilated cardiomyopathy was the indication for transplantation in 47 patients (mean age at operation was 6.5 years, range 0.3-4.8 years). Eighty-one percent actuarial survival at 4 years after operation represents reasonable progress in the treatment of this severe acquired disease. Currently, early transplantation is recommended in children with dilated cardiomyopathy and with low shortening fraction of left ventricle (below 0.13), without any improvement after 3 months of conservative treatment, will familial trait of dilated cardiomyopathy and/or with severe myocardial fibrosis.

[Long-term catheterization of the central venous system in children]. / Dlouhodobá kanylace centrálního zilního systému u detí.

The authors explain the principle of central venous catheters (CVC) for long-term use, indicators for insertion, mode of insertion and principles of care of children with these special CVC. The authors inserted since 1982 42 CVC of the Broviac-Hickmann type in 32 children (age 22 days--15 years; body weight 2.4-17 kg). Since 1987 they inserted 16 CVC for long-term use with a subcutaneous capsule to 16 children and adolescents (age 1 years-17 years; body weight 11.5-73.5 kg). These CVC were inserted under general anaesthesia, in catheterization theatre. There were no technical complications. The authors treated and followed under standard protocol a group of 14 children with 20 CVC of the Broviac type (age at onset of treatment 22-715 days; body weight 2.4-10 kg) as well as the above described group of 16 children and adolescents with CVC for long-term use with a subcutaneous capsule. During treatment of children with Broviac catheters five technical complications were observed (mechanical damage of the CVC); in children with CVC with a subcutaneous capsule one technical complication was recorded (damage of the chamber of the Chemoport Vygon system, by incorrect puncture). The authors searched for thromboembolic and infectious complications. In four of 20 children with Broviac catheters purulent phlebitis of the cannulated veins was found (all died)--one thromboembolic complication developed on average after 234 days of use of Broviac catheters.(ABSTRACT TRUNCATED AT 250 WORDS)

[Renal transplantation in children in the Czech Republic]. / Wyniki przeszczepiania nerek u dzieci w Republice Czeskiej.

The aim of the study is to review results of pediatric renal transplantation in center in Prague, Czech Republic. Results are compared with the registry data from Europe and United States. Patients, who underwent RTx at the University Hospital Motol, Prague (Czech Republic) between 1977 and the end of 1999, were analyzed. Since 1977 128 Rtx from cadaveric donors were performed in children in mean age 12.8 +/- 4.1 years. In 1977-1987, patients were treated with prednisone and azathioprine, and since 1988, cyclosporine A, added to prednisone and azathioprine. Sequential quadruple immunosuppression was used only in few highly sensitized patients. Acute graft rejections were treated with methylprednisolone pulses, antithymocyte globulin and monoclonal antibodies OKT3, in selected cases. In 1988 and 1999 cyclosporine A was replaced by tacrolimus as initial immunosuppression in some patients. The number of Tx ranged between 5 and 13 per year. Patients and graft survival were significantly lower in the first time period 1977-1987 with a median patients 5-year survival rate of only 50% and graft survival 30%. In the last period (1988-1999) 5-year patients survival is 90% and 5-year graft survival is 68% (p = 0.01). Two cases of posttransplant lymphoproliferative disease were diagnosed so far. One of them died several months after RTx, the other received cytostatic therapy for Hodgkin tumor and graft function was maintained. Main causes of graft failure were chronic rejection followed by acute steroid resistant rejections, severe cytomegalovirus infections, noncompliance, vascular thrombosis, and recurrence of original disease.

[Experimental ischemic renal injury--effect of surgical technique and the protective effect of a nonpeptide angiotensin II antagonist (losartan)]. / Ischemické poskození ledvin v experimentu--vliv chirurgické techniky a protektivní úcinek nepeptidového antagonisty angiotenzinu II (losartanu).

Experimental renal ischaemic injuries are typically produced by temporary closure of the renal artery. In rats, two different methods of such temporary closure of the renal artery were compared: snaring of the artery by tourniquet, and clamping by a microsurgical bulldog clamp. The consequences of ischaemic periods 60, 90 and 120 minutes were evaluated. In different experimental series, the potential protective effect of non-peptic AT1 angiotensin II receptor antagonist losartan on postischaemic renal injury was evaluated. The seven-day survival and the degree of functional renal damage (according to the plasma levels of creatinine and urea) were analyzed 24 hours and 7 days after experimental renal ischaemia. Ischaemia, produced by the tourniquet led to a more significant renal damage than ischaemia caused by clamping of the renal artery by a microclamp (higher 7-day mortality rate, higher postischaemic plasma levels of creatinine and urea). Losartan decreased the consequences of renal ischaemia caused by the tourniquet, but did not change the outcome of renal ischaemia produced by microsurgical bulldog clamps. We found, that not only the duration of ischaemia and pharmacology, but even the surgical technique of producing renal ischaemia are important factors in experimental studies evaluating ischaemic renal damage. These findings provide evidence of the role of angiotensin II in postischaemic renal injury by a renal tourniquet. This particular mechanism is probably not involved, when renal artery is gently temporarily closed by a bulldog microclamp.

[Distant heart procurement in the Czech and Slovak Republics]. / Vzdálené odbery srdce na území Ceské a Slovenské republiky.

Heart transplantation (HTx) became an established treatment of the end stage heart failure. The limiting factor of transplantation activity is the availability of donors which could be expanded by multiorgan harvesting and distant heart procurement (DHP). In spite of the fact that only 4-5 hours of could ischaemia (CI) is favourable it is still acceptable to organize the DHP within the radius over 1000 km from a recipient hospital. Good co-ordination, he best communication and transportation technology are absolutely necessary. Only in the case when there is no local recipient on the waiting list fr the HTx we offer an organ abroad. Paediatric Transplant Center Motol has been offered such 19 heart donors since 1992. 7 of them were accepted and in 4 (donor age 10-40 y.) successful DHP was performed, the organs were transported (900-1100 km) and HTx were performed at Harefield Hospital, UK. CI was 4:20-5:05 hours (mean 4:36). Two organs were used for orthotopic HTx (OHTx), two for heterotopic HTx (HHTx). Two failed due to the acute rejection. One was successfully retransplanted, went into chronic renal failure and is maintained on dialysis. Another recipient died 1 w. after HHTx due to the failure of his own heart. One recipient has been living already 1 y. since his OHTx. This experience demonstrates the ability and competence to organize and perform the DHP by a local team even in our conditions. We consider it suitable and necessary prerequisite to be able to start our own paediatric HTx programme.

[Technical aspects of use of the right gastroepiploic artery for myocardial revascularization]. / Technické aspekty pouzití pravé gastroepiploické arterie pro revaskularizaci myokardu.

The authors give an account of 16 cases where they used the right gastroepiploic artery (GEA) for revascularization of the heart muscle. Their own findings are based on the author's experience at a department with the greatest number of thus operated patients (Groningen, Netherlands). These data were already published. GEA was used during the revascularization operation in 16 of 112 patients operated after 1994 (14%). All operated patients were males aged 30 to 58 years (mean age 47 years). None of the patients died. The use of GEA did not cause any postoperative complications. During the short-term follow up there was no reason to doubt the patency of the graft and an invasive examination was not indicated so far. According to the authors' experience the GEA graft can be used for anastomosis with the right coronary artery or its branch almost in all patients indicated for revascularization. It is thus possible to obtain a high-standard arterial graft where long-term patency can be assumed. The authors discuss in detail the indications and technique of the operation.