Ancient cardiac myxomas - another point of view in the light of tetraspanins.

Myxomas are the most common non-invasive but life-threatening cardiac neoplasms due to obstruction of heart chambers and risk of embolism in a manner resembling thromboembolism as well. They can occasionally disseminate via their detached fragments into the bloodstream to seed and grow as secondary still benign tumors. In this study we evaluated morphological and clinical aspects of 14 ancient, degenerated left or right-sided cardiac atrial myxomas with expression of CD9 and CD63, which are found to contribute to platelet activation, aggregation and, as a result, intratumoral thrombosis or fragmentation. The appearance of tumors varied from sessile to polypoid revealing that a higher rate of endocardial thrombosis was associated with sessile compared to polypoid myxomas and left-sided tumors compared to right-sided ones in our study. In the general aspect of ancient calcifications, amorphous calcification with intra-tumor thrombosis was noted more frequently in sessile tumors, while well-formed osseous metaplasia was usually a feature of polypoid tumors. In our material osseous metaplasia did not coexist with massive thrombosis and was found in polypoid, pedunculated myxomas. Most importantly, CD9 overexpression was recorded in every studied myxoma and CD63 gave a weak reaction in myxoma cells.

Effect of on-pump versus off-pump coronary bypass surgery on cardiac function assessed by intraoperative transesophageal echocardiography.

PURPOSE: To compare cardiac function assessed by intraoperative transesophageal echocardiography in patients undergoing cardiac revascularization with or without cardiopulmonary bypass. MATERIAL AND METHODS: Forty-one patients scheduled for elective, isolated cardiac revascularization (21 on-pump and 20 off-pump) were prospectively analyzed. Patients were matched for demographic (age and gender), anthropometric (BMI), clinical (co-morbidities, EuroScore) and laboratory variables (blood counts, renal function, left ventricular function). Transesophageal echocardiography was performed after induction of anesthesia, protamine sulfate administration, and chest closure. Left ventricular wall motion score index, end-diastolic area, fractional area change, right ventricular area change and end-diastolic area were assessed. Troponin I and C-reactive protein concentrations were measured. RESULTS: Regarding echocardiographic parameters of left and right ventricular function no significant differences between on-pump and off-pump groups at any point-of-time measurements were found. Troponin I and C-reactive protein were higher in on-pump as compared to off-pump group (p=0.001 and p=0.002; p=0.003 and p=0.001, respectively). CONCLUSIONS: In elective patients scheduled for cardiac revascularization there were no difference in cardiac performance assessed by intraoperative echocardiography regardless of surgical method used.

Real-time myocardial contrast echocardiography as a useful tool to select candidates for coronary revascularization among patients with end-stage renal disease - a 3-year follow-up study.

PURPOSE: To evaluate a real-time myocardial contrast echocardiography (MCE) as a tool to select candidates for coronary revascularization among patients with ESRD and to assess the rate of revascularization and mortality. MATERIAL/METHODS: 58 ESRD patients were screened for CAD using MCE. We analyzed the rate of coronary revascularization during 3-year follow-up. Patients with and without perfusion disturbances on MCE were compared. RESULTS: CAD was found in 46.2% patients out of 39 who underwent coronary angiography. 11 (39.3%) patients out of 28 from the group with perfusion defects on MCE underwent revascularization procedure (21.4% - PCI, 17.9% - CABG). No one from the group without perfusion defects had revascularization procedure. Perfusion defect (OR 1.37 CI 1.37-1.86, p=0.022) was related to revascularization in multivariant analysis (OR 12.87, CI 1.86-89.21, p=0.025). There was no difference in mortality between the group which underwent invasive procedures and treated conservatively (p=0.6643). In ROC analysis defects on MCE and CAD on angiography were equally good in anticipating combined end-point (AUC 0.716, CI 95% 0.544-0.851 and AUC 0.747, CI 95% 0.577-0.875, p=0.701) and death (AUC 0.752, CI 95% 0.582-0.878 and AUC 0.729, CI 95% 0.558-0.861, p=0.805). CONCLUSIONS: Our results indicate that MCE is a safe and uncomplicated method which may help along with other methods to select candidates for coronary revascularization among ESRD patients. In our study coronary revascularization procedures were successful but they did not improve patients' survival on 3-year follow-up.

Trends in the incidence of the free wall cardiac rupture in acute myocardial infarction. observational study: experience of a single center.

PURPOSE: Free wall cardiac rupture (CR) is one of the most common cause of in-hospital death in acute myocardial infarction (AMI). The early diagnosis of CR and selection of the patients predisposed to CR become an important clinical tool. AIM: assessing the occurrence of CR in patients with AMI, to determine the factors which could help to identify the patients threatened with CR. MATERIAL AND METHODS: 2320 consecutive patients with AMI. CR was proved by autopsy or by echocardiography performed during cardio-pulmonary resuscitation (CPR). RESULTS: In-hospital mortality was 11% (254 patients). 50 patients (2%) died from CR. CR was the cause of 20% of total in-hospital death. Patients with CR were older than survivors (72 vs 60 years, p<0.0001). Women prevailed in CR group: (62% in CR group vs 27% in the survivors, p<0.01). 29% of patients were treated with thrombolytics (Th+). Out of 58 patients from Th (+) group who died, 17 (29.31%) died because of CR. CR occurred in 33 (16.8%) patients out of 196 died in Th (-) group. In the logistic regression analysis only age and sex remained as predictors of CR. 16 patients died from CR during first 24 h from admission (ECR). In 34 patients CR occurred >24 h (LCR). In ECR group were no prevalence of women, while in LCR women constituted 68%. In ECR group all but one patient had no previous history of MI (p=0.06). Frequency of thrombolythic therapy was equal. CONCLUSIONS: Advanced age patients, particularly women with first AMI are at risk of CR. Decision of thrombolytic treatment in this group of patients must be very cautious.

Thrombin activatable fibrinolysis inhibitor (TAFI) in stable angina pectoris patients undergoing coronary artery bypass grafting (CABG).

PURPOSE: Thrombin activatable fibrinolysis inhibitor (TAFI) seems to be a potential haemostatic risk factor of coronary artery disease (CAD). Taking into account interactions between TAFI and haemostasis, especially during cardiopulmonary bypass, we decided to determine concentration of TAFI and activated TAFI (TAFIa) and other haemostasis markers in CABG patients. MATERIAL AND METHODS: 45 CAD patients (11 women, 34 men) undergoing elective CABG were included in the study. Blood samples were taken before the operation, on the 3rd, 7th day and 3 months after CABG. A value of p<0.05 was considered statistically significant. RESULTS: We found a significant decrease in TAFIa concentration on 3rd postoperative day: 6 microg/ml (0.3-43.2) vs 8.9 microg/ml (0.5-37) before CABG (p<0.05), a significant increase in TAFI concentration on the 7th postoperative day: 127.7% +/- 36.8 vs 112.18% +/- 30.34 of standard plasma concentration before CABG (p<0.05), significant increase in plasmin-antyplasmin (PAP) complexes concentration on 3rd and 7th day, respectively: 645 microg/l (323-1237) vs 406 microg/l (197-1840) before CABG (p<0.001); and 1030 microg/l (640-2149) vs 406 microg/l (197-1840) before CABG (p<0.0001). Before operation we found a significant negative correlation between PAP complexes concentration before CABG and EuroSCORE risk scale value (p<0.01). CONCLUSIONS: In CABG patients, there is a significant increase in fibrinolytic activity due to decrease in TAFIa concentration, with simultaneous increase in PAP complexes. A significant negative correlation between PAP complexes concentration before CABG and EuroSCORE risk scale value stressed a potentially higher operation risk in patients with lower fibrinolytic activity.

Attempts to detect Helicobacter pylori in atherosclerotic plaques.

Cardiovascular and cerebrovascular diseases are regarded to be the main causes of mortality in developed countries, atherosclerosis being at their pathological base. During the recent years, attention was paid to the role of bacterial infections, including Helicobacter pylori, in the process of atherogenesis and coronary heart disease development. The aim of the study was an evaluation of H. pylori presence--by means of PCR technique--in atherosclerotic changes, obtained by endarterectomy, performed during coronary artery bypass grafting (CABG). In the analysed group of patients, the following risk factors were found: hyperlipidaemia, smoking, hypertension, obesity, diabetes mellitus, cardiac infarction. No DNA of the bacteria was traced in any of the patients.

Cardiac surgical treatment of the patients with renal insufficiency.

Cardiac surgical treatment of the patients with renal insufficiency became more frequent necessity. Also postoperative renal insufficiency occurs pretty often after cardiac surgery. That is in part a result of broadening of operative indications, which might concern patients with multiple diseases. Patients with renal insufficiency and coexistent heart diseases, patients with endocarditis and patients with renal insufficiency after cardiac surgery require the treatment of cardiac surgeons and nephrologists. Heart diseases are the main cause of the mortality in the dialysis patients. Among the patients with renal diseases the cardiac surgeon most often receive long-term dialysis patients with coexistent heart diseases, who needs cardiac surgery (coronary artery by-pass grafting, valve operations). The amount of these operations increases, however it does not exceed 1% of overall number of cardiac operations. This group however, is very exacting and carries a high operative risk. Dialysis patients are exposed to increased risk of infection. 75% of them reveal infections in the form of sepsis. The presence of bacteria in the bloodstream increase the risk of infectious endocarditis. 6% of dialysis patients with IE require surgery. The prevention of renal failure after cardiac surgery is also very important. Renal insufficiency occurs in 12% of patients after cardiac surgery with the use of extracorporeal circulation. Renal failure complicates postoperative course and is of high risk for the patient. The mortality due to acute postoperative renal failure, which requires hemofiltration, reaches 70%. The proper cardiac surgical and nephrological management of renal insufficiency in patients selected for cardiac surgery as well as in patients with postoperative renal insufficiency is necessary to obtain good operative results.

[Mitral valve prolapse--diagnostic and therapeutic implications]. / Wypadanie platka zastawki mitralnej--implikacje diagnostyczne i terapeutyczne.

In the most patients the mitral valve prolapse (MVP) syndrome has a good prognosis. The gradual progression of MR may cause the progressive LV dysfunction and development of heart failure. Long-term prognostic studies showed, that complications like endocarditis, cerebrovascular accidents occur frequently in pts. with mitral systolic murmur, thickened mitral valve leaflets and presence of MR. The diagnosis of MVP is made by cardiac auscultation and confirmed by echocardiography. The procedures usefulness in sudden death stratification are discussed. The management of the symptomatic patients, particularly the indication for prophylaxis of endocarditis and cerebrovascular accidents has been demonstrated. The indications for cardiac catheterisation and surgical treatment are presented.

[Changes of selected immunological parameters after cardiopulmonary bypass in postop period]. / Wplyw krazenia pozaustrojowego na wybrane parametry odpowiedzi immunologicznej z uwzglednieniem przebiegu okresu pooperacyjnego.

The aim of the study was to evaluate the influence of changes of chosen immunological parameters on postoperative course patients after cardiopulmonary bypass operation. Complement components C3, C4 and immunoglobulins IgA, IgG, IgM were taken into account. The group consisted of 70 patients, 51 men at mean age 52.6 +/- 10.8 years and 19 women at mean age 50.7 +/- 11.0 years. All patients were operated in moderate hypothermia 26-32 degrees C with use of crystalloid cardioplegia. We used membrane oxygenators: Safe II (Polystan), Monolyth (Sorin), Maxima (Medtronic) and Bentley (Baxter). In 36 patients with multivessel coronary artery disease the internal thoracic artery and saphena vein grafts were performed. 27 patients underwent the valve prosthesis implantation procedure and 7 correction of the congenital heart dis-ease. The mean extracorporeal perfusion time was 127.5 +/- 51.0 min. The mean aortic cross-clamping time was 65.6 +/- 26.9 min. 6 blood samples were taken in the time periods called from 0 to 5: 0--before the operation, 1--right after the operation, 2--1 day after the operation, 3--3 days after the operation, 4--7 days after the operation, 5--14 days after the operation. All the immunological parameters were measured at the Technicon RA-1000 System device using plasma antibody serum of Behring Company. We compared two groups: 1) 21 patients extubated at operation day with 42 patients extubated at 1-th postoperative day, 2) 38 patients with postoperative organ failure with 32 patients without organ complications. The intubation time was shorter in patients with higher levels of C3 (to 7-th day) and C4 (at 1-th postoperative day). The postoperative organ failure were more frequently in patients with lower postoperative C3 (to 3-th day) and with lower C4 at 1-th postoperative day. The postoperative changes of immunoglobulins IgA, IgG, IgM were similar in patients with complicated and uncomplicated postoperative course.

[Left ventricular diastolic function evaluated by Doppler echocardiography in coronary artery disease in relation to to systolic function]. / Czynnosc rozkurczowa lewej komory oceniana metoda echokardiografii dopplerowskiej w chorobie niedokrwiennej serca w zaleznosci od czynnosci skurczowej.

The aim of the study was to assess the relationship between left ventricular (LV) diastolic dysfunction measured by Doppler mitral flow indices (D.m.f.i.) and LV systolic performance in coronary artery disease (CAD). 107 pts with confirmed CAD without or after MI in I, II NYHA class was divided into 2 groups according to ejection fraction (EF) value = 55%. 13 D.m.f.i. regarding to the time, velocity, flow volume and derivates were calculated. In the patient with CAD with normal EF, the diastolic dysfunction was characterised by the impaired relaxation. There were prolonged isovolumic relaxation time IVRT and deceleration time of early filling flow DT, reduced early filling fraction EFF and increased the atrial filling fraction AFF, decreased E/A ratio and E/A-VTI. The regression analysis revealed the positive correlation between EF and DT r = 0.35 and inverse correlation between wall motion score index WMSI and DT r = DT r = -0.33. The stepwise regression analysis revealed that EF and WMSI are independent factors influencing on DT. Our results confirm that diastolic dysfunction precedes the systolic dysfunction in CAD. The correlation between D.m.f.i. and LV systolic function parameters were obtained. The results suggest that the LV systolic function should be take to account in the Doppler mitral flow analysis.

[Echocardiographic assessment of pathologic geometry in the left left ventricle with aneurysm before and after endoventricular plasty]. / Echokardiograficzna ocena zaburzen geometrii lewej komory z tetniakiem przed i po operacji metoda plastyki wewnatrzkomorowej.

UNLABELLED: Large LV aneurysm (LVA) leads to progressive distortion of ventricular geometry. Endoventricular plasty (EVP) maintains LV original shape and size and may restrain this process. AIMS: Echocardiographic estimation of LVA size. Assessment of the results of EVP regarding operative technique. Assessment if the initial parameters of LV function and LVA size could predict the choice of surgical technique. MATERIAL AND METHOD: 33 patients with LVA underwent EVP: 18 with patch (group A), 15 without patch (group B). Echocardiography was performed before and after surgical procedure. LVA-area, LVA-volume, its proportion to LV area and volume (LVA-area/LV-EDA, LVA-volume/LV-EDV) were determined apart from routine parameters of LV function. RESULTS: Mean LVA-area was 15 cm2, LVA-volume was 50 mL. Mean LVA-areal LV-EDA was 0.38 LVA-volume/LV-EDV was 0.35. LVA exceeding 0.4 of LV area/volume was considered as a large. After surgery LV-EDV diminished +/- 40 mL, LVLd decreased +/- 1.5 cm. EF improved from 44% to 54%. Patients in group A had larger LVA-volume (60 vs 39 ml, p = 0.02) as well as LV-EDV (160 vs 120 ml, p = 0.03), and lower EF (41% vs 51% p = 0.002). Only 2 patients with LVA-volume greater than 56 ml were operated on without patch. After surgery echocardiographic parameters did not differ between the groups: in group A operation was much more extensive. SUMMARY: 1.) Echocardiographic parameters concerning size (LVA-area, LVA-area/LV-EDA) and volume (LVA-volume, LVA-volume/LV-EDV) of LVA provides information about disturbances in LV geometry, are valuable in planning operative method. 2.) EVP with or without patch provides significant improvement of LV geometry and function in echocardiographic investigation.

[Cardiac rupture in acute myocardial infarction]. / Pekniecie wolnej sciany serca w swiezym zawale.

Free wall rupture of the heart is the most common cause of death following pump failure. The incidence of death is 10-16% of all deaths because of acute myocardial infarction (AMI). In respect of time between the onset of AMI to Cardiac Rupture (CR), early (80%) and late CR are distinguished. Other clinical classification distinguishes acute and subacute CR. CR is considered subacute if the time between the onset of typical symptoms of CR and irreversible shock is longer as 30 min. There are three problems to solve: 1) selection of patient particularly threatened with CR, 2) defining the prodroms of CR and early diagnosis, 3) advancing the methods of surgical treatment. CR occurs more often in women, hypertensive patients and patient > 60 years old sustaining the first infarction. Thrombolytic agents diminish overall mortality in AMI, but do not influence frequency of CR. There are three mechanisms of CR incidence: 1) blood effusion into the ischemic zone resulting in the loss of tissue strength, 2) influence of thrombolytic therapy on degradation and inhibition collagen synthesis, 3) absorption of collagen by lymphocyte infiltration in infarction zone. Cardiac insufficiency with cardiogenic shock and rapid increase of pericardial effusion in echo examination and electro-mechanical discordance are considered to be clinical signs of CR and tamponade. CRP is an independent marker of subacute CR. Surgical treatment is possible only in case of subacute CR. Pericardiocentesis and bloodletting could temporary diminish cardiac tamponade and allow transfer to the operating room.

[Difficulties in distinguishing left ventricular aneurysm from pseudoaneurysm. Case report]. / Trudnosci w róznicowaniu rzekomego i prawdziwego tetniaka sciany dolnej serca. Opis przypadku.

A case of 51-year old female with large inferior left ventricular aneurysm developed 3 months after myocardial infarction is presented. The patient demonstrated advanced congestive heart failure and angina. Coronarography revealed amputation of the distal part of 3 coronary vessels without possibility of revascularisation. In ventriculography large inferior wall aneurysm was found. Echocardiography strongly suggest the presence of pseudoaneurysm. During the operation very large real aneurysm arising from inferior wall and apex was found. Postoperative period was complicated by many cardiac and non cardiac events. Authors discuss the problems of proper diagnostic and its influence on decision about surgical management.

[The influence of ischemia provoked by dobutamine and exercise on presence of late potentials in patients after myocardial infarction]. / Wplyw przejsciowego niedokrwienia prowokowanego testem dobutaminowym i wysilkowym na obecnosc póznych potencjalów komorowych u chorych po zawale serca.

UNLABELLED: The aim of this study was to examine the influence of transient exercise- and dobutamine-induced myocardial ischemia on time domain parameters of signal-averaged ECG (SAECG) and presence of late potentials (LP) in patients after myocardial infarction (MI). The investigation covered 85 patients after healing of MI, divided into two groups. Group I (24 males and 2 females, mean age 56.8 +/- 6.4 yrs) had exercise-induced ischemia and group II consisted of 59 patients (51 males and 8 females, mean age 58.3 +/- 8.5 years) with ischemia provoked by the intravenous dobutamine stress-testing. In each patient 2-D echocardiography, 24-h ambulatory Holter ECG, coronary arteriography were performed before stress testing. The ischemia was proven by using Tc-99m MIBI myocardial perfusion and standard 12-lead ECG monitoring. Recordings of SAECG were registered at rest and during ischemia under influence of stress-testing. The following time-domain parameters of SAECG were analysed: the root-mean-square voltage of the last 40 and 50 ms of the filtered QRS complex (RMS40, 50), total time duration of filtered QRS (t-QRS) and duration of signal lower than 40 muV (LPD). LP were detected when two or three of following criteria's had been registered: RMS 40 < 20 muV, t-QRS > 114ms, LPD > 38s. There was no statistically significant differences in all time domain parameters of SAECG between records at the baseline and during ischemia in each study group. At the baseline LP have been registered in 11.5% and in 15% patients, respectively of group I and group II. On the top of ischemia during treadmill exercise stress-testing LP have been recorded in 27% subjects. Under influence of dobutamine-provoked ischemia LP have been registered in 25% patients. CONCLUSIONS: Exercise- and dobutamine-induced ischemia triggers development of LP in small grade in post-infarction patients.

[The influence of exercise and dobutamine-induced ischemia on the presence of late potentials in patients after myocardial infarction]. / Wplyw przejsciowego niedokrwienia mienia serca prowokowanego testem dobutaminowym i wysilkowym na obecnosc póznch potencjalów komorowych u chorych po zawale serca.

UNLABELLED: The aim of this study was to examine the influence of transient exercise- and dobutamine-induced myocardial ischemia on time domain parameters of signal-averaged ECG (SAECG) and presence of late potentials (LP) in patients after myocardial infarction (MI). The investigation covered 85 patients after healing of MI, divided into two groups. Group I (24 males and 2 females, mean age 56.8 +/- 6.4 yrs) had exercise-induced ischemia and group II consisted of 59 patients (51 males and 8 females, mean age 58.3 +/- 8.5 years) with ischemia provoked by the intravenous dobutamine stress-testing. In each patient 2-D echocardiography, 24-h ambulatory Holter ECG, coronary arteriography were performed before stress testing. The ischemia was proven by using Tc-99m. MIBI myocardial perfusion and standard 12-lead ECG monitoring. Recordings of SAECG were registered at rest and during ischemia under influence of stress-testing. The following time-domain parameters of SAECG were analysed: the root-mean-square voltage of the last 40 and 50 ms of the filters QRS complex (RMS40, 50), total time duration of filtered QRS (t-QRS) and duration of signals lower than 40 microV (LPD). LP were detected when two or three of following criterias had been registered: RMS 40 < 20 microV, t-QRS > 114 ms, LPD > 38 s. There was no statistically significant differences in all time domain parameters of SAECG between records at the baseline and during ischemia in each study group. At the baseline LP have been registered in 11.5% and in 15% patients, respectively of group I and group II. On the top of ischemia during treadmill exercise stress-testing LP have been recorded in 27% subjects. Under influence of dobutamine-provoked ischemia LP have been registers in 25% patients. CONCLUSION: Exercise- and dobutamine-induced ischemia triggers development of LP in small grade in post-infarction patients.

Ectopic thyroid malignancy in the right ventricle of the heart.

In a 55-year-old woman (10 years after subtotal thyroidectomy for follicular adenoma) echocardiography revealed a 25 x 23-mm tumour in the right ventricular outflow tract. The successfully removed tumour appeared to be a follicular carcinoma. Subsequently, there has been no clinical and laboratory evidence for another site of metastasis or ectopic thyroid. The whole body 131I scan showed only correct radioiodine uptake in the place of cervical residual thyroid gland. We believe this is the first description of follicular carcinoma in cardiac ectopic thyroid.

[Primary adenoma of the jejunum in a patient with chronic severe bronchial asthma]. / Pierwotny gruczolak jelita czczego u chorego z wieloletnia ciezka astma oskrzelowa.

The authors have described a case of adenocarcinoma of the jejunum, complicated with its perforation. This case represents an extremely rare of complication. It was not possible to establish the final diagnosis, until the operation was been done.

[A case of perforation of the pericardial sac by Seldinger's catheter guide]. / Przypadek przebicia do worka osierdziowego prowadnikiem cewnika Seldingera.

This is a case report of perforation by Seldinger's catheter leader into pericardial sack. The leader was inserted contrary-wise++ to the subclavian vein with the sharp end in front. The leader moved forward toward the venous system and perforated into the pericardial sack. The preceding steroid therapy which the patient had undergone due to asthmatic status resulted in mediastinitis after the primary surgery. Right technique of reoperation and intensive postoperative care led to patient recovery.

[Histologic examinations of internal mammary artery, saphenous vein and aorta specimens collected during heart surgery]. / Badania histologiczne wycinków tetnicy piersiowej wewnetrznej, zly odpiszczelowej wielkiej i aorty pobranych w czasie operacji kardiochirurgicznych.

133 patients with coronary heart disease were treated surgically. 60 patients had Internal Mammary Artery (IMA) grafting performed together with saphenous vein grafts (IMA group), another 70 patients had saphenous vein grafts only (SVG group). Material for histological examination was intraoperatively taken from saphenous vein and ascending aorta and in IMA group also from the distal part of internal mammary artery. The intensity of atherosclerosis was estimated with 5-grade scale from 0 to 4 (0-no atherosclerosis, 1-minimal, 2-insignificant, 3-moderate, 4-pronounced). To visualize and to assess the blood flow through the internal mammary artery Digital Subtraction Angiography (DSA) was performed between day 6 and day 8 postoperatively in the IMA group. Results obtained were correlated with the intensity of atherosclerosis estimated histologically and the numeric data were statistically analysed. In the IMA grafts mean atherosclerosis intensity was 0.94 which is the evidence of minimal atherosclerotic changes. In saphenous vein the corresponding value was in the IMA group 2.14 and in the SVG group 2.17, in aortic scraps 2.64 in the IMA group and 2.73 in the SVG group. Patients in the SVG group were average 8.4 years older than in the IMA group. The difference is statistically significant. Despite the age difference, the intensity of atherosclerosis was not statistically different in aortic and saphenous vein scraps. Among 63 patients in the IMA group in 31 patients (49.2%) no atherosclerosis was found during histological examination and in 32 patients (50.8%) changes ranged from minimal to moderate. There were no IMA grafts with the pronounced atherosclerosis.(ABSTRACT TRUNCATED AT 250 WORDS)

[Significance of digital subtraction angiography for estimation of early results of myocardial revascularization after internal mammary artery grafting]. / Znaczenie dotetniczej cyfrowej angiografii subtrakcyjnej dla oceny wczesnych wyników rewaskularyzacji tetnic wiencowych przy zastosowaniu przeszczepu tetnicy piersiowej wewnetrznej.

Between 1st January and 31st December 1987 126 consecutive patients underwent full myocardial revascularization using at least one internal mammary artery bypass grafting in Department of Cardiovascular Surgery of University of Freiburg. In 78 patients (75 males, 3 females) DSA was performed within 8 days after surgery to evaluate dynamics of IMA-graft. The age ranged from 38 to 67 years (mean 53.4 years). DSA study was performed through the brachial artery, contrast medium was injected with flow of 10 ml/sec. in counter current. It was only one series of angiograms necessary to visualise flow from subclavian artery, through IMA to coronary artery. Among 78 investigated patients in 61 (78%) the distal anastomosis appeared to be widely patent and flow through the IMA and anastomosed coronary artery was sufficient. Patency of one of the branches of IMA or stenosis of IMA graft contributed to inadequate flow in 12 patients (15.6%). In 5 (6.4%) operated patients the IMA graft was not patent. Counter current intraarterial DSA requires much smaller amount of contrast medium than classical angiography, moreover avoiding of aortic catheterization with all risks involved. The counter current intraatrial DSA is an excellent technics of estimation of the flow to grafted coronary arteries. The method is easy to perform, repetitive and carry very small risk for the patient. Early postoperative evaluation of IMA-graft patency is essential for estimation of effectiveness of myocardial revascularisation and prognosis for the patient.