Cardiac rhabdomyosarcoma.

Cardiac sarcoma is a very rare neoplasm and is difficult to diagnose. The case of a 51-year-old man with a left atrial tumour, locally recurrent three months after its surgical removal, is presented. Computed tomography showed metastatic spread to the lung parenchyma. On revised histology, the mass extirpated was a sarcoma. Because of the metastatic spread, further therapy was symptomatic only; the patient died 15 months after the first manifestation of his problems. Immunohistochemical staining confirmed cardiac rhabdomyosarcoma with metastatic spread to the lungs. Difficulty in diagnosing and treating cardiac tumours is discussed.

[Plasma homocysteine levels in patients with indications for cardiac revascularization]. / Plazmatické hladiny homocysteinu u pacientu s indikací k revaskularizaci srdce.

The amino acid homocysteine is a further possible risk factor for the development of atherosclerosis. The authors examined at the First Medical Clinic, Second Medical Faculty Charles University in the course of 1994-1996 59 patients with manifest IHD who were examined by coronarography and because of a major finding were indicated for revascularization surgery. This group was compared with a control group of subjects of equal age without major findings on the coronary circulation. The control group differed from the former group significantly only as regards the triglyceride level which was higher in the former group and the group comprised a larger number of diabetic patients. As regards cholesterol, HDL-cholesterol, uric acid, fibrinogen levels there was no significant difference. The authors found an insignificant difference in homocysteine levels. In the investigated group of patients indicated for revascularization surgery the mean homocysteinaemia was 12.3 mumol/l (sigma 4.3 mumol/l) and in the control group 11.8 mumol/l (sigma 3.8 mumol/l). The mean homocysteine level in the investigated group did not exceed the level of 15 mumol/l reported in the literature as the borderline of normal homocysteine blood levels. The authors did not reveal a statistically significant correlation between homocysteine levels, diabetes mellitus type II and smoking.

[Direct myocardial revascularization by antero-lateral minithoracotomy]. / Prímá revaskularizace myokardu z anterolaterální minitorakotomie.

The authors present the case of successfully treated patient with CAD, operated from left anterolateral minithoracotomy. Angiographic control two years later presents fully patent anastomosis without any signs of stenosis.

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).

[Minimally invasive myocardial revascularization. Initial experience with myocardial revascularization without extracorporeal circulation]. / Minimálne invazivní revaskularizace myokardu. První zkusenosti s revaskularizací myokardu bez mimotelního obehu.

The authors present an account on the first phase of application of minimally invasive techniques of revascularization of the heart into clinical practice at their department. Since December 1994 to the end of January 1995 in selected 15 patients from a total of 240 patients with IHD 16 arterial and 8 venous grafts were sutured on the beating heart from median sternotomy. None of the patients died and none need reoperation. All patients are free from anginous complaints after operation and their clinical condition is satisfactory. Revascularization of the heart by means of arterial and venous grafts on the beating heart from median sternotomy is a technically reproducible method which enables us to elaborate further minimally invasive procedures for the treatment of IHD. The presented paper is a preliminary communication without claims of statistical validity of the achieved results.

[Minithoracotomy in cardiac surgery. Initial experience with closure of an atrial septal defect with a minithoracotomy]. / Minitorakotomie v kardiochirurgii. První zkusenosti s uzáverem defektu sínového septa z minitorakotomie.

The authors describe their own modification of closure of an atrial septal defect (ASD) from right anterolateral minothoracotomy. This minimally invasive approach was selected in girls and women. Right anterolateral thoracotomy was used in 1987 to 1994 in twelve female patients. With regard to the general trend towards aesthetic surgery the authors use at present minimal anterolateral right-sided thoracotomy which with regard to its close relationship with the right atrium makes a safe surgical access to the atrial septum possible. Extracorporeal circulation is implemented by cannulation of the iliac artery in the groin, venous return is ensured by cannulas inserted into the venae cavae in the surgical field (by the auricle of the right atrium into the vena cava superior and the right atrial wall into the vena cava inferior). The operation itself is performed with electric fibrillation of the heart and tightening of the venous tourniquets. Between January 1995 till March 1996 the authors made by the thus modified approach a closure of the ASD type secundum in four female patients age 17, 29, 35 and 40 years. ASD was located always in the fossa ovalis and was repaired by direct suture. The duration of the extracorporeal circulation was on average 30 minutes. The length of the skin incision was 8-10 cm. The operation was free from complications. The cosmetic result is excellent and is consistent with principles of aesthetic surgery. If an arterial cannula is inserted into the groin minithoracotomy can be recommended for closure of ASD with extracorporeal circulation as a safe method.

[Dissecting aortic aneurysm combined with hepatorenal syndrome]. / Disekující výdut' aorty kombinovaná hepatorenálním syndromem.

The authors present a case of a dissecting aneurysm of the aorta type A which affected also the insertions of visceral and renal arteries, and in addition to renal ischaemia and impaired renal function caused also ischaemia of the liver parenchyma with a rise of transaminases and bilirubin. This led to temporary hospitalization at the infectious department where the patient was referred to rule out hepatitis. In the discussion the authors draw attention to the pathogenesis, differential diagnosis and contemporary therapeutic methods of the disease.

[Infectious endocarditis and congenital heart defects in adults]. / Infekcní endokarditida a vrozené srdecní vady v dospelosti.

BACKGROUND: Infective endocarditis still remains a cardiological menace. However, the type of predisposing diseases has changed: the incidence of rheumatic heart disease in advanced countries has declined, advances made in the surgical and medicamentous treatment of inborn heart disease are the reasons why we are encountering, with increasing frequency, infective endocarditis which develops on their background. METHODS AND RESULTS: The objective of the investigation was to assess the frequency of infective endocarditis and predisposing diseases. During the time interval between 1987 and 1991 16 patients (50% younger than 50 years) were hospitalized with the diagnosis of infective endocarditis. Rheumatic valvular damage and inborn heart disease were the predisposing factor in 25%. All patients were younger than 30 years (mean 24, range 18-30), and half the patients suffered from defects of the ventricular septum. Other defects were tetralogy of Fallot and inborn aortic stenosis. In 10% of the patients infective endocarditis developed on the background of a mitral valve prolapse with regurgitation. Echocardiographic examination confirmed the diagnosis in almost 70% by revealing vegetation. Bacteriological examination revealed the agent in 60%, most frequently it was Streptococcus viridans. The mortality rate in the group was 13%. CONCLUSIONS: The recorded incidence of infective endocarditis, 1.5 pro mille, is consistent with data in the literature. Corrected and not corrected heart disease plays an important role as predisposing disease. Despite the opportunity of intensive antibiotic treatment, the mortality remains high--13%.

[Congenital heart defects in adults worldwide and in the Czech Republic]. / Vrozené srdecní vady dospelých ve svete a u nás.

Congenital heart disease of adults is a new area of cardiology with specific diagnostic, therapeutic, social and economic problems of these patients. The First Medical Clinic of the Second Medical Faculty, Charles University assembled so far data on more than 1200 adult patients with congenital heart disease from different districts in Bohemia and Moravia. Atrial septal defects are recorded most frequently (25.7%), followed by ventricular septal defects (25.0%) and coarctation of the aorta (12.4%). 50.3% of the patients were treated by surgery, most frequently patients with a patent ductus arteriosus--in 83.8%, with coarctation of the aorta (82.8%) and an atrial septal defect (60.5%). The authors review reasons why for the care of these patients in other countries specialized centres developed and the foundation of such a centre in the Czech Republic is discussed.

[Takayasu's arteritis with primary involvement of the pulmonary artery]. / Takayasuova arteritida s provotním postizením plicnice.

The authors demonstrate a 23-year-old women in the fourth month of pregnancy with complaints and findings typical for Takayasu's arteritis. The onset of the disease can be safely located to the area of the pulmonary artery where the aorta and its branches were still unaltered. In the course of nine years not only a severe occlusive stage developed in the area of the thoracic aorta and its branches but there was also progression as regards the affection of the pulmonary artery. In the area of the subclavicular artery on the left balloon dilatation was performed. The collateral arterial blood supply of the left lung from the left coronary artery is also unusual.

[Congenital heart defects in pregnancy]. / Sledování tehotných s vrozenou srdecní vadou.

The authors investigated a group of 95 pregnant women with congenital heart disease. In two induced abortion was indicated fur cardiac reason (major left-to-right shunt in ASD II and in a patient with a non-corrected TOF with a significant right-to-left shunt). In the remainder the course of pregnancy was not complicated. From the total number of 132 deliveries only six were by Caesarean section, five times on obstetric grounds. One infant died, delivery during the 29th week by Caesarean section on account of premature escape of amniotic fluid--mother with a history of radial correction of TOF. Other relevant data are summarized in a table. In the conclusion the authors summarize basic provisions indicated in pregnant women with congenital heart disease.

[Hemodynamic effects of nitroglycerin and trimepranol in acute myocardial infarct]. / Hemodynamické úcinky nitroglycerinu a trimepranolu u akutního srdecního infarktu.

The authors investigated the effect of intravenous nitroglycerin and trimepranol on the haemodynamics of patients with acute myocardial infarction. They found that nitroglycerin has a favourable effect on haemodynamics as it leads to a reduction of the pressure in the wedged pulmonary artery and to a reduction of oxygen requirement of the cardiac muscle, while the changes of the minute volume and pulse rate are insignificant. Trimepranol leads to a rise of pressure in the wedged pulmonary artery, sometimes to critical values, and to a decline of the cardiac minute output. The authors conclude that trimepranol is suitable for a selected group of patients with sinus tachycardia and without signs of cardiac failure while the pulmonary pressure is carefully monitored. Nitroglycerin can be administered to the majority of patients with acute myocardial infarction. To ensure safe administration it is sufficient to monitor the heart rate and in particular the systemic pressure. It is best to administer it to patients with extensive myocardial infarctions with a high filling pressure of the left ventricle.

[Detection of atrial septal defects using esophageal echocardiography]. / Prukaz defektu sínového septa jícnovou echokardiografií.

By means of transoesophageal (oesophageal) echocardiography (TEE) the authors examined a group of 20 subjects. In 10 there was clinical suspicion (physical finding, ECG, X-ray) of an atrial septal defect. Common precordial echocardiographic examination (TTE) and dilution of indocyan green by means of an acustic sensing unit were negative or only marginally positive and did not provide a final decision. By means of TEE the defect was confirmed in 8 subjects by the finding of anatomical discontinuity of the septum and the presence of coloured Doppler shunt flow. In two subjects the finding was negative, in 10 controls no pathological findings were detected. The authors confirmed that TEE is a reliable method which proves even slight shunts in the area of the atrial septum. It is probably the most sensitive existing method.