[Pseudoaneurysms due to iatrogenic arterial injuries--observations at a vascular surgery worksite]. / Pseudoaneuryzma po iatrogenním postizení tepny--poznatky z angiochirurgického pracoviste.

With advancing care of patients with cardiovascular diseases the number of invasive cardiological operations is increasing. Although effective methods are involved, these procedures are also associated with certain risks for the patient. From the aspect of vascular surgery the most frequent complications include iatrogenic pseudoaneurysms and extensive haematomas. The objective of the present work is to evaluate the development of the number of pseudoaneurysms which occurred after puncture of the femoral artery during coronarography or PTCA, and verification of the hypothesis of the declining trend of the ratio of pseudoaneurysms in the total number of performed invasive cardiological diagnostic and therapeutic operations. The author submits in his paper the retrospectively assessed number of invasive operations performed at the 1st Medical Cardioangiological Clinic of the St. Ann Faculty Hospital Brno in 1996-2001. It summarizes the number of PA dealt with during the same period by physicians of the 2nd Surgical Clinic of the St. Ann Hospital in Brno. It analyzes also the treated complications of cardiological operations in 2001.

Rupture of the coronary artery after blunt nonpenetrating chest wall trauma detected by color Doppler echocardiography: a case report.

We report a rare case of a ruptured papillary muscle of the anterior leaflet of the tricuspid valve and the rupture of the septal branch of the left anterior descending coronary artery with drainage into the right ventricle after blunt nonpenetrating chest wall trauma. Both abnormalities were detected by transthoracic 2-dimensional and color Doppler echocardiography, and the septal branch rupture was confirmed by coronary angiography. The leading echocardiographic sign of the rupture of the coronary artery was intramyocardial mosaic-colored flow, representing the turbulent high-velocity flow in the ruptured coronary artery. Hypokinesis of the anteroseptal myocardial segments and the presence of Q waves in leads V1 through 4 on the electro-cardiogram were suggestive of anteroseptal myocardial infarction. We conclude that the history of chest trauma, the electrocardiographic changes, and wall motion abnormalities should be stimuli for a careful color Doppler flow "mapping" of the myocardium for possible identification of a coronary artery rupture.

Can dobutamine echocardiography induce myocardial damage in patients with dysfunctional but viable myocardium supplied by a severely stenotic coronary artery?

In animal experiments, dobutamine infusion was found to impair the oxygen supply-demand balance in hypoperfused areas of hibernating myocardium which may induce myocardial damage. The aim of our study was to assess whether dobutamine echocardiography can induce myocardial damage detected by an increase in the cardiac troponin T level in blood. Twenty seven patients with coronary artery disease and severe stenosis of at least one major coronary artery (> or = 90% of luminal diameter narrowing) supplying dysfunctional myocardial segments underwent dobutamine echocardiography. Dobutamine was infused in 3 min dose increments of 5, 10, 20, 30, and 40 microg per kg body weight per minute with the addition of atropine up to 1 mg if ischemia or an 85% predicted maximal heart rate were not achieved. In 15 patients the protocol with prolonged application of 40 microg per kg per minute of dobutamine for 6 min and for the next 5 min with the addition of atropine was used. To exclude minor myocardial damage, an increase in the cardiac troponin T blood level was assessed qualitatively by the TROP T sensitive Rapid Test 20 h after dobutamine echocardiography. In 20 patients the dysfunctional segments were found to be viable with inducible ischemia exhibiting either continuous worsening in systolic thickening or "biphasic" response characterised by the improvement of their systolic thickening with a small dose and by a worsening of the thickening with a high dose of dobutamine. No patient exhibited positive TROP T sensitive Rapid Test result. In patients with coronary artery disease and severe stenosis of a major coronary artery supplying dysfunctional but viable myocardial segments, dobutamine echocardiography does not induce myocardial damage detectable by an increase in cardiac troponin T level.

[Evaluation of diastolic filling of the left ventricle using Doppler echocardiography in patients with chronic ischemic heart disease and with normal left ventricular function]. / Posouzení diastolického plnení levé komory srdecní dopplerovskou echokardiografií u nemocných s chronickou ischemickou chorobou srdecní a s normální funkcí levé komory.

Twenty-five patients with chronic ischaemic heart disease and intact left ventricular systolic function who had no other cardiovascular, systemic or metabolic diseases were examined by two-dimensional and Doppler echocardiography. At rest and during an isometric load Doppler parameters of left ventricular diastolic filling were obtained such as: peak transmitral flow velocity in early diastole - E, peak transmitral flow velocity in atrial contraction - A, their ratio E/A and deceleration time of early filling. Based on the coronarographic finding, the patients were divided in two ways: 1. group A - 15 patients with critical narrowing of some major coronary artery (stenosis > or = 90% of the luminal diameter) and group B - 10 patients without critical narrowing (stenosis > or = 50%, but less than 90% of the luminal diameter), 2 group C - 6 patients with triple vessel disease, group D - 8 patients with double vessel disease and group E - 11 patients with single vessel disease. None of the groups differed mutually in any of the investigated Doppler parameters of left ventricular filling at rest, nor after an isometric load. CONCLUSION. Diastolic Doppler parameters of left ventricular filling do not make it possible to detect patients with critical coronary narrowing and they do not help to estimate the number of coronary vessels with significant stenoses.