Clinical and hemodynamic picture of Eisenmenger syndrome.

Eisenmenger syndrome represents a very specific form of pulmonary arterial hypertension (PAH). Unlike patients with idiopathic PAH, in Eisenmenger syndrome the clinical and cardiac status is often relatively stable for a long time. On the other hand, due to cyanosis and due to maladaptive body reactions many noncardiac complications may occur. Fourteen patients (pts) with Eisenmenger syndrome were analyzed, with the mean age 41 years. Invasively measured pre-capillary pulmonary hypertension was severe (mean pulmonary arterial pressure 79 mmHg) and a statistically significant difference according to the site of defect was found (pre-tricuspid shunts vs post-tricuspid shunts = 57,5 mmHg vs 88 mmHg; p = 0.01). It is neccessary to keep in mind that non-cardiac events and complications may lead to death sooner then the right ventricular dysfunction or PAH (Tab. 7, Fig. 21, Ref. 16).

Management of intracavitary left atrium tumors during pregnancy - two case reports.

OBJECTIVE: Authors documented an individual management of intracavitary left atrium tumors diagnosed during pregnancy. SUBJECT: Two case reports were presented. Brain embolisation was supposed in the case one of intracavitary left atrium tumor. An urgent cardiosurgery at 24 weeks' gestation was performed on the cardiopulmonary bypass. In case two (multiple pregnancy - twins) cardiac tumor in left atrium was detected in third trimester of pregnancy. The mother was without any serious cardiac and systemic complications during the last trimester. Surgical approach was different - removal of tumor after delivery. CONCLUSION: The surgical approach should be determined by clinical behavior of left atrial cardiac tumors.

Cardiac surgery in the elderly from the point of cardiologist. Evaluation of risk and outcome.

Prolongation of life expectancy, increasing incidence of coronary artery disease, advances in surgical techniques and in care of elderly patients are reasons of elevating the number of prospective candidates in this age group for cardiac surgery. Although advanced age is considered as a risk factor for any form of surgical treatment and is usually associated with higher postoperative morbidity and mortality rates. The paper submitted clarifies numerous problem areas concerning this topic in the group of patients over 65 years. The factors affecting decision-making for surgical treatment are analyzed. The specific problems concerning this age group: significant disease severity, more comorbid illnesses are discussed. Some specifics of cardiac surgery (coronary artery bypass grafting and/or valve surgery) are dealt with. An increased attention should be devoted to mental and metabolic state and general physical condition (level of fitness and activity). High level of activity and intellectual functions, re-socialization efforts following surgery and adequate social background of the patient also play an important role. According to these facts individualized approach in indication for surgery is emphasized. (Ref. 45.)

[Pulmonary complications after heart surgery]. / Plúcne komplikácie po operácii srdca.

The authors present a detailed analysis of pulmonary complications after open-heart surgery and of their risk factors. The results of the presented study indicate that COPD patients with functional impairments are more sensitive to complicated postoperative outcome and to respiratory infections, in general. There is a clear relationship between artificial violation of the pleural cavity, diaphragmatic dysfunction and pleural effusion. Diaphragmatic dysfunction appears more frequently in mammarocoronary bypass patients in consequence of pleurotomy. The incidence of dysfunction could be reduced by the use of phrenic nerve insulation. Patients with pulmonary complications suffer from serious pulmonary function deficit. The possibilities of identification of the patients at risk, as well as the prevention and prophylaxis are analysed. (Tab. 7, Fig. 2, Ref. 71.)

Role of left ventricular geometry in the alteration of initial QRS vectors due to concentric ventricular hypertrophy.

The relation between serial magnitudes of instantaneous spatial vectors, obtained throughout ventricular depolarization, and echocardiographically estimated left ventricular (LV) mass was investigated in 64 patients with congenital aortic stenosis and in 16 patients with coarctation of the aorta. While the correlation was positive between LV mass and vector magnitudes at 50 and 60 ms after QRS onset (r = .530 and .557, P < .01), it was found to be negative with regard to the magnitude of the initial 10 and 20 ms vectors (r = -.285 and -.355, P < .01). Computer simulation of activation propagation in different models of LV enlargement has shown that the decrease of the spatial magnitude of initial vectors, as well as a marked decrease of the area of the anterior portion of the horizontal plane QRS loop and of the Q amplitude of the orthogonal z lead, are characteristic of concentric LV hypertrophy with decreased diastolic volume and were not observed with unchanged or dilated chamber size. Repeated assessment of the magnitude of initial QRS vectors may indicate changes of LV remodeling in patients with LV pressure overload.

Triple valve surgery with triple aorto-coronary bypass and endarterectomy of the right coronary artery.

This paper presents the case report of a 50-year-old woman with a triple valve lesion of rheumatic origin and ischemic coronary disease. The patient underwent successful simultaneous triple valve surgery; the aortic and mitral valves were replaced by mechanical prostheses, and the tricuspid valve was repaired by annuloplasty, together with three aorto-coronary bypasses and endarterectomy of the right coronary artery. The peri- and postoperative courses were uneventful and the patient was discharged from hospital in good clinical condition 12 days after surgery.

[Echocardiography in the diagnosis and prevention of congenital heart defects of a primarily genetic etiology]. / Prínos echokardiografie v diagnostike a prevencii vrodených vývojových chýb srdca primárne genetickej etiológie.

Over the period from January 1982 to June 1989 the authors examined 1723 children and adolescents with congenital heart diseases (CHD), hospitalized in the Institute of Cardiovascular Diseases in Bratislava. Of these patients, 96 (5.6%) had CHD of primarily genetic etiology: monogenic diseases 51 (3%), chromosomal anomalies 45 (2.6%) patients. In indicated cases (polystigmatization, positive family history) the relatives were examined. Echocardiographic examination of 203 relatives of patients with genetically determined CHD yielded positive echocardiographic findings in 32 subjects (15.5%). In relatives of patients with CHD of primarily genetic etiology, even structural changes which hemodynamically are not severe may be of value for individuals who are carriers of pathologic genetic information. Echocardiography is a contribution not only to diagnosis but also to prevention of CHD in association with adequate genetic counselling. (Tab. 4, Ref. 7.)

[Vectorcardiographic features of right ventricular dilatation]. / Vektorokardiografický obraz dilatácie pravej komory.

Axial McFee-Parungao lead system vectorcardiograms were obtained in 55 patients with type atrial septal defect, aged 3-24 years, prior to and in average 3 years after surgical repair of the defect. Changes of the QRS loop observed after intervention led to the conclusion that the vectorcardiographic signs of right ventricular dilatation consist of a rightward shift of the posteriorly orientated horizontal plane vectors at 50-70 ms of QRS, decrease of the magnitude of vectors around the 40th ms, no changes in the magnitude and orientation of the initial (10-30 ms) QRS vectors as well abnormal departures of the spatial VCG loop from its preferential plane even in the absence of other signs of right ventricular conduction impairment. The above abnormalities vanished after normalization of hemodynamics.

[The importance of pulmonary angiography in the surgical treatment of congenital heart defects with a left-right shunt and pulmonary hypertension]. / Význam pulmoangiografie pre indikáciu na chirurgickú liecbu vrodených srdcových chýb s l'avo-pravým skratom a pl'úcnou hypertenziou.

The studied series consisted of 14 patients with ventricular septal defect and pulmonary hypertension aged from 3 months to 15 years. Three examination methods were compared: (1) Invasive hemodynamic examination; (2) Pulmoangiographic examination by means of wedge peripheral pulmoangiography; (3) Histological examination of bioptic samples. Direct correlation was found to exist between mean PA pressure, PAR/m2, TPR/SR and pulmoangiographic records, in which the following parameters were evaluated: (a) length of the narrowing of the peripheral branch of the PA, (b) background opacity, (c) circulation time. The histological findings obtained in the bioptic samples corresponded practically in all cases with the hemodynamic and PAG findings. Only in two patients did the histological picture display a less severe degree of affection than found by PAG and hemodynamic examination. The obtained results suggest that in light of surgical indications, PAG can be considered a suitable and valuable supplementary method in assessing borderline findings of pulmonary hypertension in children with congenital heart defects and left-to-right shunt.

[Diagnosis of congenital heart defects in childhood]. / Diagnostika vrodených srdcových chýb v detskom veku.

Echocardiographic diagnosis of inborn developmental defects of the heart in children differs from the approach used in adults. Examination from the subcostal and suprasternal space is of utmost importance. On using "deductive echocardiography" individual segments of the heart are gradually assessed in the two-dimensional echocardiographic picture. On evaluating pathological changes (particularly borderline values), the use of Doppler signal and one-dimensional imaging is equally important in children as it is in adults.

[The hypereosinophilic syndrome in a child with endomyocardial fibrosis treated surgically]. / Hypereozinofilný syndróm dietata s endomyokardiálnou fibrózou riesený operacne.

The authors describe the case-history of a 12-year-old patient with hypereosinophil syndrome, endomyocardial fibrosis of the left ventricle and dominating mitral valve insufficiency. By correction of the insufficiency, using a Carpentier ring, the authors achieved substantial improvement of the haemodynamics. One year after operation the patient is cardially compensated.

[Ventricular septal defect in early childhood]. / Defekt komorového septa v ranom detskom veku.

In a retrospective study the results of operations for hemodynamically severe ventricular septal defect were analyzed in 18 patients with a body weight below 10 kg who had been operated on over a period of two years at the Institute of Cardiovascular Diseases in Bratislava. The first group consisted of 12 children with the mean body weight of 6650 g in whom complete correction of the ventricular septal defect was carried out by means extracorporeal circulation. Ligation of the pulmonary artery was performed in 6 infants with the mean body weight of 3420 g (second group). Patients of both groups had a serious left-to-right shunt and marked pulmonary hypertension. An excellent operative result was obtained in 10 children after complete correction of the defect. Two patients of the first group and one patient of the second group died suffering from severe pulmonary hypertension. Surgical correction of the hemodynamically severe ventricular septal defect in early childhood is indicated when conservative treatment fails and should be carried out as an urgent procedure regardless the age and body weight of the patient.