[Reconstructive surgery of the aortic valve in rheumatic stenoses]. / Plastika aortální chlopne pri revmatické stenóze.

Recently the number of plastic operations of the cardiac valves is increasing. The authors present an account on 10 patients with stenosis of the aortic valve where they performed a reconstruction without the necessity of a prosthesis. Commissurotomy and rasping can be performed in patients when the basic anatomical shape and dimensions of the valve are preserved. None of the patients died, one was successfully reoperated on account of aortic insufficiency. The authors describe and discuss the tactics and technique of the operation. They discuss the possibility of reconstruction of the aortic valve in patients indicated for aortocoronary reconstruction where the aortic defect appears to be of minor impact.

Infarct Size Limitation: acute N-acetylcysteine defense (ISLAND trial): preliminary analysis and report after the first 30 patients.

Our previous experimental research and initial clinical observations regarding the use of N-acetylcysteine in the treatment of ischemic and reperfusion injury in acute myocardial infarction gave rise to a study entitled the Infarct Size Limitation: Acute N-acetylcysteine Defense (ISLAND) trial. Today, this randomized, echocardiographically and angiographically controlled study includes the first 30 patients with a first anterior wall myocardial infarction: Group A (n = 10) consisting of patients with successful recanalization of the infarct-related left anterior descending artery by streptokinase without any further treatment, Group B (n = 10) consisting of patients with failed infarct-related artery recanalization, and Group C (n = 10) comprising patients who had successful streptokinase-induced recanalization of the left anterior descending artery plus N-acetylcysteine administration at a dose of 100 mg/kg body weight. The parameters monitored in our study include changes in global and regional left ventricular ejection fraction of the infarct-related segment using echocardiography and, using electrocardiograms and the Wagner QRS scoring system, the amounts of acutely jeopardized and finally infarcted myocardium. In Group A, global left ventricular ejection fraction rose nonsignificantly within 2 weeks from 37.5 +/- 9.6% to 38.5 +/- 13.8%; it declined significantly in Group B from 36.2 +/- 6.1% to 30.1 +/- 6.7% (p < 0.05), while it considerably improved in Group C from 41.7 +/- 4.1% to 59.6 +/- 8.1% (p < 0.001). Regional left ventricular ejection fraction changed significantly only in Group C: from -4.5 +/- 27.3 to 45.6 +/- 16.3 (p < 0.001). In Group A, in which the amount of acutely jeopardized myocardium was 21.7 +/- 7.2, infarction actually occurred in 20.4 +/- 9.7% (practically no myocardial salvage). In Group B, risk area was 18.1 +/- 4.3%, but infarct size rose to a resulting 29.1 +/- 6.0%. Significant myocardial salvage was accomplished only in Group C: of 26.2 +/- 8.1% of jeopardized myocardium, infarct size was reduced to 10.8 +/- 7.1% (salvage by 58.8%). Also, basic division of patients by therapy showed that, although those with nonidentical findings on their coronary arteries were included into the same groups, patients treated with streptokinase plus N-acetylcysteine had significantly more favorable values of the monitored parameters than those treated with streptokinase alone. We conclude our interim analysis suggests that N-acetylcysteine has a beneficial effect, reducing the functional and structural impacts of myocardial infarction.

[Serum insulin levels affect body constitution, blood pressure, serum lipids and cardiac dimensions. Observations in clinically healthy offspring from hypertensive families]. / Sérové koncentrace inzulinu ovlivnují telesnou stavbu, krevní tlak, sérové lipidy i srdecní rozmery. Pozorování u klinicky zdravých potomku hypertenzních rodin.

BACKGROUND: According to some work hypertension is in a pathogenetic relationship with hyperinsulinaemia or is considered to be the consequence of insulin resistance. It is, however, also known that there exists a familial predisposition for hypertension; according to genetic investigations half the family relatives can suffer from hypertension. In conjunction with these views on the pathogenesis of hypertension and its familial character the authors outlined the following objectives of their investigation: to test clinically and metabolically the condition of the offspring of probands with essential hypertension requiring systematic treatment. The authors investigated in particular indicators of body composition, insulin concentration and its relationship to serum levels and some indicators of lean body mass. METHODS AND RESULTS. There were 48 offspring (25 men and 23 women) from families of 30 probands suffering from hypertension. The mean age of the offspring was 38.4 +/- 7.8 years. They were compared with a group of 72 controls, mean age 35.8 +/- 8.2 years (36 men and 36 women) without a family history of hypertension and diabetes (t-test). The basal insulin concentration (IRI O' = 20.5 +/- 12.8 microU/ml, and 14.3 +/- 7.3 microU/ml resp., p < 0.01) and basal C peptide (O' = 0.59 +/- 0.31 pmol/ml and 0.50 +/- 0.20 pmol/ml resp., p < 0.05) were elevated. The offspring of probands with hypertension had a higher body weight (BMI = 25.3 +/- 3.5 kg/m2 and 23.3 +/- 2.5 kg/m2 resp., p < 0.001) a higher ratio of waist hip circumferences (0.94 +/- 0.1 and 0.87 +/- 0.1 resp., p < 0.001) similarly as blood pressure (131.5 mmHg +/- 11.8 mmHg and 116 mmHg +/- 13.3 mmHg resp., p < 0.001) and blood sugar level (5.29 +/- 0.61 mmol/l and 4.93 +/- 0.39 mmol/resp., p < 0.01). The authors also found differences in the serum cholesterol levels (5.9 +/- 1.3 mmol/l and 5.1 +/- 0.6 mmol/l resp., p < 0.01), HDL cholesterol (1.45 +/- 0.50 mmol/l and 1.65 +/- 0.60 mmol/l resp., p < 0.01) and triacylglycerol trends (1.66 +/- 1.54 mmol/l and 1.37 +/- 0.96 mmol/l resp., p < 0.1). On echocardiographic examination the cardiac dimensions were not enlarged, however, significant relations (linear regression) were proved in offspring in particular as regards the dimensions of the left ventricle and insulin (IRI O-left atrium p < 0.05, IRI 30-left atrium, p < 0.01. C peptide O-left atrium, p < 0.05). Between the body mass index, cholesterol, uric acid HDL-cholesterol the waist/hip ratio on the one side, the dimensions of the left atrium, thickness of septum and posterior wall (p < 0.01-0.001), between insulin and C peptide (p < 0.001) on the other side even closer relations were found. CONCLUSIONS: Elevated insulin concentrations may participate in the development of body composition, they influence the lipid transport and blood pressure in clinically healthy offspring of probands suffering from hypertension. The relationship between the insulin concentration and disposition towards enlargement of the left heart needs more detailed investigation.