Does the additional usage of a local hemostatic patch reduce bleeding after aortic reimplantation?

INTRODUCTION: Our study aimed to assess the efficacy of a local hemostatic, consisting of human thrombin and fibrinogen, which was applied on the aortotomy suture line. MATERIAL AND METHODS: The study involved 93 patients undergoing elective aortic valve replacement. Patients were randomized to two groups. Group 1 comprised 41 patients, in whom a hemostatic patch (Tachosil) was used additionally. Group 2 comprised 52 patients in whom Tachosil was not applied. RESULTS: The postoperative drainage after 48 h was significantly lower in the group of patients where the local hemostatic patch (Tachosil) was additionally used, compared to the control group (p = 0.0335). The prevalence of rethoracotomies was twice as high in the control group compared to the Tachosil group (5% vs. 10%), but the statistical analysis did not show a significant difference. As a consequence, both measurements of hemoglobin concentration revealed significantly higher hemoglobin in Tachosil-treated patients than the control group (p < 0.001, p = 0.0002). Red blood cell count (RBC) was also significantly higher in the Tachosil group. The difference in perioperative blood loss between the two groups resulted in a difference in postoperative acute renal injury or renal failure. The rate of infection within the early postoperative period was also comparable between the groups, although it was slightly higher in the Tachosil group (23% vs. 18%). The perioperative mortality was higher in group 2 but the difference was not statistically significant (3% in the Tachosil group vs. 5% in the control group). CONCLUSIONS: Tachosil use reduced postoperative drainage considerably, which had an important influence on renal complications after aortic valve replacement.

Isomers of ß,ß-Dinitro-5,10,15,20-tetraphenylporphy-rin Derivatives: Valuable Starting Materials for Further Transformations.

The synthesis, chromatographic isolation, and structure elucidation of ß,ß-substituted isomers of dinitro-5,10,15,20-tetraphenylporphyrin complexes are described. meso-Tetraphenyl-porphyrin chelates (CuII, NiII, CoII) upon reaction wit e.g., itric acid (yellow HNO3, d = 1.52, diluted to 25⁻50%) in CHCl3 formed a mixture of nitro-derivatives with combined yields of ca 80%. This nitration (under optimized conditions: 25⁻30% HNO3, 30⁻40 min, r.t.) can be carried out selectively to give mainly ß,ß-dinitro-compounds in yields of up to 73%. From the above mixtures of five possible regioisomers that can be formed, usually two or three of them were isolated, for which the structures were assigned on the basis of ¹H NMR spectra including COSY and NOESY measure-ments. These types of products are attractive starting materials for synthesis of potential anticancer PDT agents with unique structures, being practically unavailable by any other alternative method.

Can the onset of heart failure be delayed by treating diabetic cardiomyopathy?

The pathophysiology of diabetic cardiomyopathy (DC) is not fully understood. This frequently undiagnosed complication of chronic hyperglycemia leads to heart failure (HF). However, it is suggested that an appropriate metabolic control of diabetes at an early stage of this deleterious disease, is able to inhibit the development and progression of DC to HF. Recently, it has been postulated that myocardial ischaemia plays an important role in the development of this pathology. Results of the antianginal pharmacological treatment and revascularization are unsatisfactory and reveal a gap in our knowledge and current approaches to treating DC. Most recent studies emphasize the ischaemic component of DC as a key target for therapeutic strategies, which could change its unfavorable history. More stress is put on an early diagnosis of coronary artery disease (CAD), promoting prompt revascularization. Choosing the accurate time of surgical revascularization, with the inclusion of the metabolic background, can ensure complete revascularization with better prognosis. This review will focus on the complexity of DC and summarize contemporary knowledge of treatment strategies for patients with diabetes and CAD.

Artificial aortic valve dysfunction due to pannus and thrombus - different methods of cardiac surgical management.

INTRODUCTION: Approximately 60 000 prosthetic valves are implanted annually in the USA. The risk of prosthesis dysfunction ranges from 0.1% to 4% per year. Prosthesis valve dysfunction is usually caused by a thrombus obstructing the prosthetic discs. However, 10% of prosthetic valves are dysfunctional due to pannus formation, and 12% of prostheses are damaged by both fibrinous and thrombotic components. The authors present two patients with dysfunctional aortic prostheses who were referred for cardiac surgery. Different surgical solutions were used in the treatment of each case. CASE STUDY 1: The first patient was a 71-year-old woman whose medical history included arterial hypertension, stable coronary artery disease, diabetes mellitus, chronic obstructive pulmonary disease (COPD), and hypercholesterolemia; she had previously undergone left-sided mastectomy and radiotherapy. The patient was admitted to the Cardiac Surgery Department due to aortic prosthesis dysfunction. Transthoracic echocardiography revealed complete obstruction of one disc and a severe reduction in the mobility of the second. The mean transvalvular gradient was very high. During the operation, pannus covering the discs' surface was found. A biological aortic prosthesis was reimplanted without complications. CASE STUDY 2: The second patient was an 87-year-old woman with arterial hypertension, persistent atrial fibrillation, and COPD, whose past medical history included gastric ulcer disease and ischemic stroke. As in the case of the first patient, she was admitted due to valvular prosthesis dysfunction. Preoperative transthoracic echocardiography revealed an obstruction of the posterior prosthetic disc and significant aortic regurgitation. Transesophageal echocardiography and fluoroscopy confirmed the prosthetic dysfunction. During the operation, a thrombus growing around a minor pannus was found. The thrombus and pannus were removed, and normal functionality of the prosthetic valve was restored. CONCLUSIONS: Precise and modern diagnostic methods facilitated selection of the treatment method. However, the intraoperative view also seems to be crucial in individualizing the surgical approach.

[Ventilatory disorders in patients with chronic heart failure]. / Zaburzenia czynnosci wentylacyjnej pluc u pacjentów z przewlekla niewydolnoscia serca.

Chronic heart failure (CHF) is a condition in which both structure and functional capacity of cardiac muscle are impaired, resulting in ineffective peripheral tissue perfusion. Affecting numerous organs and systems, it is currently considered to be a systemic illness. Among significant, however until now, hardly recognized consequences of CHF there are ventilatory disorders. Their presence may be explained by proximity of heart and lungs inside rib cage or by close functional cooperation between these two organs. Ventilatory disorders clinically manifest as exacerbations of the underlying disease, i.e. intense dyspnea--primarily exertional in nature, over time, present even at rest. On the basis of functional pulmonary tests, ventilatory disorders may be classified into three categories: restrictive, obstructive and most commonly--mixed. The restrictive model is represented in bodypletysmography as reduction in the total lung capacity to values less than 5th percentile of the predicted values for normals, while Tiffeneau index remains intact. Such condition may probably result from the chronic inflammatory process affecting lung tissue, for which the reaction of macrophage cells to both pulmonary stasis, as well as increased volume of interstitial and alveolar fluid remains the underlying cause. The increased formation of connective tissue fibers engenders thickening of alveolar-capillary membrane, occurrence of disturbed oxygen diffusion and emergence of hypoxemic respiratory failure. Ventilatory disorders of obstructive nature are characterised by reduction of Tiffeneau index--the calculated ratio between forced expiratory volume in 1. second and forced vital capacity--to values below 5th percentile of the predicted range. The research results indicate for the presence of bronchiolar narrowing--dominant in small-diameter bronchi and bronchioles, with larger structures being unaffected--clearly depicted in spirometry as reduced levels of forced expiratory flow after exhaling 50% and 75% of forced vital capacity. Due to a considerable epidemiological problem, as well as significance of the clinical symptoms manifesting ventilatory disorders in course of chronic heart failure, there should be put emphasis on cardiac injury prevention in individuals from risk groups and the proper treatment of patients already suffering from chronic heart failure.

Left atrio-esophageal fistula of a possibly iatrogenic aetiology.

The study presents an exceptionally rare case of an esophago-left atrial fistula, which was diagnosed during a forensic post-mortem examination. Due to complex nature of the disease and many attempts to cure the patient, the authors did not manage to identify the aetiology of the fistula. It was only implied that the fistula might have been a distant complication of intraoperative endocardial ablation or it might have appeared as a consequence of perforation of the esophageal wall or left atrial wall of the enlarged heart with the end of an intubation tube or nasogastric tube.

Independent predictors of early mortality after coronary artery bypass grafting in a single centre experience--does gender matter?

BACKGROUND: It is commonly believed that women undergoing isolated coronary artery bypass graft surgery (CABG) are subject to a higher risk of perioperative complications and death. AIM: To evaluate the effect of sex as a risk factor on early complications and mortality after isolated CABG performed with cardiopulmonary bypass, and to evaluate the profile of the risk determined by the patient's sex. METHODS: Data derived from 2,194 surgical procedures performed in the Department of Cardiac Surgery at the Medical University of Lodz between January 2009 and March 2011 was analysed. The database was constructed on the basis of retrospective analysis of variables contained in a form of the National Registry of Cardiac Surgery. RESULTS: Isolated CABG with cardiopulmonary bypass was carried out in 1,303 patients (59.4% of all procedures). Women constituted the minority of patients (24.2%), and were significantly older (mean age 67.3 vs. 62.8 years, p < 0.001). They more often suffered from concomitant diabetes (43.1% vs. 33.41%, p = 0.003), had impaired renal function (median eGFR 88.5 vs. 95.0 mL/min1/1.73 m2, p < 0.001), and had a history of smoking in fewer cases (54.1% vs. 83.0%, p < 0.001). Internal mammary artery was more rarely used as arterial graft in the group of women (84.8% vs. 95.0%, p < 0.001). Women were subject to a higher risk of recent postoperative myocardial infarction (5.5% vs. 2.9%, p = 0.03) and required reoperation more rarely than men (4.5% vs. 8.1%, p = 0.04). Higher 30-day mortality was observed among women (7.6% vs. 2.8%, p < 0.001) and female sex appeared to be an independent predictor of death in the multiple logistic regression analysis (OR = 1.8; 95% CI 1.2-2.7). CONCLUSIONS: Women undergoing isolated CABG are subject to higher 30-day mortality. Female sex is an independent risk factor for death after isolated CABG. Further studies are necessary to identify causes of differences in prognoses among women.

Sarcomas of the heart as a difficult interdisciplinary problem.

Cardiac tumors are assumed to be a rare entity. Metastases to the heart are more frequent than primary lesions. Sarcomas make up the majority of cardiac malignant neoplasms. Among them angiosarcoma is the most common and associated with the worst prognosis. Malignant fibrous histiocytoma comprises the minority of cardiac sarcomas and has uncertain etiology as well as pathogenesis. Transthoracic echocardiography remains the widely available screening examination for the initial diagnosis of a cardiac tumor. The clinical presentation is non-specific and the diagnosis is established usually at an advanced stage of the disease. Sarcomas spread preferentially through blood due to their immature vessels without endothelial lining. Surgery remains the method of choice for treatment. Radicalness of the excision is still the most valuable prognostic factor. Adjuvant therapy is unlikely to be effective. The management of cardiac sarcomas must be individualized due to their rarity and significant differences in the course of disease.

Isolated coronary artery bypass grafting in extracorporeal circulation in patients over 65 years old - does age still matter?

INTRODUCTION: Coronary artery bypass grafting (CABG) is conducted more and more commonly in patients in advanced age. AIM OF THE STUDY: To analyze the influence of age and concurrent risk factors on the complications and early mortality after CABG. MATERIAL AND METHODS: Medical records of 2194 patients were analyzed retrospectively. A group of 1303 patients who had undergone isolated CABG was selected. 106 (4.8%) patients were excluded due to missing data in their medical records. The remaining 1197 patients were divided into two subgroups by age: 1(st) group < 65 years (n = 662; 55.3%); 2(nd) group ≥ 65 years (n = 535; 44.7%). RESULTS: The total 30-day mortality was 3.93% and was six times higher in the older group (1.21 vs. 7.29%; p < 0.001). Complications were observed in 176 (14.70%) patients, more often in the older group (10.42% vs. 20.0%; p < 0.001). In this group all kinds of complications were noted more often and in particular: postoperative myocardial infarction (1.96% vs. 5.42%; p = 0.001), respiratory dysfunction (1.36% vs. 4.11%; p = 0.005), neurological complications (1.81% vs. 3.74%; p = 0.04) and multi-organ dysfunction syndrome (0.30% vs. 1.68%, p = 0.03). The older patients required longer time under mechanical ventilation (24.0 ± 27.9 vs. 37.0 ± 74.1 hours; p = 0.004) and stayed longer in the intensive care unit: 2.5 ± 3.0 vs. 4.1 ± 7.84 days; p < 0.001. Independent predictors of death were: female sex [OR (95% CI) = 2.4 (1.2-4.5)], age ≥ 65 years [OR = 4.9 (2.1-11.1)], eGFR < 60 mL/min/1.73 m(2) [OR = 2.2 (1.0-4.7)], time at extracorporeal circulation > 72 minutes [OR = 5.5 (2.7-10.9)] and left main stem stenosis (> 50%) [OR = 2.4 (1.3-4.6)]. CONCLUSIONS: Age still significantly influences postoperative complications and mortality after isolated CABG.

Urgent splenectomy in the course of prosthetic valve endocarditis.

We present a case of a 51-year-old male patient hospitalized due to acute coronary syndrome requiring stent implantation to the left main stem. Double antiplatelet therapy was commenced. After 2-3 days, the patient presented with high fever, dyspnea on exertion, pain in the chest, myalgia, and general weakness. Transthoracic (TTE) and transesophageal (TEE) echocardiography revealed abnormal, turbulent flow across the aortic prosthesis, which was probably caused by the presence of a pathological smooth and mobile structure (10 × 9 × 5 mm) in front of the aortic annulus. Blood cultures were positive and staphylococcal prosthetic valve endocarditis (PVE) was diagnosed. Despite antibiotic treatment, the patient's condition deteriorated, and he was referred for prosthesis reimplantation. After being transferred to the Cardiac Surgery Clinic, he presented with nausea, vomiting, and abdominal pain. The results of imaging examinations suggested spleen hematoma. The patient underwent an urgent splenectomy. Histopathological examination revealed a spleen infarction consequent to an embolic event and subscapular hematoma. On the 10(th) day after the laparotomy, cardiac surgery was performed. No large vegetations were found on the aortic prosthesis. The mechanical valve, implanted 20 years earlier, was functioning properly; it was intact and well healed. Several fragments of a thrombus and fibrous tissue, resembling a pannus and covered with minor calcifications, were removed from the ventricular surface of the discs. A decision was reached to leave the aortic prosthesis in situ. The valvular material culture revealed the presence of Streptococcus anginosus, and the antibiotic scheme was modified. The postoperative period was uneventful.

23-year experience on diagnosis and surgical treatment of benign and malignant cardiac tumors.

INTRODUCTION: Although myxoma is the most frequent cardiac tumor, other conditions should be taken into consideration in the differential diagnosis. Transthoracic echocardiography (TTE), followed by transesophageal echocardiography (TEE) remain the principal methods for cardiac tumor screening and visualizing. The aim of the study was to compare the diagnostics, surgical treatment and prognosis of malignant and benign cardiac tumors. MATERIAL AND METHODS: From 1986 to 2009 there were 121 patients with cardiac tumors operated on in the Cardiac Surgery Clinic of the Medical University in Lodz. Patients were referred to surgery mainly on the basis of the TTE and TEE image. In 4 cases valvular prosthesis implantation or valve repair were carried out. Patients remained under long-term observation in the Cardiac Surgery Outpatient Clinic. RESULTS: Myxoma was diagnosed in 114 cases. Malignancies were discovered in 7 cases. The left atrium was the most frequent localization. The echocardiographic image differed significantly in benign and malignant tumors. The postoperative period was complicated by embolic events or myocardial infarctions. Only malignant tumors were associated with mortality due to cardiovascular events. The survival for malignant tumors was significantly shorter. CONCLUSIONS: Short and long-term results of operative treatment are very good for benign tumors in contrast to cardiac malignancies. The TTE and TEE image can be very significant in the final diagnosis.

Surgical removal of stent from multiply stented vessel: problem with choice of place for anasthomosis - one year follow-up.

Since the advent of percutaneous coronary intervention there have been increasing numbers of patients with so-called 'full metal jacket' coronary arteries disease. This is creating a challenging problem for the cardiac surgeon. A 73 year-old woman after the implantation of two metal stents to the left anterior descending artery (LAD) and four to the right coronary artery (RCA), with ejection fraction of 28%, significant mitral and tricuspid insufficiency, and high systolic pulmonary pressure, was admitted to our department with unstable angina and with symptoms of pulmonary oedema. Coronary angiogram revealed restenosis in all stents. She agreed to a coronary artery bypass graft (CABG) with mitral and tricuspid valve reconstruction. The RCA was opened just above the postero-lateral branch. Due to lack of space, the metal stent was removed and saphenous bypass graft performed.Six months later, control angiography showed a properly working LITA-LAD graft; the stents in the RCA had been occluded above anasthomosis and the venous graft to RCA had been stenosed. Percutaneous cardiac intervention was performed and the metal stent was implanted with good early effect. After a further six months, coronarography revealed in stent stenosis in the place of venous anasthomosis. The patient was qualified for conservative treatment. Long term results after such procedures are hard to predict;we believe patients should be qualified earlier for CABG and that doctors should avoid implanting too many stents into one artery.

Early and long term coronary artery bypass grafting outcomes in patients under 45 years of age.

BACKGROUND: In Poland, mortality and morbidity rates due to ischaemic heart disease (IHD) remain high and concern the whole population. An interesting issue is rapid development of IHD in some younger subjects and uncertain treatment outcomes in this patient subset. Premature cessation of professional activity, along with worsening of quality of life due to IHD in the population under 45 years of age is a huge medical, economic, and social problem. Only few studies evaluated early and long-term outcomes of coronary artery bypass grafting (CABG) used for the treatment of IHD in young patients, especially in premenopausal women. AIM: The purpose of the study was to analyse early and long-term outcomes of CABG in patients under 45 years of age. METHODS: We studied 125 patients under 45 years of age who underwent a CABG procedure. The study group included 65 women aged 27-45 (mean 41.5 ± 3.5) years operated upon in 1990-1999, and 60 men aged 33-45 (mean 41 ± 3.2) years operated upon in 1993. We evaluated early postoperative outcomes. The two genders were compared in regard to survival free from death, recurrent angina, and repeated myocardial during long-term follow-up. We also evaluated other variables such as education level, professional activity, and exposure to IHD risk factors before and after the operation. RESULTS: Seven women and two men died in hospital after CABG (p = 0.2). Analysis of major postoperative outcomes like myocardial infarction, low cardiac output syndrome requiring support with intra-aortic balloon pump (IABP), a lower limb amputation following the use of IABP, ischaemic stroke, and respiratory failure showed that these complications were significantly more frequent in women than in men (p < 0.01). Differences between the two groups regarding other adverse outcomes including atrial fibrillation, sternal instability, haemothorax, and pneumothorax were not significant. Analysis of long-term survival curves did not show any significant differences between men and women in regard to rates of death, recurrent angina, and the need for repeated myocardial revascularisation (p = 0.64, p = 0.93, and p = 0.13, respectively). CONCLUSIONS: Young women who underwent CABG were burdened with higher early postoperative morbidity and mortality than young men. However, long-term outcomes (mortality, recurrent angina, and repeated myocardial revascularisation rates) did not differ significantly between the two groups. Regardless of gender, repeated myocardial revascularisation rate was significantly higher among those patients who continued to smoke after the surgery (p < 0.01).

Myocardial oxidative stress in patients with active infective endocarditis.

BACKGROUND: Infective endocarditis (IE) induces the rise of pro-inflammatory cytokines. Some of them can stimulate oxidants production in myocardium with subsequent peroxidative damage to various biomolecules. We compared indices of oxidative stress: H2O2, thiobarbituric acid-reactive substances (TBARs), thiols in myocardium specimens between patients with active IE and those with valvular heart disease (VHD) of rheumatic etiology who underwent surgical valve replacement. METHODS: 17 left ventricle papillary muscle specimens and 28 specimens of auricle of the right heart were collected from 45IE patients, and 16 papillary muscle and 12 auricle specimens from 28 VHD patients, respectively. Patients groups had similar NYHA functional class and majority of echocardiographic indices of heart morphology. H2O2 and TBARs were determined fluorometrically in myocardium homogenates whereas thiols with photometric method. Between and within groups comparisons and mutual correlations between variables were analyzed. RESULTS: H2O2 generation from all myocardium specimens and auricles was 2.14- and 2.59- times higher (p<0.001) in IE patients than in VHD group. Auricles had the highest H2O2 levels within IE group. TBARs were 10-times higher (p<0.05) in IE when compared to VHD group in auricles and papillary muscles. Thiols did not differ between groups. H2O2 positively correlated with TBARs and negatively with thiols in all IE myocardium specimens (r=0.31 and r=-0.46, p<0.05) and auricles (r=0.58 and r=-0.67, p<0.05), respectively. No such associations were noted in VHD specimens. CONCLUSIONS: Active IE induces enhanced myocardial production of H2O2 and formation of TBARs which proves occurrence of oxidative stress in the heart.

Comparison of the clinical application of reactive oxygen species and inflammatory markers in patients with endocarditis.

INTRODUCTION: Infective endocarditis (IE) is still connected with high operative mortality. Inflammatory markers are commonly used in monitoring patient clinical condition. Respiratory burst and reactive oxygen species (ROS) are the main way of pathogen elimination. Specificity of this process in the aspect of bacterial infection is the key for correlation assessment between ROS and inflammatory markers in patients with IE. In the study, assessment of ROS as a clinical indicator in IE was conducted. MATERIAL AND METHODS: During 2007/2008 in the Cardiosurgical Clinic of the Medical University in Lodz there were 20 patients operated on for IE. The examined population consisted of 13 men and 7 women, aged from 23 to 74 years. Inflammatory markers - leukocytosis (WBC), C-reactive protein (CRP), procalcitonin (PCT) and erythrocyte sedimentation rate (ESR) - were assessed preoperatively, on the 3(rd), 7(th), 12(th) and 21(st) day. Simultaneously, with the second venous blood sample chemiluminescence (luminal enhanced whole blood chemiluminescence) was carried out and used to assess ROS production. The results were analyzed statistically. RESULTS: Positive correlation between ESR, CRP and ROS in the preoperative period was confirmed. An increase in ROS and a statistically significant increase in inflammatory markers on the 3(rd) day were observed. The ROS normalized on the 12(th) day. Marked individual variability was specific for the inflammatory markers. Despite the significant decrease, not all of them achieved a normal level at the last control point. CONCLUSIONS: Assessment of ROS seems to be a universal parameter with possible application in patients with IE.

Removal of the left atrium and left ventricle tumour: a case report.

The heart is the rarest site for neoplasms to be localized. Despite modern diagnostic techniques, cardiac tumours continue to among those discovered latest and with the worst prognoses. We present the case of a 62-year-old woman with a heart tumour and mediastinal lymphadenopathy, who was admitted to the Department of Cardiac Surgery. The patient underwent surgical removal of the tumour with extracorporeal circulation. The left atrium, mitral valve and the left ventricle were occupied by the infiltration. A radical resection appeared to be impossible. A valvular prosthesis was not implanted. The perioperative period was uncomplicated. On the 9(th) day a local recurrence was confirmed in the transthoracic echocardiography. Further oncological diagnostics revealed the spread of the malignant neoplasm to bones of the pelvis and spine. Chemotherapy was initiated. The authors discuss the most appropriate diagnostic and treatment procedures employed in the above case.

Long-lasting durability of Carpentier-Edwards pericardial bovine bioprosthesis in mitral position - a case report of unfavourable post redo valve surgery course.

We describe a 73 year-old patient with mitral valve pericardial bioprosthesis Carpentier-Edwards 29M implanted due to the rheumatic mitral stenosis 21 years ago. Hemodynamic destabilisation had emerged 18 months before the admission. Echocardiography revealed significant bioprosthesis degeneration with calcification of its leaflets, small pannus on the bioprosthetic ring, moderate mitral stenosis, severe mitral and tricuspid regurgitation with high pulmonary hypertension and moderate aortic regurgitation. Redo valve surgery with mechanical Medtronic 27M valve implantation and tricuspid suture annuloplasty was successfully performed. The postoperative course was complicated by bleeding and severe respiratory insufficiency and the patient died 3 weeks after the surgery.

Elevated resting and agonist-induced whole blood chemiluminescence in patients with active infective endocarditis.

Infective endocarditis (IE) and surgical procedures related to cardiac surgery are accompanied by inflammatory responses that may alter production of oxidants by phagocytes. This study evaluates luminol enhanced whole blood chemiluminescence (LBCL) as a measure of oxidative production by circulating phagocytes in 26 IE patients in comparison to 27 matched patients with acquired valvular heart disease and 25 healthy controls. Blood was collected the day before and 3, 7, 12 and 21 days after valve replacement surgery for LBCL measurement; resting (rCL) and agonist (fMLP)-stimulated total light emission (tCL). Preoperative rCL and tCL with values observed after 3, 7, 14, and 21 days from surgery were higher (P<0.01) in patients with IE than in healthy controls. Median preoperative rCL, and tCL was about 2.5-times higher (P<0.01) in IE group than in patients with valvular heart disease (4.3 vs. 1.7 U/10(4) phagocytes and 2473 vs. 782 Uxs/10(4) phagocytes). Three days after valve replacement, LBCL rose three times (P<0.01) in both operated groups. With patient recovery, LBCL decreased and no differences were noted between groups. Patients with IE had elevated LBCL reflecting increased oxidants release from circulating phagocytes that may predispose to the development of oxidative stress.

Clinical profile, prognosis and treatment of patients with infective endocarditis--a 14-year follow-up study.

INTRODUCTION: Poor prognosis of infective endocarditis (IE) is not only attributable to high morbidity and mortality during an active phase of the disease, but also to late complications and relapses occurring after eradication of the infection. Identification of unfavorable prognostic factors allows to optimize therapeutic modalities in patients with particularly poor prognosis. OBJECTIVES: To determine clinical features and long-term prognosis among patients with IE. PATIENTS AND METHODS: The study group consisted of 69 IE patients hospitalized in our center between 1992 and 2005. The diagnosis of IE was based on the Duke University criteria. The mean age was 52 +/- 12 years. Surgical treatment was performed in 48 (70%) cases. RESULTS: The etiology of IE was Staphylococcus sp. in 32% of patients, Streptococcus sp. in 16% of patients, in 41% of cases blood cultures were negative. The infection was located on the aortic (43%), mitral (26%), tricuspid (8%) and multiple valves (20%). During 1-14 years of follow-up, 27 patients died (39%). Prognostic factors included NYHA class of heart failure (p = 0.031), lower left ventricular ejection fraction (p = 0.017), kidney failure (p = 0.012), atrial fibrillation (p = 0.006), a history of rheumatic valve disease (p = 0.046). In multivariate logistic analysis the only significant parameter related to poor prognosis after IE was atrial fibrillation. The analysis of receiver operating characteristic curve showed that patients with atrial fibrillation were significantly associated with higher mortality (HR 5.35, 95% CI 1.47-19.56, p = 0.011). CONCLUSIONS: Regardless of the mode of treatment (medical or combined medical-surgical), the mortality of patients with infective endocarditis remains relatively high. In this study atrial fibrillation seems to be the most important risk factor of death.

[Evaluation of surgical treatment of mitral valve defect in patients with chronic renal failure]. / Ocena wyników leczenia operacyjnego wady zastawki mitralnej u chorych z przewlekla niewydolnoscia nerek.

UNLABELLED: Renal failure of patients qualified for open-heart surgical treatment seems to be very important problem since years. The operation with extracorporeal circulation is large burden for kidneys and there is huge risk of intensifying of existing failure. The aim of the study was the evaluation of renal parameters, complications occurrence and mortality of patients with chronic renal failure (ChRF) (grade II--mild ChRF) subjected to mitral valve replacement. MATERIALS AND METHODS: To retro- and prospective analysis were subjected 34 patients with severe mitral valve defect, subjected to operation between 1998 and 2002 in Department of Cardiac Surgery in Lodz. All patients included to study had increased level of creatinine--1, 5-3, 0 mg/dl (at least in three measurements). All examined patients were subjected to artificial mitral valve replacement and 13 patients to simultaneous tricuspid valve plastic surgery. Postoperative evaluation of clinical condition and renal parameters was performed twice: early (till 30 day after operation) and long-term (after meanly 14 months). RESULTS: In seven patients, in early postoperative period, it was necessary to implement extracorporeal dialysis with artificial kidney dialysis machine. Among these patients we ascertained three deaths (intrahospital mortality was 8.8%). During long-term observation we noted two cases of infective endocarditis requiring reoperation and re-implantation of mitral valve. During this time of observation only one death was noted (post-hospital mortality was 3.2%). CONCLUSIONS: Dysfunction of kidneys, even in mild degree, causes significant increase of risk of early death (about 2.5 times). In most research population in long-term observation we ascertained the large improvement of kidney functions (significant decrease of creatinine level; p < 0.001). Concomitant tricuspid valve regurgitation, requiring plastic surgery is an additional factor incriminating long-term results of surgical treatment.