Influence of pressure on the endothelium of the saphenous vein coronary artery bypass graft.

The aim of this study was to evaluate the influence of pressure applied while assessing the graft's tightness on the expression of adhesion molecules. Another goal was to find a correlation between the type of fluid (heparynized blood or saline) used during preparation of the conduit and the expression of the adhesion molecules. Saphenous vein fragments were obtained from 48 patients who had undergone coronary artery surgery. Expression of the following particles was evaluated: CD 31, ICAM 1, VCAM 1 and P-selectin. Expression of the CD 31 molecule was described as a percentage of the inner surface of the vessel showing positive immunocytochemical reaction. Expression of the remaining molecules (ICAM 1, VCAM 1, P-selectin) was assessed as the percentage of the surface, determined by CD 31 positive reaction. The expression of the adhesion molecules (ICAM 1, VCAM 1, P-selectin) was higher in the fragments of the vein exposed to pressure. In reference to VCAM 1 the difference, as compared with the control group, was: 250% in the fragments infused with blood and 270% in the fragments infused with saline, respectively. The differences for the ICAM 1 were approximately 300% in both experimental groups and 450% for the P-selectin with subtle differences between the two experimental groups. The loss of the endothelial surface (determined by the expression of the CD 31 antigen) was similar in the specimens flushed either with blood or saline, which indicates that the major cause of damage of the endothelium is influence of pressure on the conduit's wall. Mechanical widening of vessels results in the increased expression of the adhesion molecules on the surface of the endothelial cells, and, as a consequence, leads to rise in the leukocyte adhesion and loss of the functional properties of the transplanted veins.

[Recent myocardial infarction, cardiogenic shock and unsuccessful coronary angioplasty--the pattern of cooperation between a centre without on-site surgical back-up and a distantly located clinical cardiosurgery centre]. / Ostry zawal miesnia serca, wstrzas kardiogenny i nieskuteczna angioplastyka wiencowa--modelowy przyklad wspólpracy osrodka inwazyjnego bez zaplecza sali operacyjnej z odleglym osrodkiem kardiochirurgicznym.

The case of a 66-year-old male with acute myocardial infarction (AMI) complicated by cardiogenic shock is presented. Because of failed primary PCI, after stabilisation of ischaemia and haemodynamics by medication and IABP he was transferred to a distantly located cardiosurgery unit. This patient underwent successful emergency CABG on the second day after infarction. The problem of transporting a patient with AMI and cardiogenic shock to a distant site and the problem of emergency CABG in such high-risk patients is discussed.

[Effect of aprotinin on selected parameters of coagulation and drainage blood loss after cardiac operations in patients without coagulation disorders]. / Wplyw aprotyniny na wybrane parametry ukladu krzepniecia i utrate krwi po operacjach kardiochirurgicznych u chorych bez zaburzen krzepniecia.

THE AIM OF THE STUDY: An estimation of influence of different doses of aprotynin on bleeding, coagulation parameters and safety of its use after coronary artery bypass grafting (CABG) in pts without coagulation disorders. MATERIAL AND METHODS: 91 patients underwent CABG, 73 men, 18 women in age 37 to 76 +/- 56.5 years. Patients were randomly assigned to 3 groups; Group I; 38 pts. 6.5 mln KIU aprotynin. Group II; placebo--30 pts. Group III; 23 pts. 2 mln. KIU. There were 4 measurements 1.--before operation, 2. after discontinuing CPB, 3.--6 h after operation, 4.--24 h after operation. We measured Hb, Ht, PLT Glucose, D-dimers, APTT, TT Fibrynogen, INR, AT3, Ca2+, factor V, VIII, GOT GPT CK, CK-MB, CRP, ACT concentration of Hb in drainage 6 h after operation. There were estimated: renal function profile, drainage loss, perioperative MI, mortality, reoperation rate due to bleeding. RESULTS: The level of blood count and coagulation parameters did not differ between the groups in any test periods. D-dimer levels were significantly higher in the placebo group than in group I and III. The decrease of fibrin degradation was not related to the dose of aprotynin. Drainage was insignificantly higher in placebo group. Renal function was impaired in neither group. Reoperation rate perioperative infarction and mortality did not differ between the groups, however was highest in group I. CONCLUSION: Aprotynin reduces blood loss after operation in CPB and decrease fibrin degradation independently to the dose of the drug. The high-dose of aprotynin may increase the risk of early graft occlusion in patients without coagulation disorders.

[Haemolytic anaemia following implantation of the mitral annuloplasty ring: a case report]. / Niedokrwistosc hemolityczna jako powiklanie po zabiegu wszczepienia pierscienia mitralnego.

Haemolytic anaemia following mitral annuloplasty is uncommon as compared with mitral valve replacement procedures. A 67-year-old woman, who underwent mitral annuloplasty and CABG, developed haemolytic anaemia. Echocardiographic examination revealed mitral regurgitation jet colliding with mitral ring. The management of these cases usually demands redo surgery. In the presented case, the direction of mild mitral regurgitant jet with respectfully high velocity contributed significantly to the early postoperative haemolysis. Redo surgery with implantation of bioprosthesis caused withdrawal of intravascular haemolysis.

[A giant left atrial myxoma as a cause of a low cardiac output syndrome: a case report]. / Dyslokacja olbrzymiego sluzaka lewego przedsionka jako przyczyna zespolu malego rzutu.

A case of a 75-year-old female with a giant left atrial myxoma (54 x 42 mm in transthoracic echocardiography) is presented. She remained in a stable condition, however, developed a low cardiac output syndrome shortly after echocardiographic examination. This was caused by tumour displacement from the atrial wall into the left ventricle. The patient underwent urgent surgery during which the tumour was successfully removed. Histopathological examination confirmed the diagnosis of myxoma. Six months after surgery the patient is doing well.

Surgical reconstruction of left ventricle after anterior myocardial infarction in both women and men.

BACKGROUND: Differences between men and women in the prevalence and clinical course of coronary artery disease (CAD) have been well documented. There are no data in literature on the differences between males and females in the incidence of post-infarction left ventricular (LV) wall motion abnormalities of akinesia/dyskinesia type and the outcome after surgical LV reconstruction. AIM: To compare gender-related differences in clinical characteristics, distribution of LV wall motion abnormalities, and outcome after surgical LV reconstruction. METHODS: Between 1993 and 2000, 3119 patients underwent surgery for CAD in our institution. Coronary artery bypass grafting (CABG) was performed in 3033 patients. Of those, 86 (2.67%) underwent CABG with concomitant surgical ventricular restoration (SVR). Clinical, echocardiographic and procedural data were compared between females and males. RESULTS: In the SVR group, the percentage of women was significantly higher than in the CABG group (29% vs 18.5%, p=0.05). Obesity, unstable angina and pulmonary oedema were significantly more common in females than in males. The end-diastolic volume and global ejection fraction were lower in women than in men. The ratio of ANV (systolic volume of akinetic/dyskinetic zone of LV) to EDV (diastolic LV volume) was significantly higher in females than in males. Cardiac output, cardiac index and stroke volume were significantly lower in females. Women had significantly higher NYHA class. Because of the greater extent of LVA in women, patch plasty was performed significantly more often in females than in males (p=0.05). Mortality in both genders was similar (4% vs 3%, NS). After the operation, a significant improvement of LV function was found in both groups, but the degree of improvement was higher in women. CONCLUSIONS: There is male predominance, both in the CABG and SVR groups, however, the proportion of females in the SVR group is significantly greater than in the whole CABG group. LV function is more depressed and NYHA class is higher in females than males. Because the extent of LV akinesia and dyskinesia is greater in females than in males, the circular plasty with patch closure is required more often in women.

[Early results of coronary artery bypass reoperations in own experience]. / Wczesne wyniki reoperacji wiencowych w materiale wlasnym.

UNLABELLED: Coronary Artery Bypass Grafting (CABG) is widely accepted as an effective and durable method of treatment of Coronary Artery Disease. In some patients however, recurrent angina and the necessity of reoperation (RE-CABG) occurs. AIM: The aim of the study is the estimation of the results of RE-CABG in own material. MATERIAL AND METHODS: In years 1995-2002 CABG operations were performed in 3452 patients (CABG group) and RE-CABG in 37 pts (1.07%) (RE-CABG group). Patients were considered for operation on condition of the presence of symptomatic CAD confirmed by coronarography in standard projections. Operations were performed using Cardiopulmonary Bypass. RESULTS: The CABG group consisted of 3452 pts in mean age 57.9 years, including 2693 men (78%) and 759 (22%) women. The RE-CABG group was composed of 37 pts in mean age 60.7 years, comprising 22 (59.5%) men and 15 (40.5%) women. The percentage of women in CABG group was significantly higher than in CABG group. The mean age in RE-CABG group was insignificantly higher than in CABG group. In the CABG group 3.1 anastomosis/pt were performed, including anastomosis IMA to LAD in 2779 pts (80.5%). From this group only in 2 pts (0.07%) coronary reoperations were performed. In the remaining 673 pts from CABG group during the first operation, only saphenous vein graft were performed and in 35 (5.2%) coronary reoperation was necessary. This difference is statistically significant. In-hospital mortality in CABG group was 5%, the IABP was used in 7.8% of pts. Mortality in the RE-CABG group reached 8.1% (3/37), the IABP was used in 16.2% (6/37). CONCLUSIONS: 1. The use of arterial grafts during the first coronary operation decreases the reoperation rate. 2. RE-CABG are performed in the older patient rather than CABG. 3. RE-CABG are performed more frequently in women than in men as compared to CABG. 4. RE-CABG are burdened with twice as high mortality rate and the necessity of use of IABP than CABG.

[Subclavian-coronary steal syndrome following CABG--a case report]. / Zespól podkradania tetnicy podobojczykowej o nietypowym przebiegu anatomicznym.

A case of 47-year-old man with occlusion of the subclavian artery occurring few months after CABG with the left internal mammary artery grafting is presented. The patient developed a subclavian-coronary steal syndrome with retrograde blood flow from the coronary circulation to the subclavian artery through the left internal mammary artery. Clinical presentation consisted of vertigo and recurrence of chest pain. The increasing frequency of this syndrome and the preoperative preventive methods such as pressure gradient measurement between the left and right upper limb are discussed.