[Tricuspid valve infective endocarditis in intravenous drug abuser]. / Infekcní endokarditida na trikuspidální chlopni u intravenózní narkomanky.

Infective endocarditis can be divided from practical point of view into native valve endocarditis and prosthetic valve endocarditis. With regard to aquired endocarditis, endocarditis in intravenous drug abusers can be separetly differentiated. Echocardiography and microbio-logical cultures are essential for dia-gnosis. Treatment consists of antibio-tic therapy and often surgical procedure is required. We present a case report of an intravenous drug abuser with a tricuspid valve endocarditis, successfully treated with antibio-tic therapy and a following surgical valve repair.

[Simultaneous carotid endarterectomy and coronary revascularization: indications and results]. / Simultánní karotická endarterektomie a koronární revaskularizace: indikace a výsledky.

AIM: Evaluation of operative results and complications in high-risk patients who underwent combined carotid and coronary revascularization. PATIENTS AND METHODS: Combined operation--carotid endarterectomy (CEA) and coronary artery bypass graft (CABG) was performed in the period 2000-2009 in 68 patients. Simultaneous operation was indicated in patients with unstable angina pectoris and 1. symtomatic internal carotid artery (ICA) stenosis > or = 50%, or 2. bilateral asymptomatic ICA stenosis > or = 60% or 3. asymptomatic ICA stenosis > or = 60% combined with contralateral ICA occlusion. Combined operations represented 5.8% of whole CEA series. Mean age was 69.9 (51-82) years, men were 46, women 22. Carotid angiography proved unilateral (always symptomatic) ICA stenosis in 25 patients, bilateral ICA stenosis in 35 patients and ICA stenosis combined with contralateral carotid occlusion in 8 patients. Neurological preoperative symptomatology: TIA was present in u 20 patients, minor stroke in 6 and major stroke in 5 patients. 37 patients were asymptomatic. One CABG was performed in 5 patients, 2 CABG in 20 patients, 3 CABG in 19 patients and 4 CABG in 6 patients. The rest of 18 patients had CABG operation combined with valve procedure. Comorbidity: hypertension 100%, diabetes mellitus 57.3%, hyperlipidemia 60.3%. Shunt was selectively used in 4.4%. The need for shunt was established using back stump pressure and near infrared spectroscopy. RESULTS: Mortality was 8.8% (6/68). The cause of death were multiorgan failure in two cases, ipsilateral stroke in two patients, respiratory insufficiency and cardiac failure due to graft occlusion both in one patient. Good recovery was recorded in 91.2%. CONCLUSION: Combined carotid and coronary revascularization has acceptable neurological morbidity/mortality in high risk patients. Strict requirement is thorough selection of patients.

[Midterm results aortic valve replacement with allograft]. / Strednedobé výsledky implantací aortálního alograftu.

INTRODUCTION: Aortic allograft implantation into the aortic position in adults is standard procedure with some controversary. The most popular indication is bacterial endocarditis. We would like to present our midterm results. RESULTS: We implanted 61 allografts in 60 patients (between 10/2002 and 04/2008). Men were 46 (76.8%) and average age was 57 +/- 10.76 year. 30 days mortality was 9 people (15.0%, all with bacterial endocarditis). Late mortality 1 man (1.6%). Follow up 1-66 months, average 39.18 SD +/- 14.3 months, median 42 months. CONCLUSION: Implantation of aortic allograft into the aortic position is standard procedure with good midterm results. Relative high early mortality is dependent on preoperative status in patiens with acute bacterial endocarditis--all early death people were people with acute bacterial endocarditis and minimally one vital organ severe dysfunction.

[Current applications of robotic heart surgery]. / Soucasné moznosti robotické kardiochirurgie.

OBJECTIVE: The objective of the article is to describe the history, development and current state of robotic heart surgery. INTRODUCTION: Robotic heart surgery is a new technology which has recorded dramatic growth in recent years. This is because of the effort to develop, in all fields of surgery, new and minimally invasive methods and to reduce surgical stress. METHOD: Overview of the relevant literature dealing with the history and development of robotic surgery, with a focus on heart surgery. RESULTS: The number of centres using a robot in clinical practice is growing fast. After a slow start, heart surgery is now the fastest growing field of robotic technology. It has been proven already that almost all heart surgeries can be performed with the use of a robot. Most of surgery fields have already introduced robots in current use. None of them, however, has yet advanced to a 100% robotic coverage of the whole range of interventions. Therefore it is a good strategy today to build multi-specialised operating theatres with robots that could be used for different fields of surgery. CONCLUSION: Even though robotic surgery is in its beginnings today, its great potential is quite apparent. Only the years to come will show the efficiency, safety, and the cost benefit of robotic technology as compared with traditional methods.

[Shot injury of the thorax associated with the left carotid trauma--a case review]. / Strelné poranenie hrudníka spojené s poranením l'avej karotídy--kazuistika.

The case review describes a shot injury of the thorax (without direct injury of the heart or lungs), with signs of advanced bleeding from the injured carotid artery. Employment of extracorporeal circulation facilitated safe extraction of the projectile and sound revisionining of all traumatized structures and their safe reconstruction.

[Aortic allograft (homograft) for the treatment of valvular disorders in adults with focus on treatment of infective aortic valve endocarditis]. / Aortální alograft (homograft) v lécbe chlopennich srdecních vad dospelých s durazem na lécbu infekiní endokarditidy aortální chlopne.

Still after 40 years of heart valve prostheses intensive development ideal valve substitute still does not exist. Aortic allograft represents one alternative which could be used for aortic and/or pulmonary valve replacement. This type of biological heart valve prosthesis is being currently discussed from the point of view of Tissue Banking, as well as from clinical aspects--e.g. surgical implantation technique and long term results. Live issue remains particularly the aortic allograft implantation into the aortic position. The authors discuss the aortic allograft role in the aortic valve infectious endocarditis treatment, which was widespread worldwide and accepted. Aortic allograft implantation is considered as a method of choice in that particular indication, especially in prosthetic aortic valve endocarditis and in left ventricle outlet tract destruction cases. The method is considered to be more technically demanding than routine heart valve surgery (heart valve replacement by means of mechanical or commercial biological prostheses), but literary and authors own experience in that particular group of patients looks encouraging. Aortic allografts permanent supply in our country is secured.

[Pulmonary embolism following aorto-coronary by-pass]. / Plicní embolie po aortokoronárním bypassu.

The authors present a case-review of a 65 year-old female patient, hospitalized for rest dyspnoea and collaps condition, 3 weeks following her completed aorto-coronary by-pass. The symptoms were caused by a massive lung embolism. Upon the echocardiographic examination, a massive thrombus in the right-sided cardiac spaces--a rare complication of cardiosurgical procedures--was detected. The patient was treated surgically. At the present time, 4 months following the procedure, the patient is completely recovered.

Implantation of cryopreserved mitral allograft into the tricuspid position in an experimental study in sheep: technical aspects of implantation and immediate results evaluated by epicardial echocardiography.

AIMS: Cryopreserved mitral allograft valve (MAV) offers theoretical advantages over conventional mechanical or biological prostheses in tricuspid position, especially in infectious endocarditis patients. MAV processing and tricuspid valve (TV) replacement in a sheep model is described. METHODS AND RESULTS: In 20 adult sheep, MAV were harvested, processed and cryopreserved. One month later, recipient's TV were excised and the MAVs were transplanted into the tricuspid position in 13 sheep, under general anaesthesia, via a right thoracotomy, with an extracorporeal circulation (ECC) and cardioplegic heart arrest. Both MAV papillary muscles were anchored into the right ventricular wall by transmural stitches and the MAV anulus was sewn into the recipient's tricuspid anulus. After weaning from ECC, the anatomy and function of the MAV in the tricuspid position was assessed by epicardial echocardiography. The average duration of the ECC was 58 minutes (42-88), the cardioplegic heart arrest was 36 minutes (28-45). Weaning from EEC was always uneventful. Right atrial & pulmonary artery pressure measurements and epicardial echocardiography documented good function of all MAVs. CONCLUSION: MAV remained mechanically strong enough for implantation into the tricuspid position. Reproducible technique of MAV transplantation into the tricuspid position with excellent early postoperative haemodynamic performance was developed.

[The radial artery in the myocardial revascularization, analysis of the patient subjects]. / Arteria radialis v revaskularizácii myokardu, analýza súboru pacientov.

INTRODUCTION: The use of arterial grafts in the myocardial revascularization procedures has grown more popular due to their long-term patency compared with that of the great saphenous vein. The aim of this retrospective study was to assess our experience and first results in the group of patients who had underwent revascularization procedures using their radial artery. MATERIAL AND METHODOLOGY: Between 7/2000-2/2004, 51 patients of acceptable age, aged 69.0 +/- 9.0 (42-82), underwent the revascularization procedure using the radial artery in combination with the left or right arteria mammaria interna. The angiographic examinations were conducted in 44 patients (86.3%), 5 patients refused to undergo their control angiographic examinations. Two patients exited a few months following their surgery, however there was no obvious connection with the use of the radial artery graft. RESULTS: Out of 44 patients (86.3%), who had their control angiographic examination completed, 9.4 +/- 9.8 months later, on average, (1-38 months), 5 patients (11.4%) suffered from the RA occlusion. In 4 patients, the occlusion was located at the branching site off the aorta, in 1 patient the occlusion was located at the site of the anastomosis with the left arteria mammaria interna. The total patency of the radial artery grafts reached 89%. CONCLUSION: The use of the radial artery in myocardial revascularization procedures has proven safe, associated with lower complication rates connected with its collection. Furthermore, the procedures result in a good short and mid-term graft patency confirmed also on the control angiographic examinations.

[What are indications for surgery in patients with chronic mitral regurgitation?]. / Kdy indikovat k operaci nemocného s chronickou mitrální regurgitací?

This review has been aimed at the presentation of present etiological spectrum of mitral regurgitation and its natural course. A basal survey of pathophysiology of this complicated and insidious defect, which should help to understand its clinical and hemodynamic classification, is presented. The developmental phases, characterized by very long asymptomatic period, when the heart function is compensated and the prognosis is good, are outlined. However, as a paradox of this defect, the contractile function of the left ventricle is damaged as early as in the compensation phase in spite of normal value of the ejection fraction. In the advanced phase the defect threatens that the carrier may suddenly die. Basic methods of quantification are presented as well as their principles. The development cardiosurgical techniques, which enable reconstruction of the mitral valve, and very good long-term and short-term results in large cohorts significantly influenced indication criteria. The causes of increasing interest in surgical treatment of mitral regurgitation, which is aimed at maintaining the inotropic function of myocardium and improvement of quality and duration of life, are presented. A successful mitral reconstruction, often connected with modification of the left atrium function, is associated with lower post-operation mortality, higher resistance of the native valve against infectious endocarditis and very frequently maintaining sinus rhythm as well. The review draws attention of wider medical audience, especially general physicians and general internal physicians, to the present possibilities of cardiosurgical treatment of mitral regurgitation. The therapy of mitral regurgitation is dramatically changing and the indication shift to markedly earlier stages.

[Cardiac damage in a young woman with Hodgkin's disease and long term survival after combination therapy and bone marrow transplantation]. / Poskození srdce u mladé zeny s Hodgkinovou chorobou dlouhodobe prezívající po kombinované lécbe a transplantaci kostní drene.

The authors describe the disease of a 22-year-old woman treated from the age of 13 years on account of Hodgkin's lymphoma by irradiation and cytostatic treatment. On account of a relapse of lymphoma at the age of 14 years megachemotherapy with subsequent transplantation of autologous bone marrow. In the course of eight years of the follow up gradual development of constrictive pericarditis with exsudate. Concurrently progression of mitral insufficiency based on valvular prolapse resulting from radiation. During the last two years refractory systemic hypertension resistant to treatment. At the peak of the disease development of cardiac tamponade and cardiac cachexia with anasarca. After anamnestic, clinical and haemodynamic analysis total pericardetomy was indicated and mitral valve replacement performed. The operation led to improvement of the patient's condition, systemic hypertension receded completely. The patient is in permanent remission.

[Is a bioprosthesis with a rigid stent a good choice for aortic valve replacement in elderly patients?]. / Je bioprotéza s rigidním stentem dobrou volbou pro náhradu aortální chlopne u starsích pacientu?

BACKGROUND: Either stented or stentless bioprostheses can be used for aortic valve replacement (AVR) in aged patients. However the choice of the valve type remains controversial. The implantation technique of the stentless valves is more complex but the haemodynamic performance supposed to be superficial to the stented ones. The aim of the study was to review our experience with stented bioprostheses implanted in the last year. MATERIAL AND METHODS: The study reviews retrospectively 35 patients who underwent AVR with Biocor fy St Jude Medical from May 2000 to May 2001. The mean age was 73 years (65-81). Associated procedures were CABG in 17, aortoplasty in 3 and Bentall procedure in 1. Thirty-two patients had aortic stenosis, the mean preoperative gradient was 44.2 mmHg. Nineteen implanted valves were 23 mm and smaller in diameter. All patients were examined by a cardiologist (including ECHO) one month after surgery. RESULTS: There was no early mortality (30 days) and no sign of structural valve deterioration or valve thrombosis. Mean hospital stay was 10.2 days (5-30). Mean postoperative gradient one month after surgery was 14.1 mmHg (6-24). CONCLUSIONS: The AVR with a stented bioprosthesis is a standard procedure with excellent results, the postoperative gradient is comparable to the gradient of the stentless valves.

[Traumatic rupture of the descending thoracic aorta. Is emergency surgery necessary?]. / Traumatická ruptura sestupné hrudní aorty. Je nezbytná urgentní operace?

The diagnosis of traumatic rupture of the descending thoracic aorta used to be an indication for urgent surgery. Recently, there has been a shift in the perspective regarding the need for an urgent procedure and increasing numbers of surgeons tend to suggest that it is safer to manage first other serious injuries and to perform reconstruction of the injured thoracic aorta in the second stage only. Provided conservative therapy is properly managed, the risk for bleeding from the injured aorta is minimal. In the present case report of a patient with descending thoracic aortae rupture, the authors demonstrate and discuss the strategy of optimal timing of surgery.

[Transmyocardial laser revascularization of the myocardium and coronary reconstruction without extracorporeal circulation]. / Transmyokardiální laserová revaskularizace myokardu a koronární rekonstrukce bez pouzití mimotelního obehu.

The authors report their experience with myocardial revacularization using transmyocardial laser revascularization combined with aortocoronary reconstruction without the use of extracorporeal circulation. The discussion section addresses indications for the procedure, operative tactics, the benefits and limitations of the above technique.

[The inferior epigastric artery. Short-term and one-year patency]. / Arteria epigastrica inferior. Krátkodobá a jednorocní pruchodnost.

The authors analyse the advantages and disadvantages of revascularization of the myocardium via the arteria epigastrica inferior. They submit short-term and one-year results in a group of 18 patients operated in 1992-1995. The short-term patency of the arteria epigastrica inferior was in the investigated group 87.5% and the one-year patency 83.3%. The limiting factor of this graft are technical problems associated with the establishment of the central anastomosis. The authors assume that the epigastric artery has its place in coronary surgery, although at present it is used mostly as a an alternative graft, mainly for the recascularization of less important coronary vessels.

[100 renal transplantations with intravesical implantation of the ureter]. / Sto transplantací ledvin s intravezikální implantací mocovodu.

Transplantation of the kidney is nowadays a common therapeutic method. During the past 30 years in the transplantation centre of IKEM more than 1200 transplantations were performed. The authors present a group of 100 patients where the ureter of the transplanted Kidney was attached to the urinary bladder of the recipient by intravesical technique. With regard to the low incidence of fistulas and the easy solution of complications this technique can be widely used in clinical transplantation programmers.

Anatomical interrelation between the phrenic nerve and the internal mammary artery as seen by the surgeon.

Paresis of the diaphragm (especially left-side paresis) is a relatively frequent finding following cardiac surgery. While, usually, it is a rather benign condition, in exceptional cases it may lead to severe impairment to death of the patient. The supposed causes of damage to the phrenic nerve include: local myocardial cooling by ice slush; opening of the pleural cavity in connection with local cooling; cross clamp length; total hypothermia; central venous cannulation; traction-related damage; mammary artery harvesting. Perhaps the commonest cause of damage to the phrenic nerve, i.e., the effect of local myocardial cooling by ice slush, and the mode of phrenic nerve protection have been studied in considerable detail. The authors focused their attention on the interrelation between the phrenic nerve and the proximal segment of the mammary artery. Using anatomical preparations, the authors demonstrate the very intimate relationship of the above entities. The interrelation of the two anatomical structures basically differs depending on whether the left or right side is concerned. 1) On the left: The phrenic nerve, on entering the thorax, runs between the subclavian artery and vein laterally from the mammary artery crossing it medially; it parts the latter and continues in mediastinal adipose tissue to run on the pericardium toward the diaphragm. 2) On the right: The phrenic nerve passes between the subclavian vein and artery medially from the mammary artery. For another 3-4 cm, it runs along the medial and dorsal edges of the mammary artery.(ABSTRACT TRUNCATED AT 250 WORDS)

[Peroperative transluminal angioplasty as a supplementary procedure to arterial reconstruction surgery]. / Peroperacní transluminální angioplastika jako výkon doplnující tepennou rekonstrukcní operaci.

Patients with affections of the vascular system of the lower extremities at several levels present a complicated problem for vascular surgery. The authors submit their experience with a combination of vascular reconstruction and peroperative transluminal angioplasty. In 25 patients, mean age 64 years, they performed 29 of these combined operations, 10 times on account of claudications, 11 times on account of pain at rest, 8 times on account of trophic defects. The pelvic vessels were dilated 6 times; the dilated vessels as well as the reconstruction remained patent. Peroperative angioplasty of the superficial femoral artery was performed 6 times, occlusion occurred once. Twelve times they dilated the distal portion of the popliteal artery or the vessels of the leg, 3 times the dilated portion became occluded. None of the patients lost the limb, one patient died from acute myocardial infarction shortly after operation. The authors describe the technique of peroperative transluminal angioplasty, evaluate the results and discuss the advantages and disadvantages of this method.