[The vein of Marshall as a source of various types of atrial arrhythmias, including adrenergic paroxysmal atrial fibrillation--successful catheter ablation]. / Zyla Marshalla--ograniczone zródlo adrenergicznego migotania przedsionków--skuteczna ablacja podloza.

We describe a case of a 44-year old man with recurrent atrial arrhythmias (atrial ectopy, atrial tachycardia and fibrillation) originating from the vein of Marshall (VoM). Stress, exertion and isoproterenol increased frequency and duration of highly symptomatic arrhythmia paroxysms. In 2002 he underwent two sessions of RF ablation. In the area of the left inferior pulmonary vein ostium (LIPV) and along the course the VoM, spiky, firing potentials were recorded. Ablation of the VoM region induced high frequency focal firing (CL approximately 200 ms) with 1: 1 VoM-->LA conduction. Before sinus rhythm return, a gradual increase of conduction of VoM-->LA block was observed. During the second session residual breakthroughs were recorded. During 5 years of follow-up the patient remained free from arrhythmia without antiarrhythmic drugs.

[Ventricular fibrillation in a patient with three accessory pathways, Ebstein anomaly and intermittent long QT interval. RF ablation and electrophysiologic considerations]. / Migotanie komór u chorego z trzema dodatkowymi szlakami przewodzenia, poronna anomalia Ebsteina i okresowo dlugim odstepem QT. Ablacja RF i refleksje elektrofizjologiczne.

We present a case of a 19-year old man with minor Ebstein's anomaly, intermittent long QT interval and WPW syndrome in whom atrial fibrillation, degenerating into ventricular fibrillation was the first symptom. QRS complex morphologies during atrial fibrillation revealed the presence of three accessory pathways (septal, right inferior paraseptal and antero-inferior). Immediately after resuscitation the patient was treated with amiodarone, which resulted in a significant prolongation of QT interval to 700 ms. After RF ablation of accessory pathways patient remains asymptomatic during 6-month follow up, however QTc interval is about 500 ms.

Clinical and morphological diagnosis of cardiac AL amyloidosis: a review of findings and difficulties as illustrated in one case.

BACKGROUND: Primary amyloid light-chain (AL) amyloidosis results from plasma cell dyscrasia. Fibrillar deposits of monoclonal immunoglobulin light chains are present in various organs, especially in the heart. The patients suffer from fatal cardiac dysfunction. CASE REPORT: We report the case of a 54-year-old man with symptoms of cardiac arrhythmia which was refractory to conventional treatment and ablations. At a later stage of his disease, the diagnosis of AL amyloidosis associated with monoclonal gammapathy of uncertain significance was established. Echocardiography, electrocardiography, serum immunofixation studies, abdominal fat aspirate biopsy, and bone marrow biopsy indirectly confirmed the diagnosis of cardiac amyloidosis. The patient died. CONCLUSIONS: The diagnosis of AL cardiac amyloidosis is difficult, the prognosis always serious, the available therapy limited, and the mortality high.

[Which echocardiographically unrecognised complications of native aortic valve endocarditis may be found during operation?]. / Jakie nierozpoznane echokardiograficznie zmiany moze stwierdzic chirurg u chorego z infekcyjnym zapaleniem wsierdzia naturalnej zastawki aortalnej?

The aim of the study was to determine the type and localisation of complications of aortic valve endocarditis, that have not been recognised on transthoracic (TTE) and/or transesophageal (TEE) echocardiographic study. The echocardiographic findings were retrospectively compared and contrasted with direct surgical inspection in 156 consecutive adults operated on native aortic valve endocarditis in our institute during the last 8 years. We analysed recognition of abscess, pseudoaneurysm, fistula and cusp rupture. Periannular complications were detected at operation in 51 pts, cusp rupture in 97 pts. Sensitivity of TTE in recognition of abscesses was 55%, TEE--60%; pseudoaneurysm--TTE--64%, TEE--100%; fistula--TTE 60%, TEE 100%; cusp rupture--TTE 65%, TEE 81%. Both echocardiographic methods have some inherent limitations while diagnosing complications of aortic valve endocarditis. In particular, these include small abscesses and cusp rupture. Using both modalities in a complementary way seems to offer the best approach in overall definition of the extent of inflammation.

Long-term results of Fontan procedure in 43 patients.

BACKGROUND: The Fontan operation eliminates the systemic hypoxemia and ventricular volume overload characteristic of prior forms of palliation, however, late outcome of systemic venous and right atrial hypertension were unknown when the procedure was initially proposed. AIM: We assessed the late mortality and the present clinical status atresia and other forms of univentricular heart who had modified Fontan procedure performed between 1981 and 1998, and survived early perioperative period. METHODS: We reviewed the clinical records of 43 early survivors of the modified Fontan procedure. Patients' outcome and late mortality rates were determined and present clinical status was ascertained in all patients. RESULTS: Late overall survival was 76.8%. Reoperation and late complication rates steadily declined according to surgery modification and homografts exclusion. Late mortality was increased only in patients with important atrio-ventricular valve dysfunction and valve replacement. Ninety seven percent of surviving patients are currently in New York Heart Association class I or II. CONCLUSIONS: Our 20-year experience with modified Fontan procedure for tricuspid atresia and various forms of univentricular heart has resulted in improved outcome with most survivors now leading lives of good quality into adulthood.