[Bicuspid aortic valve--ethiopathogenesis and natural history]. / Bikuspidální aortální chlopen--etiopatogeneze a prirozený vývoj.

Bicuspid aortic valve is a disease with autosomal dominant inheritance with small penetration. The population of patients with bicuspid aortic valve is heterogenous. In the absence of dilatation of ascending aorta, valvular lesion or degenerative changes of valve leaflets patients are considered to belong to the low risk population. On the other hand patients with the above mentioned characteristics compose a high risk group. Dilatation of the ascending aorta in patients with bicuspid aortic valve has a progressive feature and continues even after replacement of the aortic valve. With progression of aortic dilatation the risk of aortic dissection and rupture increases. The main reasons for aortic dilatation are changes in quality of aortic wall and possibly mechanical stress of aortic wall during asymmetrical and turbulent flow. The progression of aortic dilatation or aortic valve disease is not essentially influenced by farmacologic treatment. Surgery is the treatment of choice. Physiology and pathophysiology of bicuspid and tricuspid aortic valves, prevalence of bicuspid aortic valve in general population and in the group of patients operated on for aortic valve disease, phenotypes of bicuspid aortic valve and follow-up of asymptomatic patients with normal bicuspid valve are reviewed in this article. Indications for operation of dilated ascending aorta according to american, european and czech guidelines are discussed.

[Current cooling methods for induction of mild hypothermia in cardiac arrest survivors]. / Soucasné ochlazovací metody pro indukci mírné hypotermie po srdecní zástave.

Induction of mild therapeutic hypothermia early after return of spontaneous circulation improves prognosis of cardiac arrest survivors. Rapid cooling of the patients and correct maintainance of the target therapeutic temperature followed by controlled slow rewarming can be achieved by several noninvasive and invasive methods of various efficacy. Elementary and the most frequently used methods are surface cooling via ice-packs and rapid intravenous administration of cold crystaloids. Mattress cooling systems and facilities for endovascular cathether-cooling are more sophisticated, manageable and ensure more precise titration of therapeutic temperature. Cooling caps and helmets leading to selective head cooling can be used as the complementary techniques. Several other methods are too instrumentation-intensive, too invasive or investigated in animal experiments only. Anyway, near future may bring a rapid development of new effective and safe cooling systems.

[Ischemic mitral regurgitation. Clinical review emphasizing the surgical treatment]. / Ischemická mitrální regurgitace Klinické review s durazem na chirurgickou lécbu.

Ischemic mitral regurgitation represents comparatively frequent complication of the myocardial infarction. Presence of the ischemic mitral regurgitation has a negative effect on the immediate mortality after the myocardial infarction and on the long-term survival. Ischemic mitral regurgitation is a functional, not structural impairment of the mitral valve and it is caused by altered geometry of the left ventricle. The article deals with the development and pathophysiology namely of the chronic ischemic mitral regurgitation and with the contemporary potential of surgical treatment of that serious complication of the ischemic heart disease.

[Percutaneous transluminal septal myocardial ablation in the treatment of hypertrophic obstructive cardiomyopathy: short-term study]. / Perkutánní transluminální septální myokardiální ablace v lécbe hypertrofické obstrukcní kardiomyopatie: krátkodobé sledování.

In 18 patients with symptomatic hypertrophic obstructive cardiomyopathy 18 procedures involving percutaneous transluminal myocardial ablation were performed. The patients were followed up for three months after the procedure. The mean intraventricular peak gradient declined during the intervention from 51 +/- 26 mm Hg to 11 +/- 12.2 mm Hg (p < 0.001). On average 2.7 +/- 1.1 ml ethanol were administered, as a rule into the first septal branch. The target artery was detected in 13 instances by means of myocardial contrast echocardiography and in five instances by haemodynamic investigation. In one instance the procedure was combined with subsequent balloon angioplasty of the ramus circumflexus. In one patient it was necessary to implant ex post a permanent pacemaker on account of AV bloc grade III. In one instance when myocardial contrast echocardiography was not used) infarsation not only of the basal interventricular septum occurred but also of the posterolateral left ventricular wall. During the three-month follow-up the incidence of stenocardias assessed according to CCS declined from grade 2.6 +/- 0.8 to 0.8 +/- 0.8 (p < 0.0001). Dyspnoea evaluated according to NYHA declined from grade 2.9 +/- 0.5 to 1.4 +/- 0.6 (p < 0.0001). The maximal intraventricular gradient evaluated by Doppler echocardiography declined from 57.2 +/- 42 mm Hg before the procedure to 19.7 +/- 12 mm Hg (p < 0.001). An identical gradient after stimulation with one dose of isosorbide dinitrate spray (1.25 mg) declined from 82.3 +/- 27 mm Hg to 25 +/- 6 mm Hg (p < 0.0001). The diastolic thickness of the IVS in the intervened segment declined from 21.2 +/- 3 mm to 14.7 +/- 2 mm (p < 0.0001). No significant change in the size of the left ventricle was recorded, nor in its ejection fraction and size of the left atrium. One patient died suddenly during the follow up period. Percutaneous transluminal septal myocardial ablation leads during short-term follow-up to a significant weakening of the basal segment of the interventricular septum, a decline of the intraventricular gradient and symptomatology of hypertrophic obstructive cardiomyopathy.

["Ambulatory" approach to selective coronary angiography: our results and experience]. / "Ambulantní" prístup k selektivní koronarografii: nase výsledky a zkusenosti.

The authors present a group of their first 110 patients subjected to selective coronarography during an average 7-hours hospitalization period. In selection of patients they respect the criteria ruling out the following approach: age above 70 years, distance of the patients domicile above 80 km or inaccessibility of catheterization laboratory within 45 minutes, serious aortic valve disease, unstable coronary syndromes, insulin treated diabetes mellitus, renal insufficiency, cardiac insufficiency, grade III or IV, severe left ventricular dysfunction, history of malignant arrhythmia, acute myocardial infarction or cerebrovascular attack during month preceding examination, coronary finding calling for urgent revascularization, complicated course of examination and mental inability of patient. All coronarographies were performed by a 4F catheterization instrument, no complications were recorded and readmission to hospital was not called for. An early check-up by telephone was accepted by half the patients. When all the above criteria are respected the authors recommend this procedure as a standard one without the need of hospital admission.

[Catheterization therapy of the left main coronary artery in chronic stenosis of the right coronary artery. What are the limits of interventional cardiology?]. / Katetrizacní lécba stenózy kmene levé vencité tepny pri chronickém uzáveru pravé vencité tepny. Kde jsou hranice intervencní kardiologie?

The authors give an account of a 59-year-old patient with a significant stenosis of the left main coronary artery and occlusion of the right coronary artery, occlusion of the ramus interventricularis anterior after failure of surgical revascularization and with a left ventricular ejection fraction of 20%. The authors performed a successful percutaneous coronary angioplasty of the left main coronary artery with an implantation of a stent. They discuss contemporary possibilities and limitations of catheterization treatment of stenosis of the left main coronary artery.

[Treatment of significant coronary stenoses using stents without preliminary balloon angioplasty: present status, results, perspectives]. / Osetrení významných koronárních stenóz pomocí stentu bez predchozí balonkové angioplastiky: soucasný stav, nase výsledky, perspektivy.

The authors present an account on a group of 57 patients where they tried to treat 58 significant coronary stenoses by means of direct stenting without predilatation. In two patients they were able to implant the stent only after previous dilatation, in one instance postdilatation was necessary because of a residual stenosis of more than 20% and in one instance it was necessary to implant another stent on account of distal dissection. Direct stenting was successful in 93%. At the significance level of p < 0.05 significantly shorter fluoroscopic and total intervention times were achieved as compared with the control group where the standard procedures of stenting after previous balloon angioplasty was used. The authors conclude that direct stenting without previous dilatation is a safe method which can be used with the contemporary instrumental equipment in approximately 20% of carefully selected lesions.