[Occlusion of aorto-femoral vascular prostheses after long-term implantation]. / Uzáverky cévních protéz dlouhodobe implantovaných v aorto-femorálním tepenném úseku.

The authors present a report dealing with their experience with reoperations for occlusion of vascular prostheses implanted in aorto-femoral region in the late postoperative period. The most frequent cause of this occlusions was the obstruction of the outflow track at the distal anastomosis. In small arteries (under 5 mm) this obstruction was mainly caused by myointimal proliferation which originated from the host artery. In the early period after occlusion it is possible to remove the thrombus from the prostheses mostly in all patients by means of Fogarty catheter and to ensure the long lasting passage of the prostheses by plastic operations of the origin of profunda femoral artery. In long lasting occlusions of the prostheses can thrombolytic therapy 1-2 weeks before reoperation facilitate removing of the thrombus. In 113 patients with the different type of reoperations for occlusion of the prostheses in the aorto-femoral region we succeeded in 102 patients (90.3%). In 8 patients the reoperation was not successful (7%) and we had to amputate the distal extremity and three patients (2.3%) died from the heart complications in the early postoperative period.

[An unusual finding of annular sclerosis of the mitral valve during heart surgery]. / Neobvyklý nález anulární sklerózy mitrální chlopne u srdecních operací.

The authors present an uncommon finding of annular sclerosis of the mitral valve in four patients. On operation in three instances severe and in one instance a mild degree of annular sclerosis of the mitral valve was revealed. Two men were 55 and 67 years old and two women were 40 and 67 years old. In two instances the operation was indicated by a myxoma in the left atrium and in two instances by advanced insufficiency of the mitral valve.

[Coronary arteritis and its clinical significance]. / Koronární arteritis a její klinický význam.

The authors submit a report on a 47-year-old man with the syndrome of angina pectoris and history of myocardial infarction who died after a revascularization operation of the heart from left ventricular insufficiency. On necropsy extensive arteritis of the coronary vessels with aortitis was revealed and with arteritis of the small intramyocardial and lienal arteries and arteries in the renal pelvis. They describe in detail the histological finding on the blood vessels, and consistent with some data in the literature, they assume that this disease forms a separate unit. It must be considered in particular in middle-aged men who have signs of coronary ischaemia and risk factors suggesting atherosclerosis, not occur in the case-history.

[Atypical aneurysms of the abdominal aorta]. / Atypická aneurysmata brisní aorty.

The authors submit a report on two patients with pseudoaneurysmatic bulging in the subrenal portion of the abdominal aorta. They present detailed histological findings in the two operated patients and discuss the aetiology of these formations. They draw attention on the failure of aortographic examinations in the diagnosis of these formations and the necessity of sonographic or CT examination. During surgery only partial resection of these formations is possible with subsequent reconstruction of the arterial circulation. The long-term results of these operations are favourable.

Uncommon findings on surgery of benign heart tumours.

The authors describe four cases of uncommon surgical findings in patients with the diagnosis of cardiac myxoma. In the first patient an encapsulated tumourous growth in the left atrium was present which was in the mural annulus of the mitral valve and in the adjacent parts of the atrial and ventricular wall and was evaluated from the histological aspect as annular sclerosis. In the second patient a tumour-like thrombus was detected in the right atrium which had the shape of a basket handle and was attached by two stalks to the atrial septum. The third patient had a myxoma of the left atrium covering a concurrent defect of the interatrial septum and the fourth patient had a large myxoma in the left atrium with three calcified small tumours in the area of the mural annulus of the mitral valve.

[Early changes in the structure of venous grafts, their prevention and significance]. / Casné zmeny struktury zilních stepu, jejich prevence a význam.

The authors investigated, using optic and electron microscopy, the course of regressive changes in smooth muscle cells of the media in venous grafts, in relation to various physical and chemical factors. They recorded the influence of a temperature of 4 degrees C and 22 degrees C, the influence of various types of crystalloid and colloid solutions and some pharmaceutical preparations. In previous work they found that, as a result of ischaemia, regressive changes take place in the smooth muscle cells of the media, while plasmatic structures of these cells and fibrillar structures of the venous wall remain intact. They provided evidence of the adverse effect of crystalloids, where the regressive changes can be detected already after 30 minutes. A protective effect on the nuclear structure is exerted by colloids, in particular a 6% solution of detoxicated haemoglobin. More favourable results were achieved at 22 degrees C. Some pharmacological preparations have a favourable effect on the preservation of the structure of cellular nuclei. The authors draw attention to the importance of these changes for clinical practice.

[Early changes in the structure of vein grafts and their significance in the development of complications after revascularization surgery]. / Casné zmeny struktury zilních stepü a jejich význam pri vzniku komplikací po revaskularizacních operacích.

By means of light and electron microscopy the development of regressive changes in the media of vascular graft were studied. The authors found out that as a result of warm and cold ischaemia to which the vascular graft is exposed before implantation changes in nuclei of smooth muscle cells arise. The development of these changes can be postponed by keeping the graft in a suitable medium before implantation. Such medium may be e.g. the patient's blood cooled to 4 degrees C. On a group of their own patients the authors pointed out the significance of these changes in the development of early complications after vascular graft implantation.

[Personal experience with isolated regional hyperthermic perfusion of cytostatic agents in tumors of the extremities]. / Nase zkusenosti s izolovanou regionální hypertermní perfúzí cytostatiky u koncetinových nádoru.

The paper demonstrates on brief case-histories of a small group of patients some possibilities how to use isolated regional perfusion of cytostatics combined with hyperthermia as an adjuvant therapeutic method in case of melanoblastomas and liposarcomas of the extremities.

[Surgical treatment of postinfarction heart aneurysms and akinesias]. / K problematice chirurgické lécby poinfarktových srdecních aneurysmat a akinéz.

The paper deals with the problem of surgical treatment of cardiac aneurysms and akinesias from the aspect of indication of surgical tactics and technique, risk factors and achieved results. The group of 117 patients is divided into 74 patients operated in 1970-1982 and 43 patients operated in 1983-1987 when already medium hyperthermia was used permanently, similarly as cold cardioplegia, complete haemodilution, pulsed extracorporeal circulation and relieving drainage of the left ventricle via the pulmonary artery. The reduction of early mortality from 24.3% to 4.7% provides clear evidence of the advantages of this procedure. The authors draw attention to differences in indications of surgical treatment between classical aneurysms and akinesians and to the importance of revascularization operations performed nowadays, using aortocoronary bypasses.

[Surgical treatment of tumors of the heart]. / Chirurgická lécba nádoru srdce.

The authors present an account on four cases of cardiac myxoma and two cases of a secondary malignant tumour. Despite the low incidence of cardiac tumours this disease must be taken into consideration. The diagnosis was established by echocardiography and angiography. Two-dimensional echocardiography is, however, often sufficient. Early surgical treatment has very favourable results in bening tumours. The prognosis of patients with malignant tumours is very poor and experience with treatment is scanty.

[Stress perfusion tomography of the myocardium using the 201 thallium isotope in cardiac surgery--evaluation of initial results]. / Zátezová perfúzní tomografie myokardu pomocí izotopu 201talia v kardiochirurgii--hodnocení prvních výsledku.

Initial results of evaluation of scintigraphic examinations by means of the isotope 201thallium indicate the importance of this method in cardiosurgery, in particular in the postoperative evaluation of the effect of bypass operations. In patients with an objective improvement on the postoperative scintigrams also subjective improvement of the condition was recorded.

[Long-term results after implantation of the femoro-popliteal vein graft in relation to preoperative values of the ankle pressure index and peroperative flow]. / Dlouhodobé výsledky po implantaci femoropoliteálních zilních stepu ve vztahu k predoperacním hodnotám kotníkových tlakových indexu a peroperacním prutokum.

The authors investigated the importance of ankle pressure indices (aPi), peroperative blood flow and angiographic findings on peripheral arteries for the long-term patency of F-P venous bypasses. They found that neither the preoperative value of aPi nor the size of the peroperative flow through the bypass has an impact on the long-term patency of the reconstruction. As a result of general factors which lead to progression of the atherothrombosis in the arterial circulation in the implanted bypass, obstructions of the reconstruction occur even in patients with high preoperative aPi values and with a major preoperative flow, with patent peripheral arteries at the time of operation. To improve long-term results after implantation of F-P venous bypasses therefore above all prevention of the progression of atherosclerosis is essential.

[Long-term prognosis of patients with chronic post-infarct aneurysms. II. Comparison of patients treated conservatively and surgically]. / Dlouhodobá prognóza nemocných s chronickým poinfarktovým aneuryzmatem. II. Srovnání nemocných lécených konzervativne a chirurgicky.

UNLABELLED: Survival rates were determined for a group of 136 patients in whom left ventricular aneurysm was determined by angiography. They were treated medically (99 patients) or surgically (37 patients). Congestive heart failure was predominant in all patients. The two groups did not differ in regard to clinical and haemodynamic data except for a more extensive coronary artery disease in the surgical group. Survival rates at the 5, 7 and 9 years were 62.5%, 52.5% and 37.5% in the medicaly treated group and 50%, 40% and 32.5% in the surgical group. Functional improvement at least one Functional Class NYHA was present in 75% patients postoperatively, and in 27% of patients treated medically. CONCLUSION: In patients with left ventricular aneurysm with predominant congestive heart failure surgical treatment improved quality of life but did not increase long-term survival.

[The place of postoperative angiography after vascular reconstruction]. / Stellenwert der postoperativen Angiographie nach Gefässrekonstruktion.

In 284 patients after angioplasty of the aortoiliac vessels postoperative angiography discovered complications in 63 cases (22%), most frequently in case of prostheses at the bifurcation. Late thrombosis was the prime complication. In 221 patients with reconstructions in the femoropopliteal region complications were found in 24.5% of the cases, most frequently in case of venous bypass (29%). As in the first group, late thrombosis prevailed.

[Cardiac decompression using pulmonary artery drainage during operations with extracorporeal circulation]. / Srdecní dekomprese pomocí drénu v a. pulmonalis pri operacích v mimotelním obehu.

The authors report their experience with the application of decompression of the left ventricle of the heart by means or active suction from pulmonary artery. This way of heart drainage has been so far used in 53 patients, who were operated in extracorporal circulation. The drainage of pulmonary artery proved to be completely successful. It enabled a sufficient decompression of the left heart and prevented most complications which may occur if a direct drainage of the left ventricle of the heart is applied.