[Surgical treatment of pulmonary embolism]. / Chirurgická lécba plicní embolie.

BACKGROUND: Surgical embolectomy is established method of treatment of pulmonary embolism. The aim of the study is to evaluate the experience with this procedure. PATIENTS AND METHODS: Twenty two patients, aged 22-77 years, were operated on in Centre of cardiovascular surgery and transplantation in Brno from 1999 to 2009. Nine patients suffered from massive pulmonary embolism with hemodynamic instability, 13 were stable. All the operations were performed in cardiopulmonary bypass with cross clampimg time 50.4 minutes on average. In six patients the retrograde perfusion via pulmonary veins were used. Emboli in the main trunk and/or in both pulmonary branches were found in 16 patients (72.7%). No macroscopic emboli were found in three patients, but they were flushed from the pulmonary vessels during the retrograde perfusion in two of them. Emboli or thrombi in cardiac atria or ventricles were detected in 8 patients simultaneously. RESULTS: Five patients died early after operation (mortality 22.7%). The mortality was different in the group of patients with massive pulmonary embolism and cardiogenic shock (44.4%) and with submassive embolism and hemodynamic stability (7.7%). CONCLUSION: Developments in surgical technique with retrograde perfusion offer removing of emboli not only from the pulmonary trunk and main branches, but also from the peripheral branches. It improves results and facilitates extension of indications for surgical treatment.

Pneumopericardial tamponade after coronary artery bypass operation.

A case of relatively uncommon post-operative cardiac tamponade caused by air is described.

[Management and methods of delivery in women with aortic coarctation--results of 64 pregnancies in 41 women]. / Dispenzarizace a zpusob vedení porodu u zen s koarktací aorty--výsledky 64 tehotenství u 41 zen.

OBJECTIVE: To evaluate maternal morbidity and mortality of women suffering from coarctation of the aorta as well as the perinatal mortality of babies delivered by women with this anomaly of the aorta. According to our experience we recommend a suitable form of a follow up and suggest an optimal mode of delivery for these patients. DESIGN: Original paper. SETTING: 1st and 2nd Department of Gynecology and Obstetrics of the Masaryk University of Brno--Maternity Hospital, Obilní Trh 11, 602 00 Brno, Czech Republic. METHODS: Our set consists of 34 pregnant women with coarctation of the aorta. These patients were followed up during the pregnancy in the years 1964-1998 by the Centre for Cardiovascular Diseases in Pregnancy in the Maternity Hospital in Brno. Seven women who were not operated on for the coarctation of the aorta (group A) were pregnant 14 times. Twenty seven women who were operated on for the coarctation (group B) had 50 pregnancies. RESULTS: There were no maternal deaths in our set. From the 12 delivered babies of women with non operated coarctation of the aorta one child was SGA (small for gestational age). From 42 babies born by women who underwent an radical operation of the coarctation of the aorta previously we had to face one death of a newborn who was SGA as well. CONCLUSION: The radical operation of the aorta should be carried out during the first year of age if possible, between the 9th to 12th month, at best. With women who were not operated on there is a greater risk of rupture of the aneurysm of the aorta and aneurysm of the cerebral arteries in the 2nd and 3rd trimester, during the labor and in the early puerperium. We would advise therefore a through follow up during the whole pregnancy. The high BP should be lowered medicamentally. As to the mode of delivery Caesarean section is preferred. With women who were successfully operated on in their early infancy and whose BP is normal or the systolic BP does not exceed 160 mmHg the Caesarean section is not mandatory but elective. We would mostly advise a spontaneous delivery with shortening of the 2nd stage of the labor by forceps or vacuumextraction--the delivery by Caesarean section in accordance with usual obstetrical practice.

[Transplantation of a horseshoe kidney]. / Transplantace podkovovité ledviny.

Report of a case, in which a horseshoe kidney was divided and transplanted to two recipients, is described. Both transplantations were successful. This anomaly is not a contraindication to its use for transplantation.

[Severance of the accessory bundle of Kent in a 13-year-old boy with Ebstein's anomaly of the tricuspid valve]. / Prerusení akcesorního Kentova svazku u 13-letého chlapce s Ebsteinovou anomalií trikuspidální chlopne.

In patients with Ebstein's anomaly of the tricuspid valve combined with WPW syndrome, possibly other cardiac disease, in particular with the repeated occurrence of severe tachydysrhythmias we can foresee cure or at least elimination of complaints by simultaneous surgical treatment of all defects. The author presents experience with the surgical treatment, the first of its kind in this country, in a boy aged 13 years. By better diagnosis it proved possible to locate correctly and to severe by surgery the abnormal accessory bundle between the right atrium and right ventricle, simultaneously with a plastic operation of the insufficient tricuspid valve with closure of the atrial septal defect. Since the operation the patient has no signs of ventricular preexcitation and has no tachydysrhythmias.

Congenital heart disease in the adult.

On the basis of literary data and of their own series of 264 adult patients, who were in 1978-1982 subjected to invasive haemodynamic examination for congenital heart disease, 162 patients operated on, and 128 patients followed up for long-term periods after surgical treatment of congenital heart disease in adult age, the authors analyse the causes of late recognition of the disease, operative complications and long-term operative results. It is pointed out that a haemodynamically serious congenital heart disease is indicated for surgical correction even in adult age, and that age itself does not represent a limitation to cardiosurgical intervention. In adult age, it is necessary to anticipate a greater number of complications and a more severe post-operative course, but the long-term results are very good.