[An influence of cardiovascular risk factors and pharmacotherapy on the long-term results in women undergoing coronary artery bypass]. / Analiza wplywu czynników ryzyka i leczenia farmakologicznego na odlegle wyniki pomostowania tetnic wiencowych u kobiet.

This study aimed at analysing an effect of the coronary risk factors and pharmacotherapy on the long-term outcome in women following the coronary artery by-pass. In 1004-1997, 253 female patients, aged between 33 and 82 years (mean [+/- SD] 57.0 +/- 8 years) were treated surgically. The follow-up period lasted for 7 to 60 months (mean 32.0 +/- 14 months). Ten patients (3.9%) died. Answers to the questionnaire and personal interviews assessed physical fitness based on CCS classification, pharmacotherapy, and presence of risk factors. According to CCS scale, significant improvement has been seen in 195 (82.6%; p < .0001) patients. Health state did not change in 34 (14.4%) patients, and deteriorated in 7 (3.0%). Analysisn coronary risk factors, hypertension proved prevailing (60.3%), followed by diabetes mellitus (25.5%) and obesity (22.9%). Eleven percent of patients returned to cigarettes smoking after surgery. Postoperatively, 74.1% of patients received nitrates as a constant, medication, 58.2%--beta-blockers, 53.4%--ACE inhibitors, and 19.8% of patients received calcium antagonists. Lipid abnormalities have been treated in 49.1% of patients whereas antiplatelet therapy has been carried out in 74.1%. Only 9.9% of patients received hormones. The lower CCS class before surgery, the more significant improvement after it. As pharmacotherapy was used according to the European guidelines, an improvement in the long-term outcome required some modifications in patients' life style.

Preoperative and early postoperative assessment of the internal thoracic artery by transcutaneous duplex ultrasound in coronary artery bypass grafting.

We examined internal thoracic artery by transcutaneous duplex ultrasound in 26 patients on four occasions: 4 (+/-2) days before the operation, and 61 (+/-8) minutes, 5 days and 53 (+/-3) days postoperatively. There was dominant systolic flow in preoperative scans. After the operation a characteristic biphasic flow with increased peak diastolic velocity and a decrease in peak systolic/peak diastolic velocity ratio was detected in all patients. The pulsed Doppler spectrum was used to measure peak velocity, time averaged mean velocity and time averaged maximum velocity. Resting internal thoracic artery flows calculated using time averaged mean velocity were 30.9+/-5.4 ml/min preoperatively, 40.7+/-6.3 ml/min immediately after surgery, 41.1+/-8.2 ml/min at 5 days and 40.1+/-4.9 ml/min at 53 days. There were no significant changes in resting internal thoracic artery flow between early and late postoperative studies. Flow estimates calculated using 0.5 x time averaged maximum velocity or time averaged mean velocity showed good agreement. Early postoperative measurements appear to be a good predictor of later resting graft flow.

[Evaluation of reoperation results in patients after heart valve bioprosthesis implantation failure due to degeneration]. / Ocena wyników reoperacji u chorych po wszczepieniu bioprotez zastawek serca z powodu ich dysfunkcji spowodowanej zwyrodnieniem.

UNLABELLED: A retrospective study was conducted on 17 patients (11 female and 6 male) who underwent re-replacement of previously implanted bioprosthesis for it's structural failure in the period from 1989 until 1997. 1 of the patients was in NYHA class II, 7 in III and 9 in IV. There were 18 mechanical prostheses and 4 bioprostheses implanted during the reoperations. On 1 patient the procedure described by Geha was performed (the leaflets of damaged valve were excised and a reversed aortic St. Jude prosthesis was implanted). In almost all cases the postoperative period was complicated. There were 2 (11%) postoperative deaths. CONCLUSIONS: 1. The dysfunction of bioprosthesis is most often caused by leaflet calcification and thickening. Degeneration is faster in prostheses implanted in the mitral position. 2. The outcomes of the re-replacements are similar to those of the patients in the corresponding NYHA class after first replacement but the postoperative period may be more complicated. 3. The low prevalence of reoperation affirms the suitability of the bioprosthesis for selected patients over 65 years and for aortic valve replacement.

Polish vascular prostheses.

Vascular prostheses have been manufactured in Poland since 1960. Double velour crimped tube and bifurcation prostheses are currently available under the Trade Mark Dallon. The Authors present and discuss 812 grafting procedures for the aorto-iliac occlusive disease with the use of 457 Polish and 355 foreign-made vascular prostheses. Wound infection occurred in 7% of the patients with implanted Polish prostheses and in 6.8% of the patients with implanted foreign-made vascular grafts. The acute thrombosis of the operated artery was similarly frequent in case of Polish and foreign-made prostheses implantation, 7% and 6.8% respectively. Haemorrhagic complications were more frequent in patients with implanted Polish prostheses (1.7%) than those with foreign-made vascular grafts (0.8%). Early results of the grafting procedures (6-month follow-up) were nearly the same in both groups and the results reported in the available literature. The Authors conclude that the Polish knitted vascular prostheses have properties similar to the foreign-made ones.

Surgical treatment of cerebrovascular insufficiency in patients with pathological elongation of the internal carotid artery.

This study presents the results of surgery in 19 patients with cerebral ischaemia caused by an elongated internal carotid artery. Nine of them had a history of transient ischaemic attacks, eight-reversible stroke, and two-completed stroke. Angiography revealed a kink in 10 cases and a loop in 9. An aneurysm was also found in 2 cases. 8 re-implantations, 5 arterioplasties, 4 re-insertions and 2 aneurysmectomies were performed. Re-insertion was a supplementary procedure in 3 patients. There were no neurological complications, save one case of TIA. Follow-up studies during a period of 1 to 6 years revealed no recurrence of cerebral ischaemia.

[Neurologic complications after extracorporeal circulation in the light of experimental studies]. / Powiklania neurologiczne po krazeniu pozaustrojowym w swietle badan doswiadczalnych.

On the basis of experimental investigations the authors describe the causes of certain complications after extracorporeal circulation. The experiments were carried out in 11 sheep. The duration of extracorporeal circulation was from 1 to 2 hours. It was found that the intracranial pressure, which is an indicator of intracranial expansion, increased with increasing time of cannule introduction into the heart and veins, with the volume of perfusing fluid given during the procedure, with falling value of the arterial blood pressure and impairment of venous return. The intracranial pressure increased also with the duration of extracorporeal circulation. Falls of the arterial blood pressure and venous return occurred simultaneously with impairment of the cerebral blood flow causing cerebral hypoxia. The results of histological examinations of brain tissue were consistent with central nervous system hypoxia, and showed also that these changes developed within the first hour of extracorporeal circulation. The complications arising after extracorporeal circulation may be due to brain oedema. Thus it would be recommendable to pay attention during preoperative management of the patients to the possibility of brain oedema as a complication of the procedure.