Endovenous laser ablation of saphenous veins - favorable clinical results confirm theoretical advantages of the 1940nm diode laser.

INTRODUCTION: Endovenous laser ablation (EVLA) is a recognized alternative to surgical treatment of varicose veins, although an optimal laser generator and its settings still remain a matter of debate. The aim of our study was to correlate clinical results with the theoretical advantage of the 1940nm diode laser characterized by high absorption of heat in a thin layer of coagulated tissue. METHODS: From 1/2010 to 12/2021 EVLA was performed in a total of 3529 consecutive patients with varicose veins and ultrasonographically documented superficial venous reflux of lower extremities. Three types of laser were used successively with the wavelengths of 1064 nm, 1470 nm and 1940 nm, respectively. All patients were prospectively enrolled in our registry. An early postoperative followup visit was scheduled including an assessment of venous closure; additional visits were performed only in case of complications. RESULTS: The success of venous closure did not differ (p=0.054) between the three laser types and was over 98%. The catheterbased method made it possible to perform multiple ablations in one procedure the trend was 1.08, 1.31 and 1.62. In 2021 the number of ablations per patient with the laser DL Tethys 1940 nm was 1.79. With this laser it was possible to reduce the total energy applied to one half (8 W, 5080 J/cm). The postoperative course of patients treated using the 1940nm laser was smoother - no other but the early followup visit was needed in 95.6% cases (p.

Risk stratification of neurological decompression sickness in divers.

INTRODUCTION: Patent foramen ovale (PFO) is a risk factor of decompression sickness (DCS). However, data on risk stratification of divers with a PFO are sparse. This study sought to evaluate the risk of neurological DCS (DCSneuro), based on the presence and grade of a right-to-left shunt (RLS). METHODS: A total of 640 divers were screened for a RLS using TCD between 1/2006 and 4/2017. RLS was graded as low, medium, or high grade with two subgroups - after a Valsalva maneuver or at rest. Divers were questioned about their DCS history. Survival analysis techniques were used to assess risk factors for unprovoked DCS. RESULTS: A RLS was found in 258 divers (40.3 %). 44 (17.1 %) divers with a RLS experienced DCSneuro compared to 5 (1.3 %) divers without a RLS (p <0.001). The proportion of DCSneuro increased from 4.6 % in the low-grade RLS subgroup to 57.1 % in the subgroup with high-grade RLS at rest. The hazard ratio for DCSneuro and RLS was11.806 (p <0.001). CONCLUSIONS: Divers with a RLS had a higher risk of DCSneuro and the risk increased with RLS grade. We suggest that TCD is an appropriate method for RLS screening and risk stratification in divers (Tab. 4, Fig. 2, Ref. 29).

Effect of immunosuppressive therapy in inflammatory cardiomyopathy: data from The Czech Inflammatory Cardiomyopathy Immunosuppressive Trial.

INTRODUCTION: The indications for specific treatment in the cases of inflammatory cardiomyopathy are based on limited data from several small clinical trials. AIM: A comparison of the effect of two dose regimens of combined immunosuppressive therapy by adding them to conventional heart failure therapy and comparing them with conventional heart failure therapy alone in patients with inflammatory cardiomyopathy. METHODS AND STUDY POPULATION: We enrolled 20 patients; mean age 46.10±7.33 years, duration of symptoms <6 months, LVEF ≤40 %, NYHA class II-IV, with biopsy­proven myocarditis. Patients were randomly separated into groups treated with immunosuppressive therapy in addition to conventional heart failure therapy or to a group treated with conventional heart failure therapy alone. Clinical and echocardiographic parameters were evaluated. RESULTS: The baseline values of LVEF in the group of immunosuppressive therapy (LVEF 22.3±4.7 %) were similar to those in the group treated with conventional heart failure therapy (LVEF 21.7±4.7 %; p=0.757). After twelve months there was no statistically significant difference in LVEF between the two studied groups (LVEF 33.7±9.5 % for the immunosuppressive therapy group and 41.3±13.0 % for the conventional therapy group; p=0.175). CONCLUSION: In our study population, we proved no positive effect of combined immunosuppressive therapy on the left ventricular function over 12 months. The main limitation of the study is the small number of enrolled patients (Tab. 4, Fig. 1, Ref. 35).

Endovenous laser ablation of saphenous vein - mid-term results confirm permanent closure and possibility to treat more lesions in one procedure.

INTRODUCTION: Endovenous Laser Ablation (EVLA) is a common alternative to surgical treatment of varicose veins. The aim of our study was to demonstrate that laser occlusion is durable, that we can treat all patients in a one day setting, even with veins >10mm in diameter, and that multiple EVLAs can be done at the same time. METHODS: In the period from 1/2017 to 12/2019 EVLA was performed in a total of 1551 consecutive patients with varicose veins and ultrasonographically documented venous reflux. The mid-term results were evaluated in a group of patients operated from 1/2017 to 6/2017 (316 pts.). We compared a risk group that consisted of patients with veins >10mm in diameter (40 pts.) with a control group (the remaining 276 pts.). Patients with veins >10mm are traditionally considered as candidates for conventional surgery. RESULTS: The catheter-based method enabled us to perform more ablations in one procedure. In 2019 we performed 1.44 EVLA procedures per patient. There was only one postoperative follow-up visit, indicating an uncomplicated postoperative course, in 87.5% of patients of the risk group. In the control group 100% of patients had only one follow-up visit including ultrasound examination, showing an uncomplicated postoperative course (p.

Catheter laser ablation of superficial veins of the lower extremities in the symptomatic treatment of venous reflux comparison of the immediate results of two types of laser.

INTRODUCTION: Catheter-Based Endovenous Laser Ablation (EVLA) is a commonly used alternative to surgical treatment of varicose veins. Recently, catheterization methods have proved to be methods of choice due to the preference of patients who value minimal invasiveness. Research of EVLA currently focuses on optimization of the procedure, which includes study of the benefits of the individual types of laser generators and the wavelengths used. In this observational study we compared our early results in a non-selected population of consecutive patients treated with two different types of lasers. METHODS: In the period from February 2010 to June 2017, EVLA was performed in a total of 1747 consecutive patients (74% were female) with venous reflux. The average vein width was 8.5 mm (525 mm). Our study sought to compare a more economical 1470nm diode laser (DL) generator (Velas 2, China) - used to operate on 630 patients - with a Nd-Yag crystal generator (Fotona - Slovenia) used in 1117 patients. All operations were performed using the same methodology, in an outpatient setting, in one specialized center. All procedures were completed in local tumescent anesthesia under peroperative ultrasound control. Postoperative sonography was performed in all patients. RESULTS: The results did not show a statistically significant difference in early closure rates (98.8% for Nd-Yag versus 99.8 for DL p-ns). Early recurrence was observed in 9 patients (15 vein segments) and managed successfully with early re-intervention and closure in all cases. The causes of incomplete closure included mainly the known risk factors (anticoagulation therapy, history of varicophlebitis). There was no correlation with larger venous diameter. In 6 patients, thrombus prolapse was observed in the deep femoral vein lumen. All cases were successfully cured after a week of low-molecular-weight heparin therapy. Only one case of low-risk pulmonary embolism was reported in a patient who failed to follow the regime recommendations. CONCLUSION: This evidence did not show a significant difference in closure reliability and the amount of complications of the endovenous laser ablation of large and small saphenous vein with a 1060nm Nd-Yag crystal compared to the more economical 1470nm diode laser generator.

Conservative versus invasive treatment in hypertrophic obstructive cardiomyopathy: an echocardiography study.

AIM AND METHODS: The aim of our study was to compare the development of echocardiographic parameters and functional status of patients with hypertrophic obstructive cardiomyopathy (HOCM) treated conservatively (n = 41) or by alcohol septal ablation (ASA; n = 39). RESULTS: Left ventricular outflow tract gradient (LVOTG) decreased in the first year by 53.7±36.4 mmHg in ASA group versus 5.5±47.1 mmHg in conservatively treated group (p<0.001), in the third year by 53.1±41.4 mmHg versus 23.9±42.7 mmHg (p = NS) and in the fifth year, the reduction of LVOTG was 52.1±44.5 mmHg in ASA group and 3.0±63.2 mmHg in conservatively treated group (p<0.05).Change in NYHA class in the first year was -1.1±0.4 versus 0.1±0.5, in the third year -1.0±0.6 versus 0.1±0.4 and in the fifth year -0.8±0.5 versus 0.1±0.4 (all p<0.001). CONCLUSION: Our results showed for the first time that decline of LVOTG after ASA creates a favorable left ventricle remodeling and leads to significant improvement of functional status of HOCM patients in comparison with conservative treatment (Tab. 3, Fig. 2, Ref. 42).

[Patent foramen ovale and the risk of paradoxical embolization of venous bubbles in divers - cave for foam sclerotization of varicose veins]. / Perzistence foramen ovale patens a riziko paradoxní embolizace zilních bublin u potápecu - cave pro sklerotizaci varixu penovou metodou.

INTRODUCTION: Foam sclerotization of varicose veins may cause paradoxical embolization through patent foramen ovale (PFO). The aim of our study was to: 1) select an optimal screening method for the detection of PFO; 2) determine the prevalence of PFO in a non-selected population; and 3) test the risk of paradoxical embolization of venous bubbles in patients with PFO. MATERIALS AND METHODS: A diver after decompression is a suitable model for determining the risk of paradoxical embolization of venous gas bubbles. 329 Czech divers were screened for PFO. In a pilot study, we compared Transcranial Doppler Sonography (TCD) with Transesophageal Echocardiography (TEE) in 100 patients. TCD alone was used for further screening. In 31 divers with PFO, nitrogen bubbles were detected after simulated dives. Transthoracic Echocardiography (TTE) was used to detect venous bubbles in right-sided heart chambers; TTE and TCD were used to detect arterial bubbles. The right-to-left shunt was rated as non-significant (<20 arterial bubbles) or significant (20 arterial bubbles). Different decompression regimens were compared. RESULTS: In the pilot study, TCD was compared with the gold standard in PFO detection - TEE. The negative predictive value of TCD was 100%, positive predictive value was 92%. Screening was performed in a total of 329 divers, PFO was detected in 85 (25%), significant R-L shunt in 45 (14%). In simulated dive to 50 m maximum depth, venous nitrogen bubbles were detected in 7/8 (88%) divers. In 6/8 (75%) divers, paradoxical embolization was confirmed - nitrogen bubbles were detected in the systemic circulation. CONCLUSION: PFO prevalence with significant R-L shunt was 14% in the non-selected population of Czech divers. Simulated dives indicate that PFO represents a risk factor for paradoxical embolization of gas bubbles. TCD is a suitable screening method for the detection of PFO and the evaluation of R-L shunt significance. These results are indicative of a possible high risk of paradoxical embolization of gas bubbles and the trombogenic substance in patients with a larger PFO and significant R-L shunt undergoing foam sclerotization of varicose veins.

[Paradoxical embolization and patent foramen ovale in scuba divers: screening possibilities]. / Paradoxní embolizace pri foramen ovale patens u potápecu: moznosti screeningu.

INTRODUCTION: The cause of decompression sickness (DCS) in scuba-divers is bubble formation in tissues and in venous blood during ascent. Divers with patent foramen ovale (PFO) have an increased risk of paradoxical embolization to the brain or other vital organs. The aim of our study was to assess the incidence of PFO in scuba-divers with DCS, to compare the group with asymptomatic controls, and to evaluate ultrasound contrast methods suitable for screening. METHODOLOGY: We examined 28 scuba-divers (more than 100 dives). The right-to-left shunt detection was performed by bubble contrast transthoracic echocardiographic examination (TTE) and transcranial Doppler sonography over arteria cerebri media (TCD) in all divers. In divers with shunting, transoesophageal echocardiography (TEE) was performed to prove PFO. RESULTS: 15 divers had DCS associated with the ascent. In this group, PFO was diagnosed in 53% (8/15). The symptoms of all of them retrospectively were of paradoxical embolization (neurological form of DCS). In the group of asymptomatic divers, PFO was proven on the basis of right-to-left shunt screening in 1 diver (8% 1/13). TCD proved right-to-left shunt in all divers with PFO. CONCLUSION: DCS can unmask a so far asymptomatic intracardiac right-to-left shunting. PFO is a risk factor for paradoxical embolization in divers. TCD is suitable for screening; TEE is a gold standard in PFO detection. Our results showed that PFO detection is a useful clinical tool after repeated DCS and in all frequent divers and instructors.

[Intravascular ultrasound guided direct stent implantation in the treatment of significant stenosis of the left coronary artery]. / Intravaskulárním ultrazvukem rízená prímá implantace stentu pri lécbe významné stenózy kmene levé vencité tepny.

The authors present the case of a 52-year-old patient with the symptomatology of unstable angina pectoris where they diagnosed a major stenosis of the trunk of the left coronary artery as the only significant lesion in the coronary circulation. The patient was successfully treated by means of an intravascular ultrasound--guided coronary stent implanted into the trunk of the left coronary artery. The authors discuss the possibilities and trends of contemporary catheterization treatment of major coronary affections.

[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.

[Adult patients after surgery of ostium primum type of atrial septal defects in childhood: echocardiography study]. / Dospelí pacienti po operaci defektu septa síní typu ostium primum v detském veku: echokardiografická studie.

The authors examined, using transthoracic and transoesophageal echocardiography, 36 adult patients (15 men) aged 22 +/- 3.1 years (18-29 years) who were operated 12.2 +/- 3.7 years previously on account of a defect of the atrial septum type ostium primum. In these patients no other congenital cardiac defect was present. In addition to closure of the defect in the patients complete suture of the "cleft" of the anterior cusp of the mitral valve was performed, in 7 partial suture of the "cleft" of the anterior cusp of the mitral valve and in 4 commissuroplasty. In one instance later reoperation with replacement of the mitral valve by a mechanical prosthesis was performed. The control group was formed by 16 healthy volunteers (5 men) aged 22.1 +/- 3 years (19-31 years). Patients operated in childhood on account of an atrial defect of the ostium primum type have on echocardiographic examination, as compared with healthy volunteers, larger atria and the left ventricle, a thicker interventricular septum and left ventricular wall and a higher velocity of left ventricular filling during the late diastole. Higher values of parameters of the size and volume of the left ventricle are associated with the presence of mitral regurgitation. More marked changes of systolic or diastolic left ventricular function are not present, there are not even any echocardiographic signs of higher pressure in the atria and pulmonary artery. In none of the patients a residual shunt at the level of the atrial septum is present. Mitral regurgitation is found in two thirds of the patients, only in one case it was however moderately severe (grade 3). From the results it does not ensue which type of surgery of the "cleft" of the mitral valve has the best long-term results. In none of the patients tricuspid regurgitation of a higher grade than grade 1 is present.

Direct stenting without predilatation: a new approach to coronary intervention.

BACKGROUND: Implantation of coronary stents after predilatation is a standard approach in the treatment of most coronary lesions. Stenting without predilatation could be a possible alternative way of treating a certain subset of patients. OBJECTIVE: To identify a group of patients suitable for this optional method, to evaluate their immediate clinical and angiographic outcomes and to test the feasibility and safety of this new therapeutic concept. METHODS: Ninety selected patients with 91 lesions were treated by implantation of coronary stents without predilatation. RESULTS: The mean duration of this procedure was 12.3 +/- 9.1 min and the fluoroscopic time was 3.6 +/- 2.9 min. The stenoses before and after this procedure were 77 +/- 10 and 5 +/- 9%, respectively. Predilatation, postdilatation or implantation of an additional stent was necessary for seven patients. Primary success rate was 92% with an excellent immediate clinical and angiographic outcome. No major complications occurred during direct stenting. CONCLUSION: Direct stenting is feasible using commercially available stents and could be performed for about 20% of patients for whom coronary intervention is indicated. The proper selection of lesions is of crucial importance. Lesions eligible for direct stenting should be without visible calcifications and on vessels without proximal tortuosity. This procedure proved to be safe and successful in this series of coronary interventions.

[Catheter therapy in patients with stable angina pectoris. Results of 662 coronary angioplasties]. / Katetrizacní lécba nemocných se stabilní anginou pectoris. Výsledky 662 koronárních angioplastik.

Coronary angioplasty supplemented by implantation of a stent has become a standard therapeutic method in patients with stable angina pectoris. The authors analyzed the spectrum of patients indicated for this treatment, its successfulness and complications of catheterizations. In the course of a two-year period the authors implemented 662 catheterizations in 602 patients with stable angina. 58% patients indicated for coronary angioplasty on account of stable angina had a history of myocardial Q infarction, 93% had angina grade II or III according to CCS. Affection of one artery was diagnosed in 56% patients, complete revascularization was achieved in 59% of the operations. The clinical rate of success of catheterization was 97% in stenoses of the coronary arteries and 61% in coronary occlusions. In 57% of the treated lesions a coronary stent was implanted. Serious clinical complications developed in 1% of the interventions, none of the patients died. Catheterization treatment of stable angina is very successful and safe.

[Ultrasonography study of the mammary-coronary bypass]. / Ultrazvukové vysetrení mammarokoronárního bypassu.

The authors present the case of a 49-year-old female patient who was admitted with the diagnosis of ischaemic heart disease and the syndrome of angina pectoris grade IV for selective coronarography. For assessment of the affection of one artery, significant stenosis of the insertion of the ramus interventricularis anterior the authors indicated a bypass of the left mammary artery to the ramus interventricularis anterior. During the postoperative course the patient did not have any anginous symptoms or any other clinical signs suggesting ischaemia or necrosis of the heart muscle. During the ultrasonographic check-up examination of the mammarocoronary bypass the suspicion of occlusion of the graft was expressed and this was confirmed on angiography. An angiographically successful percutaneous transluminal angioplasty of occlusion of the bypass was made. During the subsequent ultrasonographic examination the authors suspected again graft occlusion and angiography confirmed a 90% stenosis. Therefore the patient was re-operated. It appears that ultrasonographic examination of the mammacoronary bypass may prove useful in the diagnosis of occlusion or critical stenosis of a graft.

["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.

[Thromboelastography--an instrument for the researcher or clinician?]. / Tromboelastografie--nástroj výzkumníka nebo klinika?

Thromboelastography is a method which is used experimentally since 1948. Since the end of the eighties it is experiencing a certain revival also in clinical medicine. The submitted case-record presents this technique as a very useful aid in the differential diagnosis of postoperative haemorrhagic conditions in cardiosurgery. Its application can facilitate aimed treatment of some typical disorders of haemocoagulation.

[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.

[Harvesting the heart for preparation of heart valve allografts]. / Odber srdce pro prípravu allotransplantátu srdecních chlopní.

Allograft heart valves (AHV) are believed to be optimal prosthetic material for surgical aortic valve and/or root replacement and an ideal valved conduit for repair of some complex congenital heart defects. At the University Hospital Motol AHV were clinically used since 1983 (annually no more than twenty were collected). 1991 the Paediatric Transplant Centre was established and was entrusted to organise cadaveric hearts harvesting and to introduce the standard technology of AHV processing and banking. The results of co-operation with other Transplants Centres, as well as with coroners and forensic medicine specialists in 1992-1995 are presented. For the AHV processing 274 cadaveric hearts were collected in the Czech and Slovak Republics, 32 of them (11.7%) came from routine post-mortem and 242 (88.3%) were retrieved from multiorgan harvesting, 14 hearts were excluded for technical reasons and another five for the seropositivity of the donor (three HBSAg, one HCV and one VDRL). Another 14 AHV were not suitable for clinical use because of a congenital lesion (bicuspid aortic valve) or acquired pathology found during the AHV processing (advanced atherosclerosis) or retrospectively diagnosed at donors post-mortem (in vivo undiagnosed malignancy). The technology of processing, cryopreservation and banking of AHV as well as the clinical use of the tissue will be discussed separately.

[Preparation, storage, transportation and use of heart valves for allotransplantation]. / Príprava, skladování, transport a pouzití allotransplantátu srdecních chlopní.

UNLABELLED: Thanks to the co-operation with Czech and Slovak Transplant Centres and with some of the Departments of Pathology and Forensic Medicine 274 hearts were collected for allograft heart valves (AHV) processing during 1992-1995. The Cardiac surgeon dissected the aortic valve with the root and the pulmonary artery trunk with the valve. Tissues were antibiotically (ATB) sterilised in cultivation medium E 199 (24 hours at 37 degrees C). ATB concentrations (mg/ml): Cepharin 0.2, Azlocilin 0.2, Tobramycin 0.08 and Amphotericin B 0.1 for harvesting at post-mortem (P) or Miconazol 0.05 for sterile retrieval during multiorgan harvesting (MOH). After sterilisation AHV were stored at 4 degrees C. 49 AHV were infected even after ATB treatment-15 of 35 collected at P (43%) and 35 of 218 procured during MOH (16%)-(p < 0.01-ch2 test). After serological screening of the donor and microbiological testing the AHV were released for clinical use. Most AHV were programmed cooled to the temperature of liquid nitrogen (-196 degrees C), in which they were stored at the Allograft Heart Valves Cryobank. Cryoprotection was achieved by 10% dimethylsulphidoxide. CONCLUSION: A technology of harvesting, processing, storage and transportation of AHV, was introduced. It enabled the routine use in many cardiac surgical units. The AHV Cryobank was established. 131 AHV were used clinically between 1992 and 1995 (transportation as far as 1300 km). 108 AHV (82.4%) were used for repair of complex congenital heart defects, while 23 (17.6%) were used for aortic valve and/or root replacement.