[Vitamin D in aortic stenosis]. / Vitamin D a aortální stenóza.

Aortic stenosis is the third most common cardiovascular disease and the most commonly operataed valve disease in developed countries. Progressive valve calcification leading to significant flow obstruction is the main pathogenetic feature. Dysregulation of the systemic calcium-phosphate metabolism with low vitamin D level is a possible risk factor of aortic stenosis even in patients with preserved renal function. This hypothesis deserves further clinical and experimental study.

[The most common heart valve diseases: aortic stenosis and mitral regurgitation. A few comments on guidelines and recommendations by societies of cardiology]. / Nejcastejsí chlopenní vady srdce: aortální stenóza a mitrální regurgitace. Nekolik poznámek ke guidelines a k doporucením kardiologických spolecností.

Recommendations of professional societies, frequently called guidelines as per the English translation, provide help to the general practice as well as specialized physicians. These are recommendations, not a legislative norm. Societies of cardiology have issued 3 new guidelines over the recent years; American ACC/AHA in 2006 and European ESC and Czech CSC in 2007. Guidelines for diagnostics and therapy are presented as Class I to III according to the suitability of the procedure and the level of evidence is classified in groups A to C. Emphasised is the effort of societies of cardiology to provide unbiased guidelines. They request the authors to provide a statement confirming they are not in any way related to any organization, institution or company that could be at present or in the future considered as a conflict of interests. Mentioned is the rapid growth of knowledge that does not allow the guidelines to consider the latest advances to trans-catheter therapy of the both most frequently occurring valve disorders.

Echocardiographic volumetry of the right ventricle.

AIMS: The aim of our study was to define the optimal geometric model for two-dimensional volumetry of the right ventricle and its clinical validation. METHODS AND RESULTS: It has been shown in previous reports that an ellipsoidal shell model best reflects the complex right ventricular geometry. We investigated 82 patients without tricuspid regurgitation and intracardiac shunt. Measurements of right ventricular stroke volume were made in modified apical four chamber and parasternal short axis views both in end-diastole and end-systole. The following controls were used:stroke volume of right ventricle estimated by thermodilution in 22 patients, stroke volume of left ventricle calculated with Teichholz formula in 77 patients, stroke volume of left ventricle estimated by Doppler volumetry in 41 patients. The correlations between right ventricular stroke volume by echocardiography and thermodilution, left ventricular volumetry by Teichholz and Doppler were r=0.87, p<0.001; r=0.91, p<0.001; and r=0.83, p<0.001, respectively. CONCLUSION: The ellipsoidal shell model of the right ventricle is a good model for right ventricular volumetry.

[ECG changes in aortic valve defects]. / EKG zmeny u aortálních chlopenních vad.

ECG is nowadays no longer the dominant way of diagnosing aortic valve diseases. The basis of accurate diagnosis of these diseases is clinical examination, ECHO and catheterization of the heart, which is essential in the great majority of valve diseases, in particular to rule out coronary changes. ECG is however important for the primary evaluation of left ventricular hypertrophy, left ventricular overburdening, for detection of enlargement or overloading of the left atrium. It is irreplaceable for evaluation of impaired rhythm, or impaired conduction of the impulse. Thus we can prove atrial fibrillation, or flutter bundle branch block, disorders of AV conduction (block of AV transmission grade one to three), supraventricular and ventricular extrasystoles etc. Changes of the ECG tracing provide also some information which cannot be obtained by other means.

[Results of surgical treatment of incomplete forms of atrioventricular septal defects in adults]. / Výsledky chirurgické lécby nekompletní formy defektu sínokomorového septa v dospelosti.

At a cardiosurgical department in Brno in 1978-1987 244 patients above 15 years of age were operated for the first ++time on account of inborn heart disease. This number comprised 21 patients (8.6%) with incomplete defects of the atrioventricular septum. Two patients died in the early postoperative period, two patients were lost from the records and 17 patients were subjected to clinical and echocardiographic examination two to 11 years after operation. All patients were in the 1st or 2nd functional class of the NYHA classification, signs of recanalization were found in one patient and progressing mitral regurgitation in two patients. Consistent with data in the literature, the authors consider it important, to check the patients regularly, incl. clinical and echocardiographic examination, after operations of incomplete defects of the atrioventricular septum and to focus special attention of progressing mitral regurgitation.

[Anomalous myocardial vascularization. Case report]. / Prípad anomální vaskularizace myokardu. Kasuistika.

A 52 years old woman was surgically treated at her 27 years of age for a defect of atrium septum of IInd type. The defect was covered by a patch taken from pericardium. The operation was followed twice by lung embolism. In 1986 there occurred deterioration of the condition. A recanalization of the defect was detected and the patient was recommended to operation. The operation was preceded by selective coronarography, which proved anomalous vascularization of myocardium in the left atrium. Echocardiography and computer tomography detected a pathological formation in this area. The suggested formation was not found during the operation. The explanation of anomalous vascularization of myocardium is believed to have been caused by a thrombus after the first operation; the thrombus may have caused proliferation of coronary vessels, then paradoxically resulted in lung embolism and the pathological vascularization persisted.

[Replacement of the aortic valve in patients over 60 years of age]. / Náhrady aortálních chlopní u nemocných starsích 60 let.

The authors evaluated a group of operated patients above 60 years of age where the main cardiosurgical operation was a aortic valve replacement. The early mortality in the group comprising 49 patients was 4.1%. (Of 33 patients where the replacement of the aortic valve was an isolated operation none of the patients died. From another 16 patients where also the mitral valve had to be replaced or IHD had to be resolved by revascularization of the heart muscle by aortocoronary bypasses, two patients died.) During a check-up examination one year after operation 92% of the checked patients where in functional group I or II according to NYHA classification (before operation all were in group III or IV). Prostheses of aortic valves do not only considerably prolong the life even in older patients but also improve its quality. Advanced age alone is no contraindication for operation and the surgical risk is not greater than in younger age groups. The authors recommend to implant in advanced age bioprostheses because of the markedly lower risk of serious haemorrhagic complications in the long-term postoperative course.

[Type II atrial septal defects in adulthood]. / Defekty sínového septa II. typu v dospelosti.

Indication criteria of adult patients with atrial septal defects type II for surgery are not uniform so far. In a group of 150 adult patients with atrial septal defects type II operated in 1978-1987 at the cardiosurgical department in Brno the authors report the following results: a mortality on operation of 0.7% and a very satisfactory postoperative condition in almost all patients. In a group of 16 patients examined in 1978-1987 but not operated because of a defect of the atrial septum type II of minor haemodynamic impact the authors observed after long-term follow up a deterioration of the health status in four patients and they express therefore doubts on the rigorous criterium for operation a 1.5:1 left-to-right shunt in adult patients and assume that in some instances the defect is indicated for surgery even when the shunt is small.

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.