[The importance of electrocardiographic changes at rest during exercise in deciding to perform immediate ("ad hoc") percutaneous transluminal coronary angioplasty]. / Význam elektrokardiografických zmien v pokoji a pri zát'azi pre rozhodnutie o bezprostredne vykonanej ("ad hoc") perkutánnej transluminálnej koronárnej angioplastike.

In 100 patients (75 men and 25 women, mean age 53 years) who had "ad hoc" percutaneous transluminal coronary angioplasty (PTCA) on one or two vessels retrospectively the ECG records were evaluated (signs of necrosis or ischaemia) at rest and/or after exercise and compared with the finding of major obstruction (complete occlusion, stenosis > 50%) on coronarography. In obstruction of the ramus interventricularis anterior the positive ECG finding was consistent with the area of the impaired blood supply in 87%, in case of obstruction of the right coronary artery in 79%, in obstruction of the ramus circumflexus in 90%. In concurrent obstruction of two coronaries despite a 100% positive ECG no close topical correlation was found between coronarography and ECG. On the whole no reliable consistency was found between ECG and kinetic disorders detected by echocardiography. The results indicate that topical analysis of ECG ischaemic findings in patients with coronary arterial disease before planned coronarography contributes to the decision to make "ad hoc" PTCA in affections of one artery. In affections of two arteries ECG is of no particular value.

Value of echocardiography in results evaluation of transcatheter atrial septal defect closure in adults.

Transcatheter closure of secundum atrial septal defect using Amplatzer occluder is accepted treatment modality. Transthoracic (TTE) and transoesophageal (TEE) echocardiography provides indispensable informations in the selection of eligible atrial septal defects, evaluates the exact size, location and morphology of the defect. In the closure procedure assistance of TEE enables precise determination of device size, correct placement of the device and immediate and follow-up closure results assessment. The present prospective study was performed in order to investigate the value of both approaches--TTE and TEE in the intermediate-term follow-up. Before, during transcatheter defect closure and in the follow-up echocardiography studies [TTE and TEE] were performed in 33 adult patients with secundum atrial septal defect with fulfilled TEE criteria. Correct placement of the device without interference with surrounding structures under TEE monitoring was possible in all patients. Immediate complete closure was achieved in 49% of patients, after 3 months in 94%. TEE findings corresponded well with TTE. In the follow-up echocardiographic signs of right ventricle overload retreated. Results indicate that TEE provides valued data for the selection and closure procedure. TTE is a sufficient reliable approach for results evaluation in intermediate follow-up. Echocardiography plays crucial role in the safety and efficacy assessment of transcatheter treatment of secundum atrial septal defect.

Echocardiography and exercise electrocardiography in the assessment of long-term outcome after percutaneous mitral valvuloplasty.

Before and immediate (invasive examination) and long-term follow-up (4.5 year; echocardiography, exercise electrocardiography) studies after percutaneous transvenous mitral valvuloplasty (PTMV; Inoue technique) were prospectively performed in 123 consecutive patients with pure or dominant mitral stenosis. These patients consisted of two groups: Group A with suitable valve morphology (n = 108, mean age 49.6 years, echocardiographic score 8.2 +/- 1.5), and Group B with less favourable valve morphology (n = 15, mean age 59.3 years, echocardiographic score 11.3 +/- 2.3) rejected for surgery because of high surgical risk. PTMV is a safe and effective nonsurgical method of treatment for symptomatic mitral stenosis and has long-lasting results in patients with pliable mitral valve as well as in patients with less suitable valve morphology. Echocardiography (Doppler approach) is the most efficient noninvasive method for assessment of PTMV effect. Exercise electrocardiography test is a valuable complementary method for objective measurement of patient working capacity and to confirm the success of PTMV.

[Invasive diagnosis, transcatheter and surgical treatment of acute coronary syndromes]. / Invazívna diagnostika, transkatétrová a chirurgická liecba akútnych koronárnych syndrómov.

On the basis of long-term personal experiences and critical evaluation of the present literatury sources authors described the role of invasive diagnostic methods and transcathetral and cardiosurgical possibilities in the recognition and therapy of acute coronary syndromes. These techniques are, and in the forthcoming year shall be available only in specialized institutions. The paper describes the indication for these aggressive techniques as well as their limitations and complications. The goal of the presented article is to inform both the cardiological and frequently broad physicians' societies about the possibilities of diaventional cardiology and cardiosurgery which will be gradually more applied in the care of the patients with acute coronary syndromes. (Ref. 39, Tab. 2, Fig. 3.)

Invazivna diagnostika, transkatetrova a chirurgicka liecba akutnych koronarnych syndromov.

On the basis of long-term personal experiences and critical evaluation of the present literatury sources authors described the role of invasive diagnostic methodes and transcathetral and cardiosurgical possibilities in the recognition and therapy of acute coronary syndromes. These techniques are, and in the forthcoming year shall be available only in specialized institutions. The paper describes the indication for these aggressive techniques as well as their limitations and complications. The goal of the presented article is to inform both the cardiological and frequently broad physician s societies about the possibilities of diaventional cardiology and cardiosurgery which will be gradually more applied in the care of the patients with acute coronary syndromes. (Ref. 39, Tab. 2, Fig.3.).

[Arrhythmogenic right ventricular dysplasia]. / Arytmogénna dysplázia pravej komory.

Arrhythmogenic dysplasia of the right ventricle as a nosological entity was described relatively recently. However, at present, it is gradually being diagnosed more frequently. The authors describe the typical clinical picture of this disease in one of several patients with this disease, who were hospitalised at SUSCH. The authors describe the diagnostical value of individual findings. They indicate the importance of knowledge of individual diagnostical criteria in order to be able to recognize this disease and distinguish it from idiopathic ventricular tachycardia, the prognosis of which is generally better and also the therapeutical approach less aggressive. (Fig. 6, Ref. 29).

[Angiocardiography of cardiopathy of unknown origin]. / Angiokardiografia kardiopatií nejasného pôvodu.

Authors described their experiences with angiocardiography, (selective coronarography and left ventriculography), in 41 patients aged from 32 to 59 years with the preliminary diagnosis of cardiopathy of unknown origin. The patients with diagnosis of cardiopathy of unknown origin were those, who cannot be assigned to any of the known and acknowledge diagnostic categories, not even by using complex clinical, laboratory and noninvasive cardiological diagnostic procedures. Angiocardiography enabled to produce new and unexpected data of diagnostic value three patients with heart disease (all of the three mentioned patients had significant changes of the coronary supply, i.e. the reduction in lumen diameter of the coronary vessel being of more than 50% with local or total wall motion abnormalities). The other thirty-eight patients had normal findings of the coronary supply. One patient had a normal coronarographic findings, normal left ventricular wall motion and also the subsequent histological examination from the endomyocardial bioptic sample of the heart tissue, did not confirm pathological abnormalities. Selective coronarography and left ventriculography is a useful and safe clinical diagnostic procedure in exactly defined groups of patients.

[Heart transplantation--one possibility in the treatment of advanced congestive heart failure]. / Transplantácia--jedna z mozností liecenia pokrocilého kongestiívneho zlyhania srdca.

The authors present epidemiological data about congestive heart failure, its most common etiology and prognosis. They justify the performance of heart transplantation (HTx) in the treatment of congestive heart failure. They analyze the present state of HTx in the world and describe also the history of HTx in Slovakia. They present the review of contraindications and indications for the inclusion of recipients into the HTx programme and describe the further fates of these patients. They regard the HTx as an integral component of the therapeutical approach to the precisely defined group of patients with otherwise refractory congestive heart failure. (Tab. 4, Fig. 6, Ref. 38.)

[Analysis of risk factors for perioperative myocardial infarct in aortocoronary bypass]. / Analýza niektorých perioperacného infarktu myokardu pri aortokoronárnom bypasse.

BACKGROUND: Perioperative myocardial infarction (PMI) belongs to the main complications of revascularization surgery of the heart. Perioperative analysis of PIM risk factors can aid the cardiosurgeons, anestesiologists and cardiologists to stratify the group exposed to the risk of PIM origin and to prepare the most appropriate complex peroperative procedure for this group of patients. AIM: The particular aim is to evaluate and analyze some PIM risk factors prior to and during surgery. METHODS: The paper represents a retrospective study which analyzes two period (1984-1986 and 1992). The total number of patients in the investigated group is 277. The group afflicted with PIM is constituted of 29 patients. The following clinical, hemodynamic, angiographic risk factors are analyzed prior to surgery: age, sex, precedence of infarction of myocardium, arterial hypertension, instabile angina pectoris, end-diastolic pressure and left ventricular ejection fraction, affliction of the main trunk of the left coronary artery and some peroperattive factors (number of grafts, sequence bypass, endarterectomy, completion of revascularization, a. mammaria interna graft, duration of the artificial vascular circuit and clamping of the aorta). RESULTS: Significant relation for the pIM origin was found in arterial hypertension (p<0.05), affliction of the main trunk (p<0.05), prolonged period of clamping of the aorta (p<0.05 in 1984-86, p<0.01 in 1992) and artificial vascular circuit (p<0.001). CONCLUSION: The basic PIM risk factors include the following: arterial hypertension prior to surgery, affliction of the main trunk of the left coronary artery, prolonged duration of the artificial vascular circuit and clamping of the aorta. MEANING FOR PRACTICE: 1. The analyzed problem represents a positive feedback for cardiosurgeons, anestesiologists and cardiologists. 2. The analysis of the risk factors can be utilized also by future surgical workplaces in the Slovak Republic.

[Personal experience with determination of endogenous, digoxin-like substances in patients with myocardial infarct and other cardiopathies]. / Nase skúsenosti s vysetrením endogénnych, digoxínu podobných látok u chorých s infarktom myokardu a inými kardiopatiami.

A group of 65 patients with acute infarction of myocardium (IM) who were not treated with digitalis preparations were subdued to examination to the presence of digitalis-like substances in their urine by means of radioimmuno-analytic method with use of anti-digoxin antibodies. The control group was constituted of 69 healthy subjects. Patients afflicted with IM had significantly increased concentrations of DLS in serum in comparison with health subjects. No significant relations of DLS to the activity of creatinkinase, IM localisation, occurrence of dysrhythmias, heart insufficiency and IM mortality were discovered. An increase in DLS in the blood of patients with acute IM probably coincides with a decreased cardiac output, with the activation of the stress axis and retention of sodium and fluids. The second examined group of patients was constituted of 20 subjects with other severe cardiopathies (inborn and acquired heart defects, chronic ischemic heart disease, inflammatory and degenerative diseases of the heart, and hypertension), who were subdued to catheter examinations. The authors discovered no significant differences of DLS concentrations in the blood during catheterization of individual compartments of inferior vena cava, superior vena cava, and the right ventricle. They were not successful in defining the particular site of DLS secretion on the basis of this examination. The authors pay attention to interaction of DLS during the radioimmuno-analytic examination of the digoxin serum concentration.

[Thrombosis and thromboembolism in patients with a Björk-Shiley prosthesis]. / Trombóza a tromboembolizmus u chorých s Björkovou-Shileyovou protézou.

Thrombosis and thromboembolism are, in addition to left ventricular function, the basic factors which deteriorate the score and long-term prognosis in patients with valvular prostheses. The authors analyze the problem of thrombosis and thromboembolism in 261 patients with Björk-Shiley's prosthesis who were operated during the last five years. The authors consider as the main risk factors in the first place inadequate anticoagulation treatment, the position of the implant in the mitral orifice, the type of valvular implant and atrial fibrillation. The authors present a brief account of successful thrombolysis of a thrombotized Björk-Shiley prosthesis in the mitral orifice, the basic diagnostic procedure when thrombosis of an artificial valve is suspected and possible ways how to reduce the risk of thrombosis and thromboembolism.