[Mycotic aneurysm of the coronary artery]. / Mykotické aneuryzma koronární arterie.

Mycotic aneurysm of the coronary artery occurs in less than 1% of patients with infective endocarditis and only few cases of successful treatment has been described in the literature. The paper presents a case of 64 years old man with infective endocarditis of the mitral valve, complicated with a development of mycotic aneurysm of the right coronary artery, who was successfully surgically treated.

[Uncommon indications for coronary angioplasty]. / Méne obvyklé indikace ke koronární angioplastice.

During the period between March 16, 1989 and October 7, 1992 at the Second Medical Clinic of the First Medical Faculty, Charles University Prague a total of 173 coronary angioplasties were performed. With expanding experience and greater availability of controllable super thin conductors and balloon catheters with a small profile, gradually the indication criteria of coronary angioplasty were extended. In 93.1% of patients simple balloon dilatation of a significant stenosis of the coronary arteries was performed and in 6.9% before dilatation in addition an attempt of recanalization of a chronic occlusion of the coronary artery was made. In 74% of the patients one coronary stenosis was dilated, in 16.7% several stenoses, in 1.2% of the patients a covered stenosis of the trunk of the left coronary was dilated and in the same number an aortocoronary bypass was performed. Even in the group of patients where only one coronary stenosis was dilated the type B coronary affection according to the classification ACC/AHA predominated and the same applied to the entire group of patients.

[Occurrence and prognosis of silent ischemia]. / Výskyt a prognóza nemé ischémie.

The authors assessed in a group of 486 asymptomatic middle-aged men (50-60 years) the prevalence of silent myocardial ischaemia. For screening they used the exercise test on a bicycle ergometer and in men with a positive test the presence of silent ischaemia was confirmed by perfusion scintigraphy with thallium-201 or by. The prevalence of silent ischaemia was compared with the incidence of angina angiography, myocardial infarction and sudden deaths in a similar group of 1419 men followed up for 10 years in the same department. In patients with a confirmed diagnosis of silent ischaemia the prognosis was monitored, as well as possible clinical manifestations of IHD, in the course of 4-7 years of the investigation. The presence of silent ischaemia was confirmed in 32 men, i.e. 6.6%. As compared with other forms of IHD, silent ischaemia was detected almost equally frequently as myocardial infarction and as compared with angina pectoris it was observed twice as frequently. In the course of the investigation period two patients were subjected to a revascularization (CABC or PTCA). In the remaining group of 30 patients who underwent conservative treatment two patients died (sudden deaths), seven developed angina and five myocardial infarctions (incl. one clinically silent).

[Early results and complications of percutaneous transluminal coronary angioplasty]. / Nase casné výsledky a komplikace perkutánní transluminální koronární angioplastiky.

The authors summarize the early results of coronary angioplasty in 234 patients, with special emphasis on complications. The follow-up group included 182 men (77.8%) and 52 women (22.2%) with a mean age of 52 (34-74) years. Single-artery involvement prevailed (216 patients, 92.3%); multiple artery involvement was diagnosed in 18 patients (7.7%). Overall, dilatation was performed in 273 stenoses; of this number, 213 procedures were successful (78.0%). The primary success rate in the whole group was 76.9% (180/234). The highest success rates were attained in concentric stenoses (88.8%), the lowest ones in complete occlusions (53.8%). Complications were present in 36 patients (15.3%), of this number 14 patients (5.9%) developed acute arterial occlusion; the complications were less severe in 22 patients (9.4%). Of the 14 patients with acute occlusion, eight (3.5%) developed severe complications. One female patient (0.43%) died, one (0.43%) had emergency surgery, and six (2.6%) developed uncomplicated acute myocardial infarction. Perfusion was restored by multiple dilatation in four patients; arterial occlusion, with good collateral circulation, did not result in myocardial infarction in two. Other complications were less severe and had no sequelae including, most often, arterial spasm (3.4%), large dissection demonstrated by angiography (2.6%), protracted hypotension (0.8%), and ventricular fibrillation in one case (0.43%). The article also considers the factors raising the risk of severe complications of coronary angioplasty, and the potential for their prevention and treatment. Coronary angioplasty, employed in an increasing number of patients with symptomatic stenosing atherosclerosis of the coronary arteries, is an effective method successful in 85-95% of patients. The complication rate, while low, is not absolutely negligible.(ABSTRACT TRUNCATED AT 250 WORDS)

[Noninvasive diagnosis of coronary spasm]. / Moznosti neinvazivní diagnostiky koronárních spazmu.

The objective of this work was to compare the sensitivity of non-invasive tests used for the diagnosis of variant angina pectoris (VAP). In a group of 38 patients with VAP the authors compare the sensitivity of the cold test (CT), hyperventilation test (HT), handgrip (HG), bicycle ergometry (BE) and a newly suggested combination of hyperventilation with HG and BE resp. The authors evaluated first the sensitivity of ST elevations which are an entirely specific sign and in particular denivelization of ST (by depression or elevation) which is a less specific sign. The sensitivity of different tests was as follows: CT 5% and 5% resp., HT 18% and 39% resp., HG 13% and 29% resp., BE 26% and 66% resp., HV+HG 37% and 63% resp., HV+BE 50% and 87% resp. Then the authors assessed the sensitivity of repeated examinations HV+HG 47% and evaluation during denivelization of ST 63%, HV+BE 66% and 89% resp. The authors evaluated moreover the sensitivity of ST elevations in patients according to the activity of the disease. Patients with at least five stenocardias per week had a higher sensitivity, as compared with patients with less frequent attacks: HV+HG 42% and 25% resp., HV+BE 60% and 33% resp. The highest sensitivity was found in a combination of HV+BE. Repetition of the test in case of a negative result increased markedly the sensitivity, a higher sensitivity was found also in patients with more frequent stenocardias.

[Recording of monophasic action potentials using a contact catheter in humans. Preliminary report]. / Moznost zápisu monofázového akcního potenciálu kontaktním katétrem u cloveka. Predbezné sdelení.

Investigations of a monophasic action potential (MAP) at a cellular level in experiments provided basic findings on the course of the electric activity in cells in various cardiac compartments and tissues under physiological conditions and various pathological states and has become an indispensible part of the evaluation of electrophysiological properties of various cardiovascular drugs, in particular antiarrhythmic drugs. A record corresponding to the MAP can be obtained also from the surface of the human endocardium during catheterization by means of a Franz contact catheter. MAP is induced by pressure depolarization after applying the catheter to the endocardium of different cardiac compartments. The objective of the author's preliminary communication is to present the initial experience with the MAP record from right-sided cardiac compartments during a routine electrophysiological examination in five patients at rest, during increasing stimulation of the atria and ventricles and after administration of some antiarrhythmic drugs. The authors evaluated the duration of MAP, the duration of 10%, 50% and 90% repolarization, the MAP amplitude, the activation time, repolarization time and the incidence of spontaneous diastolic depolarization. The recording and evaluation of MAP during the routine electrophysiological examination can contribute to the understanding of the development of arrhythmias, the action of antiarrhythmic drugs and to the evaluation of ischaemic changes of the myocardium. The clinical impact of MAP records is not clear so far and its assessment will call for further experience with this method.