[Myocardial infarction in the young - our results and experience]. / Infarkt myokardu v mladom veku - nase výsledky a skúsenosti.

AIMS: Coronary artery disease in young adults is important task of contemporary cardiology. Presented our results experience and opinion were obtained by our long term investigation of myocardial infarction in young patients under 40 years. METHODS: Two sets of patients were examined - 78 patients (74 men, 4 women) hospitalised in pretrombolytic era in prospective 8 years follow up (1984-1992) and 39 patients (35 men, 4 women) admitted during period 2000-2010 analysed retrospective. RESULTS: Myocardial infarction in young age belongs roughly to two different groups with considerable overlap in pathogenetic mechanisms: 1. angiographycally normal coronary arteries or unilocular nonsignificant atherosclerotic stenosis (less 50%) in 25-30% with thrombotic occlusion of one infarct related artery probably with substantial vasospastic component. Patients were younger (average 31.7 ± 3.7 years), dominant risk factors smoking, hyperlipidemia, excessive physical and emotional stress. Disease course and prognosis are favourable. 2. premature accelerated atherosclerosis with significant (more 50%) in 70-75 % often multivessel affection. Pts were significantly older (average 35.8 ± 2.6 years; < 0.001) bad risk factors profile, worse clinical course and poor long-term prognosis. CONCLUSIONS: Study of myocardial infarction in young adults indicates: great role of risk factors, mainly smoking, hyperlipidemia, family history and type A behaviour, hostility with participation of low education level and social inequality (unemployment). Noticeable are hypercoagulable states and trauma. Dominancy of men (90-95%). Prognosis depends on age, extend of coronary atherosclerosis and residual cardiac function. Disease picture has not been changed during last 30 years. Aggressive control over risk factors is unavoidable. Current requirement is to evaluate impact of modern treatment strategy on long-term survival. Key words: coronary artery disease - myocardial infarction at young age.

Clinical and hemodynamic picture of Eisenmenger syndrome.

Eisenmenger syndrome represents a very specific form of pulmonary arterial hypertension (PAH). Unlike patients with idiopathic PAH, in Eisenmenger syndrome the clinical and cardiac status is often relatively stable for a long time. On the other hand, due to cyanosis and due to maladaptive body reactions many noncardiac complications may occur. Fourteen patients (pts) with Eisenmenger syndrome were analyzed, with the mean age 41 years. Invasively measured pre-capillary pulmonary hypertension was severe (mean pulmonary arterial pressure 79 mmHg) and a statistically significant difference according to the site of defect was found (pre-tricuspid shunts vs post-tricuspid shunts = 57,5 mmHg vs 88 mmHg; p = 0.01). It is neccessary to keep in mind that non-cardiac events and complications may lead to death sooner then the right ventricular dysfunction or PAH (Tab. 7, Fig. 21, Ref. 16).

Initial experiences with novel therapy for pulmonary hypertension in Slovakia.

Pulmonary hypertension (PH) is the most serious and potentially devastating chronic disorder of the pulmonary circulation with diverse etiologies and pathogenesis characterized by abnormal increased vasoconstriction and vascular remodelling. Current specific therapy of PH is based on an understanding of its pathogenesis and is acting through pathogenic pathways and therefore changes therapeutic strategy, effectively improves clinical course and prolongs life. The authors discuss the actual classification, pathogenesis in short and particularly actual treatment modalities and the impact on the natural history of this disorder. In chronic thromboembolic pulmonary hypertension is pulmonary endarterectomy if correct indicated the curable method, warranted substantial improvement of life quality and survival. These novel therapies of PH were absent in Slovakia until recently. The authors present initial experiences, results of PH management up to date on the basis of cooperation with PH centres in Austria and Czech Republic (Tab. 1, Fig. 6, Ref. 32).

The internal mammary artery bypass--the principles of preoperative and postoperative diagnosis using colour-duplex ultrasound.

BACKGROUND: The aim of the study was the assessment of functional characteristics of the left internal mammary artery (LIMA) bypass in patients after coronary artery bypass grafting (CABG) in comparison with the native LIMA using colour-duplex ultrasound as the non-invasive diagnostic method. METHODS: We examined 303 patients after myocardial revascularization with the internal mammary artery bypass using the Hewllett Packard 2500, 5500 ultrasound units. Using the 7.5 MHz linear transducer we detected the LIMA from the left supraclavicular approach. We assessed the peak systolic velocity (PSV--cm/s), peak diastolic velocity (PDV--cm/s), end-diastolic velocity (EDV--cm/s) and we calculated the peak systolic/peak diastolic velocity ratio (SDVR) and resistance index RI (PSV-EDV/PSV). The obtained parameters were compared with the native LIMA flow characteristics of the 70 consecutive patients before CABG. RESULTS: We observed the transformation of internal mammary artery flow from the predominantly systolic high resistance type of the native LIMA, to the low resistance biphasic waveform after its use as a coronary artery graft. We detected a significant increase of diastolic flow velocities and a significant decrease of resistance and of the SDVR ratio. In dysfunctional grafts we found a decrease of diastolic flow and an increase of LIMA resistance and SDVR. CONCLUSION: The colour-duplex ultrasound is a perspective non-invasive method for the postoperative follow-up of patients with the LIMA graft. It allows the assessment of the bypass flow characteristics, functional status and patency and it could contribute to the early diagnosis of bypass failure. (Fig. 6, Tab. 4, Ref. 21.)

[Hematologic aspects of heart transplantation]. / Hematologické aspekty transplantácie srdca.

Heart transplantation is an accepted therapeutic method for end-stage heart failure. The aim of the presented paper is to provide a short review of haematologic problems of heart transplantation. Haemostatic disorders, cytopenias and lymphoproliferative diseases are the most frequent haematologic complications of this highly sophisticated procedure. Perioperative bleeding tendency is due to cardiopulmonary bypass, both qualitative and quantitative platelet disorders and hyperfibrinolysis are the main causes. Incidence of cytopenias (mono- and/or bi- and/or tricytopenia) reaches up to 70%. They are multifactorial as to etiology and coincidence with viral infection, antimicrobial and immunosuppressive therapy. Lymphoproliferative disease affects about 1.2% of patients during the first year after transplantation. Posttransplant lymphoproliferative diseases are highly variable as to manifestation and prognosis-ranging from indolent course to rapid, aggressive growth. Routine cytostatic therapy is generally ineffective. Crucial therapeutic measure is to turn off immunosuppressive therapy. (Tab. 3, Fig. 2, Ref. 41).

[Endomyocardial biopsy in cardiopathy of unknown origin]. / Endomyokardiálna biopsia u kardiopatií nejasného pôvodu.

The authors described their experiences with endomyocardial biopsy (EMB) in 21 adult patients aged from 18 to 59 years with the preliminary diagnosis of cardiopathy of uncertain origin (CPUO). Their definition of CPUO is as symptoms and/or findings of cardiac disease, which cannot be exactly identify using even complex clinical and noninvasive cardiological diagnostic procedures. Diagnostic value of EMB was substantial in two of their patients (in one hypereosinophilia of myocardium, and in another amyloidosis), non specific results were found in 18 patients, and 1 patient had normal pattern of the biopsy. EMB is useful and safe clinical diagnostic procedure in exactly defined groups of patients.

5-Deoxy-5-fluoro-L-sorbose originating from 2-deoxy-2-fluoro-D-glucitol by fermentation with Acetomonas oxydans.

Using fermentation with a selected strain of Acetomonas oxydans it was possible to convert 2-deoxy-2-fluro-D-glucitol to 5-deoxy-5-fluoro-L-sorbose, in agreement with Bertrand's and Hudson's rule. The last-named compound was isolated in a yield of 88%. Both compounds were little toxic against Acetomonas oxydans.