[Initial experience with laparoscopic adrenalectomy]. / Prvé skúsenosti s laparoskopickou adrenalektómiou.

We present the first experience with laparoscopic adrenalectomy, which was in Slovakia introduced to the surgical practice on March 3, 1996. We analyse first seven patients who underwent completed laparoscopic adrenalectomy (five leftsided, two right-sided). Four patients had cortex adenoma (clinically 2 incidentalomas and 2 Cishing syndroma), three patients had cortex hyperplasia (clinically Conn syndroma). Average duration of operation was 120 minutes, there were no postoperative complications. Average postoperative hospital stay was 5 days. Our initial experiences are comparable with that of surgical departments which has more than two-years experiences. Laparoscopic adrenalectomy is a perfect method for the small adrenal tumors and it is better than traditional transabdominal approach.

[Evaluation of planimetric parameters in various mechanical heart valve prostheses]. / Hodnotenie planimetrických parametrov rôznych mechanických chlopnových srdcových protéz.

Authors make an analysis of 9 currently used mechanical valves and the mounting area of the valve is defined as 100%. They compare the following parameters: 1-area of the fixed part of the prostheses, 2-area of the moving part of the valve in open position, 3-effective orifice of the valve. As 4-the parameter is the evaluation of number of central opening. Parameters of the primary orifice area are the most important. From the results of the study we got the following list number: 1 Omniscience, 2 Sorin bileaflet valve, 3 CarboMedics, 4 St. Jude Medical, 5 Medtronic, 6 Bicer, 7 Björk-Shiley Monostrut, 8 B-S sferic disc and 9 B-S convex-concave valve.

[A mechanical heart valve prosthesis with a spherical shape and open center]. / Mechanická srdcová chlopnová protéza sférického tvaru s otvoreným stredom.

A mechanical valve prosthesis is described with central blood flow. The generations I and II of the mechanical valve obstruct the blood flow and cause turbulence with undesirable consequences. The opening in the centre of Simkovic-Bolf valve preserves the laminar blood flow, reduces the trauma of blood and myocardium stress. Our new valve represents a mechanical valve prosthesis of generation III. (Fig. 5, Ref. 16.).

[A new type of construction of artificial heart valves]. / Nová konstrucia umelých srdcových chlopní.

All mechanical valve prosthesis have a moving part that during systole totally or partially obstructs the opening area of the valve. As the result the flow of blood to the left ventricle or to the aorta is restricted. The authors present mechanical valve proSthesis with central opening during diastole and have its function similar to the human valve.

[The first selective coronarographies in the former Czecho-Slovakia]. / Prvé selektívne koronarografie v bývalom Cesko-Slovensku.

The study observes the history and the beginning of selective coronarographies performed in the territory of the Slovak Republic. The first aortocoronary bypass in Slovakia was performed in Bratislava. It was realized by the team of the Surgical Clinic of Academician Dérer in november 1969, namely on the basis of coronarographic examinations which were performed by Smrecanský, Cagán and Krajcovic. Coronographies have been performed in the Central X-ray Department of the Hospital and Clinic of Academician Dérer since the end of the year 1968. During the period of december 1968 to june 1970 selective coronographies were realized in 70 patients and they represented the first performances of this method in former Czechoslovakia. (Ref. 8.)

[Late postoperative complications after primary treatment of aortic coarctation]. / Neskoré pooperacné komplikácie po primárnom riesení koarktácie aorty.

During the period between 1963 and 1988, 343 patients were operated due to aortic coarctation. 14 patients (4%) were necessarily reoperated for late postoperative complications. In 3 cases (0.8%) reoperation was indicated due to the development of aneurysm in the region of primary operation of aortic coarctation. The development of aneurysm is prevalently predisposed by Vosschulte's indirect aortoplastic operation by the use of a synthetic patch. In the remaining 11 patients (3.2%) the reoperation was indicated owing to the development of recoarctation. Today recoarctation concerns children which were operated under the age of two. The most important moment favourable for the recoarctation development is the secondary constriction of the repaired region in consequence of the coarctation listel fibroid tissue and owing to the incapability of the anastomosis to grow. The perspective rests on using new suture material and combined techniques. Late postoperative complications which follow operations performed due to aorta coarctation remarkably augment the peri and postoperative mortality. Three cases out of the given group of 14 patients terminated by exitus (21%). Hence, it is necessary to remove all moments of predisposition creating a condition favourable for the development of recoarctation and aneurysm. (Tab 2, Fig. 1, Ref. 14.).

[Surgical treatment of supravalvular aortic stenosis]. / Operacná liecba supravalvulárnej aortálnej stenózy.

Over the last 22 years, two children were operated on for supraventricular aortic stenosis at the Institute of Cardiovascular Diseases in Bratislava. Both cases presented a localized form of supravalvular aortic stenosis. Simple elipsoid flaps were used without extended aortoplasty. One of the two children, a 12-year-old boy with Williams' syndrome died of endocarditis in the early postoperative period. In the 10-year-old girl with familial supravalvular aortic stenosis the operation was successful, although the defect was combined with supravalvular muscular obstruction. The authors emphasize the possibility of choice between two surgical procedures according to the localization of the stenosis with respect to the valvular apparatus.

[Endarterectomy of the coronary arteries]. / K problematike endarterektómie koronárnych artérií.

The authors analyze 50 patients with endarterectomy of the coronary arteries during the periods of 1972-1974 and 1988-1990. The results of endarterectomy of the right and left coronary artery provide evidence of its justification in indicated cases whereby contrary to some departments the results of endarterectomy of the left coronary artery are comparable with endarterectomy of the right coronary artery.

[Indications for cardiac surgery on the basis of noninvasive examination methods with major emphasis on echocardiography]. / Indikácie kardiochirurgického výkonu na základe neinvazívnych vysetrovacích metód s hlavným zretel'om na echokardiografiu.

Over the years 1983-1988 cardiosurgical procedures with extracorporeal circulation without catheterization of the heart were indicated in 191 patients, representing 19.8% of all the patients operated on at extracorporeal circulation (n--962). Indications for surgery were made on the basis of the clinical state of the patient and of the results of noninvasive methods, with main emphasis on echocardiographic findings. The close relationship between the methodological level of ultrasound diagnosis and the increasing number of patients operated on without preceding hemodynamic examination is documented (13% in 1983, 35% in 1988). With a few exceptions, noninvasive techniques provide a sufficient amount of relevant information definitely deciding on the indication for operation without catheterization in heart tumors and infective endocarditis, in about one half of the patients with dissecting aneurysm of the aorta and with deranged function of valvular prostheses, in one third of the patients with mitral defects, and in about one third of the patients with atrial septal defects. On the basis of their own results, the authors present the criteria for indicating cardiosurgical procedures without catheterization of the heart in the diagnoses studied. The diagnostic conclusion was confirmed by the operative finding in 99.5%. The obtained results are comparable with those reported by authors from abroad and demonstrate the significant medical and economic contribution.

[In vitro comparison of properties of aortic allotransplants and the Björk-Shiley valve]. / In vitro porovnanie vlastností aortálnych allotransplantátov a chlopne Björk Shiley.

The authors performed an in vitro test and compared some hydrodynamic parameters of Björk Shiley valves and aortic allotransplants. Both types of valves are comparable from the aspects of most parameters. The Björk Shiley valve gives some better values with the exception of sufficiency. The great scatter of assessed values in biological valves draws attention to the necessity to make the test before implantation. From the hydrodynamic aspect the authors consider allotransplants valvular prostheses suitable for implantation. Ref. 5, Tab. 1.

[Surgery of congenital heart defects in adulthood]. / Operácie niektorých vrodených srdcových chýb v dospelosti.

During the period between 1983-1989 the authors operated 165 patients with the diagnosis of coarctation of the aorta, 197 cases of patent ductus arteriosus and 360 atrial septal defects. In all diagnostic groups they operated a large number of patients above 10 years of age whereby the oldest patient with a septal defect was 57 years old, patients with coarctation of the aorta or a patent ductus arteriosus 35 years old. The authors discuss the reasons why the patients were indicated for operation so late.

[The hypereosinophilic syndrome in a child with endomyocardial fibrosis treated surgically]. / Hypereozinofilný syndróm dietata s endomyokardiálnou fibrózou riesený operacne.

The authors describe the case-history of a 12-year-old patient with hypereosinophil syndrome, endomyocardial fibrosis of the left ventricle and dominating mitral valve insufficiency. By correction of the insufficiency, using a Carpentier ring, the authors achieved substantial improvement of the haemodynamics. One year after operation the patient is cardially compensated.

[Atrial septal defects: the importance of peroperative morphometric evaluation of defects]. / Defekty predsienového septa: význam peroperacného morfometrického hodnotenia defektov.

The authors analyze the results of preoperative morphometry of atrial septal defects. They compare the area of the defect and the septal area in different types of defects. Based on the thus obtained relative value, they select either suture of the defect or its correction by means of a patch. They emphasize that during correction defects deformations and reduction of the septal area must be avoided. They do not admit the possibility that the suture of the defect is exposed to traction. Ostium secundum defects the area of which is greater than 40% of the septal area are suited for correction by means of a patch. An important indicator is the transverse dimension of the defect and of the septum. This relation determines the grade of deformity during an inadequately selected suture and the presence of traction mechanisms in the area of the suture and cardiac skeleton. The authors recommend more frequent use of patches also in ostium secundum defects in the cranial lateral and distal part of the atrial defect.

[Endarterectomy of the coronary arteries]. / Endarterektómia koronárnych artérií.

The authors present an account, based on their clinical material, of 15 endarterectomies of the coronary arteries, which from the chronological aspect are divided into two groups. The first six were performed in 1972-1974 without the use of cardioplegia, total cardias arrest, only with ventricular fibrillation, with a 50% rate of success. The series of the remaining nine patients was operated during the period between October 1987 and the end of 1988 under far more favourable conditions, using cold cardioplegia, hypothermia and total cardias arrest. Only one patient died 24 hours after operation, the remaining eight patients are being followed up for one to 14 months after operation. In six patients endarterectomy of the right coronary artery was performed and in three instances in the area of the r. interventricularis of the left coronary artery. There was no case of perioperative myocardial infarction. The immediate postoperative development of the patients is promising and encourages us to proceed with this surgery (endarterectomy of the coronary artery) which is the only alternative method in the group of patients with diffuse distal arteriosclerosis of the coronary arteries.

[Anomalies of venous drainage of the left lung]. / Anomálna venózna drenáz l'avých pl'úc.

The authors present their experiences with diagnosis and surgical treatment of anomalous venous drainage of the left lung into the left innominate vein. The anomaly was found only in four out of 704 patients operated on for atrial septal defect. In three patients in whom leftsided anomalous pulmonary venous drainage was associated with atrial septal defect, the derangement was corrected by using extracorporeal circulation. The patient who had no atrial defect was operated on without extracorporeal circulation on applying leftsided thoracotomy. The mean age of the patients was 26.25 years. After correcting the defect, drainage of the left lung into the left atrium was found satisfactory in all operated patients. Exact assessment of the possibility of an associated intracardiac defect is being emphasized, as it is crucial for selecting the appropriate surgical approach.

[Microcomputer-assisted system for photographing the movements of biological valve prostheses]. / Mikropocítacom riadený systém fotografovania pohybu biologických chlopnových protéz.

The aim of the study was to develop a clinically usable system of photographic imaging of the movements of biological valve transplants and of evaluating temporal and spatial relationships. The system has been established by means of a microcomputer and associated peripheral electronic equipment so that there is no need to use a high-speed camera. Functioning of the system was verified by testing 37 aortal valve allotransplants and the Björk Shiley mechanical valve prosthesis.

Post-traumatic coronary occlusion and its consequences in a young child.

A 250-kg metal plate fell on a six-year-old boy. The resulting internal, nonpenetrating trauma caused multiple coronary arterial occlusions leading to complete heart block and ischemic changes in the electrocardiogram. Later two left ventricular aneurysms developed that were resected.