High-Altitude Decompression Sickness Treated with Hyperbaric Therapy and Extracorporeal Oxygenation.

BACKGROUND: High-altitude decompression sickness (HADCS) is a rare condition that has been associated with aircraft accidents. To the best of our knowledge, the present paper is the first case report of a patient treated for severe HADCS using recompression therapy and veno-venous extracorporeal oxygenation (VV-ECMO) with a complete recovery.CASE REPORT: After depressurization of a cabin, the 51-yr-old jet pilot was admitted to the Military Institute of Medicine with a life-threatening HADCS approximately 6 h after landing from a high-altitude flight, in a dynamically deteriorating condition, with progressing dyspnea and edema, reporting increasing limb paresthesia, fluctuating consciousness, and right-sided paresis. Hyperbaric oxygen therapy in the intensive care mode was initiated. A therapeutic recompression with U.S. Navy Treatment Table 6 was performed with neurological improvement. Due to cardiovascular collapse, sedation, mechanical ventilation, and significant doses of catecholamines were started, followed by continuous veno-venous hemodialysis. In the face of disturbances in oxygenation, during the second day of treatment the patient was commenced on veno-venous extracorporeal oxygenation. Over the next 6 d, the patient's condition slowly improved. On day 7, VV-ECMO was discontinued. On day 19, the patient was discharged with no neurological deficits.DISCUSSION: We observed two distinct stages during the acute phase of the disease. During the first stage, signs of hypoperfusion, neurological symptoms, and marbled skin were observed. During the second stage, multiple organ dysfunction dominated, including heart failure, pulmonary edema, acute kidney injury, and fluid overload, all of which can be attributed to extensive endothelial damage.Siewiera J, Szalanski P, Tomaszewski D, Kot J. High-altitude decompression sickness treated with hyperbaric therapy and extracorporeal oxygenation. Aerosp Med Hum Perform. 2020; 91(2):106-109.

Combined total mitral and tricuspid valve reconstruction with the use of CorMatrix in an adult.

The article confirms the possibility of simultaneous implementation of custom-made mitral and tricuspid valve prostheses together with their subvalvular apparatuses from extracellular matrix. Both prostheses were implanted in a 43-year-old man experiencing severe mitral and tricuspid regurgitation, decreased left ventricle ejection fraction, acromegaly, macrocardia and a history of undiagnosed infective process. Postoperative echocardiography showed good haemodynamic function of implanted valves. On postoperative day 11, a paravalvular leak of mitral valve was noticed and required reoperation. The predischarge echocardiography showed no paravalvular leak. The patient was discharged in good condition 52 days after the surgery. The custom-made extracellular matrix valves do not require postoperative anticoagulation. They also serve as prostheses of subvalvular apparatus and, therefore, ameliorate the functioning of ventricles. They prevent the postoperative adverse ventricular remodelling as well. Despite good early haemodynamic results, extracellular matrix mitral valve prosthesis requires further study to assess its long-term function.

Minimally invasive aortic valve replacement - pros and cons of keyhole aortic surgery.

Over the last twenty years, minimally invasive aortic valve replacement (MIAVR) has evolved into a safe, well-tolerated and efficient surgical treatment option for aortic valve disease. It has been shown to reduce postoperative morbidity, providing faster recovery and rehabilitation, shorter hospital stay and better cosmetic results compared with conventional surgery. A variety of minimally invasive accesses have been developed and utilized to date. This concise review demonstrates and discusses surgical techniques used in contemporary approaches to MIAVR and presents the most important results of MIAVR procedures.

[Angiographic and stress echocardiographic evaluation after surgical treatment of Bland-White-Garland syndrome and mitral valve insufficiency]. / Ocena angiograficzna i obciazeniowa echokardiograficzna po chirurgicznym leczeniu zespolu Bland−White−Garlanda oraz wady zastawki mitralnej.

We report case of 58-year-old male patient with severe mitral insufficiency in whom in preoperative angiography anomalous left anterior descending coronary artery arising from pulmonary artery was revealed. Patient successfully underwent mitral valve replacement, ligation and bypass of left anterior descending artery. Eighteen months after surgery control exercise echocardiography and angiography were performed to evaluate coronary flow, valve prosthesis and left ventricle function.

[Off-pump coronary artery bypass]. / Pomostowanie aortalno-wiencowe bez uzycia krazenia pozaustrojowego.

Development of beating heart coronary artery bypass surgery was possible since introduction of heart stabilizing instruments in mid-90's. THE AIM OF THIS REVIEW: To summarize available evidence of benefits of beating heart coronary artery bypass surgery in comparison with use of cardiopulmonary bypass during surgery. Methods of heart stabilization during operation without cardiopulmonary bypass allow to performing complete revascularization with lower degree of myocardial damage. The main advantage of beating heart coronary bypass surgery is excluding systemic inflammatory response following cardiopulmonary bypass use. And therefore less incident of renal failure, clotting disturbances, respiratory complications. There is lower incidence of microthrombotic formation and central nervous system complications. Early mortality is significantly lower and it is safer to operate on high risk patients (over 75 years old, female, with acute coronary syndrome, ascending aorta arteriosclerosis). CONCLUSION: The technique of beating heart coronary artery bypass surgery reduces risk of central nervous system complications, renal failure, respiratory problems and coagulation disturbances. The complete revascularisation is possible. This technique is available to enlarging group of patients, especially the high perioperative risk patients.

[Severe cardiovascular complications due to the pituitary adenoma with acromegaly. An interdisciplinary approach to the treatment. A case report]. / Ciezkie powiklania sercowo-naczyniowe w przebiegu guza przysadki powodujacego akromegalie. Propozycja równoczesnego wielospecjalistycznego leczenia. Opis przypadku.

Acromegaly reduces life expectancy and leads to 3-5-fold increase in mortality. The main causes are cardiovascular, pulmonary and enhanced prevalence of deaths from malignancy. Successful therapy ought to normalize GH, IGF-I secretion, remove the adenoma mass and its local pressure effects and preserve pituitary functions intact to improve systemic morbidity and normalize mortality. The primary therapy for most patients with acromegaly is still transsphenoidal adenomectomy. The authors present a 64-year-old woman with diagnosed GH-secreting pituitary macroadenoma suffering from severe coronary heart disease and diabetes mellitus. Somatostatin analogue therapy was ineffective in our patient. She was unfit for transsphenoidal adenomectomy. The patient was qualified for coronary artery bypass grafting after cardiological investigation. We have decided to carry out the bypass grafting and transsphenoidal adenomectomy during one anaesthesia. Both surgical procedures and postoperative time were uncomplicated. Our patient feels well and she is in outpatient follow-up.