[Should fiber gastroscopy be standard in preoperative examinations for cardiac surgery?]. / Má byt' gastrofibroskopické vysetrenie pred operáciou srdca standardným vysetrením?

UNLABELLED: We introduced a gastrofibroscopy into a standard preoperative protocol for all patients indicated to the cardiac surgery. AIM OF THE STUDY: Validation of our protocol. MATERIAL AND METHODS: 957 consecutive patients operated on from May 1995 to January 2002 were divided to group A--gastrofibroscopy only for patients with positive history or clinical signs of peptic ulcer (151 pts.) and group B--patients with gastrofibroscopy as a standard procedure (806 pts). RESULTS: Significant difference in incidence of peptic ulcer complications between groups (A--5.9% versus B--1.1%, p < 0.05). Related mortality was 1.3% in-group A versus 0% in-group B. Positive history of peptic ulcer had only two patients (11% of 18) with postoperative complication. In-group B we found high incidence of peptic defects (B--35% versus A--9%, p < 0.01) requiring treatment by gastroenterologist. Majority (230 of 281-82%) of pts. with preoperative positive defect had negative history of a peptic ulcer. CONCLUSIONS: Current tendency to perform gastrofibroscopic examination only in patients with positive history of peptic ulcer is not able to detect "silent" lesions. Perioperative treatment with H2 blockers fails to prevent the manifestation of peptic ulcer complication. Gastrofibroscopy should be a routine part of the preoperative protocol in cardiac surgery.

[Surgical treatment of renal carcinoma and thrombosis of the inferior vena cava]. / Chirurgická liecba karcinómu oblicky s trombózou dolnej dutej zily.

INTRODUCTION: In Slovakia every year some 600 renal carcinomas are diagnosed. This number includes 5 to 10% carcinomas with a tumours thrombus is the renal vein or inferior vena cava. The objective of the present work is to describe diagnostic and surgical methods is patients with this disease. MATERIAL AND METHODS: The authors describe the surgical procedures, depending on the level of the tumours thrombus in the inferior vena cava in a group of 22 patients operated at the Urological department of the F. D. Roosevelt Hospital in Banská Bystrica in 1997 to 2001. RESULTS: In all 22 patients the tumours thrombus was removed along with the tumours kidney. In two instances the thrombus reached as far as the right atrium and in 4 patients with a tumours thrombus in a subdiaphragmatic position extracorporeal circulation was used. There was no death in conjunction with the surgical operation. There was one complication caused by haemorrhage which called for surgical revision. Eight patients died during the investigation period as a result of a relapse and generalization of the disease. CONCLUSION: Based on the authors' experience and data in the literature the authors recommend surgery of the kidney with a tumours thrombus of the inferior vena cava as safe treatment in special hospital departments.

[Removal of the intravenous pacing system using the inflow occlusion technique]. / Extrakcia intravenózneho stimulacného systému pomocou techniky "inflow occlusion".

Infection of the stimulative system with a septic state or endocarditis is the ultimate requirement for the extraction of intravenous parts of the implanted stimulative system. The extraction performed by the classical method or by means of catheter does not have to be necessarily successful. The use of extracorporeal circulation is optimal for the surgeon, however, it is expensive and not indifferent for the patient. The inflow occlusion technique under our conditions has shown to be fast, safe and an advantageous alternative. We have used it in 11 patients out of 14. All cases involved an extraction of a foreign body. 78.5% of extractions were performed due to infected stimulative system. 2 patients were subdued to a simultaneous implantation of DDD, others have had VVI system implanted by epimyocardial or transvenous way. We have not been encountered with any serious complications. (Tab. 1, Fig. 3, Ref. 7.)

[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.).

[The effect of glutaraldehyde preparations on the properties of biological heart valve prostheses]. / Vplyv preparácie glutaraldehydom na vlastnosti biologických chlopnových protéz.

Changes in hydrodynamic properties of biological valve prostheses (37 aortic allotransplants, 40 pericardial allotransplants) induced by glutaraldehyde treatment were studied in vitro. With the exception of sufficiency, the majority of hydrodynamic characteristics exhibited significant deterioration after glutaraldehyde treatment when compared to the data in untreated valves. The value of the dynamic test of valve prostheses is pointed out.

[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.

[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.

[Ventricular septal defect in early childhood]. / Defekt komorového septa v ranom detskom veku.

In a retrospective study the results of operations for hemodynamically severe ventricular septal defect were analyzed in 18 patients with a body weight below 10 kg who had been operated on over a period of two years at the Institute of Cardiovascular Diseases in Bratislava. The first group consisted of 12 children with the mean body weight of 6650 g in whom complete correction of the ventricular septal defect was carried out by means extracorporeal circulation. Ligation of the pulmonary artery was performed in 6 infants with the mean body weight of 3420 g (second group). Patients of both groups had a serious left-to-right shunt and marked pulmonary hypertension. An excellent operative result was obtained in 10 children after complete correction of the defect. Two patients of the first group and one patient of the second group died suffering from severe pulmonary hypertension. Surgical correction of the hemodynamically severe ventricular septal defect in early childhood is indicated when conservative treatment fails and should be carried out as an urgent procedure regardless the age and body weight of the patient.

[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.

The effects of open heart surgery on growth hormone, cortisol and insulin levels in man. Hormone levels during open heart surgery.

Plasma growth hormone, cortisol, insulin and blood glucose concentrations were measured intra- and postoperatively in ten patients who underwent open heart surgery with moderate hypothermia. Diazepam-ketamine anaesthesia for 10-20 min failed to precipitate any significant alterations in the levels of measured hormones and blood glucose. In the pre-bypass period of surgery, an increase in cortisol and a slight elevation in growth hormone levels was observed; insulin level showed no change in spite of marked hyperglycaemia. The bypass period, including hypothermia and haemodilution, was accompanied by unchanged cortisol and elevated growth hormone levels, while insulin demonstrated a slight rise which did not correspond with the degree of hyperglycaemia. The post-bypass period with rewarming the restoring spontaneous circulation was characterized by further marked increase in cortisol and growth hormone levels and, in spite of decreasing levels of blood glucose, by a paradoxical elevation in plasma insulin. It is suggested that hypothermia, haemodilution, reduced tissue perfusion affecting endocrine glands, as well as denaturation of some hormones in the oxygenator, participate in the moderate endocrine response, disproportionate to the stress of cardiopulmonary bypass surgery. The rise in hormone levels on terminating bypass seems to be dependent on the improved blood flow to endocrine glands due to recovered spontaneous circulation, rewarming and, as for insulin, presumably even on the reduced inhibitory effect of catecholamines.

In vitro study of hormone degradation by heart-lung machine with bubble oxygenator.

In the present experiment with heart-lung machine set in a closed system in vitro, the blood containing increased levels of hormones was circulated at 30 degrees C for 90 min and at 37 degrees C for 30 min; a fraction of the priming perfusate was studied in parallel at the same temperatures in an incubator. The level of growth hormone decreased gradually to a mean of 76% at 30 degrees C and no further decrease was found at 37 degrees C. The mean insulin level fell within 30 min to 32% and no substantial further changes were observed during the remaining period of study; re-warming failed to produce significant additional changes. Cortisol did not change appreciably. However, the oxygenator altered the level of catecholamines markedly. At 30 degrees C the initial level of noradrenaline fell precipitously to 9% within 30 min and this excessively low level was sustained throughout the study. Adrenaline showed even more pronounced changes. Denaturation of dopamine was less marked falling to about 70% within 30 min. The present experiment revealed that the levels of hormones respond differently to artificial oxygenation during extracorporeal circulation. Cortisol resisted degradation by the oxygenator, while growth hormone and insulin were denatured significantly. The moderate degradation of growth hormone by the machine may not play an important role during open heart surgery. However, a marked oxidation denaturation of catecholamines by 90% and 70% and denaturation of insulin by 70%, might prove relevant during surgery.