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ABSTRACT: OBJECTIVES: We previously presented early results employing a technique designed for beating heart, ventricular volume reduction (surgical ventricular restoration, SVR) without ventriculotomy for patients with antero-septal scar and dilated ischaemic cardiomyopathy. Significant volume reduction and clinical improvement were achieved. We now report durability in the first 11 patients available for assessment at 6 and 12 months after operation. METHODS: After the Ethics Committee approval, 31 symptomatic patients with left ventricular (LV) dilatation and antero-septal scars underwent operation. The scarred lateral LV wall was apposed to the septal scar with serial paired anchors placed through epicardial transmural catheters, excluding non-viable portions of the chamber. Patients were followed at 1, 3, 6 and 12 months postoperatively with echocardiograms. Data are presented for the first 11 patients for whom core lab echocardiographic data were available at 12 months of follow-up. RESULTS: LV end-systolic index (LVESVI), percent decreases from baseline at 6 and 12 months were 36.2 ± 18.3 (P < 0.001) and 39.6 ± 14.8 (P < 0.001). LV end-diastolic volume index (LVEDVI) percent decreases from baseline at 6 and 12 months were 28.6 ± 18.8 (P < 0.001) at 6 months and 32.2 ± 14.9 (P < 0.005) at 12 months. All comparisons were by one-tailed t-tests using paired data. CONCLUSIONS: These results demonstrate the persistence of volume reduction employing a technique designed to be used on beating hearts without ventriculotomy or cardiopulmonary bypass. The extent of volume reduction was consistent with results of conventional SVR in experienced centres. These early data validate the further development of technical iterations leading to a clinical study employing a closed chest endovascular platform.
European journal of cardio-thoracic surgery: official journal of the European Association for Cardio-thoracic Surgery 06/2013; · 2.40 Impact Factor
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Bartłomiej Guzik,
Agnieszka Sagan,
Dominik Ludew,
Wojciech Mrowiecki,
Maciej Chwała,
Beata Bujak-Gizycka,
Grzegorz Filip,
Grzegorz Grudzien,
Boguslaw Kapelak,
Krzysztof Zmudka,
Tomasz Mrowiecki, Jerzy Sadowski,
Ryszard Korbut,
Tomasz J Guzik
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ABSTRACT: Aortic abdominal aneurysms (AAA) are important causes of cardiovascular morbidity and mortality. Oxidative stress may link multiple mechanisms of AAA including vascular inflammation and increased metalloproteinase activity. However, the mechanisms of vascular free radical production remain unknown. Accordingly, we aimed to determine sources and molecular regulation of vascular superoxide (O2(-)) production in human AAA. METHODS AND RESULTS: AAA segments and matched non-dilated aortic samples were obtained from 40 subjects undergoing AAA repair. MDA levels (determined by HPLC/MS) were greater in plasma of AAA subjects (n=16) than in risk factor matched controls (n=16). Similarly, superoxide production, measured by lucigenin chemiluminescence and dihydroethidium fluorescence, was increased in aneurysmatic segments compared to non-dilated aortic specimens. NADPH oxidases and iNOS are the primary sources of O2(-) in AAA. Xanthine oxidase, mitochondrial oxidases and cyclooxygenase inhibition had minor or no effect. Protein kinase C inhibition had no effect on superoxide production in AAA. NADPH oxidase subunit mRNA levels for p22phox, nox2 and nox5 were significantly increased in AAAs while nox4 mRNA expression was lower. Superoxide production was higher in subjects with increased AAA repair risk Vanzetto score and was significantly associated with smoking, hypercholesterolemia and presence of CAD in AAA cohort. Basal superoxide production and NADPH oxidase activity were correlated to aneurysm size. CONCLUSIONS: Increased expression and activity of NADPH oxidases are important mechanisms underlying oxidative stress in human aortic abdominal aneurysm. Uncoupled iNOS may link oxidative stress to inflammation in AAA. Oxidative stress is related to aneurysm size and major clinical risk factors in AAA patients.
International journal of cardiology 03/2013; · 7.08 Impact Factor
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ABSTRACT: Arterial hypertension is one of the main causes of cardiovascular disease morbidity and overall mortality. Aim: To report the single centre experiences with changes in arterial blood pressure (BP) in patients after intra-arterial application of radiofrequency (RF) energy to cause renal sympathetic efferent and somatic afferent nerve and report vascular and kidney safety in a six month follow up.
Twenty-eight patients, with hypertension despite medical therapy (median age 52.02 years, range 42-72 years) consented to therapeutic renal nerve ablation. SIMPLICITY RF catheters and generator provided by Ardian (currently Medtronic Inc., USA) were used to perform renal artery angiography and ablation.
The mean BP at baseline, and after one month, three months and six months were measured [mm Hg]: systolic 176.6; 162.3 (p = 0.004); 150.6 (p < 0.001); 147.2 (p < 0.001); diastolic 100.2; 90.3 (p < 0.001); 91.79 (p = 0.03); 88.5 (p < 0.001); pulse pressure 76.57; 75.18 (p = NS); 65.80 (p < 0.001); 62.15 (p < 0.001). Neither procedure-related nor therapy-related complications were reported in the six month follow up.
In our cohort of patients, intra-arterial renal nerve denervation was not associated with either vascular or renal complications out to six months. Nerve ablation of renal arteries led to significant reduction of mean values of arterial systolic, diastolic BP and significant reduction of pulse pressure. The Polish experience is not significantly different compared to that reported in the Symplicity I and Symplicity II international cohorts. The long term durability of this therapy and its application to earlier stages of hypertension or other disease states will require further investigation.
Kardiologia polska 01/2013; 71(2):152-8. · 0.51 Impact Factor
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ABSTRACT: Altered fibrin clot structure has been reported both in patients with coronary artery disease (CAD) and those with type 2 diabetes mellitus (DM2). The aim of the present study was to evaluate plasma fibrin clot permeability and susceptibility to lysis in patients with DM2 and CAD. We studied 132 consecutive CAD patients, including 67 subjects with DM2, scheduled for elective coronary artery bypass grafting surgery. Ex vivo plasma fibrin clot permeability (K(s)) and lysis time (t(50%)) induced by 1 μg/mL recombinant tissue plasminogen activator (tPA), along with plasma levels of plasminogen activator inhibitor-1 (PAI-1), thrombin activatable fibrinolysis inhibitor (TAFI), tPA, von Willebrand factor (vWF), P-selectin, soluble CD40 ligand (sCD40L), were measured. Diabetic and non-diabetic patients did not differ in regard to demographics and remaining cardiovascular risk factors. Concomitant DM2 was associated with higher glucose (+24.3 %, p < 0.001), fibrinogen (+9.0 %, p = 0.037), PAI-1 (+58.7 %, p < 0.001), tPA (+24.0 %, p < 0.001) and P-selectin (+12.2 %, p < 0.001). Compared with the non-diabetic group, the CAD patients with DM2 had lower K(s) (-6.1 %, p = 0.02) and prolonged t(50%) (+5.1 %, p = 0.04). Multiple regression analysis of the whole study group showed that vWF, PAI-1, fibrinogen and DM2 were the independent predictors of t(50%) (R (2) = 0.58, p < 0.001), while only vWF was an independent predictor of K(s) (R (2) = 0.22, p < 0.001). This study indicates that DM2 is potent enough to unfavorably affect plasma fibrin clot characteristics despite abnormal clot phenotype typically observed in CAD. Of note, platelet and endothelial markers appear to contribute to fibrin clot properties in CAD concomitant with DM2.
Journal of Thrombosis and Thrombolysis 10/2012; · 1.48 Impact Factor
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ABSTRACT: Pulmonary embolectomy is a treatment option in selected patients with high-risk pulmonary embolism (PE). Efficiency of thrombus degradation in PE largely depends on the architecture of its fibrin network, however little is known about its determinants. We present the case of a 56-year-old woman with high-risk PE and proximal deep-vein thrombosis, whose thrombotic material removed during embolectomy from the right atrium and pulmonary (lobar and segmental) arteries has been studied using scanning electron microscopy (SEM). SEM images showed that distally located thrombi are richer in densely-packed fibrin fibers and contain more white cells and less erythrocytes than the proximal ones and the atrial thrombus. Fibrin fibers alignment along the flow vector was observed in the thrombi removed from high-velocity flow pulmonary arteries, and not in the atrial thrombus. The content of denser fibrin network and platelet aggregates was increased in segmental thromboemboli. Our findings describe the relation between thrombus architecture and location, and might help to elucidate thrombus resistance to anticoagulant therapy in some PE patients.
Journal of Thrombosis and Thrombolysis 10/2012; · 1.48 Impact Factor
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ABSTRACT: Abstract Background: Lipoprotein-associated phospholipase A2 (Lp-PLA2) is an inflammatory mediator involved in atherosclerosis. Since aortic valve stenosis (AVS) is regarded as an atherosclerosis-like inflammatory disease, we sought to investigate whether AVS is associated with elevated Lp-PLA2. Methods: Plasma Lp-PLA2 levels were determined in 48 consecutive patients with severe AVS without atherosclerotic vascular disease and compared with the values obtained in 48 controls matched for age, sex and cardiovascular risk factors. Results: Lp-PLA2 was higher in AVS than in controls (242.3±50.4 vs. 151.9±28.1 ng/mL, p<0.0001). Lp-PLA2 correlated inversely with aortic valve area (AVA) (r=-0.53; p=0.0001) and positively with mean pressure gradient (PG) (r=0.32; p=0.029). In multivariable analysis C-reactive protein (CRP) (OR=1.42; 95% CI 0.95-2.1; p=0.09) and AVA (OR=0.003; 95% CI 0.00004-0.23; p<0.01) were independently associated with Lp-PLA2 above a mean of 242 ng/mL. After adjustment for CRP, AVA was the only independent predictor of Lp-PLA2 in AVS patients (p<0.001). Conclusions: This study is the first to show that AVS is characterized by increased plasma Lp-PLA2 levels associated with the severity of AVS, which suggests active involvement of Lp-PLA2 in the pathogenesis of AVS.
Clinical Chemistry and Laboratory Medicine 10/2012; 50(10):1825-31. · 2.15 Impact Factor
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ABSTRACT: OBJECTIVES: The purpose of the study was to determine the efficacy and safety of left atrial appendage (LAA) closure via a percutaneous LAA ligation approach. BACKGROUND: Embolic stroke is the most devastating consequence of atrial fibrillation. Exclusion of the LAA is believed to decrease the risk of embolic stroke. METHODS: Eighty-nine patients with atrial fibrillation were enrolled to undergo percutaneous ligation of the LAA with the LARIAT device. The catheter-based LARIAT device consists of a snare with a pre-tied suture that is guided epicardially over the LAA. LAA closure was confirmed with transesophageal echocardiography (TEE) and contrast fluoroscopy immediately, then with TEE at 1 day, 30 days, 90 days, and 1 year post-LAA ligation. RESULTS: Eighty-five (96%) of 89 patients underwent successful LAA ligation. Eighty-one of 85 patients had complete closure immediately. Three of 85 patients had a ≤2-mm residual LAA leak by TEE color Doppler evaluation. One of 85 patients had a ≤3-mm jet by TEE. There were no complications due to the device. There were 3 access-related complications (during pericardial access, n = 2; and transseptal catheterization, n = 1). Adverse events included severe pericarditis post-operatively (n = 2), late pericardial effusion (n = 1), unexplained sudden death (n = 2), and late strokes thought to be non-embolic (n = 2). At 1 month (81 of 85) and 3 months (77 of 81) post-ligation, 95% of the patients had complete LAA closure by TEE. Of the patients undergoing 1-year TEE (n = 65), there was 98% complete LAA closure, including the patients with previous leaks. CONCLUSIONS: LAA closure with the LARIAT device can be performed effectively with acceptably low access complications and periprocedural adverse events in this observational study.
Journal of the American College of Cardiology 09/2012; · 14.16 Impact Factor
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ABSTRACT: OBJECTIVES
The use of bilateral internal thoracic arteries (BITAs) grafting has been documented to be advantageous over left internal thoracic artery (LITA) grafting. It has been shown to significantly improve clinical outcomes and increase long-term survival in patients with diabetes. However, harvesting BITAs may result in a greater risk of superficial wound infection (SWI) or deep sternal wound infection (DSWI) and cardiovascular complications (major adverse cardiac and cerebrovascular events; MACCE) in such a patient group. The objective of this study was to compare the incidence of SWI or DSWI and cardiovascular events in a series of isolated coronary artery bypass grafting (CABG) patients who underwent BITA grafting vs LITA grafting.METHODSA total of 147 patients with coronary artery disease and diabetes underwent isolated CABG at John Paul II Hospital. Of these, 38 procedures were performed using BITA grafting and 109 with LITA-saphenous vein grafting.RESULTSMACCE were similar in bilateral groups (7.9%-BITA group and 9.2%-LITA group). No significant difference was found in mortality and length of stay between bilateral groups. The MACCE risk factor was age. The incidence of SWI and DSWI and sternal re-fixation did not differ between the BITA or LITA groups (5.2 vs 9.1%, 5.2 vs 7.3% and 5.2 vs 6.4%). The risk factors for DSWI were age (odds ratio 3.47, P = 0.032 for every 10 years) and body mass index >30 kg/m(2).CONCLUSIONS
Perioperative complications do not increase with the use of BITAs in this group of diabetic patients. There are no statistically significant differences in the number of superficial or deep wound infections or number of sternal resuturing between the BITA and LITA groups.
Interactive cardiovascular and thoracic surgery 09/2012;
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ABSTRACT: We tested the hypothesis that fibrin structure/function is unfavorably altered in patients with residual vein obstruction (RVO). Ex vivo plasma fibrin clot permeability, turbidimetry and efficiency of fibrinolysis were investigated in 86 patients with RVO following first-ever proximal deep vein thrombosis (DVT), and 86 DVT controls with no evidence of RVO. The RVO patients had 14.1% lower clot permeability (p=0.011), 11.3% longer lysis time (p=0.009) and 7.8% lower rate of D-dimer release from fibrin clots than controls (p=0.022), with no differences related to thrombophilia, and duration or stability of anticoagulant therapy. RVO patients showed higher lipoprotein(a) (p=0.014) with overrepresentation of smaller apolipoprotein(a) isoforms, corresponding approximately to 21 or fewer kringle IV type 2 repeats (p=0.09), both associated with alterations to plasma fibrin clot characteristics. In conclusion, prothrombotic plasma fibrin clot phenotype related to elevated lipoprotein(a) with smaller apolipoprotein(a) isoforms might represent a novel risk factor for RVO.
Thrombosis Research 07/2012; 130(3):e184-7. · 2.44 Impact Factor
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Karol Wierzbicki,
Dorota Sobczyk,
Maciej Bochenek,
Irena Milaniak,
Dorota Ciołczyk-Wierzbicka,
Piotr Węgrzyn,
Krzysztof Bartuś,
Piotr Przybyłowski,
Bogusław Kapelak,
Rafał Drwiła, Jerzy Sadowski
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ABSTRACT: Heart failure (HF) is a growing health care problem in the world. Secondary pulmonary venous hypertension is usually observed in patients with end‑stage heart failure.
The main purpose of the study was to evaluate the relationships between N‑terminal pro‑B‑type natriuretic peptide (NT‑proBNP) levels and the markers of secondary venous pulmonary hypertension in patients referred for heart transplantation (HTX).
This retrospective analysis included 35 patients (32 men, 3 women; median age, 55.0; interquartile range [IQR] 12.0 years). The study group consisted of all consecutive patients referred for HTX, in whom the right‑heart catheterization using the Swan‑Ganz catheter was performed at the same time as the measurement of NT‑proBNP levels.
A high median value of NT‑proBNP (3187.0; IQR 2964.0 pg/ml) and elevated pulmonary pressure were observed in the study group. There was a significant correlation between NT‑proBNP levels and the values of systolic, mean, and diastolic pulmonary artery pressure (r = 0.5, P = 0.001; r = 0.5, P = 0.001; r = 0.5, P = 0.002; respectively) as well as cardiac output (r = -0.4, P = 0.007). There was also a positive correlation between pulmonary artery resistance and NT‑proBNP levels (r = 0.5, P = 0.006).
In our study population, the median value of NT‑proBNP levels exceeded the normal range 25 times. There was a correlation between the markers of secondary pulmonary hypertension and cardiac output and NT‑proBNP levels. Elevated NT‑proBNP levels in patients with end‑stage HF may be associated with significant secondary venous pulmonary hypertension.
Polskie archiwum medycyny wewnȩtrznej 05/2012; 122(6):291-7. · 1.37 Impact Factor
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ABSTRACT: There is a need to make medical diagnosis available to critically ill patients on-site, without the necessity of time-consuming
and risky transportation to larger reference hospitals. The teleconsultation of medical images is possible with the use of
Internet-based TeleDICOM software developed in Krakow, Poland. Interactive consultation between two or more centers offers
real-time voice communication, visualization of synchronized Digital Imaging and Communications in Medicine images, and use
of interactive pointers and specific calculation tools. If direct interaction between physicians is not needed, the system
can also be used in “offline” mode. In 2006, TeleDICOM was successfully deployed in the John Paul II Hospital in Krakow as
well as a dozen other cooperating medical centers throughout southeast Poland. It is used for routine referral for cardiosurgical
procedures. Aims of the study were to evaluate the image quality, software stability, constant availability, data transmission
speed, and quality of real-time synchronized viewing of the images during the TeleDICOM teleconsultation; to evaluate the
clinical utility of the TeleDICOM system; and to analyze the compatibility of TeleDICOM with the storage data formats of various
imaging machine manufacturers. The analysis of angiographic offline teleconsultations was based on 918 patients referred remotely
for coronary artery bypass grafting (CABG). The echocardiographic teleconsultations were performed during 63 live interactive
consultations, several of them were presented to live during medical conferences. Measurement tools of the TeleDICOM software
were tested against original measurement tools of echocardiographic machines from four different manufacturers. As a result
of TeleDICOM consultation, a CABG decision was made in 806 of 918 patients consulted (87.8%). In remaining 12 patients, medical
therapy or percutaneous angioplasty was recommended. CABG was performed in 98.6% of the admitted patients. Treatment decisions
were changed after admission in 1.4% of patients—however, in all cases, it was not related to analysis of angiography data
but rather to the change of clinical condition of the patients. All medical personnel involved in both offline and interactive
teleconsultations judged the system positively in all assessed aspects. Lesser scores were observed only in the centers connected
by slower networks. Measurements performed in the ECHO-TeleDICOM module were accurate as compared with those performed on
a standard echo-machine (correlation r > 0.980, p < 0.001), independently of the echocardiograph model. Conclusion: This study
demonstrates that telemedicine can improve patients' management using a clinically effective teleconsultation system. The
TeleDICOM system is suited for professional use in the field of cardiovascular disease. It is also prepared for remote live
demonstrations of clinical cases during large medical meetings.
Key wordsTelemedicine–angiography–cardiac imaging–clinical application–computers in medicine–digital image management–image analysis–ultrasonography
Journal of Digital Imaging 04/2012; 24(3):541-551. · 1.25 Impact Factor
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ABSTRACT: Patients with peripheral artery disease (PAD) following peripheral percutaneous transluminal angioplasty (PTA) with stent implantation are prone to stent thrombosis despite treatment with aspirin and clopidogrel. Impaired clopidogrel responsiveness is associated with increased risk of ischemic events in patients following coronary stent implantation. We sought to assess platelet responsiveness to clopidogrel and aspirin in patients with PAD and recurrent stent thrombosis. Platelet aggregation induced by 5 and 20 µmol/l adenosine diphosphate (ADP) and 0.5 mmol/l arachidonic acid (AA), together with platelet reactivity index (PRI) and serum thromboxane B(2) (TXB(2)), were determined in 11 patients with PAD and a history of stent thrombosis (mean, 3.1 ± 1.14) after PTA and in 15 patients with PAD with no such history, also in 11 controls with coronary artery disease (CAD) and previous stent thrombosis. Platelet aggregation to 5 µmol/l ADP was higher in subjects with PAD and stent thrombosis than in those without stent thrombosis (p = 0.0003) and CAD subjects (p = 0.002). Aggregation induced by 20 µmol/l ADP was higher in PAD group with stent thrombosis than in PAD subjects without thrombosis (p = 0.004). The PAD group with stent thrombosis had higher AA-induced platelet aggregation than CAD controls (p = 0.007) and serum TXB(2) concentrations higher than PAD group without thrombosis (p = 0.002) and CAD group (p = 0.02). Concluding, platelet responsiveness to clopidogrel and aspirin is impaired in patients with PAD and recurrent stent thrombosis following PTA, as compared with similar individuals with CAD, and PAD with no history of stent thrombosis. This indicates that atherosclerosis burden affects platelet function and might contribute to stent thrombosis following percutaneous intervention in peripheral arteries.
Platelets 04/2012; · 1.85 Impact Factor
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Krzysztof Bartuś,
Andy C Kiser,
Jacek Majewski,
Bogusław Kapelak,
Janusz Konstanty-Kalandyk,
Jacek Lelakowski,
Jacek Bednarek,
Stanisław Bartuś,
Karol Wierzbicki,
Robert Sobczyński, Jerzy Sadowski
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ABSTRACT: Atrial fibrillation (AF) is a common arrhythmia affecting approximately 1% to 2% of the general population.
The aim of the study was to evaluate the efficacy and safety of thoracoscopic ablation in patients with AF.
A total of 25 patients aged from 42 to 77 years (mean 56.4 years) with persistent or long-standing persistent AF were scheduled for the procedure. Thoracoscopic epicardial ablation of the right atrium, pulmonary veins, and left atrium was performed on the beating heart using the Cox MAZE III-based diagram, via 3 ports and 2 cm incision below the xiphoid. Exit block was always assessed. Patients were prospectively followed for 12 months after the procedure. 24-hour electrocardiography (Holter monitoring) was used to confirm the results.
Conduction block across ablation lines was achieved in 21 patients (84%). At 1 month of follow-up, the sinus rhythm (SR) was observed in 18 of 20 patients. At 3 months, the SR was observed in 19 patients (76%). Two patients had atrial flutter, while 3 still experienced AF. At 6 months, the SR was observed in 21 patients (84%); 2 patients still had AF, 1 patient atrial flutter, and 1 patient had a pacemaker implanted. Results of follow-up at 1 year did not differ from those at 6 months. No changes in the size of the left atrium and left ventricular ejection fraction, no deaths, stroke, transient ischemic attack, or infectious complications were observed.
The efficacy of epicardial thoracoscopic ablation of the left and right atrium was high, reaching 84% during 1-year follow-up. No serious complications were observed in the postoperative period (except for the need for pacemaker implantation in 1 patient).
Polskie archiwum medycyny wewnȩtrznej 04/2012; 122(5):189-94. · 1.37 Impact Factor
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ABSTRACT: Circulating active tissue factor (TF) and activated factor XI (FXIa) have been detected in subgroups of acute coronary syndromes (ACSs) and stable angina patients. We sought to evaluate the determinants of active TF and FXIa in stable angina patients. We studied 124 consecutive stable angina patients. Recent ACS, atrial fibrillation, and anticoagulant therapy were the exclusion criteria. Plasma active TF and FXIa were determined by measuring the response to inhibitory antibodies. T helper 1 lymphocyte (Th1) and Th2 responses were assessed in plasma by interleukin (IL)-4, IL-6, IL-8, IL-10, IL-18, interferon-γ, and tumor necrosis factor-α, oxidative stress by 8-isoprostaglandin F(2α) (8-iso-PGF(2α)), and coagulation by prothrombin fragments F1+2 (F1+2) and free TF pathway inhibitor (f-TFPI). TF and FXIa activity were detected in 25 (20.2%) and 49 (39.5%) stable angina patients, respectively. Both factors were found in 23 (18.5%) patients. Patients with detectable TF or FXIa had higher F1+2, 8-iso-PGF(2α), IL-6, but not other cytokines, and lower f-TFPI (all P < 0.001) compared with the remainder. There were no intergroup differences with regard to cardiovascular risk factors or medication. Multivariate analysis showed that F1+2 and f-TFPI were the only independent predictors of the TF presence, whereas 8-iso-PGF(2α) and F1+2 predicted the presence of FXIa in stable angina patients. In stable angina patients, circulating active TF and FXIa are associated with enhanced thrombin formation, with a minor effect of inflammatory mediators. Moreover, FXIa is also related to oxidative stress, indicating additional links between coagulation and free radical generation in stable angina.
Blood coagulation & fibrinolysis: an international journal in haemostasis and thrombosis 02/2012; 23(3):189-94. · 1.25 Impact Factor
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ABSTRACT: Myxomas are the most common primary cardiac tumors, with an estimated incidence of 0.5 per million per year. Familial myxoma constitutes 10% of all myxomas, among these tumors, one in ten is part of Carney complex - an autosomal dominant syndrome, which are related to some mutations in the PRKAR1A
gene. We report a case of 75-year-old man with sporadic cardiac myxoma of a 4-cm large tumor, arising from the left side of the atrial septum and causing a severe left ventricle inflow obstruction. Cytogenetic analysis confirmed by fluorescence in situ hybridization method (FISH), demonstrated a numerical aberration in atrial myxoma cells: 47, XY, +21. Flow cytometry analysis demonstrated that a quarter of tumors cells were hematopoietic progenitor cells (CD34+) and that a similar number were endothelial specific neovascular
cells (CD31+). These finding suggest that, hematopoietic progenitor cells may play an important role in the histogenesis of cardiac myxomas and the karyotype aberrations have an impact on sporadic tumor genesis. Nevertheless, genetic screening for sporadic (non-familial) cardiac myxomas is not recommended.
Cardiogenetics. 01/2012; 2(e3).
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ABSTRACT: During years more and more advanced Technologies are used for treatment of severe aortic stenosis. One of them is equine pericardial stentless bioprothesis. Aim of the study: the aim of the study was prospective assessment of circulatory sufficiency of the patients after 3F equine pericardial stentless bioprothesis replacement (ATS-Medtronic, Inc, Minneapolis, USA).
Patients qualified to valve replacement were qualified to the study. The procedures were performed in general anesthesia and medial thoracothomy. The New York Heart Association (NYHA) scale was analyzed to estimate clinical results of the procedures.
45 patients (10 women and 35 men) aged 23-78 (mean 54 (+/- SD 12.7) were included into the study. Patients were observed during one-year follow up (FU). At the baseline three pts had NYHA II stage, 35 - III and 7 - IV. There was no pts in NYHA I stage. After 3-6 months FU 34 pts were at NYHA I stage (79%) and 9 at NYHA II. After 11-14 FU 33 pts were at NYHA I (80.4%) and 8 NYHA II (19.5%). There was no pts at NYHA IV during 12 months FU (differences between observational periods statistically significant p < 0.001).
During one-year FU after equine pericardial stentless bioprothesis implantation the improvement of NYHA grade was observed.
Przegla̧d lekarski 01/2012; 69(6):229-32.
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ABSTRACT: Stentless bio-protheses are more and more frequently used in patients with severe aortic stenosis, due to good hemo-dynamic parameters and durability after aortic valve replacement (AVR). Aim of the study was the clinical evaluation of complications after surgical AVR using the 3F equine pericardial stentless bioprothesis (ATS Medtronic, Inc, Minneapolis, USA).
45 patients (10 women, 35 men), aged from 23 to 78 had implanted the bioprothesis.
Two patients died in perioperative period, but the bioprotehsis function was correct. In two patients gastrointestinal (GE) bleeding was observed due to anticoagulation therapy. In remaining 41 patients during one year follow-up no complications were noted.
After implantation 3F bioprotehesis two unrelated deaths and 2 GE bleeding complications were observed. Other 41 patients had no complications during 1 year follow-up.
Przegla̧d lekarski 01/2012; 69(6):233-6.
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Kardiologia polska 01/2012; 70(1):109-10. · 0.51 Impact Factor
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International journal of cardiology 11/2011; 158(3):e55-6. · 7.08 Impact Factor
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ABSTRACT: Diabetes predisposes to aortic stenosis (AS). We aimed to investigate if diabetes affects the expression of selected coagulation proteins and inflammatory markers in AS valves. Twenty patients with severe AS and concomitant type 2 diabetes mellitus (DM) and 40 well-matched patients without DM scheduled for valve replacement were recruited. Valvular tissue factor (TF), TF pathway inhibitor (TFPI), prothrombin, C-reactive protein (CRP) expression were evaluated by immunostaining and TF, prothrombin, and CRP transcripts were analyzed by real-time PCR. DM patients had elevated plasma CRP (9.2 [0.74-51.9] mg/l vs. 4.7 [0.59-23.14] mg/l, p = 0.009) and TF (293.06 [192.32-386.12] pg/ml vs. 140 [104.17-177.76] pg/ml, p = 0.003) compared to non-DM patients. In DM group, TF-, TFPI-, and prothrombin expression within valves was not related to demographics, body mass index, and concomitant diseases, whereas increased expression related to DM was found for CRP on both protein (2.87 [0.5-9]% vs. 0.94 [0-4]%, p = 0.01) and transcript levels (1.3 ± 0.61 vs. 0.22 ± 0.43, p = 0.009). CRP-positive areas were positively correlated with mRNA TF (r = 0.84, p = 0.036). Diabetes mellitus is associated with enhanced inflammation within AS valves, measured by CRP expression, which may contribute to faster AS progression.
Inflammation 09/2011; 35(3):834-40. · 1.75 Impact Factor
