[Show abstract][Hide abstract] ABSTRACT: Chronic thromboembolic pulmonary hypertension (CTEPH) is an ominous disease leading to progressive right heart failure. Selected patients can be treated by pulmonary endarterectomy (PEA). We assessed long-term clinical outcome of patients with CTEPH who underwent PEA and patients who remained on medical treatment alone. A total of 112 consecutive patients with CTEPH referred between 1998 and 2008 to one center were followed for a mean of 35 (range 0-128) months after diagnosis. All the patients had advanced pulmonary hypertension at baseline. The operated group had higher World Health Organization functional class compared to the nonoperated group. No other differences in hemodynamic, echocardiographic, or biochemical parameters were observed at baseline. Despite the perioperative mortality rate of 9.1%, patients who underwent PEA had significantly lower long-term mortality compared to nonoperated patients (12.7% vs 34.8%; P = .003), and PEA survivors showed sustained clinical improvement. All efforts should be undertaken to perform PEA in all patients with operable CTEPH.
Clinical and Applied Thrombosis/Hemostasis 05/2014; DOI:10.1177/1076029614536604 · 2.39 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: Background:
Right ventricular failure does not explain all cases of death in patients with chronic pulmonary hypertension. Searching for alternative explanations, we evaluated the prognostic significance of main pulmonary artery (PA) dilatation in patients with pulmonary arterial hypertension (PAH) or chronic thromboembolic pulmonary hypertension (CTEPH).
A retrospective outcome analysis was made of 264 patients (aged 46 ± 17 years; women, 69%; PAH, 82%) who underwent both CT scan measurement of the PA and right-sided heart catheterization (mean PA pressure, 57.6 ± 16.5 mm Hg) at initial evaluation.
The diameter of the PA ranged from 28 to 120 mm (mean, 39 ± 8.6 mm; median, 38 mm) and was largest in patients with unrepaired congenital defects (42.6 ± 7.6 mm). Pulmonary pulse pressure (P = .04), lower age (P = .03), and duration of symptoms (P < .001) were independently but weakly related to PA diameter. During follow-up (median, 38 months), 99 patients (37%) died. Of these 99 deaths, 73 (74%) were due to heart failure or comorbidities, and 26 (26%) were unexpected deaths (UE-Ds). PA diameter (hazard ratio [HR], 1.06 per 1 mm; 95% CI, 1.03-1.08), heart rate (HR, 1.30 per 10 beats/min; 95% CI, 1.01-1.66), and systolic pulmonary arterial pressure (HR, 1.02 per 1 mm Hg; 95% CI, 1.01-1.04) were the only independent predictors of UE-D and differed from the usual predictors found in the study group for all-cause mortality. PA diameter ≥ 48 mm had 95% specificity and 39% sensitivity and carried 7.5 times higher risk of UE-D (95% CI, 3.4-16.5; P < .0001) during follow-up.
PA dilatation emerges as an independent risk factor for death unexplained by right ventricular failure or comorbidities in patients with PAH and CTEPH. The possible mechanisms include, but are not limited to, PA compression of the left main coronary artery, PA rupture, or dissection with cardiac tamponade.
[Show abstract][Hide abstract] ABSTRACT: BACKGROUND: Published data concerning risk factors of VF in WPW patients are inconsistent or contradictory. METHODS AND RESULTS: We included 1007 patient (pts) (mean age 35years; 45% female) with an accessory pathway (AP) referred for non pharmacological treatment. Group 1 consisted of 56 pts (42M, aged 34±15yrs) with an AP and documented VF and Group 2-951 pts (513M, aged 35±15yrs) with an AP and without VF. Univariate predictors of VF were: overt pre-excitation, male gender, multiple AP, large AP. Multivariate predictors were: overt pre-excitation, male gender and MAP. The mean shortest pre-excited RR interval during AF was significantly shorter in Group 1: 205±27 vs. 243±64, P=0.019. VF as an end point of the first arrhythmia episode (AVRT or AF) was observed in 20 pts (15M, 5F). Primary VF (no documented arrhythmia prior to aborted SCD) occurred in 16 pts (13M, 3F). The mean age of primary VF pts was significantly lower than of pts with history of AVRT or AVRT and/or AF (24.5 vs. 36.5 vs. 38yrs., P<0.005 and P=0.002, respectively). Age at VF occurrence shows a bi-modal distribution with peak occurrences in the 2-nd/3-rd and 5-th decades. CONCLUSION: In patients with an accessory pathway, overt pre-excitation, male gender and multiple AP constitute independent risk factors of VF episodes. Young patients in the 2-nd/3-rd and older patients in the 5-th decade might be at higher risk of VF occurrence.
International journal of cardiology 02/2012; 167(2). DOI:10.1016/j.ijcard.2012.01.076 · 4.04 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: Chronic thromboembolic pulmonary hypertension (CTEPH) can be defined as pulmonary hypertension with persistent pulmonary perfusion defects causes by unresolved thrombi. All symptomatic CTEPH patients with documented pulmonary vascular resistance > 300 dyn*sec*cm(-5) and proximal lesions should be considered for surgical treatment--pulmonary endarterectomy. The role of pharmacological treatment remains controversial and should be restricted to inoperable cases and persistent pulmonary hypertension after pulmonary endarterectomy. Every year about 30 procedures is performed in two specialised centers in Poland with 1 year mortality at 8-9%. Number of procedures done gives the frequency of pulmonary endarterectomy at 0.7/million of population/year. Current data from UK indicate the actual ratio of surgical treatment of CTPH at 2/million/year. The article discusses reasons for CTEPH is underdiagnosed and why rate of surgical therapy in Poland is too low.
Kardiologia polska 01/2011; 69(8):875-8. · 0.54 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: Standard treatment of patients with coexisting cardiac and non-cardiac diseases includes two separate operations. We report a case of 55-year-old man with combined valvular heart disease and renal carcinoma infiltrating inferior caval vein, who underwent one-stage cardio-urologic procedure. In the first step, mitral and tricuspid valvuloplasty were performed by cardiac surgeons. Then, urologists performed radical nephrectomy and thrombectomy. The postoperative course was uneventful. In twelve months follow-up the patient shows no signs of recurrence and he had no symptoms of cardiac disease. To the best of our knowledge such a case has never been reported before in the literature.
World Journal of Surgical Oncology 07/2010; 8:63. DOI:10.1186/1477-7819-8-63 · 1.41 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: We present a rare case of giant, metastatic renal cell carcinoma of the pericardium diagnosed 20 years after nephrectomy. An endovascular procedure was used to place coils preoperatively in the large collateral vessels supplying the tumor to achieve mass reduction and reduce intraoperative bleeding. The tumor was resected through a median sternotomy, and the patient's recovery was uneventful. Preoperative coil placement in the tumoral arteries enabled a safe and bloodless resection in this rare presentation.
The Annals of thoracic surgery 07/2010; 90(1):292-3. DOI:10.1016/j.athoracsur.2009.12.031 · 3.85 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: The aim of our study was to select the most relevant markers of impaired left ventricle (LV) function in patients with heart failure (HF) symptoms due to severe chronic mitral regurgitation (MR).
Thirty-six patients with decompensated HF due to severe MR underwent echocardiography, 6-minute walk test (6MWT) and measurements of plasma renin activity, angiotensin II, aldosterone, noradrenaline (NA), brain natriuretic peptide (BNP), tumour necrosis factor alpha (TNFalpha) with its receptors, and interleukine-6. Patients presented with significant neurohumoral/cytokine activation. By stepwise multiple regression analysis the strongest prediction model for 6MWT included LVEDVI (R2 = 0.95, P = 0.024), BNP (R2 = 0.67, P = 0.0006), IL-6 (R2 = 0.90, P = 0.044); for BNP: 6MWT (R2 = 0.36, P = 0.003), LA (R2 = 0.56, P = 0.0077), LVESVI (R2 = 0.83, P = 0.0072); for NA: EF (R2 = 0.4 1, P = 0.036), and for TNFalpha: LVESVI (R2 = 0.65, P = 0.003).
6MWT and neurohumoral markers (mainly BNP, but also NA and TNFalpha) are good predictors of the degree of LV remodelling, showing an independent correlation with the level of LV dilatation/dysfunction in chronic severe MR.These assessments may supplement standard echocardiography in LV decompensation due to severe MR.
[Show abstract][Hide abstract] ABSTRACT: Atrial fibrillation (AF) in WPW syndrome occurs earlier and is more common than in the general population.
To evaluate the predisposing factors for the first episode of AF in patients with WPW.
We analysed data on 930 patients (510 males, 420 females) with WPW treated in our centre during 1988-2007. AF was diagnosed in 236 patients (25% - 161 males, 75 females, aged 36 +/- 15 years). The AF group was divided into two subgroups - patients with AF and atrio-ventricular reentrant tachycardia (AVRT), and patients with AF only. The analysis included subjects' age and gender, the presence of AVRT, the number and properties of accessory pathways, left ventricular ejection fraction (LVEF) and concomitant cardiovascular diseases.
The groups did not differ in terms of concomitant diseases and LVEF. In the whole group of patients with AF, arrhythmia occurred earlier in men than in women (34 +/- 14 vs. 40 +/- 15 years of age, p = 0.013). In the subgroup with AF and AVRT, AF was documented earlier compared to patients with AF only (34 +/- 15 vs. 41 +/- 15 years of age, p = 0.0072). AVRT was more common in patients with AF compared to those without AF (69 vs. 53%, p < 0.001). In the whole group of 930 patients, AF was observed more often in patients with overt pre-excitation compared to concealed WPW (29 vs. 12%, p < 0.001).
In patients with WPW syndrome, AF occurs earlier in patients with AVRT compared to patients with AF and without documented AVRT, earlier in men compared to women, and is more common in patients with overt WPW.
Kardiologia polska 09/2009; 67(9):973-8. · 0.54 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: Reduced myocardial contractility is often attributed to altered Ca(2+) transients and expression of Ca(2+)-ATPase of the SR (SERCA) and Na+/Ca(2+)exchanger (NCX) genes.
To assess myocardial expression of SERCA and NCX protein levels in left ventricular (LV) remodelling due to chronic severe mitral regurgitation (MR).
Myocardial expression of SERCA/NCX in biopsy specimens obtained during mitral surgery was assessed in 36 MR patients with LV remodelling and plasma neurohumoral/cytokine activation and in four non-failing hearts (NFH).
Myocardial protein levels of SERCA were significantly (20%) lower in the MR group than in NFH group (p=0.016). No significant changes in NCX were observed. However, a lack of homogeneity with regard to SERCA/NCX proteins was observed. Moreover, SERCA was negatively correlated with BNP (r=-0.49, p=0.02), TNFalpha (r=-0.68, p=0.0005) and IL-6 (r=-0.52, p=0.02), whereas NCX was only negatively correlated with TNFalpha (r=-0.62, p=0.002).
MR patients showed wide variations in SERCA/NCX protein expression. Myocardial protein levels of SERCA were significantly lower in the MR population. Moreover, a correlation between BNP, cytokines (IL-6, TNFalpha) and the expression of SERCA/NCX proteins was observed.
European Journal of Heart Failure 06/2007; 9(6-7):579-86. DOI:10.1016/j.ejheart.2007.01.011 · 6.53 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: A 51-year-old woman with antiphospholipid syndrome was readmitted to the hospital two years after successful surgical pulmonary thrombendarteriectomy for severe chronic thromboembolic pulmonary hypertension (CTEPH). Exertional dyspnea, chest pain and ECG pattern could suggest relapse of pulmonary thromboembolism. However, no signs of pulmonary hypertension were found at echocardiography. Coronary angiography revealed proximal critical occlusion in the left anterior descending artery which was successfully treated with PTCA and stenting. Coronary artery disease may mimic relapse of CTEPH and this should be remembered especially in patients with antiphospholipid syndrome, who have increased risk of coronary artery disease especially in the presence of other classical risk factors.
Kardiologia polska 02/2007; 65(1):50-3. · 0.54 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: Chronic thrombembolic pulmonary hypertension is a rare complication of acute pulmonary embolism. Narrowing or closure of pulmonary arteries is the cause of pulmonary hypertension and results in right ventricular overload and failure. The treatment of choice is pulmonary thrombendarterectomy. Deep hypothermic circulatory arrest is a very important factor required for complete removal of the thrombembolic material from the pulmonary arteries during the operation. The aim of the study was the evaluation of the effectiveness of the use of deep hypothermic circulatory arrest during pulmonary thrombendarterectomy in patients with chronic thrombembolic pulmonary hypertension. Material and methods. Between October 1995 and October 2006 seventy patients were operated on. All of them were operated on with the use of deep hypothermic circulatory arrest. Deep hypothermia (18-19°C, pharmacotherapy, and neuromonitoring were used as a protection of the central nervous system during circulatory arrest. Results. In fifly-seven patients out of seventy, complete thrombendarterectomy was performed (more than 75% of branches opened). The average pulmonary artery pressure and pulmonary vascular resistance were decreased, and cardiac output and index were increased. Six patients died (8.6%). Conclusions. Complete thrombendarterectomy gives significant hemodynamical improvement in patients undergoing the operation. Deep hypothermic circulatory arrest during the operation does not cause significant neurological complications. Incomplete thrombendarterectomy may be the cause of right ventricular failure and death after the operation.
Polish Journal of Surgery 01/2007; 79(9):576-580. DOI:10.2478/v10035-007-0090-y
[Show abstract][Hide abstract] ABSTRACT: Left ventricle (LV) function was shown to be a principal determinant of morbidity and mortality in both uncorrected and surgically corrected mitral regurgitation (MR). However, the cellular mechanisms that develop in the LV remodeling secondary to volume overload in chronic severe MR is still not well defined. In single ventricular myocyte, a reduced contraction and slowed relaxation have been mainly attributed to defective intracellular Ca2+ currents. Between several Ca2+ handling proteins, sarcoplasmic reticulum Ca2+-ATPase 2 (SERCA2) expression and activity determines not only the extent and rate of relaxation, but also the rate and amplitude of contraction. The aim of the study was to determine whether modifications of SERCA2 gene expression occurs in LV wall remodeling process secondary to chronic severe MR.
The LV samples were obtained from 12 patients presented LV wall remodeling (LV: diastolic/systolic diameter-70+/-7 mm vs 46+/-10 mm; diastolic/systolic volume-260+/-65 ml vs 102+/-68 ml) due to chronic, severe MR. Expressions of SERCA2 isoforms-SERCA2a and 2b mRNAs were estimated by semiquantitative RT-PCR and normalized to GAPDH. The protein levels of SERCA2 were determined by Western blot after normalization to actin. Results were compared with samples from non-failing human hearts (NFH).
On SERCA2 mRNA levels, important reduction on both SERCA isoforms SERCA2a (-40%) and SERCA2b (-49%) compared to NFH, together with significant correlation between isoforms (r = 0.89; p = 0.01) were observed. SERCA2 protein levels were decreased (-38%) in MR compared to NFH. Also significant correlations between SERCA2a/2b and SERCA2 protein expression (r = 0.83, p = 0.017; r = 0.68, p = 0.05, respectively) were observed. Moreover, a negative correlation between protein levels of SERCA2 (r = -0.64, p = 0.053) and left ventricular diastolic diameter was observed.
In chronic volume overload the down-regulation of SERCA2a and 2b at the mRNA and SERCA2 protein levels exist. Moreover, protein levels of SERCA2 tend to correlate to the grade of left ventricular diastolic dilatation and suggest an important role LV remodeling.
European Journal of Cardio-Thoracic Surgery 12/2006; 30(5):737-43. DOI:10.1016/j.ejcts.2006.07.008 · 3.30 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: Incidence and clinical presentation of thromboembolic complications in patients with arrhythmogenic right ventricular dysplasia/cardiomyopathy (ARVD/C) were analysed. In reports on ARVD/C, thromboembolism is rarely mentioned. The possible risk factors are: right ventricle (RV) dilatation, aneurysms, and wall motion abnormalities.
A group of 126 patients (89 male, 37 female, aged 43.6+/-14.3) with ARVD/C was retrospectively analysed for the presence of thromboembolic complications. The mean follow-up period was 99+/-64 months. Thromboembolic complications, i.e. pulmonary embolism (n=2), RV outflow tract thrombosis with severe RV failure (n=1), and cerebrovascular accident associated with atrial fibrillation (n=2) were observed in 4% of the patients. Spontaneous echogenic contrast was observed in seven patients with severe damage to RV. In four of them supraventricular arrhythmias resulting in heart failure were reported. Annual incidence of thromboembolic complications was 0.5/100 patients.
(i) ARVD/C may be complicated by thrombosis. Annual incidence of such complications is significantly lower than reported for left ventricle failure. (ii) Anticoagulation should be used in ARVD/C patients with large, hypokinetic RV and slow blood flow. (iii) Patients with severe forms of ARVD/C, thrombus formation in the RV and/or spontaneous echocardiographic contrast are at higher risk of a poor outcome.
[Show abstract][Hide abstract] ABSTRACT: Introduction: Pulmonary veins isolation (PVI) is useful method in patients (pts) with mitral valve disease (MVD) and chronic atrial fibrillation (AF) during prosthetic valve implantation.
The aim of the study: To evaluate e.ectiveness of PVI in the treatment of AF in pt with MVD during valve implantation.
Material and methods: 45 pts (mean age 55 yrs) with AF were operated on for MVD.RF ablation around the pulmonary veins, a lesion between them and to the mitral annulus were performed. There were 44 prostheses implanted, 1 case of mitral valve annuloplasty, associated with tricuspid valve repair (5 pts), aorto-coronary bypass procedure (2 pts), ASD II closure (1 pt).
Results: SR was achieved in 2 (44,5%) pts, 21 (46,5%)pts were in AF, 4 (9%) pts needed pacing. No correlation between SR restoration and preoperative echocardiographic parameters, age, gender, NYHA functional class were found. In long-term follow-up 1 pt have reversed AF to SR spontaneously. There were 6 cases of paroxysmal AF,1 pt needed pacemaker implantation. 20 (44,5%) pts are in SR, 20 (44,5%) in AF, 5 (11%) in permanent pacing.
Conclusion: PVI with RF use is effective in restoring sinus rhythm in patients with chronic AF secondary to mitral valve disease.
Central European Journal of Medicine 03/2006; 1(1). DOI:10.2478/s11536-006-0006-y · 0.15 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: A case of a 59 year old male with infective endocarditis is presented. Antibiotic therapy seemed effective, however, inflammation laboratory parameters increased two weeks after clinical improvement and body temperature normalisation. Subsequent extensive laboratory investigations revealed multiple myeloma. The patient underwent successful aortic valve replacement and received pharmacological therapy for multiple myeloma. Difficulties in diagnosing and treatment of patients with infective endocarditis who have other concomitant diseases, are discussed.
Kardiologia polska 11/2005; 63(4):414-8. · 0.54 Impact Factor