Bogusław Kapelak

Publications of Bogusław Kapelak

• Thoracoscopic epicardial ablation of left and right atrium: beating heart procedure in patients with atrial fibrillation.

  Authors: Krzysztof Bartuś, Andy C Kiser, Jacek Majewski, Bogusław Kapelak, Janusz Konstanty-Kalandyk, Jacek Lelakowski, Jacek Bednarek, Stanisław Bartuś, Karol Wierzbicki, Robert Sobczyński, Jerzy Sadowski

  Polskie Archiwum Medycyny Wewnetrznej. 04/2012;

  INTRODUCTION Atrial fibrillation(AF) is a common arrhythmia affecting ca. 1-2% of the general population. OBJECTIVES The objective of the study was to evaluate the efficacy and safety ofINTRODUCTION Atrial fibrillation(AF) is a common arrhythmia affecting ca. 1-2% of the general population. OBJECTIVES The objective of the study was to evaluate the efficacy and safety of thoracoscopic ablation in AF patients. PATIENTS AND METHODS 25 patients aged from 42-77(mean 56.4 years) with persistent or longstanding persistent AF were selected. Thoracoscopic epicardial ablation of the right atrium, pulmonary veins and left atrium was performed on the beating heart using Cox MAZE III based diagram, via 3 ports and 2 cm incision below the xiphoid. Exit block was always attempted. Patients were prospectively followed up(FU) for 12 months(M) after the procedure. ECG and 24 h Holter examination was used to confirm results. RESULTS Conduction block across ablation lines was achieved in 21 (84%) patients. At 1 M FU sinus rhythm (SR) was observed in 18 out of the 20 patients. At 3 M FU SR was observed in 19 patients (76%). Two patients had atrial flutter, while three still experienced AF. At 6 M FU SR was observed 21 patients (84%); two patients had AF, one patient atrial flutter, one patient had a pacemaker implanted. Results of the FU performed at one year did not differ from the 6 M FU results. No changes in the sizes of left atria and left ventricular ejection fractions, no deaths, stroke, TIA nor infectious complications were observed. CONCLUSIONS The efficacy of epicardial thoracoscopic ablation of left and right atria was high, reaching 84% during a 12-month follow-up period. No significant complications were observed in the postoperative course, except for the need for pacemaker implantation in one of the patients.

• Single nucleotide polymorphisms may be useful as short-term predictors after coronary artery by-pass grafting surgery: the role of FGB g.4884C>T polymorphism.

  Authors: Ewa Stępień, Bogusław Kapelak, Rafał Drwiła, Jerzy Sadowski

  Kardiologia polska. 01/2012; 70(1):109-10.

• Mechanisms of increased vascular superoxide production in human varicose veins.

  Authors: Bartłomiej Guzik, Maciej Chwała, Paweł Matusik, Dominik Ludew, Dominik Skiba, Grzegorz Wilk, Wojciech Mrowiecki, Bogdan Batko, Andrzej Cencora, Bogusław Kapelak, Jerzy Sadowski, Ryszard Korbut, Tomasz J Guzik

  Polskie Archiwum Medycyny Wewnętrznej. 08/2011; 121(9):279-86.

  Varicose vein disease is one of the most common morbidities in the developed countries. Recent studies have shown that oxidative stress is increased in varicose veins (VV) and venous insufficiency.Varicose vein disease is one of the most common morbidities in the developed countries. Recent studies have shown that oxidative stress is increased in varicose veins (VV) and venous insufficiency. However, the exact mechanisms of oxidative stress in VV remain unknown. The aim of the study was to measure superoxide anion production and analyze its enzymatic sources in VV in comparison with control human saphenous veins (HSV). Superoxide production was also compared between the proximal and distal segments of the veins. Proximal and distal segments of varicose veins (14 patients, aged 52 ±3.5 years) and control veins (15 patients, aged 56 ±4 years) were obtained during VV removal or elective coronary artery bypass graft surgery, respectively. Subjects were matched for age, sex, and the major risk factors for atherosclerosis. Superoxide was measured by lucigenin-enhanced chemiluminescence (5 μmol/l) in the presence and absence of oxidase inhibitors. Superoxide production was increased in VV compared with control HSV. This increase was particularly evident in the distal segments of VV. There was a significant correlation between superoxide production in the proximal and distal segments of HSV but not of VV. Nicotinamide adenine dinucleotide phosphate (NADPH) oxidases and uncoupled nitric oxide synthase (NOS) were the major sources of superoxide in VV, because their inhibitors greatly attenuated superoxide production in VV. NADPH oxidases and NOS could represent valuable drug targets for pharmacological treatment and prevention of varicose vein disease. Oxidative stress may provide a link between endothelial dysfunction, inflammation, and immune activation and the development of chronic venous dysfunction.

• Effect of the E-selectin gene polymorphism (S149R) on platelet activation and adverse events after coronary artery surgery.

  Authors: Ewa Stępień, Sylwia Krawczyk, Bogusław Kapelak, Robert Sobczyński, Jarosław Stoliński, Ewa Wypasek, Anetta Undas, Jerzy Sadowski

  Archives of medical research. 08/2011; 42(5):375-81.

  A common single nucleotide polymorphism in the E-selectin (SELE) gene S149R results in the loss of E-selectin ligand binding specificity. The 149R allele has been associated with severeA common single nucleotide polymorphism in the E-selectin (SELE) gene S149R results in the loss of E-selectin ligand binding specificity. The 149R allele has been associated with severe cardiovascular diseases. We hypothesized that S149R may regulate platelet activation after stimuli associated with perioperative procedures in patients undergoing isolated coronary artery bypass grafting (CABG). Associations between the S149R polymorphism and an increased risk of perioperative acute thrombotic events with regards to a platelet count and activity were analyzed. In elective CABG patients (n = 152) we analyzed associations between S149R polymorphism and an increased risk of perioperative acute thrombotic events with regard to platelet count and activity. The S149R SELE gene polymorphism was determined by real-time polymerase chain reaction. Platelet count and activation marker (β-thromboglobulin-βTG) were evaluated. Prevalence of the S149R genotypes was as follows: 81.8% (n = 121) of homozygotes (149SS), 15.5% (n = 23) of heterozygotes and 2.7% (n = 4) of homozygotes (149RR). The 149R allele carriers had significantly higher postoperative βTG levels than the homozygotes (97 [79-120] vs. 76 [66-91] IU/mL, p = 0.03). Sixteen patients had adverse events: myocardial infarction (n = 14), stroke (n = 1) and fatal pulmonary embolism (n = 1). Twelve patients were carriers of the 149R allele. Relative risk (RR) of postoperative adverse events in the 149R allele carriers was 2.03 with 95% CI (1.05-3.03). Postoperative platelet activation is related to the S149R polymorphism, which enhances the risk of adverse events after CABG.

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• [Percutaneous coronary intervention and aortic valve implantation in a patient with breast cancer].

  Authors: Paweł Kleczyński, Danuta Sorysz, Lukasz Rzeszutko, Jacek Legutko, Bogusław Kapelak, Jerzy Sadowski, Jacek Dubiel, Dariusz Dudek

  Kardiologia polska. 01/2011; 69(11):1165-7.

  We present a case of a 70 year-old female with severe aortic stenosis, multivessel coronary artery disease and breast cancer who successfully underwent complex percutaneous coronaryWe present a case of a 70 year-old female with severe aortic stenosis, multivessel coronary artery disease and breast cancer who successfully underwent complex percutaneous coronary revascularisation, transapical aortic valve implantation and mastectomy.

• [Hybrid ablation of the left atrium on beating-heart - initial experience].

  Authors: Krzysztof Bartuś, Jacek Bednarek, Jacek Majewski, Bogusław Kapelak, Jacek Lelakowski, Stanisław Bartuś, Krzysztof Oleś, Jerzy Sadowski

  Kardiologia polska. 01/2011; 69(5):513-5; discussion 516.

• Surgical ablation for atrial fibrillation using the Ex-Maze III procedure on the beating heart in patients undergoing mitral valve surgery.

  Authors: Krzysztof Bartuś, Jacek Majewski, Bogusław Kapelak, Jacek Lelakowski, Jacek Bednarek, Stanisław Bartuś, Krzysztof Oleś, Jerzy Sadowski

  Kardiologia polska. 01/2011; 69(12):1228-32.

  The Ex-Maze III procedure is a recently developed surgical method for ablation of atrial fibrillation (AF). The procedure uses epicardial approach and can be performed on the beating heart. ToThe Ex-Maze III procedure is a recently developed surgical method for ablation of atrial fibrillation (AF). The procedure uses epicardial approach and can be performed on the beating heart. To evaluate the efficacy and safety of Ex-Maze III ablation in patients undergoing mitral valve (MV) surgery. The study group consisted of 20 consecutive patients (8 males, mean age 67 years) who underwent MV surgery and had concomitant AF. Eighteen patients were diagnosed with long-standing permanent AF and 2 patients with paroxysmal AF. The mean duration of AF was 9.5 years prior to surgery. All the patients underwent the Ex-Maze III procedure on the beating heart immediately before the MV surgery (MV replacement in 17 patients and MV repair in 3 patients). The patients were followed 1, 3, 6 and 12 months after procedure with ECG and 24-h ambulatory ECG monitoring (at 12 months). There were no serious complications in the study group. All the patients were in AF immediately after the procedure and underwent electrical or pharmacological cardioversion (4 and 16 patients, respectively). The proportion of patients remaining in sinus rhythm was 15 (75%) patients at 1 month, 16 (80%) patients at 3 months, 17 (85%) patients at 6 months and 12 months after procedure. The Ex-Maze III procedure for ablation of AF on the beating heart is safe and effective in patients with AF undergoing concomitant MV surgery. In order to better evaluate the outcomes of the procedure a prospective randomised multicentre study is needed.

• Shorter preoperative fibrin clot lysis time predisposes to higher chest tube drainage in patients undergoing elective coronary artery bypass grafting surgery.

  Authors: Anetta Undas, Ewa Wypasek, Bogusław Kapelak, Jerzy Sadowski

  Blood coagulation & fibrinolysis : an international journal in haemostasis and thrombosis. 06/2010; 21(4):380-1.

• [The predicting role of high sensitive troponin testing after coronary artery bypass graft surgery].

  Authors: Bogusław Kapelak, Grzegorz Grudzień, Ewa Stepień

  Przegla̧d lekarski. 01/2010; 67(12):1319-21.

  An article is a short review which summarize the utility of high sensitive cardiac troponins measurements after coronary artery bypass grafting surgery and their prognostic value in the short- andAn article is a short review which summarize the utility of high sensitive cardiac troponins measurements after coronary artery bypass grafting surgery and their prognostic value in the short- and the long-term survival.

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• Forward stroke volume is predictor of perioperative course in patients with mitral regurgitation undergoing mitral valve replacement.

  Authors: Andrzej Gackowski, Anton Chrustowicz, Bogusław Kapelak, Tomasz Miszalski-Jamka, Nader El-Massri, Jerzy Sadowski

  Cardiology journal. 01/2010; 17(4):386-9.

  Decreased left ventricle ejection fraction (LVEF) is a predictor of poor late outcome in patients with mitral regurgitation (MR). The relationship between pre-operative forward stroke volume (SV) andDecreased left ventricle ejection fraction (LVEF) is a predictor of poor late outcome in patients with mitral regurgitation (MR). The relationship between pre-operative forward stroke volume (SV) and right heart parameters and perioperative outcome in patients with MR has been little studied. Forty patients with severe organic MR, unsuitable for mitral valve repair, who underwent mitral valve replacement (MVR) were included in the study (50% men, average age 61 +/- 9 years). Exclusion criteria were: aortic valve disease, coronary artery disease, rethoracotomy, stroke, infection or significant perioperative bleeding. Pre-operative detailed echocardiographic examination was performed. The end-point was post-operative prolonged intensive care unit (ICU) stay of more than three days because of the need for inotropic support. Pre-operative NYHA class was 2.6 +/- 0.4, mean right ventricular end-diastolic diameter (RVEDD) was 28.7 +/- 4 mm, TAPSE was 20 +/- 4 mm, mean right ventricular systolic pressure (RVSP) was 38 +/- 13 mm Hg, left ventricular end-systolic diameter was 43.5 +/- 11 mm, left ventricular end-diastolic diameter was 60 +/- 11 mm, left ventricular end-diastolic volume (Simpson) was 155 +/- 47 mL, LVEF was 55 +/- 11%, mean regurgitation fraction was 58% and forward SV (measured by Doppler) was 35 +/- +/- 11 mL. All patients survived the operation. Mean ICU stay was 3.2 +/- 2.9 days (range 1-10 days), mean TISS-28 was 623 +/- 293 and mean NEMS 151 +/- 85. By univariate analysis, ICU stay was significantly longer in patients in higher pre-operative NYHA (p = 0.04), lower LVEF (p = 0.01), lower forward SV (p = 0.001) higher RF (p = 0.01), pre-operative right ventricular dilatation (p = 0.04), higher RVSP (p = 0.006) and right ventricular dysfunction (p = 0.04). By multivariate analysis, forward SV (p = 0.002, b = -0.45) and RVEDD (p = 0.02, b = 0.31) were independent predictors for prolonged ICU stay. Pre-operative forward stroke volume and right ventricle size are predictors of the perioperative hemodynamic status in patients with mitral regurgitation undergoing MVR.

• The +405 GG variant of vascular endothelial growth factor polymorphism is associated with poor prognosis in patients undergoing coronary artery bypass graft surgery.

  Authors: Maciej Pastuszczak, Agnieszka Branicka, Bogdan Jakiela, Ewa Stępień, Andrzej Jaworek, Anna Wojas-Pelc, Bogusław Kapelak, Jerzy Sadowski

  Polskie archiwum medycyny wewnetrznej. 11/2009; 119(11):719-725.

  INTRODUCTION: Coronary artery bypass graft (CABG) surgery is associated with systemic response and increased concentrations of numerous cytokines. Vascular endothelial growth factor (VEGF) relatedINTRODUCTION: Coronary artery bypass graft (CABG) surgery is associated with systemic response and increased concentrations of numerous cytokines. Vascular endothelial growth factor (VEGF) related pathway also seems to be involved in inflammatory response induced by CABG. OBJECTIVES: The aim of this study was to analyze the association between the VEGF gene +405 G>C polymorphism (linked to serum VEGF production), and the short-term clinical outcome during the in-hospital period (30 days) in patients undergoing CABG. PATIENTS AND METHODS: Genotyping for VEGF gene +405 G>C polymorphism was performed in 64 patients with coronary artery disease at a mean age of 66 years (76.6% males), with a mean EuroSCORE (European System for Cardiac Operative Risk Evaluation) of 2.5 (0-2 points: 50% patients, 3-4: 25%, >=5 points: 25%), who underwent CABG surgery. RESULTS: Twenty-one (33%) patients were homozygous for the +405 G allele, 40 (63%) were heterozygous, and 3 were homozygous for the +405 C allele. Ten patients died during the 30-day follow-up (7 subjects with +405 GG genotype, and the other 3 carriers of the +405 C allele). Using multivariate logistic regression analysis, the risk of death after CABG was increased in patients with +405 GG genotype (odds ratio [OR] = 6.7; 95% confidence interval [CI] 1.5-29.4) and with EuroSCORE >=5 points (OR = 4.4; 95% CI 1.1-18.1). CONCLUSIONS: The VEGF gene +405 G>C polymorphism might be a prognostic factor of an adverse postoperative course in patients undergoing CABG surgery. Apart from its proangiogenic action, VEGF may have additional, possibly proinflammatory properties.

• [Thoracoscopic Ex-Maze III procedure and radiofrequency catheter ablation - a hybrid therapy for permanent atrial fibrillation. A case report.]

  Authors: Jacek Majewski, Krzysztof Bartuś, Bogusław Kapelak, Jacek Myć, Jerzy Sadowski, Jacek Lelakowski

  Kardiologia polska. 09/2009; 67(9):1044-7.

  We desribe a case of a 57-year-old patient with persistent longstanding atrial fibrillation (AF) in whom paracardioscopic Ex-Maze III procedure converted AF to typical counterclockwise atrialWe desribe a case of a 57-year-old patient with persistent longstanding atrial fibrillation (AF) in whom paracardioscopic Ex-Maze III procedure converted AF to typical counterclockwise atrial flutter. Subsequent catheter RF ablation of cavo-tricuspid isthmus restored sinus rhythm. We propose that the hybrid therapy including thoracoscopic maze procedure and catheter RF ablation of flutter isthmus might be effective in some patients with permanent AF. To the best of our knowledge this approach was never published before. Lelako.

• Factor XIII Val34Leu polymorphism as a modulator of fibrin clot permeability and resistance to lysis in patients with severe coronary artery disease.

  Authors: Ewa Stępień, Dariusz Plicner, Bogusław Kapelak, Ewa Wypasek, Jerzy Sadowski, Anetta Undas

  Kardiologia polska. 08/2009; 67(8):947-955.

  Background: A common G to T transition in codon 34 with the subsequent valine with leucine replacement in the factor (F) XIII A-subunit affects fibrin formation and stabilisation in vitro. Data onBackground: A common G to T transition in codon 34 with the subsequent valine with leucine replacement in the factor (F) XIII A-subunit affects fibrin formation and stabilisation in vitro. Data on the effects of Leu34 allele on cardiovascular thromboembolic events in vivo are conflicting. Aim: We investigated 113 patients, aged 62.8 +/- 6.1 years, who were scheduled for elective isolated coronary artery bypass grafting surgery (CABG). Patients were compared with 98 healthy age-matched controls. Ex vivo fibrin clot permeability and lysis time (t50%) were determined in citrated plasma. Results: Patients scheduled for CABG had lower clot permeability (9.14 +/- 1.64 vs 10.02 +/- 1.12 x 10-9cm2; p = 0.0002) and longer t50% (8.45 +/- 1.94 vs 7.63 +/- 1.24 min; p < 0.0001) than controls. The Leu34 carriers, i.e. 9 (8%) Leu34Leu homozygous and 23 (20%) Val34Leu heterozygous subjects, had lower permeability by 23% in the CAD group compared with 81 (72%) patients with Val34Val genotype. A similar intergroup difference was observed for t50% which was longer in Leu34 carriers (p < 0.0001). The FXIII Leu34 allele on permeability and t50% was not affected by homocysteine, C-reactive protein and fibrinogen leveles in CAD patients and controls. Conclusions: Like in healthy subjects, in patients scheduled for CABG, the FXIII Leu34 allele is associated with decreased fibrin clot permeability and efficiency of lysis.

• Sutureless aortic valve bioprothesis '3F/ATS Enable' - 4.5 years of a single-centre experience.

  Authors: Jerzy Sadowski, Bogusław Kapelak, Roman Pfitzner, Krzysztof Bartuś

  Kardiologia polska. 08/2009; 67(8):956-963.

  Background: Management of patients with acquired heart malfromations, including aortic valve disease, is still challenging. Due to ageing of population, patients undergoing valve surgery are olderBackground: Management of patients with acquired heart malfromations, including aortic valve disease, is still challenging. Due to ageing of population, patients undergoing valve surgery are older than in the past. The 3F Therapeutics, conducting a programme of construction of heart valves for transarterial or transapical implantation, prepared the 'Enable' bioprosthetic valve for sutureless insertion in the aortic position. The first world implantation was performed in our Department on 13 January 2005. Aim: To present our experience, qualification criteria and methods of implantation of sutureless bioprosthesis of aortic valve - 'Enable' Methods: The 'Enable' valve is a tubular structure, tailored and sutured of equine pericardium, treated with glutaraldehyde, and mounted on an opnework NitinolTM alloy stent. It consists of two distal rings, connected with three vertical sticks. The characteristic property of nitinol is thermoplaticity: due to refrigeration it becomes elastic and easy to bend, after rewarming returns to the initial dimensions and shape, remaining stable at the body temperature. Distension of the nitinol ring make possible strong mounting of the valve in aortic annulus. The examined group consisted of 27 patients (16 males, 11 females), aged 60-70 years (average 69.5), withadvanced aortic valve disease, left ventricular hyperthophy, and aortic gradient up to 102 mmHg. Exclusion criteria were: severe annular deformations or bicuspid aortic valve, other valves' malformations, coronary disease, severe other comorbidities or no agreement for 'Enable' valve implantation. The patients were operated using extracorporeal circulation, general geometry, valve size selection, and orientation of the valve toward coronary ostia. The mounting time was approximately one min, and the aorta cross-clamp time was reduced to 26-56 min, mean 30 min. Results: There was no mortality in the perioperative period, and during 3 months to 4.5 years of follow-up. No severe complications were present after surgery. One patient needed reoperation on the post operative day 4 due to severe perivalvular leak. One other patient presented discrete leak with no need for intervention. The clinical improvement of one to three NYHA classes was observed. Echocardiographic and MSCT examinations confirmed adequate position of the valves, no structural deretiorations, normal movemenet and coaptation of the leaflets. The average maximal transvalvular gradient was 11.6 mmHg and the mean gradient - 6.8 mmHg, which remained stable during the follow-up period. No thromoembolic or infective complications were present. Conclusions: 1. The 'Enable' aortic bioprosthetic valve has very good hemodynamics properties. 2. Self-expanding thermoplastic nitinol-made ring allows permanent stable mounting. 3. The quick fixation (about 1 min) significantly shortens the operation time. 4. The 'Enable' valve seems to be suitable for patients with increased perioperative risk.

• [POL-TAVI First - Polish report on transcatheter aortic valve implantation (TAVI) of Edwards-Sapien prosthesis in the first 19 high risk patients with severe aortic stenosis and comorbidities.]

  Authors: Marian Zembala, Krzysztof Wilczek, Roman Przybylski, Piotr Chodór, Paweł Nadziakiewicz, Marcin Krasoń, Jerzy Sadowski, Dariusz Dudek, Bogusław Kapelak, Danuta Forysz [......] Andrzej Bochenek, Marek Cisowski, Maria Trusz-Gluza, Paweł Buszman, Stanisław Woś, Zbigniew Kalarus, Lech Poloński, Mariusz Gasior, Grzegorz Opolski, Witold Ruzyłło

  Kardiologia polska. 08/2009; 67(8):936-40.

  Patients with severe symptomatic aortic stenosis, who from November 2008 to March 2009 were treated with Edwards-Sapien transcatheter aortic valve implantation (TAVI) within the POL-TAVI First PolishPatients with severe symptomatic aortic stenosis, who from November 2008 to March 2009 were treated with Edwards-Sapien transcatheter aortic valve implantation (TAVI) within the POL-TAVI First Polish Registry, were included in the analysis. Nineteen patients aged 78+/-4,8 years with high operation risk and Logistic EuroSCORE 25 +/- 7.6% were reported (74% were females). In 15 (79%) patients the valve was implanted transapically (TA), in the other four (21%) - via the femoral arterial access (TF). The valve was successfully implanted in 16 (84%) patients, in one patient aortic valvuloplasty alone was performed. During in-hospital period two patients died (one during periprocedural period and another one - two months after the implantation). During the mean follow-up of 5 +/- 1.5 months (except for one patient who is still in hospital) all patients are in NYHA class I or II. Results of the initial series of 19 TAVI patients in Poland are satisfactory, and the trial will be continued with careful medical and economical analysis.

• [Factors influencing thrombin generation measured as thrombin-antithrombin complexes levels and using calibrated automated thrombogram in patients with advanced coronary artery disease]

  Authors: Ewa Stepień, Dariusz Plicner, Agnieszka Branicka, Elzbieta Stankiewicz, Agnieszka Pazdan, Maria Sniezek-Maciejewska, Izabela Górkiewicz, Bogusław Kapelak, Jerzy Sadowski

  Polskie archiwum medycyny wewnȩtrznej. 08/2007; 117(7):297-305.

  INTRODUCTION: Haemostatic factors play an important role in atherothrombosis. Thrombin generation is a crucial stage of blood coagulation. OBJECTIVES: Comparison of different thrombin generationINTRODUCTION: Haemostatic factors play an important role in atherothrombosis. Thrombin generation is a crucial stage of blood coagulation. OBJECTIVES: Comparison of different thrombin generation markers: thrombin-antithrombin complex (TAT) generation and calibrated automated thrombogram method (CAT). Identification of factors influencing thrombin generation in patients with stable angina (SA) enrolled to the coronary artery bypass grafting (CABG) surgery. Analysis of traditional (age, gender, hypertension and diabetes) and novel (fibrinogen and C-reactive protein [CRP]) risk factors and the antiplatelet therapy (aspirin 75-150 mg/d) in relation to coagulation. PATIENTS AND METHODS: In 135 SA patients with left main coronary artery stenosis (> 50%) or major epicardial artery stenosis (> 70%), plasma TAT levels, maximal thrombin concentration (C(max)) and endogenous thrombin potential (ETP) were determined. A marker of the platelet activation (beta-thromboglobulin) was also measured. RESULTS: No correlations among TAT, C(max), ETP, risk factors and beta-thromboglobulin were observed. Linear regression model showed that independent predictors of TAT levels were age (beta = 0.5; p = < 0.0001), male gender and diabetes (beta = 0.36; p = 0.02). CRP independently predicted TAT and ETP (beta = -0.24 and beta = 0.22; p < 0.05, respectively), while fibrinogen predicted C(max) (beta = 0.21; p < 0.05). Independent predictors of beta-thromboglobulin were a male gender and aspirin use cessation (beta = 0.46; p = 0.01). Aspirin treatment had no effect on thrombin generation. CONCLUSIONS: Age, higher fibrinogen, CRP, diabetes and male gender influence thrombin generation and/or coagulation activation in SA patients. Plasma levels of thrombin-antithrombin complexes do not correlate with the parameters obtained using the calibrated automated thrombogram method (C(max), ETP).

• Lipoma of the aortic valve in a patient with acute myocardial infarction.

  Authors: Andrzej Surdacki, Bogusław Kapelak, Agata Brzozowska-Czarnek, Wiesław Frasik, Agnieszka Jasztal, Tomasz Rakowski, Danuta Sorysz, Grzegorz Szastak, Michał Chyrchel, Waldemar Słowiok, Jacek Nowak, Andrzej Urbanik, Jerzy Sadowski, Jacek S Dubiel

  International journal of cardiology. 02/2007; 115(1):e36-8.

  We hereby report the first--to the best of our knowledge--case of primary lipoma of the aortic valve. The tumor has been diagnosed by echocardiography supported by magnetic resonance imaging in aWe hereby report the first--to the best of our knowledge--case of primary lipoma of the aortic valve. The tumor has been diagnosed by echocardiography supported by magnetic resonance imaging in a 63-year-old man with acute inferior ST-elevation myocardial infarction (STEMI) and one-vessel coronary artery disease. Five weeks from the onset of STEMI, direct implantation of a bare metal stent into the right coronary artery was successfully undertaken and 6 weeks later aortic valve with an encapsulated mass was excised with subsequent artificial valve implantation. Histological examination revealed typical features of lipoma. Three months after the operation the patient was asymptomatic and exhibited a good function of the artificial valve.

• [Massive pulmonary embolism treated successfully with embolectomy following failed thrombolysis--the role of repeated spiral computerised tomography and echocardiography--a case report]

  Authors: Piotr Kukla, Barbara Malarczyk-Zaher, Kazimierz Szczuka, Bogusław Kapelak, Jerzy Sadowski

  Kardiologia polska. 02/2007; 65(1):58-61; discussion 62.

  A case of a 29-year-old male with massive pulmonary embolism is presented. The diagnosis was confirmed by spiral computerised tomography and echocardiography. The patient received streptokinase, butA case of a 29-year-old male with massive pulmonary embolism is presented. The diagnosis was confirmed by spiral computerised tomography and echocardiography. The patient received streptokinase, but he continued to be in cardiogenic shock without any improvement. Repeated tomography and echocardiography revealed progression of pulmonary embolism. The patient was transferred to a cardiosurgical department where successful embolectomy was performed.

• [Alcohol ablation of the interventricular septum in a patient with hypertrophic obstructive cardiomyopathy complicated by an increase in the pressure gradient in the left ventricular outflow tract. A case report]

  Authors: Wojciech Płazak, Piotr Podolec, Marek Krochin, Andrzej Gackowski, Piotr Pieniazek, Bogusław Kapelak, Jerzy Sadowski, Wiesława Tracz

  Kardiologia polska. 10/2006; 64(9):989-93.

  A case of a 70 year old female with hypertrophic obstructive cardiomyopathy who underwent alcohol ablation of the interventricular septum, is presented. Following the procedure, the pressure gradientA case of a 70 year old female with hypertrophic obstructive cardiomyopathy who underwent alcohol ablation of the interventricular septum, is presented. Following the procedure, the pressure gradient decreased from 120 mmHg to 80 mmHg. However, 30 minutes after ablation the patients developed hypotension and pulmonary oedema. Echocardiography revealed a significant systolic anterior movement of the anterior leaflet of the mitral valve and elevated pressure gradient up to 200 mmHg. The patient underwent urgent surgery (myectomy), followed by the mitral valve replacement with a favourable outcome.

• Discontinuation of calcineurin inhibitors in heart transplant patients with end stage renal insufficiency as an alternative model of immunosuppression.

  Authors: Sadowski Jerzy, Karol Wierzbicki, Bogusław Kapelak, Janusz Konstanty, Piotr Przybyłowski, Sławomir Wójcik, Rafał Drwiła, Krzysztof Wróbel, Jacek Piatek

  Przegla̧d lekarski. 02/2006; 63(12):1256-8.

  Five heart recipients were followed up with mycophenolate mofetil and low dose cyclosporine due to progressive severe chronic postcyclosporine renal failure. Cyclosporine was gradually withdrawn andFive heart recipients were followed up with mycophenolate mofetil and low dose cyclosporine due to progressive severe chronic postcyclosporine renal failure. Cyclosporine was gradually withdrawn and finally eliminated from immunosuppressive regimen to slow the rate of renal function loss. Improvement of renal function was observed. In the follow up after cyclosporine elimination no risk increase of acute rejection and no deterioration of left ventricle function was observed. Non-calcineurin inhibitors model in heart recipients can be the treatment of choice (but only in very selective cases) in patients with severe chronic renal insufficiency.