J Malý

Publications (12)8.52 Total impact

• Source

  Available from: Vojtech Melenovsky

  Article: Is severe pulmonary hypertension a contraindication for orthotopic heart transplantation? Not any more.

  J Kettner, Z Dorazilová, I Netuka, J Malý, H Al-Hiti, V Melenovský, I Skalský, H Říha, I Málek, J Kautzner, J Pirk
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  ABSTRACT: Pulmonary hypertension (PH) unresponsive to pharmacological intervention is considered a contraindication for orthotopic heart transplantation (OHTX) due to risk of postoperative right-heart failure. In this prospective study, we describe our experience with a treatment strategy of improving severe PH in heart transplant candidates by means of ventricular assist device (VAD) implantation and subsequent OHTX. In 11 heart transplantation candidates with severe PH unresponsive to pharmacological intervention we implanted VAD with the aim of achieving PH to values acceptable for OHTX. In all patients we observed significant drop in pulmonary pressures, PVR and TPG (p < 0.001 for all) 3 months after VAD implantation to values sufficient to allow OHTX. Seven patients underwent transplantation (mean duration of support 216 days) while none of patients suffered right-side heart failure in postoperative period. Two patients died after transplantation and five patients are living in very good condition with a mean duration of 286 days after OHTX. In our opinion, severe PH is not a contraindication for orthotopic heart transplantation any more.
  Physiological research / Academia Scientiarum Bohemoslovaca 08/2011; 60(5):769-75. · 1.55 Impact Factor
• Article: Increased circulating and epicardial adipose tissue mRNA expression of fibroblast growth factor-21 after cardiac surgery: possible role in postoperative inflammatory response and insulin resistance.

  T Kotulák, J Drápalová, P Kopecký, Z Lacinová, P Kramář, H Říha, I Netuka, J Malý, D Housa, J Bláha, Š Svačina, M Haluzík
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  ABSTRACT: We studied the changes in serum fibroblast growth factor-21 (FGF-21) concentrations, its mRNA, and protein expression in skeletal muscle and adipose tissue of 15 patients undergoing cardiac surgery. Blood samples were obtained: prior to initiation of anesthesia, prior to the start of extracorporeal circulation, upon completion of the surgery, and 6, 24, 48, and 96 hours after the end of the surgery. Tissue sampling was performed at the start and end of surgery. The mean baseline serum FGF-21 concentration was 63.1 (43.03-113.95) pg/ml and it increased during surgery with peak 6 hours after its end [385.5 (274.55-761.65) pg/ml, p < 0.001], and returned to baseline value [41.4 (29.15-142.83) pg/ml] 96 hours after the end of the surgery. Serum glucose, insulin, CRP, IL-6, IL-8, MCP-1, and TNF-alpha concentrations significantly increased during the surgery. Baseline FGF-21 mRNA expression in skeletal muscle was higher than in both adipose tissue depots and it was not affected by the surgery. Epicardial fat FGF-21 mRNA increased after surgery. Muscle FGF-21 mRNA positively correlated with blood glucose levels at the end of the surgery. Our data suggest a possible role of FGF-21 in the regulation of glucose metabolism and insulin sensitivity in surgery-related stress.
  Physiological research / Academia Scientiarum Bohemoslovaca 08/2011; 60(5):757-67. · 1.55 Impact Factor
• Article: [Technique of implantation and experience with temporary mechanical cardiac support in right ventricular failure].

  I Netuka, J Malý, O Szarszoi, H Ríha, D Turek, M Urban, I Skalský, T Kotulák, Z Dorazilová, J Pirk
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  ABSTRACT: Severe right heart failure remains unfrequent but fatal complication of cardiac surgical procedures. Implantation of temporary right ventricular assist device may be life-saving procedure in various situations of right heart failure as: heart transplantation, LVAD therapy and post-cardiotomy failure. The aim of the study is an introduction of the implantation technique and retrospective review of current experience with the method. Since January 2007 isolated right ventricular assist device Levitronix CentriMag has been implanted in 16 patients. Patients were divided into 3 groups: post transplantation (post-Tx), post LVAD implantation (post-LVAD) and other cardiac procedures (OCP). Success rate of weaning from RVAD, 30-days mortality and major complications has been assessed. Distribution of implants in groups was: post-Tx 5 pts (31%), post-LVAD 6 pts (38%) and 5 in OCP group (31%). The mean support time was 12 days. Off-pump implantation was achieved in 9 pts. The device was successfully weaned in 13 (81%) patients. 30-days mortality occurred in 1 case only. Presented outcomes are encouraging for broader acceptance of the therapy. Excellent success rate has been reached in post-Tx and post-LVAD. This study emphasises decesive role of proactive approach in early indication of RVAD implantation for achieving satisfactory results.
  Rozhledy v chirurgii: měsíčník Československé chirurgické společnosti 02/2011; 90(2):88-94.
• Article: [Cardiosurgical procedures in patients refusing blood transfusions: IKEM outcomes].

  O Szárszoi, I Netuka, D Janák, M Urban, J Malý, J Besík, D Turek, P Kacer, I Skalský, J Pirk
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  ABSTRACT: Jehovah's Witnesses who require cardiac operation represent a specific challenge to the physicians. Members of this faith will not accept blood or blood products under any circumstances on the basis of religious grounds. Nevertheless cardiac operations belong to surgical interventions with potential severe bleeding and necessity of blood transfusions. The aim of this retrospective study was to analyze clinical data, operative and postoperative courses of patients operated at IKEM who refused blood transfusions. From January 1995 to August 2010, 73 Jehovah's Witnesses ranging in age from 19 to 82 years underwent cardiac surgery at our institute. Aortocoronary bypass were performed in 34 patients, valve surgery in 25 patients, 6 patients underwent concomitant aortocoronary bypass and valve surgery, 2 patients underwent aortocoronary bypass and resection of the left ventricle aneurysm and 2 patients underwent atrial septal defect repair and tricuspid valve anuloplasty. Ventricular septal sefect repair, atrial septal defect repair, Cor Cap device implantation and left ventricular epicardial electrodes implantation were performed in the other patients. Early 30-days mortality was 2.8 % (2 patients). We can conclude that cardiac surgery in Jehovah's Witnesses can be performed safety without blood transfusion and belongs to standard operating procedures at our institution.
  Rozhledy v chirurgii: měsíčník Československé chirurgické společnosti 02/2011; 90(2):102-5.
• Article: [Vascular complications in transcatheter aortic valve implantation in IKEM].

  J Malý, M Zelízko, I Netuka, B Janek, O Szárszoi, T Kotulák, T Marek, J Pirk
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  ABSTRACT: Retrograde transfemoral arterial approach is the most common technique of transcatheter aortic valve implantation. Diameter of available catheters is the limiting factor for percutaneous usage. We currently use 18 French third generation Medtronic Core Valve system. We retrospectively analyzed procedure related complications in our patient cohort. Transcatheter aortic vale implantation with 18 French Medtronic Core Valve was performed in 35 patients (23 females, 12 males) in between 12/2008 and 7/2010. Mean age was 81.4 +/- 6.1 years (range 69-92), mean logistics EuroSCORE was 19.3 +/- 8.9% (range 8-42), mean aortic valve gradient 59.8 +/- 19.8 mm Hg (range 30-86 mm Hg (mean indexed aortic valve area 0.37 +/- 0.11 cm.
  Rozhledy v chirurgii: měsíčník Československé chirurgické společnosti 02/2011; 90(2):106-10.
• Article: [Right ventricular dysfunction after left ventricular assist device implantation].

  H Ríha, I Netuka, T Kotulák, J Malý, M Pind'ák, P Kellovský, F Kopác, D Hodr, O Szarszoi, J Kettner, H Al-Hiti, Z Dorazilová, T Marek, I Skalský, J Pirk
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  ABSTRACT: The frequency of long-term left ventricular assist device (LVAD) implantation is increasing. Acute right ventricular dysfunction or right ventricular failure after LVAD implantation has important influence on morbidity and mortality. The aim of our study was to assess the management of right ventricular dysfunction after LVAD implantation. The study group comprised 21 patients with implanted HeartMate II LVAD since December, 2006 to April, 2009. We evaluated in retrospective fashion baseline parameters of cardiovascular and other organ systems before LVAD implantation, applied pharmacological and mechanical support for the right ventricle, and important clinical outcomes to the end ofJune, 2009. LVAD was implanted in 18 men and 3 women with mean age of 48.7 +/- 11.2 years. The most frequent diagnosis was dilatational cardiomyopathy (9 patients; 42.9%), and the most frequent indication for implantation was bridge-to-transplantation (19 patients; 90.4%). Pharmacological support of the right ventricle after LVAD implantation comprised dobutamine (21 patients; 100%), milrinone (21 patients; 100%), isoproterenol (1 patient; 4.8%), and levosimendan (5 patients; 23.8%). In 2 (9.5%) cases there was a need for repeated application of levosimendan during postoperative course. Inhalational nitric oxide was used in 14 (66.7%) patients. Despite extensive pharmacological support, 3 (14.3%) patients needed right ventricular assist device (RVAD) implantation. Most patients (9; 42.8%) survived to heart transplantation; in one (4.8%) case LVAD was successfuly explanted; 6 (28.6%) patients is living with LVAD; 5 (23.8%) patients died during LVAD support. After LVAD implantation there is a need for aggressive pharmacological, and in some cases mechanical, support of the right ventricular function to provide adequate blood flow to LVAD in order to minimize morbidity and mortality.
  Vnitr̆ní lékar̆ství 01/2010; 56(1):30-6.
• Source

  Available from: Bohuslav Ostadal

  Article: Late effect of early hypoxic disturbance in the rat heart: gender differences.

  I Netuka, O Szárszoi, J Malý, H Ríha, D Turek, I Ostádalová, B Ostádal
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  ABSTRACT: Perinatal hypoxemia may have serious long-term effects on the adult cardiovascular system and may lead to sex-dependent changes in cardiac tolerance to acute ischemia in adult life. The aim of the study was to answer the question whether gonadectomy of the male and female rats in the early phase of ontogenetic development affects the late effect of perinatal hypoxia. Pregnant Wistar rats were placed into a normobaric hypoxic chamber (12 % O(2)) 7 days before the expected date of delivery. Newborn pups were kept in the chamber with their mothers for another 5 days after birth. After hypoxic exposure all animals were kept for 3 months in room air. Some of the pups were gonadectomized right after removal from the hypoxic chamber. Ventricular arrhythmias were assessed on isolated perfused hearts. Castration did not influence arrhythmogenesis in the adult normoxic or perinatally hypoxic female hearts. Nevertheless, the number of arrhythmias was decreased in perinatally hypoxic gonadectomized males. In conclusion, we have shown that perinatal normobaric hypoxia increased cardiac tolerance to acute ischemia in adult male rats; however, it had no late effect in females. Gonadectomy did not affect arrhythmogenesis in both normoxic and hypoxic female hearts, whereas in males significantly decreased the number of arrhythmias.
  Physiological research / Academia Scientiarum Bohemoslovaca 01/2010; 59(1):127-31. · 1.55 Impact Factor
• Article: [Management of deep device related infection in patient implanted with mechanical cardiac support device using V.A.C. system].

  D Turek, I Netuka, J Malý, O Szárszoi, J Besík, M Urban, J Pirk, V Petkov
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  ABSTRACT: Infection remains the most significant cause of morbidity and mortality in pacients implanted with mechanical circulatory support devices (MCSD), reaching prevalence of 40-60% according various authors. Successful treatment of the whole spectrum of infectious complications is the basic determinant in archieving good results in MCSD patients. The treatment involves standard surgical procedures, as well as the use of vacuum assisted closure (V.A.C.) therapy in the last few years. We demonstrate successful management of deep device related infection using V.A.C therapy in a patient with MCSD, giving him the opportunity to heart transplantation, and thereafter successful treatment of poststernotomy mediastinitis in this imunosupressed pacient after heart transplantation.
  Rozhledy v chirurgii: měsíčník Československé chirurgické společnosti 12/2009; 88(12):693-6.
• Source

  Available from: cas.cz

  Article: Effect of acute and chronic simvastatin treatment on post-ischemic contractile dysfunction in isolated rat heart.

  O Szárszoi, J Malý, P Ostádal, I Netuka, J Besík, F Kolár, B Ostádal
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  ABSTRACT: Statins are powerful lipid-lowering drugs, widely used in patients with hyperlipidemia and coronary artery disease. It was found, however, that statins appear to have a pleiotropic effect beyond their lipid-lowering ability. They exert anti-inflammatory, antithrombotic and antioxidant effects, increase nitric oxide production and improve endothelial dysfunction. The aim of our study was to examine the effect of chronic and acute treatment with simvastatin on the contractile function of the isolated perfused rat heart after ischemia/reperfusion injury. Contractile function was measured on isolated rat hearts, perfused according to Langendorff under constant pressure. The hearts were subjected to 20 min of global ischemia, followed by 40 min of reperfusion. To investigate the acute effect, simvastatin at a concentration of 10 micromol/l was added to the perfusion solution during reperfusion. In chronic experiments the rats were fed simvastatin at a concentration of 10 mg/kg for two weeks before the measurement of the contractile function. Acute simvastatin administration significantly increased reparation of the peak of pressure development [(+dP/dt)(max)] (52.9+/-8.2 %) after global ischemia, as compared with the control group (28.8+/-5.2 %). Similar differences were also observed in the time course of the recovery of [(+dP/dt)(max)]. Chronic simvastatin was without any protective effect. Our results reveal that the acute administration of simvastatin during reperfusion, unlike the chronic treatment, significantly reduced contractile dysfunction induced by ischemia/reperfusion injury. This supports the idea of possible cardioprotective effect of statin administration in the first-line therapy of the acute coronary syndrome.
  Physiological research / Academia Scientiarum Bohemoslovaca 02/2008; 57(5):793-6. · 1.55 Impact Factor
• Source

  Available from: cas.cz

  Article: Tolerance to acute ischemia in adult male and female spontaneously hypertensive rats.

  J Besík, O Szárszoi, J Kunes, I Netuka, J Malý, F Kolár, J Pirk, B Ostádal
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  ABSTRACT: Clinical and experimental studies have repeatedly indicated that overloaded hearts have a higher vulnerability to ischemia/reperfusion injury. The aim of the present study was to answer the question whether the degree of tolerance to oxygen deprivation in hearts of spontaneously hypertensive rats (SHR) may be sex-dependent. For this purpose, adult SHR and their normotensive control Wistar Kyoto (WKY) rats were used. The isolated hearts were perfused according to Langendorff at constant pressure (proportionally adjusted to the blood pressure in vivo). Recovery of contractile parameters (left ventricular systolic, diastolic and developed pressure as well as the peak rate of developed pressure) was measured during reperfusion after 20 min of global no-flow ischemia in 5 min intervals. Mean arterial blood pressure was measured by direct puncture of carotid artery under light ether anesthesia in a separate group of animals. The degree of hypertension was comparable in both sexes of SHR. The recovery of contractile functions in SHR males and females was significantly lower than in WKY rats during the whole investigated period. There was no sex difference in the recovery of WKY animals; on the other hand, the recovery was significantly better in SHR females than in SHR males. It may be concluded that the hearts of female SHR are more resistant to ischemia/reperfusion injury as compared with male SHR. This fact could have important clinical implications for the treatment of cardiovascular disease in women.
  Physiological research / Academia Scientiarum Bohemoslovaca 02/2007; 56(3):267-74. · 1.55 Impact Factor
• Article: [Mechanical cardiac support--the first use in Czech Republic].

  J Kettner, J Pirk, I Netuka, A Brezina, H Ríha, J Malý, J Masín
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  ABSTRACT: Implantation of mechanical assist device is widely accepted modality of treatment of patients with refractory heart failure. In the present study we evaluated our first one-year experiences with this method for bridging patients to cardiac transplantation. Between April 2003 and May 2004, the Thoratec VAD (Thoratec, Pleasanton, CA, USA) was implanted in 6 patients ( males; age 28-61 years) as a bridge-to-transplant procedure after having received maximum inotropic support and who were at imminent risk of death. In all patients was performed VAD as biventricular device (BiVAD). During a week after placement was observed recovery of organs function in all patients. Five patients survived to heart transplantation. One patient died 21 days after BiVAD placement due to massive bleeding to the respiratory tract. In post-transplantation period 1 patient died second day from acute graft failure and other patient died 34 days after from intracranial bleeding. Three patients has been discharged from the hospital and they are surviving more than I year. Analysis of our first experiences with the Thoratec BiVAD implantation as bridging to heart transplantation suggests that it is well suited method with respect to long- term prognosis of this group of patients.
  Casopís lékar̆ů c̆eských 02/2005; 144(1):38-42; discussion 42.
• Article: On approximation of affine Baire-one functions

  J. Lukeš, J. Malý, I. Netuka, M. Smrčka, J. Spurný
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  ABSTRACT: It is known (G. Choquet, G. Mokobodzki) that a Baire-one affine function on a compact convex set satisfies the barycentric formula and can be expressed as a pointwise limit of a sequence of continuous affine functions. Moreover, the space of Baire-one affine functions is uniformly closed. The aim of this paper is to discuss to what extent analogous properties are true in the context of general function spaces. In particular, we investigate the function spaceH(U), consisting of the functions continuous on the closure of a bounded open setU⊂ℝ m and harmonic onU, which has been extensively studied in potential theory. We demonstrate that the barycentric formula does not hold for the spaceB 1 b (H(U)) of bounded functions which are pointwise limits of functions from the spaceH(U) and thatB 1 b (H(U)) is not uniformly closed. On the other hand, every Baire-oneH(U)-affine function (in particular a solution of the generalized Dirichlet problem for continuous boundary data) is a pointwise limit of a bounded sequence of functions belonging toH(U). It turns out that such a situation always occurs for simplicial spaces whereas it is not the case for general function spaces. The paper provides several characterizations of those Baire-one functions which can be approximated pointwise by bounded sequences of elements of a given function space.
  Israel Journal of Mathematics 11/2003; 134(1):255-287. · 0.75 Impact Factor