[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.
No preview · Article · May 2014 · Clinical and Applied Thrombosis/Hemostasis
[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.
No preview · Article · Feb 2012 · International journal of cardiology
[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.
No preview · Article · Aug 2011 · Kardiologia polska
[Show abstract][Hide abstract] ABSTRACT: Background: Chronic thromboembolic pulmonary hypertension (CTEPH) has poor long term prognosis [1, 2]. Pulmonary endarterectomy (PEA) is a treatment of choice for patients with proximal location of thrombotic material . Aim: Evaluation of post-PEA complication and its risk factors with special reference to development of respiratory failure (RF). Materials and methods: Records of 115 CTEPH patients, 80 males with a mean age of 53 ±13 (25-77) years, operated from October 1995 to April 2010 were reviewed. The patients were divided into two groups: group I without RF and group Il with post-PEA RF. Hemodynamic data, procedural data and postoperative course were analysed. Results: Respiratory failure occurred in 32 (28%) of the operated patients. The causes of RF were reperfusion pulmonary oedema (RPO) 26 (22,6%), persistent pulmonary hypertension (PPH) 11 (9,6%), airways bleeding 3 (2,6%). Seven patients died (6,1%). The patients with post-PEA RF (group II) were older (57 ±12 vs. 52 ±14; p = 0,0344) and had significantly higher mean pulmonary arterial pressure (PAP; 54 ±10 vs. 47 ± 11 mm Hg; p = 0.0055) and preoperative pulmonary vascular resistance (PVR; 1015 vs. 584 dyn ×; S × cm-5; p = 0.0020) and also longer extracorporeal circulation (ECC; 189 ±62 vs. 161 ± 34 min, p = 0.0187) and cardiac arrest (CA; 43 ±17 vs. 32 ±16 min; p = 0.017). Conclusion: Respiratory failure is a frequent complication after PEA. High PVR and PAP before PEA are risk factors of RF and death. RF occurs more frequently after PEA in elderly patients and in those with longer ECC and CA.
[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.
No preview · Article · Jul 2010 · The Annals of thoracic surgery
[Show abstract][Hide abstract] ABSTRACT: Chronic thromboembolic pulmonary hypertension (CTEPH) is a type of pulmonary hypertension induced by the partial obliteration of pulmonary arteries by organized thromboemboli, usually with coexisting remodeling of still patent pulmonary arterioles. It is compatible with group 4, according to the current classification of pulmonary hypertension. CTEPH has several peculiarities. They include persistent incertainties regarding its causes and pathogenesis, but also the possibility of highly effective surgical treatment in a significant proportion of patients by means of pulmonary endarterectomy. This complex intervention may restore exercise capacity, quality of life and life expectancy, otherwise all significantly limited by CTEPH.
[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.
No preview · Article · Feb 2010 · Acta cardiologica
[Show abstract][Hide abstract] ABSTRACT: Aim: The goal of the study was to evaluate early complications in patients with "no option" coronary heart disease subjected to lone transmyocardial laser revascularization (TMLR), or TMLR with coronary artery bypass grafting (CABG). Material and methods: 150 consecutive patients with "no option" coronary artery disease (CAD) were operated on between January 2004 and November 2008. There were 45 female and 105 male patients aged 42 to 81 years, mean age 65.5 years. 35 pts underwent lone TMLR procedure, and 115 pts underwent TMLR + CABG. All patients were monitored for: need for inotropic support, troponin release, myocardial ischaemia or MI, heart rhythm disturbances, bleeding or septic complications. Results: 6 pts (4%) needed support with dobutamine and IABP; 3 pts (2%) needed support with dobutamine, epinephrine and IABP; 33 pts (22%) had increased level of troponin above 10; 9 pts (5.9%) had diagnosis of new myocardial infarction; 13 pts (8.6%) had ventricular arrhythmia, 4 pts with VF required defibrillation. Other complications were rare and transient and included: re-thoracotomy for bleeding in 4 patients; neurological deficit, infection and asystole in 1 patient each. One patient died on the second postoperative day, because of intraoperative myocardial infarction. Conclusions: TMLR as a lone procedure, or combined with CABG, is a safe procedure with low mortality and minor transient complications. This procedure can be recommended for patients with "no option" CAD.
[Show abstract][Hide abstract] ABSTRACT: Aim: The purpose of this study was to investigate the efficacy of techniques designed to minimize right heart compression and provide better exposure of the posterior wall vessels during cardiac surgery. Material and methods: The study included 88 elective, low-risk patients with multivessel disease including the circumflex branches. All patients were analysed for changes in haemodynamic parameters. Patients were divided into three groups. In Group I (25 pts), measurements were obtained after exposure of the posterior wall with a pleuropericardial window and Trendelenburg position. In Group II (35 pts), measurements were taken after exposure of the posterior wall using three stabilizations and exposure methods (Octopus, Starfish, and deep pericardial sutures). In Group III (28 pts), measurements were taken after exposure of the posterior wall with a pleuropericardial window, Trendelenburg position, and inotropic support. Results: The most significant changes in all three groups were observed during exposure of the posterior wall, with a considerable reduction in mean arterial pressure, stroke volume index, and cardiac index, and an increase in right atrial pressure. Trendelenburg positioning and opening the right pleura resulted in an increase in mean arterial pressure, stroke volume index, and cardiac index when the posterior wall was exposed. Conclusion: Pleuropericardial window combined with the Trendelenburg manoeuvre might reduce compression of the right ventricle and haemodynamic compromise during anastomoses of posterior wall vessels. This simple technique enhances surgery on the beating heart.
[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.
No preview · Article · Sep 2009 · Kardiologia polska
[Show abstract][Hide abstract] ABSTRACT: Background: Acute aortic dissection (AAD) is a fatal disease if early diagnosis and institution of appropriate therapy are delayed. For type A dissections, surgical repair is essential. The goal of this study is to summarize the diagnostic algorithm, long-term management regimen that offer patients with an acute aortic dissection the best chance for short-term and long-term survival. Material and methods: 68 [50 males (78.5%) and 18 females (26.5%), mean age 48.1 ± 11 years] consecutive patients undergoing surgery for AAD in a 20-year period (1986-2006) were evaluated. In all patients computed tomography (CT) and doppler ultrasound examination were performed in the aim to analyze thoracic and abdomen aorta as well as following arteries: carotid arteries, brachiocephalic trunk, coeliac trunk, renal, mesenteric and iliac arteries. Results: Hypertension was observed in 51 patients (75%). Chronic dissection of the arch and descendent aorta was present in 44 patients (64.7%), in abdominal aorta in 40 patients (58.8%). 10 patients (14.7%) required surgical retreatment, 5 patients (7.4%) underwent endovascular stent-graft repair of the thoracic and abdomen aorta. There were 4 (5.9%) late deaths. At 10 years survival was 92,6%. Conclusion: Long-term mortality in our series was low. Patients after surgical treatment of acute aortic dissection type A require very close follow-up and a plan for retreatment to prevent sudden aortic rupture and late death.
No preview · Article · Jan 2009 · Nadcisnienie Tetnicze
[Show abstract][Hide abstract] ABSTRACT: Aim of the study: Results of surgical treatment in congenital heart defect patients should be assessed not only by long-term survival but also Quality of Life (QoL). We believe that congenital heart disease surgery affects the patient's lifestyle. This study was aimed at assessing QoL, life satisfaction and disease acceptance in three age categories, separately for males and females. Material and Methods: Patients with various types of congenital heart disease were contacted 10-15 years after their operation in the Institute of Cardiology in Warsaw, Poland. They were asked to complete a questionnaire to assess their quality of life using the Nottingham Health Profile (NHP), the Acceptance of Illness Scale (AIS) and the Satisfaction with Life Scale (SWLS). Of the original 1070 patients, 680 patients were randomly selected. From this group 269 completed and returned the surveys. Three patient age groups were established. The Kruskal-Wallis test was used for means comparison. P value <0.05 was considered significant. Results: The mean age for all patients was 40.1±15.3 years, for males 35.613.1, for females 43.3±15.9, p<0.0001. The mean follow-up from the operation was 13.3 years. The mean age at the time of the operation was 26.7±15.7. In the male group QoL, satisfaction with life and acceptance of illness depended on the age, although the acceptance of illness did not change significantly. Post-surgery male patients with congenital heart disease demonstrate slightly better, but not significantly so, acceptance of the illness, better QoL and higher life satisfaction level than female patients. Age in male patients has no effect on these parameters. In post-surgery female patients, the QoL and life satisfaction level deteriorate with the patient's age. Acceptance of disease was not altered significantly. Conclusions: Post-surgery female patients with congenital heart disease require psychological support many years after the operation.
No preview · Article · Dec 2008 · Polish journal of cardio-thoracic surgery
[Show abstract][Hide abstract] ABSTRACT: Background: Aortic valve sparing operations were developed to preserve the native aortic valve in patients with relatively normal aortic cusps and aortic root aneurysms with or without aortic insufficiency secondary to dilatation of the sinotubular junction or annulus. These operations are an alternative to replacement of the aortic valve and ascending aorta using a conduit containing a tissue or mechanical valve, which has been considered the standard operation to treat patients with aortic root aneurysm. An important feature of this method is the absence of the need for anticoagulation treatment and lack of other complications resulting from mechanical prosthesis implantation. Aim: The aim of this study was to determine the early and mid-term results of aortic valve reimplantation to treat aortic root and ascending aorta aneurysm. Material and Methods: From 2001 to 2008, 45 patients (male 32, female 13) underwent aortic valve sparing operations for aortic root aneurysms (10 patients) and aortic root with ascending aorta aneurysms (35 patients). Their mean age was 45.5±17.1 years. In all patients the reimplantation technique was used. Mean early follow-up was performed 21.1±9.1 days and at mid-term, 21.9±16.1 months after the operation. Severe aortic insufficiency (AI) was diagnosed in 31.1% of patients (n=14), moderate in 42.2% (n=19) and mild 26.6% (n=12). 8 patients had Marfan's syndrome, 8 patients had bicuspid aortic valve, in 22 patients hypertension was diagnosed and in 4 patients aortic dissection was noted. The tube graft was implanted using pledged sutures at the level of the aortic root and with reimplantation of coronary ostia to the tube graft. During the operation transoesophageal echocardiographic assessment of the reimplanted aortic valve function was performed. Early and mid-term results of the operation were assessed on the basis of transthoracic echocardiographic study. Quality of life (QoL) was evaluated using the Nottingham Health Profile (NHP) form. Results: In the transoesophageal echocardiographic examination no significant AI was revealed. Early echocardiographic assessment revealed 89.9% of patients free from moderate or severe AI. In mid-term observations 7 had developed moderate AI (15.5%) and 1 severe AI (2.2%). 82.3% of patients were free from significant AI. Freedom from aortic valve reoperation at 8 years was at the level of 97.8%. There were two hospital deaths. One was on the 20 th postoperative day in a patient with severe AI and with III/IV NYHA heart failure. He underwent kidney transplantation, had severe kidney failure and required chronic dialysis. The second patient, with acute aortic dissection, died on the 10th postoperative day, because of heart failure. An additional death was registered due to leukaemia two years after the operation. One female became pregnant after the operation and delivered successfully by vaginal delivery. QoL in all six sections of NHP - energy, physical mobility, emotional reactions, pain, sleep and social isolation - was assessed as very good (60-100 points). Conclusions: Early and mid-term observation of patients treated because of aortic root aneurysms with the used reimplantation technique revealed good results of the operation and high quality of life.
[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.
Full-text · Article · Jun 2007 · European Journal of Heart Failure
[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.
No preview · Article · Feb 2007 · Kardiologia polska