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We report a very rare case of Streptococcus canis native infective endocarditis in a 73-year-old woman living in close con- tact with her dog. Her echocardiography showed large calcifications in the mitral annulus, massive regurgitation below the posterior leaflet, and adjacent vegetation. Blood culture was positive for Streptococcus Lancefield group G. A coronary artery bypass and mitral valve replacement had to be done. Streptococcus canis was detected in a heart valve using a broad range PCR followed by 16S rRNA and confirmed by tuf gene sequencing, while tissue culture remained negative. The patient was not bitten by her dog nor did she have comorbidities or skin ulcers. She fully recovered.

Uvod: Srdecni resynchronizacni lecba (SRL) je v soucasne době považovana za ucinnou a bezpecnou lecebnou metodu u pacientů s pokrocilým srdecnim selhanim. V připadě selhani endovazalniho zavedeni levokomorove (LK) elektrody je alternativou kardiochirurgicka implantace.Cile: Cilem prace bylo zhodnotit elektricke parametry kardiochirurgicky implantovaných LK elektrod a porovnat je s transvenozně implantovanými elektrodami, identifikovat přiciny selhani endovazalni implantace, srovnat klinický a echokardiografický resynchronizacni ucinek a porovnat bezpecnost obou přistupů.Metody a výsledky: U pacientů s indikaci k SRL byla LK elektroda implantovana buď endovazalně (skupina endo) nebo v připadě selhani endovazalniho přistupu, nebo jako soucast jineho kardiochirurgickeho výkonu byla elektroda implantovana epikardialně (skupina epi). Studie byla koncipovana jako studie připadů a kontrol. V každe skupině bylo zařazeno 92 pacientů (26 žen, 66 mužů) průměrneho věku 69 let (epi) a 68 let (endo). Levokomorova stimulace byla při třilete kontrole ucinna u 98,1 % pacientů ve skupině epi, resp. u 96,6 % pacientů ve skupině endo (p = NS). Stimulacni prah byl mezi oběma skupinami srovnatelný při propustěni a při třilete kontrole. Při jednoměsicni kontrole byl prah signifikantně vyssi v epi skupině (1,62 V vs. 1,06 V, p < 0,001), podobně jako při jedno- a dvoulete kontrole (1,57 V vs. 1,09 V a 1,54 V vs. 1,21 V, p < 0,001). Energetický výdej pro LK stimulaci byl u pacientů v epi skupině ve vsech casových okamžicich signifikantně vyssi. Celkova proceduralni uspěsnost endovazalni implantace cinila 94,6 %. Klinicka odpověď na SRL byla zaznamenana u 71,4 % pacientů v epi a u 68,1 % pacientů v endo skupině (p = NS). Průměrný narůst ejekcni frakce LK v absolutnich hodnotach byl v obou skupinach srovnatelný (6,0 % vs. 7,2 %, p = NS). V epi skupině byla zaznamenana signifikantně vyssi jedno- i třileta mortalita (19,0 % vs. 5,5 %, resp. 21,7 % vs. 6,5 %, p < 0,001).Zavěr: Ve střednědobem sledovani jsou epikardialni elektrody schopne ucinne LK stimulace. Energeticka narocnost epikardialni LK stimulace je vyssi. Resynchronizacni ucinek je u pacientů s epikardialni a endokardialni LK elektrodou podobný, ale mortalita pacientů s epikardialni LK elektrodou se zda být významně vyssi.

Uvod: Prezentujeme způsob provedeni a výsledky thorakoskopicke radiofrekvencni ablace technikou tzv. box-leze jako metodu lecby izolovane fibrilace sini (FS).Metoda: Celkem 31 pacientů ve věku 63,3 ± 8,4 roku podstoupilo oboustrannou thorakoskopickou ablaci pro symptomatickou paroxysmalni FS (n = 8; 25,8 %) a pro dlouhodobě perzistujici izolovanou FS (n = 23; 75,2 %). Technika tzv. box-leze zahrnuje oboustrannou izolaci plicnich žil a soucasně vytvořeni spojnice lezi na zadni stěně leve sině za použiti davkovane radiofrekvencni energie.Výsledky: Během výkonů se nevyskytly žadne komplikace souvisejici s vlastni ablaci, žadný periproceduralni infarkt myokardu ani cevni mozkova přihoda. Nulova byla take 30denni mortalita. Průměrna doba operace dosahovala 152,1 ± 36,7 min a průměrna doba hospitalizace byla 6,26 ± 1,24 dne. Při propustěni mělo 29 pacientů (93,5 %) na výstupnim EKG sinusový rytmus. Průměrna doba sledovani cinila 20,4 ± 8,3 měsice. Při prvni kontrole po třech měsicich od výkonu bylo 20 (66,6 %) pacientů z třiceti bez zachytu FS a bez nutnosti uživat antiarytmika. Sest pacientů podstoupilo v průběhu sledovani katetrizacni ablaci. Celkem 23 pacientů (76,6 %) vykazovalo trvalý sinusový rytmus v jednom roce po posledni provedene ablaci (chirurgicke ablaci nebo katetrizacni reablaci).Zavěr: Thorakoskopicka ablace box-leze je bezpecna miniinvazivni metoda lecby izolovane fibrilace sini. Tato metoda vykazuje výborne kratkodobe výsledky.

Introduction This work is focused on mapping issues of hemostasis in patients during continuous renal replacement therapy, or the possible impact of the use of anticoagulants. Methods The study included 30 consecutive patients requiring continuous renal replacement therapy following cardiac surgery in the period of 2009 to 2012. Patients were placed into 2 branches according to the selected method of anticoagulation (regional citrate anticoagulation-RCA, unfractionated heparin UFH). According to the given scheme (t1–t7) thromboelastography and laboratory testing related to the testing of blood clotting during continuous renal replacement therapy were performed. Results The average lifespan of a hemofilter during continuous renal replacement is 58.13 ± 9.968 hours. During continuous renal replacement therapy there are significant changes in the initiation of coagulation according to thromboelastographic parameters (R, K, alpha angle) in both branches of anticoagulation. The maximum image changes in hemostasis occur around 24 hours (t4) from the start of the procedure. The nature of the changes is the procoagulant activity in these parameters. In the branch of regional citrate anticoagulation a higher value of functional fibrinogen is apparent. There was no significant difference in the activation of native blood between UFH and RCA. Conclusions During continuous renal replacement therapy significant changes occur in the thromboelastographic image and the laboratory parameters in blood clotting. The nature of the change is the procoagulant activity. The question remains about the complexity of the changes that TEG is not able to detect, especially in the cellular area.

Ventricular septal rupture is a serious mechanical complication of myocardial infarction with important hemodynamic consequences. Without a rapid diagnosis and correction by surgical intervention, the short-term mortality of these patients is higher than 90%. We report the case of a patient with acute inferior myocardial infarction and a ventricular septal rupture with early diagnosis based on clinical examination and transthoracic echocardiography and postponed successful surgical correction.

When cardiopulmonary bypass (CPB) is used, the blood comes into contact with foreign surfaces. To diminish this impact, various types of biocompatibly coated surfaces have been developed. The study assessed the effects of heparin-coated CPB systems on the level and function of fibrinogen as measured by thromboelastography (TEG), as compared with non-coated systems. No statistically significant differences between both groups were revealed by comparing paired data. In our study, heparin-coated CPB circuits had no significant effect on either fibrinogen level or its function.

Cil: Analýza výsledků a vývoje zkusenosti s endoskopickým odběrem vena saphena magna pro chirurgickou revaskularizaci myokardu.Metoda: Do prospektivniho sledovani bylo zahrnuto celkem 400 elektivnich nemocných, kteři podstoupili endoskopický odběr vena saphena magna v obdobi od zaři 2005 do zaři 2010. Hodnoceny byly demograficke, perioperacni a odběrove charakteristiky a cetnost komplikaci spojených s endoskopickým odběrem vena saphena magna v kratkodobem a střednědobem sledovani. Výsledky odběru byly vztaženy k vývoji zkusenosti s technikou odběru a byla doplněna mnohorozměrna analýza vlivu rizikových faktorů poruch hojeni na cetnost komplikaci endoskopickeho odběru vena saphena magna.Výsledky: Průměrný věk osob v souboru byl 68,9 ± 8,5 roku, castěji byli zastoupeni muži (69 vs. 31 %) a celkový průměrný BMI dosahl 31,1 ± 4,1. Odebrano bylo průměrně 2,1 ± 0,8 žilniho stěpu celkove delky 34,4 ± 9,6 cm při průměrnem casu odběru 41,8 ± 10,4 min.U sedmi nemocných (1,8 %) byl odběr konvertovan. V pooperacnim obdobi byl u 33 % nemocných zaznamenan hematom sledujici průběh odběroveho kanalu, u 12 % rezidualni otok koncetiny, 7,8 % nemocných udavalo mirnou bolest koncetiny a u 5,3 % bylo přitomno neurologicke postiženi v inervacni zoně n. saphenus. U žadneho nemocneho nedoslo k rozvoji ranne infekce, přechodna lymfaticka sekrece v mistě vstupni incize byla zaznamenana u 1,2 % nemocných. Při sledovani s odstupem tři měsiců doslo k poklesu incidence otoku (5 %), neurologickeho postiženi (3,2 %) i bolesti (4 %). V jednorozměrne analýze nebyla nalezena korelace mezi přitomnosti rizikových faktorů a cetnosti jednotlivých komplikaci. Rostouci zkusenost s metodou vedla k signifikantnimu zkraceni doby odběru, narůstu delky stěpu a poklesu cetnosti jednotlivých komplikaci.Zavěr: Endoskopický odběr je zatižen velmi nizkým rizikem komplikaci spojených s odběrem v. saphena magna. Přitomnost rizikových faktorů poruch hojeni nema vliv na jeho výsledky, do nichž se promita hlavně zkusenost s metodou.

Cil: Stanovit skutecný výskyt heparinove rezistence u pacientů před kardiochirurgickou operaci. Zjistit, zda je zavislost mezi předoperacni lecbou heparinem a výskytem heparinove rezistence. Dale zjistit, zda je zavislost mezi poctem trombocytů, koncentraci antitrombinu, věkem pacientů a heparinovou rezistenci.Soubor pacientů a metodika: Během tři let jsme postupně zahrnuli do prospektivni studie celkem 624 pacientů před operaci v mimotělnim oběhu. U pacientů jsme sledovali hodnoty ACT (activated clotting time) před operaci a během operace. U vsech nemocných jsme sledovali ctyři faktory, ktere jsou v literatuře považovany za možne přiciny výskytu heparinove rezistence: věk ≥ 65 let, pocet trombocytů předoperacně ≥ 300 × 109/l, předoperacni podavani různých druhů heparinů, koncentrace antitrombinu ≤ 60 % a kombinace vsech faktorů. Pokud davka heparinu ≥ 5 mg/kg nevyvolala antikoagulacni odpověď ≥ 480 s podle ACT, pak jsme pacienty zařadili do skupiny heparin-rezistentnich. K vyhodnoceni nasich výsledků byl použit test shody relativni cetnosti a χ2 test nezavislosti.Výsledky: V nasem souboru se heparinova rezistence vyskytla u 203 z 624 pacientů, tj. u 32,5 %. Výskyt heparinove rezistence se statisticky významně lisil od předpokladaných 22 %. Z celkoveho poctu 624 pacientů bylo 363 (58,2 %) starsich 65 let. Hypoteza zavislosti na věku ≥ 65 let se zamita (p = 0,0391), resp. je na hranici statisticke významnosti. Pro pocet trombocytů před operaci vyssi než 300 × 109/l byla testovana hypoteza nezavislosti vůci alternativě zavislosti. Hypoteza nezavislosti byla zamitnuta (p = 0,000027). Před operaci byl heparin podan 181 pacientům (29 %). Byla testovana hypoteza zavislosti vůci alternativě nezavislosti. Hypoteza nezavislosti byla zamitnuta (p < 0,001). Pro koncentraci antitrombinu ≤ 60 % před operaci se testovala hypoteza nezavislosti vůci alternativě zavislosti. Pro antitrombin byla zamitnuta hypoteza nezavislosti heparinove rezistence na koncentraci antitrombinu ACT ≤ 60 % (p < 0,001).Zavěr: Výsledky nasi prace potvrdily statisticky významně vyssi výskyt heparinove rezistence, než byl předpoklad. Výsledky potvrdily take statisticky významnou zavislost výskytu heparinove rezistence na rizikových faktorech, ktere jsme sledovali kromě věku pacientů, který byl na hranici statisticke významnosti.

Uvod: Degenerativni aortalni stenoza je spojena s koncentrickou hypertrofii leve komory, k jejiž regresi by mělo dojit postupně po nahradě postižene chlopně protezou. Vzhledem k věku pacientů s touto vadou jsou stale castěji implantovany bioprotezy, ktere ale nemaji fyziologicke průtokove parametry. Cilem nasi studie bylo posoudit, zda u biologických chlopni se stentem dochazi po operaci k regresi hypertrofie svaloviny leve komory.Soubor a metodika: Od března 2002 do prosince 2006 bylo na Kardiochirurgicke klinice Fakultni nemocnice v Olomouci implantovano celkem 293 biologických aortalnich chlopni se stentem. Použite bioprotezy byly od výrobců SJM (St. Jude Medical, St. Paul, USA; typy Epic, Epic Supra), Edwards (Edwards Lifesciences, Irvine, USA; typy 2650, 2900, 3000 Magna), Sorin (Sorin Biomedica, Sallugia, Italie; typy More, Soprano) a Medtronic-Hall (Medtronic, Minneapolis, USA; typ Mosaic).Soubor tvoři 165 mužů a 128 žen, průměrný věk byl v době operace 73,5 ± 6 let. Po operaci jsme dopplerometricky měřili efektivni a indexovanou efektivni plochu usti implantovane chlopně, soucasně jsme statisticky srovnavali tlousťku septa a zadni stěny leve komory v diastole před operaci, půl roku po operaci a jeden rok po operaci.Výsledky: Efektivni plochy usti bioprotez, indexovane na tělesný povrch, se v nasem souboru u 91,5 % nemocných pohybuji v rozmezi 0,65-0,8 cm2/m2, což je pod hranici publikovane hodnoty vzniku "patient-prosthesis mismatch" (PPM). Pouze u 8,5 % pacientů jsme naměřili plochu větsi než 0,85 cm2/m2. Statisticke srovnani tlousťky septa a zadni stěny leve komory bylo provedeno pomoci Mannova-Whitneyova testu. Prokazali jsme signifikantně nižsi hodnoty tlousťky septa v diastole půl roku po operaci a jeden rok po operaci ve srovnani s hodnotami před operaci (p < 0,0001), dale signifikantně nižsi hodnoty tlousťky zadni stěny v diastole půl roku po operaci a jeden rok po operaci ve srovnani s hodnotami před operaci (p ≤ 0,001).Zavěr: Bioprotezy se stentem, ktere jsme použili v nasi studii, nevykazuji podle nasich výsledků po implantaci zcela optimalni hemodynamicke parametry. I když byla indexovana efektivni plocha usti pod publikovanou hodnotou vzniku PPM (0,85 cm2/m2), u pacientů doslo k signifikantni regresi hypertrofie leve komory.

Background: Cardiac surgery using cardiopulmonary bypass (CPB) is associated with some adverse postoperative complications caused by an altered immune response. An alternative approach to cardiac surgery, operating without the use of CPB (i.e. off-pump surgery), seems to display less adverse impacts on the immune response. Patients and Methods: Peripheral blood lymphocytes in 40 patients undergoing cardiac surgery either with CPB (“on-pump”) or without CPB (“off-pump”) were followed using flow cytometry. The samples of peripheral blood were taken at five intervals: preoperatively, after termination of the surgery, on the first, on the third and on the seventh postoperative day, respectively. Results: The most substantial changes appeared on the first postoperative day in both subgroups of patients. While the percentage of both total T cells and CD4+ T cells were decreased, the percentage of HLA-DR+ activated lymphocytes was increased. These changes were more profound in the “on-pump” subgroup compared to the “off-pump” subgroup. Conclusion: Our results may suggest that the “off-pump” surgical approach reveals less adverse impact on adaptive immune responses.

Inflammation has been recognized to form an integral part of the atherosclerotic process. Much consideration has been given lately to the role played in atherogenesis by C-reactive protein (CRP). Although not accepted unequivocally, CRP appears to be not only a marker, but also an active mediator of the atherosclerotic process. Pentraxin 3 (PTX3) is a newly identified acute phase reactant which shares some structural and some functional properties with CRP. On the other hand, pentraxin 3 displays unique biological properties of its own, including a possible role in the pathogenesis of cardiovascular diseases and in processes accompanying the natural evolution of surgical wounds. This review article discusses recent information concerning basic pentraxin 3 biology in inflammation and in innate immunity reactions as viewed by a cardiologist in the context of acute coronary events and by a surgeon in patients struck with multiple wounds who are at the same time menaced by bacterial infections.

The purpose of the study was a retrospective evaluation of the outcome of surgical therapy of lung cancer in patients where there was concomitant cardiac disease and who underwent a cardiac operation either because of ischemic heart disease or because of valvular disease. These patients were operated on at various time intervals (two to ten months) after their cardiac operation. Some patients had their lung cancer surgery after the cardiac operation because of the high risk of possible cardiac postoperative complications; in one patient the lung operation preceded the cardiac one.

Deep sternal wound infection (DSWI) after a cardiac operation is a rare but serious complication associated with significant morbidity and mortality. It can lead to wound dehiscence with sternal osteomyelitis and both bony and soft tissue residual defects. When the infection is eradicated, reconstruction of the thoracic wall remains the main challenge. Tissue used for covering the defect must be well nourished and sutures must be tension free. We present our unique modification of the method using the pectoral muscle axial flap with a V-Y skin paddle.

Myeloid cells are extensively activated in patients undergoing cardiosurgical operations. It is supposed that this activation is more profound in patients operated with cardiopulmonary bypass (CPB) ("on-pump") in comparison with patients operated without CPB ("off-pump").To evaluate changes in the expression of a novel activation marker expressed on myeloid cells recognized by MEM-148 antibody.The expression of MEM-148 positive myeloid cells was evaluated by flow cytometry in 40 patients who underwent coronary artery bypass surgery (CABG) randomly assigned to "on-pump" or "off-pump" technique.The relative and absolute number of MEM-148 positive myeloid cells is significantly diminished during "on-pump" surgery. A significant increase in their number in postoperative period in both "on-pump" and "off-pump" patients was found. There were no significant differencies between "on-pump" and "off-pump" patients.The very trauma of surgery seems to be more relevant in starting on activation of myeloid cells them CPB itself.

Cardiac surgical operations are associated with the development of a systemic inflammatory response syndrome (SIRS). In most cases, the inflammatory response is apparent only in its subclinical form. In some cases, however, it can become clinically manifest or even life-threatening. This review article presents some new data regarding its biological importance, along with an insight into the recently discovered role played by heat shock proteins 60 and 70.

Objective: The aim of this study was to monitor and compare metabolic changes in the skeletal muscle during coronary artery bypass grafting surgery with and without cardiopulmonary bypass (CPB) by means of interstitial microdialysis. Glucose, lactate, pyruvate and glycerol were assessed as markers of basic metabolism and tissue perfusion. Methods: Twenty patients undergoing surgical myocardial revascularization were enrolled in this pilot study. Ten patients were operated on without CPB (group A, off-pump) and 10 patients using normothermic CPB (group B, onpump). Interstitial microdialysis was performed by a CMA 60 (CMA/Microdialysis AB, Sweden) probe, inserted into the patient’s left deltoid muscle.Microdialysismeasurements wereperformedat30 minintervals.Glucose,lactate,pyruvateandglycerolweremeasuredinsamplesusing a CMA 600 Analyser (CMA/Microdialysis AB, Sweden). Results in both groups were statistically processed and the groups were compared. Results: Both groups were similar with regards to preoperative characteristics. Dynamic changes of interstitial concentrations of the measured analytes were found in off-pump (group A) and on-pump (group B) patients during the operation. There were no significant differences in dialysate concentrations of glucose and lactate between the groups. Significant differences were detected in pyruvate concentrations, lactate—pyruvate ratio and glycerol concentrations between off-pump versus on-pump patients. Pyruvate concentrations were higher in the off-pump group (p < 0.05),thelactate—pyruvateratiosindicatingtheaerobic/anaerobicmetabolismstatuswerelowerintheoff-pumpgroup(p < 0.01)andthe values of the concentrations of glycerol were lower in the off-pump group (p < 0.01). Conclusion: Dynamic changes in the interstitial concentrations of the glucose, glycerol, pyruvate and lactate were found in both groups of patients (off-pump and on-pump). The presented preliminary results suggest that extracorporeal circulation during cardiac operations could compromise skeletal muscle energy metabolism. # 2008 European Association for Cardio-Thoracic Surgery. Published by Elsevier B.V. All rights reserved.

The aim of this study was to monitor the metabolism and blood flow in the interstitium of the skeletal muscle during cardiac surgery with cardiopulmonary bypass (CPB) and in the early postoperative period by means of microdialysis and to compare metabolic changes during CPB at normothermia (NT) and hypothermia (HT). Surgical revascularization using CPB was performed in 50 patients, 25 patients (group HT) were operated using hypothermic CPB, 25 (group NT) using normothermic CPB. Interstitial microdialysis was performed by two CMA 60 probes (CMA Microdialysis AB, Solna, Sweden) inserted into the patient’s deltoid muscle. Constituents analysed in the obtained dialysates, collected at intervals, were glucose, urea, glycerol and lactate. Tissue blood flow was monitored by dynamic microdialysis with gentamicin as a marker. In both groups, NT versus HT, similar dynamics of concentrations were found. Low initial concentrations were followed by gradual increases during CPB and in the following phase of the operation. Concentrations were higher in the NT group. Immediately after the operation, the decrease in values continued, with a gradual increase in the succeeding postoperative period in both groups. Similar dynamic changes in the lactate concentration were found in both groups. The gentamicin concentrations were lower in the NT group (versus the HT group). The results showed dynamic changes in the interstitial concentrations of glucose, urea, glycerol and lactate, which depend on the phase of the surgery in the CPB and early postoperative phase in the both groups of patients. Higher tissue perfusion of the skeletal muscle was noted in those patients operated on in normothermia. The dynamics of the concentration changes of these substances in the interstitium of the skeletal muscle has been proven to be caused by both the metabolic activity of the tissue and by the blood flow through the interstitium of the muscle.

A 42-year old patient with suspected Marfan syndrome was admitted for examination of resting chest pain occurring intermittently for 1 week. Physical examination was completely normal with a normal blood pressure and present symmetrical upper extremities pulsation. ECG showed 2 mm ST-elevation in II, III, aVF, V4–6 leads. Selective coronarography was performed with a negative finding. On the basis of negative troponin test, myocardial infarction and myocarditis were excluded. Transthoracic …

Background: Cardiac surgery provokes a systemic inflammatory response in any patient. This complex body reaction involves also RANK/RANKL molecules which have been recently identified as principal regulators of bone metabolism. Aims: To follow the changes in the expression of RANK/RANKL molecules on innate immune cells of cardiac surgical patients. Patients and Methods: Twenty-six patients undergoing cardiac surgical were assigned to undergo coronary artery bypass grafting using either cardiopulmonary bypass (“on-pump”) or modified “miniinvasive on-pump”. The expression of RANK/RANKL was performed by flow cytometry. Results: Significantly increased expression of RANK on monocytes of “miniinvasive on-pump” patients was found at the 1st, the 3nd, and 7th postoperative days. The similar pattern was found also for monocyte RANKL expression. In addition, RANKL expression was significantly increased at the 3rd postoperative day in “on-pump” patient. No significant differences between “miniinvasive on-pump” and “on-pump” cardiac surgical patients were found. Conclusion: The expression of both RANK and RANKL molecules is significantly enhanced on monocytes of “miniinvasive on-pump” cardiac surgical patients.

We present three cases of pneumopericardium following blunt chest trauma injury. All three patients were victims of road traffic accidents. All had multiple associated injuries and pneumopericardium was found as the additional finding. Pneumopericardium was treated conservatively with thoracic drains placement and patients observation. Transesophageal echocardiography was used as a method of choice for exclusion of cardiac air tamponade. All three patients survived.

Background: This study was aimed at following the changes in the expression of CD38 ADP-ribosyl cyclase ectoenzyme on peripheral blood immune cells of patients undergoing cardiac surgical operations. Patients and Methods: The expression of CD38 on lymphoid and myeloid cells was determined by immunofluorescence and flow cytometry in forty cardiac surgical patients assigned to surgery either using (“on-pump”, n=20) or without the use (“off-pump”, n=20) of cardiopulmonary bypass. Results: There was a very rapid upregulation of CD38 expression in “on-pump” patients, becoming significant at declamping of aorta (p