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Study objective: To determine if treatment with inhaled budesonide forte can diminish increased bronchial hyperreactivity and improve symptoms in patients with mitral valve stenosis. Design: The study was randomized, double [...]

The hybrid ablation (HABL) of atrial fibrillation which combines endoscopic, minimally invasive, closed chest epicardial ablation with endocardial CARTO-guided accuracy was introduced to overcome limitations of current therapeutic options for patients with persistent (PSAF) and long-standing persistent atrial fibrillation (LSPAF). The purpose of this single-centre, prospective clinical registry was to evaluate procedural safety and feasibility as well as effectiveness of the HABL in patients with PSAF and LSPAF 1-year post-procedure. From 07.2009 to 12.2014, ninety (n=90) patients with PSAF (n=39) and LSPAF (n=51) underwent HABL. Mean AF duration was 4.5±3.7 years. At 6 months post-procedure 78% patients were in SR. At 12 months post-procedure 86% patients were in SR and 62.3% in SR and of class I/III AADs. These results suggest that combination of epicardial and endocardial RF ablation should be considered as a treatment option for patients with persistent and long-standing persistent atrial fibrillation as it is safe and effective in restoring sinus rhythm.

Despite advanced techniques and improved clinical outcomes, patient survival following coronary artery bypass grafting (CABG) is still a major concern. Therefore, predicting future CABG mortality represents an unmet medical need and should be carefully explored. The objective of this study is to assess whether pre-CABG platelet activity corresponds with 30 days mortality post-CABG. Retrospective analyses of platelet biomarkers and death at 30 days in 478 heart surgery patients withdrawn from aspirin or/and clopidogrel. Platelet activity was assessed prior to CABG for aspirin (ASPI-test) with arachidonic acid and clopidogrel (ADP-test) utilizing Multiplate impedance aggregometer. Most patients (n = 198) underwent conventional CABG, off-pump (n = 162), minimally invasive (n = 30), artificial valve implantation (n = 48) or valves in combination with CABG (n = 40). There were 22 deaths at 30 days, including 10 in-hospital fatalities. With the cut-off value set below 407 area under curve (AUC) for the ASPI-test, the 30-day mortality was 5.90% for the lower cohort and 2.66% for patients with significantly higher platelet reactivity (P = 0.038). For the ADP-test with a cut-off at 400AUC, the 30-day mortality was 9.68% for the lower cohort and 3.66% for patients with higher platelet reactivity, representing a borderline significant difference (P = 0.046). Aside from the platelet indices, patients who received red blood cell (RBC) concentrate had a highly significant (P < 0.0001) risk of death at 30 days. Both aspirin and clopidogrel tests were useful in predicting 30 days mortality following heart surgery, suggesting the danger of diminished platelet activity prior to CABG in such high-risk patients. These preliminary evidence supports early discontinuation of antiplatelet therapy for elective CABG and requires adequately powered randomized trials to test the hypothesis and potentially improve survival.

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Acute kidney impairment requiring renal replacement therapy is an infrequent but dangerous complication of cardiac surgery. Its development is associated with high mortality and morbidity. A recently published simple risk stratification engine has been developed and validated in the USA and Canada, but its discriminatory power has never been tested in Europe. We aimed to cross-validate the newly developed risk stratification algorithm in a group of patients operated on in a single centre in Poland.

Every patient after heart valve replacement belongs to the risk group of infective endocarditis (IE). Some of the laryngological procedures are related to the transient bacteriaemia and consequently IE. Patients after heart valve replacement need a proper care before some laryngological procedures. The proper cooperation of cardiologist, cardiac surgeon, and laryngologist can decrease the risk of IE. In the paper the laryngological procedures for which prophylaxis against infective endocarditis is recommended have been identified. The standarts therapy for prophylaxis have been presented. The specificity of prophylaxis in the case of some other laryngological procedures have been shown. The other cardiac conditions predisposing to endocarditis demanding prophylaxis before laryngological procedures have been mentioned. Every patient after heart valve replacement in Silesian Center of Heart Disease in Zabrze obtains Identity Card of the Patient with Artificial Heart Valve. It contains a list of procedures, including laryngological ones, for which prophylaxis against IE is recommended.

Se intentó el cierre percutáneo de la comunicación interventricular postinfarto (CIVPI) en 19 pacientes: 2 con recanalización tras el cierre quirúrgico y 17 con CIVPI primaria. En estos últimos, el procedimiento se realizó en 3 pacientes con CIVPI aguda dentro de las primeras 3 semanas postinfarto, en 13 con CIVPI subaguda 3,5-12 semanas postinfarto y en uno con CIVPI crónica. Se llevaron a cabo 22 intervenciones mediante la utilización de 17 oclusores Amplatzer auriculares, 2 ventriculares postinfarto y 2 ventriculares musculares. El procedimiento fue satisfactorio en 14 pacientes: 11 con CIVPI subaguda, uno con CIVPI crónica y 2 posquirúrgicos. El cierre percutáneo de CIVPI con el Amplatzer Atrial Occlusor es probablemente el tratamiento de elección en pacientes con más de 3,5 semanas después del infarto de miocardio y en casos con recanalización tras el cierre quirúrgico.

In patients with acute myocardial infarction (MI), the efficacy of thrombolysis is low. Angioplasty after failed thrombolysis (rescue percutaneous coronary angioplasty [PTCA]) has been associated with an increase in the incidence of inhospital complications. It has been proposed that these complications result from the procedure itself. Thus, the aim of this study was to compare the efficacy, inhospital complications, and mortality rate of patients with MI who are treated with primary PTCA and PTCA after initial thrombolysis (rescue or immediate rescue) in an experienced clinical center specializing in percutaneous coronary interventions.

El cierre percutáneo de la comunicación interauricular (CIA) es una alternativa de tratamiento cada vez más utilizada.

Construction of a pericardial conduit to bypass an obstructed superior vena cava is described.

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