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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: 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.

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.

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.

The very large patient (weight 142 kg, height 197 cm, body surface 2.76 m2) was referred to acute operation with dissecting type A ascending aortic aneurysm. The calculated blood flow was 6.63 l/min. To anticipate potential difficulties with perfusion and oxygenation two oxygenators connected in parallel were incorporated into the circuit. Bentall procedure with ACB to the RCA was performed. The perfusion was uneventful. Bypass time was 259 minutes, cross – clamp time 141 minutes, circulatory arrest 7 minutes. The highest oxygenators gas flow was 2.6 l/min with maximum FiO2 0.42. The use of two in parallel connected oxygenators is a very effective, easy and safe method in such extreme perfusions, offering to the perfusionist a great reserve of oxygenator output.

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.

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 sterility of previously assembled cardiopulmonary bypass circuits was investigated for 100 extracorporeal circuits. The closed circuits were assembled using aseptic technique and remained in the pump room until time of use. The mean time from point of setup to point of priming for the 100 consecutive circuits was 32 hours, with a range of 19 to 89 hours. Circuits were primed with the calculated volume of priming solution, circulated for 5 minutes and tested for microbial contamination by withdrawing 20 ml of the priming solution and 10 days incubated in Thioglycolate and Sabouraud culture mediums. All were found to be free of microbial comtamination. The results of this investigation demonstrate that the sterility of the extracorporeal circuit, pre-assembled in advance of actual priming, can be maintained over an extended interval when standard aseptic technique is used. This allows the utilization of a pre-assembled circuit for emergency cardiopulmonary support.

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 …

Uvod: Kombinovane srdecni operace s resekcnimi výkony na plicich jsou stale kontroverznim tematem. Tento přistup umožňuje lecbu dvou různých onemocněni v ramci jedne intervence, celkově kratsi dobu hospitalizace, mensi zatěž pro nemocneho a nižsi naklady spolu s uspokojivými výsledky. Diskutovanou otazkou zůstava nejasný vliv mimotělniho oběhu na rozsev malignity, dostatecnost rozsahu plicni resekce z nestandardniho chirurgickeho přistupu a větsi riziko pooperacniho krvaceni.Metody: Od listopadu 2010 do dubna 2014 podstoupilo na nasi klinice celkem deset nemocných (devět mužů, jedna žena) kombinovaný kardiochirurgický výkon spolu s resekci plic (průměrný věk 69 ± 7 let). Patologický nalez na plicich byl nasledujici (ctyři primarni karcinomy, ctyři benigni leze, jedna metastaza, jeden karcinoid). Prava plice byla operovana v pěti připadech, leva plice take v pěti připadech (pětkrat lobektomie, jednou extraanatomicka resekce, třikrat enukleace). V jednom připadě, v souvislosti s rozsahem malignity, byla provedena pouze explorace, pneumonektomie pote v druhe době z thorakotomie. Kardiochirurgicke výkony byly nasledujici: pětkrat aortokoronarni bypass, třikrat nahrada aortalni chlopně, jednou nahrada mitralni chlopně, jednou nahrada vzestupne aorty, třikrat ablace MAZE. Sternotomie byla metodou přistupu v osmi připadech, ve dvou byla použita levostranna thorakotomie a revaskularizace myokardu byla provedena metodou MIDCAB (minimally invasive direct coronary artery bypass). Revaskularizace bez mimotělniho oběhu byla použita ctyřikrat.Výsledky: V souboru byla zaznamenana nulova hospitalizacni mortalita. Žadný z nemocných nebyl revidovan pro pooperacni krvaceni, vsechny kardiochirurgicke výkony byly bez komplikaci. V jednom připadě byl lecen protrahovaný "air-leak". Vsichni nemocni s benignim nalezem (ctyři) jsou naživu. Nemocný s rozsahlou malignitou, operovaný dvoufazově, zemřel v terminalni fazi onemocněni. Dalsi nemocný s malignitou zemřel z důvodů nevztahujicich se k operaci rok po výkonu. Ostatni jsou pravidelně sledovani v pneumo-onkologicke ambulanci.Zavěr: Kombinovane srdecni operace s resekcnimi výkony na plicich mohou být provaděny bez zvýsene mortality a morbidity. Tento přistup eliminuje nutnost druhe intervence a ma uspokojive výsledky.

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.

Severe post-sternotomy dehiscence resulting in sternum and ribs losses, represent a surgical issue with mortality risk of 40%. Chest instability causes respiratory insufficiency, obstruction in disconnection from mechanical pulmonary ventilation and other soft tissue healing complications. Extensive bone tissue loss hinders the use of AO osteosynthesis.

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