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The objective of this study was to evaluate the short-term results of surgical treatment in patients with acute aortic dissection. PATIENTS AND METHODS: A retrospective analysis of 38 patients with acute type A aortic dissection who were surgically treated at the Clinic of Cardiac, Thoracic, and Vascular Surgery, Hospital of Kaunas University of Medicine, from January 2004 to December 2007 was conducted. The diagnosis of aortic dissection was confirmed by employing special techniques. Two-dimensional transthoracic echocardiography was performed in 34 (89.5%) patients; transesophageal echocardiography, in 24 (63.1%); computed tomography, in 29 (76.3%); coronagraphy and angiography, in 20 (52.6%). Preoperative shock was reported in 3 (7.9%) and cardiac tamponade in 18 (47.4%) cases. More than half (57.9%) of patients were operated on within the first 24 hours after admission. In the majority of cases (73.7%), the diameter of the aorta exceeded 4 cm. In the presence of type A aortic dissection, all patients underwent surgery on cardiopulmonary bypass; its duration varied from 20 to 485 min, with a mean of 214.6+/-102.9 min. The mean aortic cross-clamp time was 114.5+/-62.7 min. Complete circulatory arrest was needed in the majority of cases (86.8%), and it lasted 2 to 97 min (mean, 27.4+/-18.6 min). During cardiopulmonary bypass, body temperature was decreased to 17-28 degrees C (mean, 18.9+/-1.95 degrees C). The duration of surgery ranged from 1 to 14 hours, with a mean of 6.1+/-2.49 hours. During the early postoperative period, 12 (31.6%) patients died. Postoperative bleeding was seen in 16 (42.1%) patients, and 6 of them died later. Due to prolonged bleeding, 4 (10.5%) patients were left with an open sternum after surgery. Resternotomy was performed in 9 patients; 3 of them died due to multiorgan injury. [...].

Darbo tikslas. Pateikti pastarųjų metų literatūrą, nagrinėjančią išeminės kardiomiopatijos įrodymais pagrįstas chirurginio gydymo rekomendacijas bei tokio gydymo galimybes. Didelis sergančiųjų progresuojančiu širdies nepakankamumu sergamumas ir mirštamumas yra tikras iššūkis šiuolaikinei medicinai. Viena dažniausių kairiojo skilvelio disfunkcijos priežasčių – išeminė širdies liga. Revaskulizacija yra pagrindinis išeminės kardiomiopatijos gydymo metodas. Optimalią chirurginio gydymo strategiją sunku pasirinkti, nes nėra randomizuotų prospektyviųjų studijų, be to, didelė operacijos rizika. Šiuo metu taikomi neinvaziniai miokardo gyvybingumo nustatymo metodai gali padėti pasirenkant išeminės kardiomiopatijos gydymo metodą. Gydant išeminę kardiomiopatiją ir didelio laipsnio širdies nepakankamumą, dažnai vien revaskulizacijos nepakanka. Kai yra vidutinis ir sunkus išeminis mitralinio vožtuvo nesandarumas, kartu atliekama mitralinio vožtuvo anuloplastika, retais atve¬jais – protezavimas. Dažniausias išeminio mitralinio nesandarumo mechanizmas yra Carpentier tipo IIIb disfunkcija, kuri gydoma atliekant anuloplastiką. Atliekama ir kairiojo skilvelio tūrio bei formos chirurginė rekonstrukcija, nes aneurizmektomija ir kairiojo skilvelio diametro sumažinimas pagerina kairiojo skilvelio funkciją. Dabar vykdomos trys prospektyviosios randomizuotos klinikinės studijos: išeminės širdies ligos chirurginis gydymo tyrimas (angl. the Surgical Treatment for Ischemic Heart Disease trial)... [toliau žr. visą tekstą] The high morbidity and mortality in patients with serious heart failure is a therapeutic challenge for current medicine. The leading cause of left ventricular dysfunction remains ischemic heart disease. Coronary artery bypass surgery is a treatment of choice in moderate-to-severe ischemic cardiomyopathy. The scarcity of completed prospective randomized clinical trials and high surgical risks create significant uncertainty concerning the optimal current treatment strategy. The role of imaging techniques of assessment for myocardial viability based on current guidelines may be very important in clinical decision-making. Present paper reviews some of the relevant literature concerning surgical treatment of ischemic cardiomyopathy and current evidence-based recommendations on this method of treatment. In advanced heart failure, coronary revascularization alone is an insufficient treatment modality. In the presence of moderate-to-severe ischemic mitral regurgitation, mitral valve repair or replacement should be considered at coronary artery bypass grafting surgery. One of the most common mechanisms of ischemic mitral regurgitation is Carpentier’s type IIIb dysfunction, in which an undersized mitral anuloplasty might be helpful. Surgery of left ventricular shape and volume restoration leads to improvement of left ventricular function in patients with ischemic cardiomyopathy. When the results from three ongoing prospective randomized studies – the Surgical Treatment for Ischemic... [to full text]

Degeneracinė aortos stenozė ir mitralinio žiedo kalcinozė yra dažniausios vyresnių žmonių širdies ydos, kurios dažnėja ilgėjant gyvenimo trukmei. Pastaraisiais metais širdies ydų diagnostika gerėja, tačiau dar pasitaiko ilgai nenustatytų didelio laipsnio aortos vožtuvo stenozės sąlygotos sunkios vožtuvinės kardiomiopatijos atvejų. Straipsnyje aprašomas sėkmingo kompleksinio gydymo klinikinis atvejis, esant kritinei degeneracinei aortos stenozei ir mitralinio žiedo kalcinozei bei sudėtinei degeneracinei mitralinei ydai ir reliatyviam triburio vožtuvo nesandarumui, vožtuvinei kardiomiopatijai ir sunkiam širdies nepakankamumui. Iki hospitalizavimo į Kauno medicinos universiteto klinikas, ligonę aštuonerius metus vargino krūtinės angina, stiprėjo dusulys. Vadovaujantis tik elektrokardiograma ir klinika, II lygio sveikatos priežiūros įstaigoje buvo klaidingai įvertinta, jog pacientė serga išemine širdies liga, negrįžtamu širdies nepakankamumu, išsivysčiusio dėl aortos ir mitralinio vožtuvų nesandarumo bei prieširdžių virpėjimo. Kauno medicinos universiteto klinikų Kardiologijos klinikoje atlikus širdies echoskopiją ir vainikinių arterijų angiografijos tyrimus, nustatyta kritinė aortos vožtuvo stenozė, mitralinio žiedo kalcinozė ir degeneracinė sudėtinė mitralinė yda paneigiant nedokumentuotą buvusį infarktą. Diagnozuota vožtuvų yda – vožtuvinės kardiomiopatijos stadijos, kai kairiojo skilvelio išstūmimo frakcija buvo kritiškai maža – 15 proc. Vainikinių arterijų susiaurėjimų... [toliau žr. visą tekstą] Degenerative aortic stenosis and mitral annulus calcification are the most common valvular abnormalities in elderly population. The incidence of these abnormalities has increased due to increased life expectancy. In recent years, new diagnostic techniques have improved the accuracy of diagnosis of valvular heart disease, however, cases of advanced critical aortic stenosis with valvular cardiomyopathy and severe heart failure still occur. A clinical case of critical degenerative aortic stenosis and mitral annulus calcinosis, mitral stenosis and regurgitation, subsequently significantly decreased ejection fraction (15%) accompanied by valvular cardiomyopathy and severe congestive heart failure is described. Ischemic heart disease was excluded. Cardiosurgery including implantation of aortic and mitral bioprosthesis and tricuspid annuloplasty was performed after intensive medical treatment and improvement of heart failure symptoms. After follow-up of six months, a 76-year-old female patient has just symptoms of mild left-ventricular dysfunction corresponding to New York Heart Association functional class II.

Darbo tikslas. Įvertinti pakartotinių operacijų perioperacinio laikotarpio neigiamas ypatybes bei sumažinti jų įtaką pooperaciniam sergamumui bei mirštamumui. Tyrimo medžiaga ir metodai. Atlikta retrospektyvioji duomenų analizė 53 sergančiųjų, kuriems atlikta miokardo revaskulizacijos pakartotinė operacija dirbtinės kraujo apytakos sąlygomis. Ligoniai, kuriems atlikta miokardo revaskulizacijos pakartotinė operacija anksčiau kaip per keturias savaites arba kompleksinė, neanalizuoti. Analizuojamuoju laikotarpiu pakartotinės operacijos sudarė 2,98 proc. visų miokardo revaskulizacijos operacijų. Analizuojamos grupės ligonių amžiaus vidurkis – 67,1±7,5 metų. Moterų ir vyrų santykis – 11,3/88,7 proc. Rezultatai. Įvertinus analizuojamojo laikotarpio 53 pakartotinių ir 1775 pirminių operacijų rezultatus, pooperacinis mirštamumas – (7,5 proc. ir 2,52 proc., atitinkamai) nesiskiria nuo kitų šalių kardiochirurgijos centrų analogiškų rezultatų. Vidutinis laikotarpis tarp pirmos ir pakartotinės operacijų – 93,9±49,0 mėn. Angiografijos, atliktos prieš pakartotinę operaciją, metu nustatyta, kad veninių jungčių pratekamumas – 34,6 proc., o arterinių – 76,5 proc., todėl net 29 (54,7 proc.) ligoniams suformuotos tik veninės jungtys. Operacijos metu vienam ligoniui vidutiniškai suformuota 2,4±1,1 jungties, o tuo pačiu laikotarpiu pirminių operacijų metu – 3,5±0,9. Išvados. Remiantis šiais duomenimis, galima teigti, kad atliekama miokardo revaskulizacijos pakartotinė operacija – palyginus... [toliau žr. visą tekstą] Objective. To evaluate the features of coronary artery bypass reoperations and to reduce the influence of the factors affecting postoperative morbidity and mortality. Material and methods. The records of 53 consecutive patients (88.7% of men, 11.3% of women; mean age 67.1±7.5 years) who underwent coronary artery bypass reoperations were reviewed retrospectively. Coronary artery bypass reoperations comprised 2.98% of all coronary artery bypass grafting operations during that period. Coronary artery bypass reoperations performed within 4-week period after the last operation and complex procedures were excluded. Results. Postoperative mortality after 53 reoperations and 1775 primary coronary artery bypass grafting operations was 7.5 and 2.52%, respectively, and the results are comparable with the results from other clinics of cardiac surgery. Mean time interval between primary coronary artery bypass grafting and reoperation was 90.7±49.9 months. Angiography at that period showed patency of venous and arterial conduits – 34.6 and 76.5%, respectively. Twenty-nine patients (54.7%) received only venous conduits during reoperation. There were 2.4±1.1 anastomoses constructed during reoperation comparing to 3.5±0.9 anastomoses per patient during primary coronary artery bypass grafting. Conclusions. According to our data mortality after coronary reoperations remains higher comparing to primary coronary artery bypass grafting, however, it does not differ significantly. We observed... [to full text]

Summary. The purpose of the present study was to determine whether extracellular osmotic pressure modulates b2-adrenergic stimulation of the contraction force and L-type Ca2+ current in human atrial myocytes. Experiments were performed on human atrial trabeculae and myocytes isolated from the right atrium. We have studied the effect of salbutamol (SAL), a β²-adrenoceptor agonist, on peak tension (P), time to half peak tension (tc), time to half relaxation (tr), resting tension (contracture) (C) and L-type calcium current (ICaL) under isosmotic (345 mOsm) and hyperosmotic (525 mOsm in experiments for P, and 405 mOsm for ICaL) conditions. Salbutamol (10–8÷10–5 M) added to the control solution increased P, with a half-stimulation constant EC50=(2.7±0.6)×10-8 M (p

This article analyzes data obtained from the medical records of the patients with primary mitral valve prolapse. The study population was the patients admitted to Kaunas University of Medicine Heart Center (KUMHC) between 1999 and 2003. The objective of our study was to analyze the natural course of mitral valve prolapse, complications and their frequency, treatment strategy in KUMHC, as well as to review the results of surgical treatment. We gathered data from the medical records of 160 patients and analyzed their age, medical history, complications, comorbidities, functional status and echocardiographic parameters. Patients who underwent mitral valve surgery were followed 7.9±8.4 months after procedure. On average, 32±14 patients with primary mitral valve prolapse were treated at KUMHC annually. Their mean age was 48.4±16.5 years, 44.4% of them were male. The most frequent complications of mitral valve prolapse were ≥II° mitral regurgitation (78.4%), various cardiac arrhythmias (68.1%) and heart failure of ≥II NYHA class (79%). Surgical treatment was recommended for 64 (40%) KUMHC patients with primary mitral valve prolapse. Surgical treatment was applied in 44 (28.1%) of study patients. The patients, who were recommended surgical treatment, were older (mean age 53.2±11.9 years, p

Pacientų, kuriems protezuoti širdies vožtuvai, priežiūra tampa aktuali. Lietuvoje neatlikta tyrinėjimų, ir, žinoma, neįvertintos pacientų, kuriems protezuoti širdies vožtuvai, problemos, atsirandančios po operacijos, neparengtos ambulatorinės priežiūros rekomendacijos. Tyrimo tikslas. Įvertinti komplikacijas, kurių randasi po operacijos, ir parengti nuolatinės ambulatorinės priežiūros rekomendacijas. Tyrimas atliktas Kauno medicinos universiteto Širdies centre. Atliekant tyrimą, taikytas analitinis-aprašomasis metodas įvertinant penkerių metų (1999–2003) širdies vožtuvų protezavimo rezultatus, apžvelgta mokslinė literatūra, kur moksliškai pagrįsta pacientų, kuriems protezuoti vožtuvai, gydymo ir priežiūros ypatybių analizė. Tyrimo duomenimis, daugėja pacientų, kuriems protezuoti širdies vožtuvai. Per penkerius metus protezuoti 766 vožtuvai. Kasmet atitinkamai – 82, 180, 167, 135, 202. Užfiksuotos komplikacijos po operacijos: tromboembolijos – 3,8 proc., vožtuvo trombozė – 2 proc., hipokoaguliacinės būklės – 1,1 proc., protezuoto vožtuvo infekcinis endokarditas – 3,2 proc. pacientų. Jos buvo dažnesnės nei nurodoma literatūroje. Išvados. Dažniausios komplikacijos po vožtuvų protezavimo operacijos yra tromboembolijos, vožtuvo trombozė, hipokoaguliacinės būklės. Dažnas ir protezuoto vožtuvo infekcinis endokarditas. Parengta nuolatinės ambulatorinės priežiūros schema padės greičiau atpažinti anksty¬vąsias ir vėlyvąsias komplikacijas po operacijos ir pagerinti pacientų gyvenimo... [toliau žr. visą tekstą] The amount of patients with prosthetic valves is increasing and their follow up is an actual problem. The aim of this study was to estimate postoperative complications after valve replacement and to give the follow up schedule for family doctors and cardiologist. The article demonstrates late postoperative results of valve replacements performed in Heart Centre of Kaunas University of Medicine during five years (1999–2003). Hemodynamics, auscultation of patients with prosthetic valves, antithrombotic treatment, specificity of anticoagulants use before noncardiac surgery are described according to the last practical guidelines (1998). The follow up schedule after valve replacement is recommended for practical purposes. A total of 766 valves were replaced in this period: 82, 180, 167, 135 and 202, respectively per year. There were seen these late postoperative complications: thromboembolism (3.8%), valve thrombosis (2%), hypocoagulation (1.1%) and infective endocarditis (3.2%). Conclusion. Postoperative complications such as thromboembolism, valve thrombosis, hypocoagulation and infective endocarditis were detected more often than it is described in literature. The follow up schedule will help to identify near and late postoperative complications and to improve patients’ life quality.

The purpose of the present study was to determine whether extracellular osmotic pressure modulates ß2-adrenergic stimulation of the contraction force and L-type Ca2+ current in human atrial myocytes. Experiments were performed on human atrial trabeculae and myocytes isolated from the right atrium. We have studied the effect of salbutamol (SAL), a ß2-adrenoceptor agonist, on peak tension (P), time to half peak tension (tc), time to half relaxation (tr), resting tension (contracture) (C) and L-type calcium current (ICaL) under isosmotic (345 mOsm) and hyperosmotic (525 mOsm in experiments for P, and 405 mOsm for ICaL) conditions. Salbutamol (10–8÷10–5 M) added to the control solution increased P, with a half-stimulation constant EC50=(2.7±0.6)×10-8 M (p

The aim of the study was to compare late results of the minimally invasive operations of myocardial revascularization and conservative treatment in patients with acute ischemic syndrome. Material and methods. Demographic, clinical and echocardiographic data was collected on patients with acute ischemic syndrome; data of 109 patients treated conservatively and data of 26 patients, who underwent minimal invasive operation of myocardial revascularization during acute phase of ischemic syndrome, were compared and ischemic consequences after one-year follow up period were determined in both groups. Results. The patients of both groups did not differ significantly according to the most clinical characteristics. One third of the patients in the surgery group had previous myocardial infarction, also they had higher rate of paroxysmal atrial fibrillation (26.9% vs 6.4%) and acute left ventricular failure (73.1% vs 44.0%) than the patients without operation. During one-year follow up period there were no cases of lethal events or myocardial infarction in the surgical group, however 37.5% of them had mild angina pectoris. At that time lethal outcome was observed in 6.1%, myocardial infarction in 3.5% and mild-severe angina pectoris in 68.8% of patients. Conclusion. The functional status of the patients significantly improved during one-year period after minimally invasive operation of myocardial revascularization compared to the patients treated conservatively.

The aim of our study was to evaluate the influence of residual ischemic mitral insufficiency on patient’s functional status and left ventricle remodeling after repair of ischemic mitral insufficiency. Material and methods. The study group consisted of 95 out of 128 patients who underwent mitral valve repair for ischemic mitral insufficiency at the Department of Cardiac Surgery of the Heart Center of Kaunas University of Medicine in 1996–2002. The study protocol included general clinical data, patients NYHA functional class, pre, peri and postoperative echocardiographic data. Results. In patients with residual MI (MR≥2 grade) late postoperative left ventricle morphometric parameters, left ventricle ejection fraction and mean pulmonary artery pressure did not change. Size of left ventricle was reduced (left ventricle end diastolic diameter index decreased from 28.9±0.4 to 27.7±0.4 mm/m2, p

Objective. The aim of the study was to estimate the differences in hemodynamic, metabolic and cardiovascular parameters in early postoperative period in hypertonic colloid solution and usual infusion therapy groups. Material and methods. The study was blind placebo controlled. Thirty patients were randomly divided into two groups. The control group received usual Ringer solution for hypovolemia correction and the study group received 250 ml of 7.2% NaCl/6% Hydroxyethylstarch (HyperHaes®, Frezenius) solution. The measurements were made before, immediately after the infusion, 60 min and 180 min after infusion. The parameters of central hemodynamics, oxygen transport, the temperature gradient, electrolyte concentration and fluid balance were evaluated. Results. After infusion of HyperHaes® solution cardiac index increased from 2.8±0.2 to 3.8±0.3 L/min/m2, pulmonary vascular resistance and systemic vascular resistance decreased. Serum Na+ and Cl– increase in investigative group did not exceeded normal range and returned to initial level after an hour. The total fluid balance and fluid balance during surgery in investigative group was less than that in the control group. Conclusions. HyperHaes® solution in early postoperative period after coronary artery bypass grafting surgery increased preload, had the tendency of decreasing afterload, increased cardiac index, decreased total fluid balance and did not cause hypernatremia and hyperchloremia.

The aim of the study was to evaluate late changes of left ventricular geometry and function following non-ischemic mitral valve reconstructive surgery. Material and methods. The study included 43 patients with non-ischemic mitral valve incompetence due to mitral valve fiber degeneration, Barlow disease, and endocarditis. Doppler echocardiography was performed prior, 10–14 days and 12 months following mitral valve anuloplasty. Results. Early after surgery preload reduction resulted in reduction of left ventricular end diastolic diameter index (from 31.7±2.8 to 27.9±2.4 mm/m², p

Objective. Neuropsychological (cognitive) dysfunction has been described as an important complication, affecting up to 80% of patients early after cardiac surgery. Also it has been shown that cognitive abnormalities persist in a later postoperative follow up. The aim of our study was to determine incidence of cognitive complications early after isolated coronary artery bypass grafting using cardiopulmonary bypass, and to identify predictive factors, associated with perioperative cerebral dysfunction. Material and methods. Eighty-six patients (63 men and 23 women; mean age 66.1±6.7 year) with identified isolated coronary artery disease were enrolled into prospective study using Case Report data collection document. Neuropsychological status was examined using Symbol Digit Modalities Test with additional Euro QOL test. All tests were performed at baseline (1 day before operation), at the 5th to 7th postoperative day and one month after operation. Results. Neuropsychological dysfunction (as compared with baseline) occurred in 59 patients (68.6%) at the 5th–7th postoperative day and persisted in 19 patients (22.1%) after one month. Patients who suffered postoperative cerebral dysfunction more often had history of prior cerebrovascular morbidity (p

The aim of the study was to determine the effect of pyruvate, a substrate of energetic metabolism, on the dependence of electromechanical activity on stimulation frequency in human myocardium. The experiments were performed on human ventricle myocardium from patients undergoing cardiac corrective open heart surgery at Clinic of Cardiac Surgery in Kaunas University of Medicine by using standard method of registration of myocardium electromechanical activity. The stimulation frequency of myocardial strips were 0.2, 0.5, 1.0, 1.5, 2.0, 2.5 and 3 Hz, duration of pulses –2–5 ms. In control, i.e. at perfusion of mycoardial strips by Tyrode solution and stimulation frequency 1 Hz, an average of contraction force (P) was 0.94±0.18 mN (n=12), half time of relaxation (ta) – 178.88±9.31 ms (n=12), and action potential duration measured at 50% repolarization level (VP50) – 294.75±27.95 ms (n=9). Pyruvate (10 mM) increased P to 159.9±13.4% (p

The aim of our study was to evaluate the impact of stentless aortic bioprosthesis implantation on early and late postoperative results and hemodynamic changes. Material and methods. Study group consisted of 66 patients, who received stentless aortic bioprosthesis in 1999–2003, and control group of 38 patients, randomly selected for data analysis out of 203 patients, who received mechanical aortic valve substitute during the same period at the Heart Center of Kaunas University of Medicine. Study protocol included clinical data, patients functional status and echocardiographic data pre and postoperatively up to 2 years. Results. Within a stentless bioprosthesis group clinically more severe forms of aortic valve disease were present (NYHA f. cl. 3.47 vs 3.0), with concomitant ischemic heart disease (51.5% vs 36.8%), and mitral valve insufficiency (51.5% vs 21.1%). Subsequently coronary artery bypass grafting was performed in 50% of patients within a stentless bioprosthesis group vs 28.9% in a mechanical valve group, and mitral valve repair in 30.49% vs 10.5%. Aortic cross clamp time in a stentless bioprosthesis group was 89.1±21.3 min, compared to 74.6±39.5 min in a “mechanical” group. Data analysis of valve/body surface area match was in favor of stentless valves: patients with the same body surface area received one size larger stentless valves. Mortality in a “stentless” group was 4.54 vs 7.3% in mechanical group. Mean transvalvular gradients after 2 years were statistically significantly lower in a “stentless” group: 9.4±3.1 mmHg vs 11.1±4.1 mmHg. Also there was significant decrease of left ventricular mass and mass index in both groups, however it was more pronounced in the “stentless” valve group.

The aim of the study was to evaluate early complication rate and changes of left ventricular geometry and function after two types of left ventricular reconstruction surgery. Methods. The study included 54 patients with ischemic heart disease and left ventricular aneurysm, who underwent coronary artery bypass grafting and left ventricular reconstruction surgery: I group (31 patients) underwent modified Dor aneurysmectomy and II group (23 patients) underwent infarcted wall compression. The study protocol included operative data, early postoperative complications and evaluation of left ventricular function 10th–14th day after surgery. Results. Early complication rate had tendency to be higher in I group. Among patients with left ventricular ejection fraction

Objective. The aim of this study was to review early postoperative results of the combined coronary artery bypass grafting and carotid endarterectomy (CABG/CEA) performed at the Clinic of Cardiac Surgery Heart Center of Kaunas University of Medicine. Material and methods. A series of consecutive 19 patients (64.5±8.2 years old, 17 (89.5%) male patients) with coexisting severe ischemic cardiac and carotid artery disease were operated on during 8-year period ending December 2001. Seven (36.8%) patients with carotid artery stenosis were asymptomatic. Previous neurological events had occurred in 12 (63.2%) patients: five (26.4%) patients presented with a previous stroke, seven (36.8%) – with a transient ischemic attack. Demographics and perioperative variables of these patients were compared with variables of 42 patients, that underwent isolated CABG during this period (control group). Results. After introducing of the routine preoperative screening carotid ultra-sonography in the year 2000, the rate of asymptomatic carotid artery stenosis among all diagnosed hemodynamically significant carotid stenoses has raised up to 43.8%. The in-hospital results were similar between the two groups with regard to 30-day perioperative mortality, stroke and major postoperative complications. Conclusions. Based on our results, combined interventions of CEA and CABG can be performed with an acceptable morbidity and mortality when severe carotid stenosis is associated with advanced, symptomatic ischemic heart disease. Patients with total occlusion of the carotid artery compose a high-risk subgroup for perioperative stroke. The introduction of routine preoperative carotid duplex scanning resulted in higher rate of asymptomatic carotid artery disease among the patients scheduled for combined CABG/CEA procedure.

Technological development, implementation of new techniques and scientific knowledge into clinical practice, has a strong impact on development of surgical and anesthesiological professions. However, it creates new and unknown ethical issues within surgeons–anesthesiologist and their patient’s relationship. Development of physiological–individualized anesthesia techniques focused on patient’s outcome unquestionably is related to more general organizational ethical issues. Presented article analyzes factors influencing unavoidable, concomitant development of surgical and anesthesiological professions. It also addresses several ethical issues within the context of society development. There is a body of evidence ascribing identities of profession and different attitudes as well as interpretations of interspeciality relations. There is a need for constant discussion between the speciality representatives groups elaborating professional recommendations for further co-operation accepted by both sides.

An impact of surgery for infective endocarditis on survival and heart failure has been analyzed. A total of 131 patients with IE have been observed during 1999–2001. Eighty seven of them were male and 44 female, mean age – 50±16 years. Sixty three (48.1%) patients underwent surgery, remaining 68 (51.9%) were treated conservatively. The surgical patients had signs of remarkably worse heart failure (p=0.0001), higher grade aortic (p=0.0001) and mitral (p=0.001) valve regurgitation. Surgery resulted in significant improvement of heart failure (p=0.01). Hospital mortality was 25.2% and did not differ between the groups. Elimination of the influence of complications revealed reduced hospital mortality of all patients by 9.9% and mortality of NYHA III–IV patients by 23.9% (p=0.02) as a result of surgery.

Objective. The aim of this prospective study was to review incidence of neurological and cognitive complications after coronary artery bypass graft surgery and find out predictive factors, associated with perioperative cerebral dysfunction. Material and methods. A prospective pilot study of 35 (27 men and 8 women, mean age 64.5±4.3 year) patients with identified coronary artery disease was conducted using Case Report data collection document. All patients underwent isolated elective CABG procedure at Cardiac center of Kaunas University of Medicine Hospital. Results. There were two cases (5.7%) of postoperative transient ischemic attack, two cases (5.7%) of restless agitation with delirium, characterised as an postoperative encephalopathy and eight patients (22.8%) with cognitive abnormalities.

Minimally invasive operations of myocardial revascularization (MIMR) are done using usual approaches, but without extracorporeal circulation and cardioplegia. Doing these operations according to indications, there is no difference in early results of these operations and the operations with extracorporeal circulation and extracorporeal circulation (1, 2). Objective. To evaluate the late results of minimal invasive operations of myocardial revascularization 1 year after intervention, according to detection of patient’s functional class, findings of echocardiography and stress test. Also to compare the results of operations in patient’s groups of age up to 65 years old and over 65 years old. Material and methods. From 88 patients, that underwent minimal invasive operations of myocardial revascularization, 34 patients were checked according to investigation protocol, evaluating functional class, myocardial contractility and stress test tolerance. The late results of two different groups of age were compared (each group includes 17 cases). Results. All patients have survived 1 year after operation. Findings of stress test showed, that 60% of patients have reached 100 W and more strain tolerance. Pectoral angina was detected in 12% of cases. There was no difference, that was improved statistically in findings of myocardial contractility before and after operation. Conclusions. Evaluating the late results of minimally invasive operations of myocardial revascularization (1 year after operation), we can consider, that these operations, that were done according to indications, are improved, safe and suitable also to elderly patients.

The aim of our study was to evaluate the patients’ (pts) survival, changes of functional status after repair of ischemic mitral insufficiency (IMI) and to determine their prognostic determinants. Study group consisted of 128 pts who underwent mitral valve (MV) repair for IMI at Kaunas University of Medicine hospital during 1996 to 2002. Study protocol included general clinical data, coronary artery involvement, patients NYHA functional class, pre, post and operative echocardiografic data, mitral valve repair procedures. Results. There was a significant reduction of MR in all survivals from grade 2.8±0.1 to 1.5±0.1 (pI grade (p

Earlier we have shown significantly more frequent B blood group and a significantly more rare O blood group of ABO blood group system in men aged under 45 years suffering from coronary atherosclerosis compared with these frequencies in the population of Lithuania. The aim of the study was to investigate the frequency of blood groups of ABO system in women with coronary atherosclerosis. MATERIALS: The frequency of the ABO blood groups was examined in 441 women, suffering from coronary atherosclerosis, divided into two groups: I group - 109 women till 60 years old (mean age 55.1+/-4.8) and II group - 332 women aged over 60 years (mean age 68.1+/-5.0). For all patients coronary atherosclerosis was diagnosed by coronary angiography and confirmed during coronary bypass surgery. The frequency of the ABO blood group in the studied pts was compared with the frequency of the blood group in the control group of healthy blood donors (n=595). To evaluate the significance of data, we compared the frequency of ABO blood groups with the data in women long-livers (n=75, mean age 94.1+/-3.8). Earlier our studies showed that long-livers are an important antiatherosclerotic control group for evaluation of the genetic markers of atherosclerosis. RESULTS: The O blood group was found significantly more rarely in the women group I as compared to that of healthy donors group (28.4% vs 38.2%, p

The aim of our study was to evaluate the initial results of left ventricular CABG and left ventricular remodelling operations. Study group consisted of 47 patients (pts) who underwent left ventricular geometry and volume restoration operations at the Kaunas University of Medicine Hospital during 1996 to 2002. Protocol included general clinical data, NYHA functional class, pre- and postoperative echocardiographic data, left ventricular aneurysm repair procedures. Pts mean age was 63.4±1.2 years. Men/women ratio 38/9. At admision NYHA functional class was 3.5±0.1. Mean left ventricular ejection fraction preoperatively was 24.2±0.9%, LV end diastolic diameter – 60.3±1.2 mm. Correction of left ventricular aneurysm consisted of: 1) direct aneurysmectomy – 11 pts, 2) endoventricular patch plasty – 7 pts, 3) circular suture – 19 pts, 4) aneurysmal reinforcement – 10 pts. Rezults. Early postoperative NYHA functional class decreased from 3.5±0.1 to 2.8±0.1 (p

Introduction. Surgical interventions because of mitral valve disease have been ascribed since 1951. Many changes within mitral valve replacement have passed including closed and open mitral commissurotomy, mitral valve repair operations implantation of mechanical, biological heart valve and finally use of mitral valve homograft. Despite changes in chirurgical tactics and medico-technical environment, mitral valve homograft implantation remains one of the most complex surgical interventions. Surgical and technical details of mitral valve homograft implantation are discussed. Objective. to estimate technical difficulties and anatomical positioning of mitral valve homograft considering a spectrum of indications of mitral valve replacement. Case report. 62-year-old woman 26 years ago underwent mitral valve replacement with Starr-Edwards mitral valve prosthesis, because of rheumatic heart disease by homograft. Due to malfunction of the mitral valve prosthesis, and progressive left ventricular failure patient was reoperated on 26th of February 2002. Fresh antibiotic preserved mitral valve homograft was implanted. Surgical techniques were guided using left ventricle size measurement indicated by echocardiography. Results. The technique described by Acar/Carpentier was used except of mitral valve annuloplasty ring implantation. Peri- and early postoperative period was free of homograft related complications. The left ventricle function was improving and the heart size decreased dramaticaly during first postoperative week. Conclusion. The most important peculiarities for mitral valve homograft implantation are echocardiography data and intraoperative left ventricle measurements. [...].

Objective.This retrospective study was undertaken to evaluate the accuracy of risk-adjusted EuroSCORE models in predicting mortality in individual patients who are undergoing coronary artery bypass grafting. Material and methods. The study population is a consecutive series of 1698 isolated primary and repeat coronary artery bypass grafting patients, inclusive patients in cardiogenic shock or resuscitation, operated in Kaunas Heart Center from January 1997 to December 2001. The pre-operative risk of death was calculated with EuroSCORE models and then compared with the actual outcome. The accuracy score was used to evaluate the reliabilty of each score to predict the individual outcome. The studied event was in-hospital death, defined as mortality during hospital stay, which was unlimited in time and included a stay in a secondary hospital without discharge home Results. Eighty deaths (4.7%) were observed. The age of this patients was 66.0±9.5 years, 73.7% were male and 3.7% were repeat procedures. In most patients who died the mean predictive scores were high. The EuroSCORE average was 11.0±4.3, with a range from 3 to 21. Conclusions. The EuroSCORE presurgical predictive models were highly accurate to predict overall mortality, but vere inaccurate to predict mortality in individual patients.

Objective. Patients with coronary artery disease associated with peripheral vascular disease often raise problems of operative strategy. Particulary the sequence of procedures in which lesions must be treated is a frequent source of controversy. The aim of this study was to research surgical strategy, early and late clinical outcomes for patients undergoing one-stage coronary and abdominal aortic or magistral artery surgical interventions. Material and methods. From 1999 through 2002 twenty eight patients underwent combined major vascular reconstruction with coronary artery bypass grafting. Results. In group with abdominal aortic aneurysm 2 patients died. One patient died from intraoperative acute abdominal aortic aneurysm and bifemoral artery thrombosis with continuous bleeding from the vascular prosthesis in association with disseminated intravascular coagulation. Another patient died from bleeding from the sudden multiple gastroduodenal ulcers on post-operative day eight. In groups with peripheral vascular occlusive disease and carotid artery disease there were no deaths. Conclusions. The data show that combined coronary artery bypass grafting and vascular operations are feasible on patients with concomitant carotid artery or peripheral vascular occlusive disease. Management of CAD associated with abdominal aortic aneurysm remains controversial.

Patients with coronary disease associated with abdominal aortic aneurysm or aortoiliac occlusive disease often raise problems of operative strategy. In particular, the order in which these lesions should be treated is a frequent source of controversy. Our approach for the past two years has been a combined myocardial revascularization with abdominal aortic reconstruction in patients with both lesions. From 1999 through 2001 seven patients underwent combined abdominal aortic reconstruction with coronary artery bypass grafting. We report here the fatal case of combined coronary artery bypass grafting and abdominal aortic aneurysm repair. Partial heparinization and operation without extracorporeal circulation caused acute thrombosis of abdominal aortic aneurysm and femoral arteries. Our first experience advocates using total heparinisation and cardiopulmonary bypass for combined cardiac-aortic procedures.