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Degenerative mitral regurgitation is currently the most frequent indication for mitral valve repair.To visualize and assess the mid-term results of mitral valve repair with neochordae implantation, using computed tomography angiography (CTA) imaging.The CTA with ECG gating and without modulation was applied in 10 patients to assess the results of a mitral valve sparing procedure. The results of 3 patients are presented. The patients were operated on for severe symptomatic degenerative mitral regurgitation, defined according to a modified Carpentier's functional classification.Neochordal repair, by placing expanded polytetrafluoroethylene sutures between the leading edge of the prolapsing segment and the corresponding papillary muscle, was conducted. From 1 to 3 double Gore-Tex loops were used. Leaflet clefts, if present, were sutured. All repairs included mitral valve ring annuloplasty. The CTA was performed at 20-24 months after the surgery. Long-axis views, reconstructed during mid-systole, seemed to be the most valuable. Good quality cardiac images, precisely presenting the mitral valve complex with its constituents, were obtained in the case of patients without obesity, with a relatively small anterior-posterior thorax dimension, with sinus, slow heart rhythm and quite good left ventricle contractility. The evaluation of the mitral valve included presence of calcifications, fibrosis or thickening, chordal insertion and coaptation points, and papillary muscle locations. Primary and secondary native chordae tendineae and artificial chordae were visualized.Contrast material-enhanced ECG-gated CTA applied after mitral valve repair with Gore-Tex neochordae allows one to obtain satisfactory mitral valve images, especially during mid-systole, and evaluate mid-term results of the surgery in chosen patients.Niedomykalność mitralna na tle zwyrodnienia stanowi obecnie najczęstsze wskazanie do plastyki zastawki mitralnej.Ocena średnio odległych wyników plastyki mitralnej za pomocą angiografii tomografii komputerowej (CTA).Angiografia tomografii komputerowej bramkowana EKG bez modulacji została zastosowana u 10 pacjentów, z czego wyniki przedstawiono dla 3 pacjentów. Wszystkich chorych operowano z powodu ciężkiej degeneracyjnej niedomykalności mitralnej zdefiniowanej według klasyfikacji Carpentiera.Plastyka sztucznymi strunami ścięgnistymi pomiędzy wypadającym segmentem a odpowiadającym mięśniem brodawkowatym obejmowała użycie od 1 do 3 podwójnychAngiografia tomografii komputerowej pozwala z dobrym efektem ocenić średnio odległe wyniki plastyki zastawki mitralnej z użyciem sztucznych strun ścięgnistych w wybranej grupie pacjentów.

Background: EuroSCORE is used to predict postoperative mortality in patients undergoing cardiac surgery. Its updated version was published in 2011. Aim: To assess whether EuroSCORE II (ESII) predicts more accurately postoperative mortality after cardiac surgery in comparison with additive (addES) and logistic EuroSCORE (logES). Methods: A total of 461 patients (aged 21–88 years, 63.4% of men) who underwent cardiac surgery (December 2010 – June 2011) were included into the prospective research. For each patient ESII, addES and logES were calculated. Accuracy, calibration, and clinical performance of these models were assessed with receiver operating characteristics analyses using the area under the curve and the Hosmer-Lemeshow test. Out of this population, a group of 300 coronary artery bypass grafting (CABG) patients (aged 42–85 years, 73% of men) was selected and statistically analysed using the same methods. Results: The mortality rate was 5.21%. Predicted mortality rates were as follows: addES 4.68%, logES 4.57%, and ESII 1.89%; the accuracy was: 0.589, 0.728, and 0.726, respectively. Only logES presented good predictive power (Hosmer-Lemeshow test: c2 = 12.79, p = 0.12). In the CABG patients, the postoperative mortality rate was 5.33%. Predicted mortality rates were as follows: addES 4.69%, logES 4.59%, and ESII 1.88%; the accuracy was: 0.512, 0.691, and 0.687, respectively. In the Hosmer-Lemeshow test also logES presented good predictive power (c2 = 10.72, p = 0.218). Conclusions: EuroSCORE II did not estimate mortality risk better in comparison to its previous versions, in the entire studied population or in the CABG patients. On the basis of the analysed data, it seems that the closest to the actual risk of death for the Polish population is the EuroSCORE logistic model.

Degenerative aortic stenosis (AS) is an active inflammatory process similar to that in atherosclerosis plaque. The aim was to evaluate the atherosclerotic risk factors, concomitant diseases and risk of cardiovascular death using the SCORE system in degenerative AS-patients aged 60 and over with preserved left ventricle ejection fraction related to severity of AS. The database contains retrospectively consecutive series of 126 patients (mean age 69). Patients were analyzed related to severity of AS: severe AS with mean gradient of 64.6±8.7mmHg (n=79) and non-severe AS with mean gradient of 24.4±8.4mmHg (n=47). There were analyzed: age, gender, BMI, laboratory data, presence of hypertension (HA), diabetes, CAD, smoking cigarettes, positive family history, results of 12-lead ECG and coronary arteriography. There was estimated 10 year risk of cardiovascular death using the SCORE system. Both studied populations presented high 10-year risk of cardiovascular death with higher SCORE in non-severe AS (5.64+/-3.3% vs. 6.95+/-3.13%, P=0.006). Multivariate analysis revealed that only HA was an independent parameter determining higher SCORE in non-severe AS (P

Background: Atherosclerosis is currently being investigated as a chronic inflammatory process and the role of infectious agents is unclear. The presence of mycotic DNA in the wall of the non-atherosclerotic aorta of patients with coronary artery disease (CAD) and its association with levels of soluble intercellular adhesion molecule (sICAM)-1 expression was examined in the present study. Methods and Results: In 40 patients with CAD and a comparative group of 20 patients with aortic valve stenosis (AS) without CAD, specimens of the aortic wall were obtained during cardiac surgery. Mycotic DNA was analyzed by polymerase chain reaction (PCR) using a fungus-specific universal primer pair, ITS3 and ITS4, to amplify a portion of the 5.8S rDNA region, the entire ITS2 region and a portion of the 28S rDNA region, and using a species-specific primer pair, CALB1 and CALB2, to specifically amplify Candida (C.) albicans. The nested PCR method was performed to amplify the intergenic transcribed spacer regions of the rRNAs of Candida species. Before surgery the serum level of sICAM-1 was estimated. Mycotic DNA was detected in 48% of the CAD patients and in 40% of the AS patients, with C. albicans DNA in 58% and 100%, respectively (P>0.05). In CAD patients with a high level of sICAM-1, C. albicans DNA was found more frequently than in patients without elevated levels of sICAM-1 (P

Introduction: The study was carried out to estimate BNP concentration in patients with mitral stenosis and to check dependence of this concentration on the selected morphological parameters. Material and methods: Investigations were performed in two groups. Group I comprised 24 patients (mean age 55 years) with mitral stenosis without other coexistent heart diseases. Group II included 18 subjects (mean age 53 years) with excluded circulatory system diseases. The following parameters were examined: mean mitral valve area (MVA), mean mitral valve gradient (MVG) and maximal pulmonary arterial pressure (MPAP). Dimensions of cardiac cavities were also compared: left ventricular end-diastolic diameter (LVEDd), left atrial diameter (LAd), right ventricular diameter (RVd), and thickness of posterior wall diameter (PWd) and interventricular septum diameter (IVSd) were estimated. BNP was determined in blood samples by the radioimmunological method. Results: Mean BNP concentration in group I was elevated as compared to group II. In subgroups: Ia (with atrial fibrillation) and Id (with right ventricular hypertrophy), BNP concentration was also significantly elevated as compared to group II. Mean BNP concentration in group I correlated with MVA (r=-0.500) MVG (r=0.701), MPAP=(r=0.898) and with Lad (r=0.630) and RVd (r=0.870). Conclusions: The results of the study allow to state that BNP can be a useful, biochemical indicator of progression of morphological lesions accompanying mitral stenosis.

A 60 year-old woman with rheumatic mitral stenosis underwent re-replacement of Cross-Jones caged lens mitral valve prosthesis, 36 years after valve implantation. In 1968, she underwent mitral commissurotomy. In 1992, she had a stroke, and in July 2009 echocardiography revealed the malfunction of the prosthesis with pannus and reduced mitral prosthetic area < 1.0 cm 2 with the elevated transprosthetic gradient of 30 mm Hg. To begin with, she did not approve of the reoperation. Finally, she consented to this therapeutic option. In October 2009 Medtronic prosthesis Advantage 27 was re-implanted. We report the longest period of working Cross-Jones mitral valve in the literature. (Cardiol J 2011; 18, 6: 698–700)

We have evaluated the activation of platelets in blood samples taken from patients with stable angina undergoing balloon angioplasty (percutaneous transluminal coronary angioplasty [PTCA]) (n=11) or coronary artery bypass grafting (CABG) under hypothermic (n=11) or normothermic conditions (n=11). We have found that surface expression of P-selectin on platelets in whole blood from PTCA patients upon thrombin treatment was significantly reduced, as compared with control platelets from healthy subjects. This effect was partially reversed when platelets washed from the same blood sample were used, but even then P-selectin expression was significantly lower in PTCA patients than it was in control subjects. There was a significant increase in basal expression of P-selectin in blood platelets taken from patients who underwent CABG under normothermic conditions (warm blood cardioplegia) as opposed to hypothermic patients (cold crystalloid cardioplegia). These platelets retain the ability to respond to agonists, although to a much lower extent than do those from healthy control donors. The surface exposure of P-selectin on resting and thrombin-treated platelets isolated from CABG surgery patients was not different from that of the control platelets. The adhesion to fibrinogen of resting and thrombin-treated platelets from patients who underwent balloon angioplasty as well as CABG surgery under normothermic and hypothermic conditions was significantly reduced when compared with the fibrinogen of the control platelets. These results suggest that the function of platelet fibrinogen receptor is impaired in patients with stable angina pectoris and that PTCA and CABG surgery activates platelets.

Cardiac rehabilitation (CR) is recommended after cardiac surgery. Secondary prevention through exercise training is one of the best scientifically-proven ways of decreasing mortality and enhancing quality of life in cardiovascular disorders. Studies into the use of CR in different groups of patients after cardiac surgery are limited.To find the factors determining the reasons for the lack of CR in cardiac surgery patients.The study group consisted of 82 patients (mean age 58.6 years, 80.7% male) in stable II/III NYHA class, who had undergone coronary artery bypass graft surgery, valvular surgery, or both. The following were analysed: age, gender, body mass index, basic laboratory results such as serum lipids level, cholesterol ratio LDL/HDL, creatinine and glucose levels, results of electrocardiography, echocardiography and coronary arteriography, presence of hypertension, diabetes, coronary artery disease, renal failure, previous stroke, obliteration of peripheral arteries, EuroSCORE and length of hospitalisation. Patients were divided into two groups: those referred for CR (n = 46, the CR group) and those referred for CR but who did not receive it (n = 36, non-CR group).From multiple logistic regression analysis with backward stepwise, only female gender (p = 0.0208, OR = 0.07) and length of hospitalisation (p = 0.0198, OR = 1.17) were significant for non-CR patients.We found a lower rate of use of CR after cardiac surgery in those patients hospitalised for longer periods, and in women.

In a 62-year old woman with arterial hypertension, a left atrial myxoma and a concomitant atrial septal defect, diagnosed intraoperatively, were recognized. The atrial septal defect was not observed pre-operatively by transthoracic and transoesophageal echocardiography with color Doppler. The myxoma was pedunculated and situated on the inferior part of the interatrial septum and moved to the left ventricle in the diastolic phase. The histopathologic finding was consistent with the diagnosis of myxoma.

From January 1975 to June 1988, 275 patients underwent mitral valve repair for mitral regurgitation, pure (148 patients) or associated with mitral stenosis (127 patients). Patients with pure mitral stenosis were excluded from this study. The cause of mitral regurgitation was rheumatic in 180 patients (aged 28.6 ±1.2 years, mean ± standard error of the mean) and degenerative in 84 patients (aged 54.7 ±1.5 years). Fifty-nine percent of the patients were in New York Heart Association classes III and IV before the operation. Intraoperative assessment of the mitral valve led us to identify four major mechanisms of mitral regurgitation: (1) restriction of leaflet motion by fibrosis (group I, 63 patients); (2) enhancement of leaflet motion by leaflet and chordal extension and prolapse (group II, 139 patients), (3) combination of both (group III, 64 patients); and (4) isolated dilatation of the anulus (group IV, 10 patients). One hundred sixty-one patients had isolated mitral disease and 114 had associated aortic or tricuspid valve disease, or both. The hospital mortality rate was 4.0%. Follow-up was 96% complete and totaled 1247.47 patient-years. At 13 years’ follow-up, the survival rate was 93.0% ± 6.8% in group I, 90.0% ± 6.0% in group II, and 96.6% ± 4.6% in group III. Freedom from reoperation was 78.1% ± 21.0%, 83.2% ± 18.9%, and 79.6% ± 16.2%, respectively. Freedom from embolism was 94.7% for the whole series. In patients with isolated mitral valve repair, the cumulative morbidity was significantly higher in groups I (6.3% ± 2.0%/pt-yr) and III (6.3% ± 1.7%/pt-yr) than in group II (2.5% ± 0.9%/pt-yr, p

Introduction Several studies have been suggested that infectious agents may induce or progress the process of atherosclerosis in humans. In the present study, the samples of visually healthy human aortic wall were examined for the presence of Chlamydia pneumoniae , Mycoplasma pneumoniae , Helicobacter pylori , herpes simplex virus (HSV), and cytomegalovirus (CMV). Methods Bacterial DNA of C. pneumoniae , M. pneumoniae , and H. pylori and viral DNA of HSV and CMV were analyzed by polymerase chain reaction. The specimens were obtained from 40 patients with atherosclerotic three-vessel stable coronary artery disease referred to surgical revascularization (coronary group) and 20 controls referred to aortic valve replacement (valve group). Results C. pneumoniae was detected in 11 of 40 samples of aorta in coronary group (27.5%) and 5 of 20 in valve group (25%). M. pneumoniae was found in 6 of 40 (15%) and 5 of 20 (25%) samples, and CMV was found in 22 of 40 (55%) and 10 of 20 (50%) samples. The most frequent detected pathogens were H. pylori and HSV. H. pylori was found in 32 of 40 samples of aortic wall in coronary group (80%) and 17 of 20 samples in valve group (85%), whereas HSV was found in 27 of 40 (67.5%) and 17 of 20 (85%) aortic wall specimens. Conclusion Results demonstrate that C. pneumoniae , M. pneumoniae , H. pylori , CMV, and HSV can be detected in macroscopically healthy aortic wall of coronary and valve patients in similar frequency, which do not support hypothesis concerning the role of microorganisms in atherosclerosis etiology.

Experimental models and human studies have supported a role of infection in the initiation of atherosclerosis. There are many known microorganisms who can play an important role in atherosclerosis, but especially two of them--Chlamydia pneumoniae and Cytomegalovirus are suspected to stimulate the process of atheromatosis. Until antibiotics or vaccines are useful in artery diseases prevention, therapies with proven vascular anti-inflammatory effects (diet, exercise, smoking cessation, aspirin, statins) should be optimized.

276 patients aged 65 years or more, who underwent coronary artery bypass grafting in the Department of Cardiac Surgery, Medical University of Łódź in 1999 and 2000, were assessed. The analyzed group consisted of 193 men (69.93%) and 83 women (30.07%). The mean age of the patients was 69.14 years (+/- 3.42, age range from 65 to 79 years), 18 (6.52%) patients were in the first functional class of CCS classification, 55 pts (19.93%) in the second, 106 pts (38.41%) in the third and 97 pts (35.14%) in the fourth class. 87 patients (31.52%) had no history of myocardial infarction, 137 pts (49.28%) had a history of 1 infarction and 53 pts (19.2%) of 2 or more myocardial infarctions. 68.12% of patients smoked cigarettes. Arterial hypertension was observed in 176 pts (63.77%), diabetes mellitus in 50 pts (18.11%), chronic renal failure in 10 pts (3.62%), a history of stroke in 8 pts (2.9%), peptic ulcer in 42 pts (15.22%). Left ventricular ejection fraction below 30% was observed in 16 (5.8%) patients. 10 pts (3.62%) underwent coronary angioplasty and in 26 pts (9.42%) critical stenosis of the left main stem was observed. All patients were operated on cardiopulmonary bypass and myocardial protection was obtained by the use of cold crystalloid cardioplegy solution based on St. Thomas Hospital formula. 224 patients (81.16%) were operated electively. In early postoperative period the following complications were observed: death--35 (12.68%), low cardiac output syndrome--84 (30.43%), need of use of intraaortic contrapulsation--31 (11.23%), perioperative myocardial infarction--44 (15.94%). Respiratory complications were observed in 83 pts (30.07%), neurological complications in 7 pts (2.54%), acute renal failure in 25 pts (9.06%), intestinal bleeding in 5 pts (1.81%). Rethoracotomy was necessary in 12 of the operated (4.35%). Currently the age of a patient is considered as one of many risk factors and should not be treated as a contraindication to surgical revascularization procedure. In the analyzed material mortality correlated with a number of risk factors. It is to remember that the elderly have higher prevalence of coexisting diseases and that is why their exposure to the perioperative complications is also higher.

One hundred fifteen consecutive patients were operated on for myocardial revascularization or valvular disease or both with continuous antegrade and retrograde aerobic warm (37 degrees C) blood cardioplegia. Mean cross-clamp time was 56.3 +/- 21 minutes (+/- standard deviation). Mean reperfusion time was 18.4 +/- 11.8 minutes (range, 5 to 81 minutes). Five patients (4.3%) died, and 15 (13%) needed inotropic support. Two (1.7%) required intraaortic balloon support. Two patients (1.7%) had evidence of perioperative myocardial infarction, and 98 (85%) returned spontaneously to normal sinus rhythm. Sixteen patients had a cross-clamp time greater than 80 minutes. All 16 of them had an uneventful postoperative course except for 1 patient who required inotropic drugs. This method of myocardial protection is now used for all open heart procedures in our institution.