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An impairment of standard echocardiographic parameters of right ventricular (RV) function is a known phenomenon in patients undergoing cardiac surgery, but its significance remains unclear.This study aimed to assess changes in RV function in patients undergoing cardiac surgery using speckle tracking and 3D echocardiography.The study population comprised 122 patients referred for cardiac surgery. Transthoracic echocardiographic (TTE) examinations were performed: before the surgery (TTE1), 1 week after surgery (TTE2), and 1 year after surgery (TTE 3). Parameters measured during these examinations included both standard and advanced indices of the RV size and function, as well as a new parameter introduced by our team - RV shortening fraction (RV SF).TTE1 was performed on average (standard deviation [SD]) 24 (15) hours before surgery, whereas TTE2 and TTE3 were performed on average 7.2 (3) days and 346 (75) days after the surgery, respectively. A postoperative impairment of parameters of RV longitudinal function was observed (P0.001). However, neither the RV size assessed by both 2D and 3D techniques changed, nor the global RV function measured with the use of fractional area change and ejection fraction. Additionally, during the postoperative period, an increase in the value of an RV SF by 12.9% was observed. After 12 months we observed an improvement in the parameters of the longitudinal RV function.Uncomplicated cardiac surgery causes transient impairment of the longitudinal systolic RV function, with no influence on the global RV function. The preservation of global function results from increased RV SF. After 12 months, an improvement of the longitudinal function can be observed.

Background: Erythropoietin (EPO) deficiency or inadequate EPO secretion in response to bleeding may result in profound or prolonged anaemia after cardiac surgery. Aim: The aim of the study was to evaluate the changes in EPO secretion in patients undergoing off-pump coronary artery bypass grafting (OPCAB). Methods: Blood samples from 43 patients (mean age 65.1 ± 7.6 years) were obtained before surgery and on the 1 st , 2 nd , and 6 th day post isolated OPCAB. EPO levels ≥ 4.3 mIU/mL were considered normal. Results: Thirteen (30%) patients had the preoperative EPO level below normal range even though their preoperative haemoglobin was ≥ 13 g/dL. In patients with basal EPO deficiency lower peak EPO levels were observed compared to the group with normal basal EPO levels, even though reduction in haemoglobin concentrations was comparable in both groups. Moreover, lower reticulocytosis was noted on day 1 (8.5 ± 4.0‰ vs. 11.7 ± 4.4‰; p = 0.04) and a tendency toward lower values was seen on day 2 (9.6 ± 4.3‰ vs. 13.0 ± 5.8‰; p = 0.07) among patients with preoperative EPO deficiency. Conclusions: Erythropoietin deficiency is common in patients scheduled for OPCAB, and it results in diminished increase in EPO secretion in response to bleeding. Consequently, in patients with EPO deficiency, reticulocytosis is lower than it could be predicted based on the observation of patients with normal EPO levels and similar blood loss.

Background An impairment of certain echocardiographic parameters of right ventricular (RV) function, such as tricuspid annular peak systolic excursion (TAPSE), is a known phenomenon in patients undergoing cardiac surgery. However, little is known about significance of these alterations with regard to other aspects of RV function. The aim of our study was to clarify this issue using parameters based on 3D echocardiography and speckle tracking technique. Methods The study population comprised 105 patients (76 men, mean age 65 ± 16 years), referred for coronary artery bypass grafting and/or replacement of mitral or aortic valve. Patients undergoing tricuspid annuloplasty and with baseline suboptimal image quality were excluded from the study group. Transthoracic echocardiographic examination was performed on average 2 ± 2 days prior to surgery (TTE1) , and 7 ± 4 days after surgery (TTE2), whereas follow-up TTE (TTE3) was performed on average 12 ± 2months after the surgery. Parameters measured during these examinations included both standard and advanced indices of RV size and function, such as TAPSE, systolic velocity of tricuspid annulus (S"), fractional area change (FAC), RV ejection fraction (EF) and RV global longitudinal systolic strain (GLS). Results Echocardiographic measurements were completed for TTE1, TTE2 and TTE3 in 95% of patients. We noticed a significant postoperative (TTE2) impairment of parameters of RV longitudinal function (TAPSE, S’ and GLS; p Conclusion Cardiac surgery results in an impairment of the longitudinal systolic RV function, with no influence on the global RV function. After 12 months, an improvement of the longitudinal function can be observed.

Surgical ablation for atrial fibrillation (AF) performed at the time of other valvular- or nonvalvular cardiac procedure is a mainstay of therapy; yet the data regarding its influence on remote survival are sparse. We aimed to evaluate late survival in patients undergoing mitral valve (MV) surgery with concomitant surgical ablation for AF.Procedure-related data from the Polish National Registry of Cardiac Surgery Procedures (Krajowy Rejestr Operacji Kardiochirurgicznych) were retrospectively collected. A total of 11,381 patients with baseline AF (46.6% men; mean age 65.6 ± 9.0 years) undergoing MV surgery between 2006 and 2017 in 37 reference centers across Poland and included in the registry were analyzed. Median follow-up was 5 years (mean, 4.6 years; interquartile range, 1.9-7.9 years). Cox proportional hazards models were used for computations. Propensity score matching for the comparison of MV + ablation versus MV alone was performed.Of included patients, 2449 (21.5%) underwent surgical ablation for AF. Patients in this group were significantly younger (63.8 ± 8.7 years vs 66.1 ± 9.0 years; P .001) and were at lower baseline surgical risk (EuroSCORE, 2.86 vs 3.69; P .001). During the 12-year study period, there was a significant survival benefit (hazard ratio, 0.71; 95% confidence interval, 0.63-0.79; P .001) for MV + ablation compared with MV alone. After rigorous propensity matching (logit model, 1784 pairs) surgical ablation was associated with nearly 20% improved survival (hazard ratio, 0.82; 95% confidence interval, 0.70-0.96; P = .011). Benefit of surgical ablation was maintained in subgroup analyses, yet most benefit was appraised in low-risk patients such as those with EuroSCORE of 2 to 5 or age 50 years.Concomitant surgical ablation for AF in patients undergoing mitral valve procedures is safe, feasible, and significantly improves late survival.

Left ventricular assist device (LVAD) is one of the modern management therapies in patients with advanced heart failure, and it serves as a bridge to heart transplantation or even as destination therapy. However, it is burdened with a high risk of thromboembolic, hemorrhagic, and infectious complications despite prophylactic management. Splenic abscesses, as septic complications following implantation of mechanical ventricular support, have not yet been described in the literature. We report of a patient with severe left ventricular insufficiency (NYHA II/III), pulmonary hypertension, and arrhythmia who underwent implantation of the Heart Ware® pump for left ventricular support with simultaneous tricuspidvalvoplasty, as a bridge therapy to heart transplantation. During two years after LVAD implantation, the patient had three MRSA skin infections, localized at the exit site of the drive-line connecting the artificial ventricle with external unit, that were complicated by sepsis and treated with broad-spectrum antibiotics. A few months later, abdominal CT revealed two abscesses in the spleen, and the patient was qualified for splenectomy. Open splenectomy was performed under full-dose anticoagulant therapy with continuous intravenous infusions of unfractionated heparin (UFH). The intra- and postoperative course was uneventful. UFH therapy was continued for 6 days, and oral anticoagulation was re-administered on day 4 after surgery. The patient was discharged on day 7 after surgery with primary healed wound. Open splenectomy, performed with full-dose anticoagulant therapy, proved to be an effective and definitive method of treatment without any complications.

Background Modern Polish medicine offers patients various treatments for end-stage treatment-resistant heart failure. Methods applied at the right time before the occurrence of irreversible changes in organs give a chance for survival and prolong life. Case report Here, we report on the safety and efficacy of the sequential use of the above treatments in a 58-year old patient with heart failure in dilatative cardiomyopathy (DCM). A 7-day mechanical blood circulatory support and extracorporeal membrane oxygenation of blood (ECMO), followed by a 13-day implantation of a left ventricular assist device, Religa Heart EXT, was used as a bridge to a successful orthotopic heart transplant (OHT). On Day 40 after OHT, the patient was discharged home with stable function of the circulatory system. We describe our experiences with the qualification, preparation, and procedure of sequential ECMO, Religa Heart EXT, and OHT. Conclusions Application of short-term ECMO as a bridge-to-bridge helped save the patient from severe cardiogenic shock caused by increased left ventricular afterload. The experimental implantation of an innovative Religa Heart EXT prosthesis was a safe and efficacious bridge to transplantation. Too short time of Religa Heart EXT implantation in the discussed patient prevented the possibility to evaluate the occurrence of thromboembolic complications and infections compared to the documented complications of POLVAD implanted until now. OHT is a safe and efficacious method of treatment of patients previously supported by ECMO and Religa Heart EXT.

Aims Having several recently published reports on increased rate of cardiac perforation with some lead models as background, we assess the relation between cardiac perforations and models of leads used. Methods and results All pacing and defibrillation leads implantations between 1 January 2007 and 31 March 2008 were analysed retrospectively. There were 2247 leads implanted in 1419 patients aged 67.6 ± 14.1, 1200 (53%) active and 1047 (47%) passive fixation leads. Cardiac perforation occurred in eight patients (0.5%). The number of perforations does not differ significantly between the pacemaker and implantable cardioverter defibrillator implantations (five and three cases, respectively, P = 0.13). All perforations were associated with the active fixation leads implantation (8 vs. 0, P < 0.01). Only four models of leads were associated with perforations, but the risk of their use was not statistically significantly increased, when compared with other active fixation leads placed in the adequate position. Conclusions The incidence of cardiac perforation related to pacing and defibrillation leads is low. The use of active fixation leads is associated with an increased risk of cardiac perforation. We did not find any correlation between the perforation rate and any particular model of the implanted lead.

BACKGROUND The aim of this study was to assess the quality of life of patients before and after heart transplantation (HTX). MATERIAL AND METHODS We included 63 patients after a heart transplant under the care of the Transplantation Clinic. The authors' questionnaire was used, which consisted of 2 parts: questions concerning the life of patients before and after a heart transplant. The significance level was p

Background— Current guidelines recommend coronary artery bypass graft surgery (CABG) when treating significant de novo left main coronary artery (LM) stenosis; however, percutaneous coronary intervention (PCI) has a class IIa indication for unprotected LM disease in selected patients. This analysis compares 5-year clinical outcomes in PCI- and CABG-treated LM patients in the Synergy Between PCI With Taxus and Cardiac Surgery (SYNTAX) trial, the largest trial in this group to date. Methods and Results— The SYNTAX trial randomly assigned 1800 patients with LM or 3-vessel disease to receive either PCI (with TAXUS Express paclitaxel-eluting stents) or CABG. The unprotected LM cohort (N=705) was predefined and powered. Major adverse cardiac and cerebrovascular event rates at 5 years was 36.9% in PCI patients and 31.0% in CABG patients (hazard ratio, 1.23 [95% confidence interval, 0.95–1.59]; P =0.12). Mortality rate was 12.8% and 14.6% in PCI and CABG patients, respectively (hazard ratio, 0.88 [95% confidence interval, 0.58–1.32]; P =0.53). Stroke was significantly increased in the CABG group (PCI 1.5% versus CABG 4.3%; hazard ratio, 0.33 [95% confidence interval, 0.12–0.92]; P =0.03) and repeat revascularization in the PCI arm (26.7% versus 15.5%; hazard ratio, 1.82 [95% confidence interval, 1.28–2.57]; P Conclusions— At 5 years, no difference in overall major adverse cardiac and cerebrovascular events was found between treatment groups. PCI-treated patients had a lower stroke but a higher revascularization rate versus CABG. These results suggest that both treatments are valid options for LM patients. The extent of disease should accounted for when choosing between surgery and PCI, because patients with high SYNTAX scores seem to benefit more from surgery compared with those in the lower tertiles. Clinical Trial Registration— URL: http://www.clinicaltrials.gov. Unique identifier: NCT00114972.

Many bacterial species can be a cause of various heart diseases, such as: Borrelia burgdorferi sensu lato, Coxiella burnetii and Bartonella spp. The aim of the present studies was to establish if any tick-borne infections can contribute to serious heart disorders resulting in the need for heart transplantation. Myocardium, aortic and mitral valve samples from hearts removed from patients undergoing heart transplantation were tested. The presence of Bartonella spp., Borrelia afzeli and C. burnetii bacteria in malfunctioning human hearts has been shown. DNA of Bartonella spp., B. burgdorferi and C. burnetii were detected in various parts of tested hearts. DNA of B. afzelii and Bartonella spp. were found in the aortic valves. DNA of C. burnetii was detected in the myocardium. Mixed infections with Bartonella spp. and C. burnetii were also observed. Obtained results indicate that diagnosis of Bartonella spp., B. burgdorferi C. burnetii and Rickettsia spp. infections should be considered in cases of infectious endocarditis with negative blood cultures.

The etiology of peripartum cardiomyopathy (PPCM) is not well understood. Potential causal mechanisms include infection, autoimmune disease, and abnormal response to the hemodynamic stress of pregnancy. Recently it was shown that the development of PPCM in an experimental model is associated with the generation of a cleaved antiangiogenic and proapoptotic 16-kDa form of the nursing hormone prolactin, which impairs the cardiac capillary network and its function. The purpose of this study was to evaluate the ultrastructure of the myocardium in a patient with PPCM and in a comparative group of patients and to identify structural characteristics that may predispose to myocardium dysfunction.A 28-year-old woman with PPCM had fulminant heart failure leading to the implantation of a biventricular assist device, but no myocarditis was found on histological examination of her myocardial tissue. An ultrastructural study of myocardial tissue taken from three patients (mean age: 22 years, 2 females) with fulminant heart failure not related to PPCM (2 myocarditis, 1 dilated cardiomyopathy) served as a comparison. The ultrastructural analysis revealed the presence of small capillary damage. Vascular lumen occlusion, endothelial cell remodeling, and apoptosis with the appearance of mast cells, plasma cells, and preadipocytes were the most characteristic features of the damaged myocardial tissue with secondary interstitial fibrosis. No vascular pathology of cardiac capillaries was observed in the comparative group.A myocardial tissue study in PPCM revealed ultrastructural remodeling of small capillaries with the presence of endothelial cell apoptosis and impairment of the microcirculation.

In the last few years endomyocardial biopsy becomes a useful diagnostic tool for the investigation of idiopathic dilated cardiomyopathy. The aim of our current study was to try to identify ultrastructural and immunohistochemical specificity of truncated cardiac proteins in affected heart. The focal loss of plasma membrane continuity together with the lack of dystrophin activity in affected myocytes facilitated to find mutation in dystrophin gene. The accumulation of granulofilamentous desmin-positive material in cytoplasm of myocytes was the main indicator of presented mutation in the desmin gene. Nuclear structure remodeling, concomitantly with loss of lamin A/C activity, contributed to identify mutation in lamin A/C gene. Analysis of hypertrophic heart with disarray of sarcomeres and lack of I-Z-I bands suggested embryonic faiulure in titin activity. All this findings indicate that endomyocardial biopsy reperesent a useful method for a correct diagnosis of heart dysfunction.

Major nuclear envelope abnormalities, such as disruption and/or presence of intranuclear organelles, have rarely been described in cardiomyocytes from dilated cardiomyopathy (DCM) patients. In this study, we screened a series of 25 unrelated DCM patient samples for (a) cardiomyocyte nuclear abnormalities and (b) mutations in LMNA and TMPO as they are two DCM-causing genes that encode proteins involved in maintaining nuclear envelope architecture. Among the 25 heart samples investigated, we identified major cardiomyocyte nuclear abnormalities in 8 patients. Direct sequencing allowed the detection of three heterozygous LMNA mutations (p.D192G, p.Q353K and p.R541S) in three patients. By multiplex ligation-dependant probe amplification (MLPA)/quantitative real-time PCR, we found a heterozygous deletion encompassing exons 3–12 of the LMNA gene in one patient. Immunostaining demonstrated that this deletion led to a decrease in lamin A/C expression in cardiomyocytes from this patient. This LMNA deletion as well as the p.D192G mutation was found in patients displaying major cardiomyocyte nuclear envelope abnormalities, while the p.Q353K and p.R541S mutations were found in patients without specific nuclear envelope abnormalities. None of the DCM patients included in the study carried a mutation in the TMPO gene. Taken together, we found no evidence of a genotype–phenotype relationship between the onset and the severity of DCM, the presence of nuclear abnormalities and the presence or absence of LMNA mutations. We demonstrated that a large deletion in LMNA associated with reduced levels of the protein in the nuclear envelope suggesting a haploinsufficiency mechanism can lead to cardiomyocyte nuclear envelope disruption and thus underlie the pathogenesis of DCM.

Atrial fibrillation (AF) is the most common arrhythmia among patients (pts) with heart failure and has significant influence on survival.to assess prognosis of pts with refractory heart failure (HF) qualified for heart transplantation (HTX).872 pts (107 W and 765 M) were qualified for HTX between Dec 2003 and Oct 2007. Patient's death or super urgent heart transplantation were considered the end point in Kaplan-Meier survival curves.680 pts were on sinus rhythm (SR) and 192(22.0%) had atrial fibrillation (AF). During follow-up (1-1464 days, mean 550 days) 155 pts (17.7%) died, 17.65% with SR and 18.23% with AF (ns). EF - mean 21,6 (SR) and 21,8 (FA), NYHA 3,1 (SR), NTproBNP- mean 3635, 4 (SR) and 4349,4 (FA), Arronson - mean 7,8 (SR) and 7,7 (FA). There were no significant differences between groups. We analyzed influence of heart rate (Kaplan-Maier method) on survival. The pts were divided according to HR: gr.I70/min, gr II 71-89/min, gr III90/min. The shortest survival rate was noticed in group III. There was no difference in survival between group I and II.The prognosis for patients qualified for heart transplant does not depend on the type of the dominant cardiac rhythm (atrial fibrillation or sinus rhythm). The prognosis is significantly better for those patients whose basic, resting heart rate does not exceed 90 bpm regardless of the rhythm type.

We present the results of standard transthoracic echocardiographic assessment of a biventricular assist device implanted in a patient with progressive heart failure caused by acute giant-cell myocarditis.

We analysed the architecture of cardiomyocyte nuclei lacking lamin A activity in three patients with dilated cardiomyopathy. The diagnosis was established on the basis of clinical and electrophysiological examinations, chest radiography and electrocardiography. An ultrastructural study of affected cardiomyocytes showed dramatic alterations in nuclear distribution and organization affecting nuclear shape, lamina structure, chromatin and nuclear interior organization. The most specific hallmark of nuclei with lamin A deficiency was the reorganization of the nuclear interior, the appearance of a various number of mitochondria within the nuclear matrix, and focal or total lack of nuclear membrane.

Atrial fibrillation (AF) is a common complication after coronary artery bypass grafting (CABG). The aims of the study were to assess possible predictors and identify modes of prevention of new-onset AF following coronary surgery.Retrospective clinical and statistical analysis was made of the medical records of 217 patients who had undergone coronary surgery.AF occurred in 28% (61/217) of the patients. In univariate analysis the age of the patients with AF was higher (p = 0.0033), they had a longer history of coronary disease (p = 0.0417) and more had3 grafts (p0.05). Low ejection fraction (40%) was also a risk factor of arrhythmia (p0.0001). In multivariate regression analysis two independent predictors of AF were identified: no ACE inhibitor treatment before surgery (p = 0.0005) and age60 years (p0.01). Patients with AF had a higher mean heart rate after the procedure: 115 +/- 34 vs. 78 +/- 21/min (p0.0005). Patients treated with ACE inhibitors before and after surgery had a lower incidence of AF than non-treated patients: 8% vs. 48% (p0.0001) and 4% vs. 61%, p0.0001) respectively. Beta-blocker treatment before and after surgery resulted in a lower incidence of AF: at 23% vs. 75% (p0.001) and 19% vs. 96% (p0.0001), respectively.No ACE inhibitor therapy before surgery, advanced age, low ejection fraction, high post-procedure heart rate, duration of coronary disease and the number of grafts (corresponding to the length of the procedure) were found to be strong probable predictors of AF following cardiac surgery. ACE inhibitor therapy may be effective in the prevention of newonset AF. Treatment based on individual variables is crucial for proper treatment and to diminish the risk of arrhythmia. (Cardiol J 2007; 14: 274-280).

A case of an echocardiographic diagnosis of biventricular assist device inflow cannula obstruction, associated with low cardiac output in a 29-years old male with dilated cardiomyopathy and severe congestive heart failure is presented. The reasons for low cardiac output in patients supported with ventricular assist devices and the role of transoesophageal echocardiography in the diagnosis of device failure are briefly discussed.

There are limited data on early and long-term prognosis in patients after aortic valve replacement who have left ventricular dysfunction, reduced ejection fraction (EF)or =35% and no concomitant coronary artery disease.To assess the prognosis in this group of patients depending on the mean aortic gradient (MAG) value.This study involved 60 patients with severe aortic stenosis and EFor =35%. Patients with coronary artery disease, more than moderate aortic regurgitation and any other valvular lesion were excluded. Patients were divided into two groups based on the MAG values: group I included patients with MAGor =35 mmHg, and group II included patients with MAG35 mmHg.Early mortality after aortic valve replacement was 14.2% in group I, and 5.1% in group II. During a mean follow-up of 48 months mortality in groups I and II was 16.6% and 2.6%, respectively. In the follow-up period, a significant functional improvement according to NYHA scale as well as significant decrease of left ventricular dimensions and increase of EF was observed in both groups of patients.Patients with severe aortic stenosis, left ventricular ejection fraction35% and MAGor =35 mmHg constitute a group of the highest early and long-term mortality risk after valve replacement. In turn, patients with MAG35 mmHg should be classified as the group of slightly increased risk.

Atrial fibrillation is the most common tachyarrhythmia after coronary artery bypass grafting. The etiology of this arrhythmia and factors responsible for its genesis are unclear. The aim of this study was to compare the frequency of AF in patients undergoing coronary artery bypass grafting without the use of cardiopulmonary bypass (CPB) with those undergoing CABG using standard CPB. The study population consisted of 325 patients who underwent coronary artery bypass grafting between June 2000 and December 2001 (mean age 60.02, range 38-83 years, 242 males). Each patient had continuous ECG monitoring since the operation to the third postoperative day. AF occurred in 100 of 325 patients (30.76%). Patients were divided into two groups according to the presence (group A-100 patients) or absence (group B-100 patients) of post-CABG AF. Patients in both groups were compared. Intraoperative variables were used to compare the two groups. Patients with AF were significantly older (66.04 +/- 7.88 vs. 60.49 +/- 9.74 p = 0.0001). There was no statistically significant difference in the incidence of atrial fibrillation between the patients after coronary artery bypass grafting procedures, performed with or without cardiopulmonary bypass.

Mortality in patients with a significant left main and right coronary artery ostia stenosis is high, reaching 50% during a five-year follow-up period. To date, this type of lesion has been rarely treated with percutaneous coronary interventions (PCI). We present a case of a 50-year-old man who had had coronary artery bypass surgery because of left main stenosis in the past and was currently admitted to the hospital because of unstable angina. Coronary angiography showed tight left main and right coronary ostia stenosis and total occlusion of the left anterior descending artery. Vein grafts were occluded. The PCI procedure combined with the cardiopulmonary bypass was performed. The lesions were dilated and stents were successfully implanted. The patient tolerated the procedure well. He was discharged five days after PCI and the course of a 12-month follow-up was uneventful.

Background BAG3 gene mutations have been recently implicated as a novel cause of dilated cardiomyopathy (DCM). Our aim was to evaluate the prevalence of BAG3 mutations in Polish patients with DCM and to search for genotype-phenotype correlations. Methods We studied 90 unrelated probands by direct sequencing of BAG3 exons and splice sites. Large deletions/insertions were screened for by quantitative real time polymerase chain reaction (qPCR). Results We found 5 different mutations in 6 probands and a total of 21 mutations among their relatives: the known p.Glu455Lys mutation (2 families), 4 novel mutations: p.Gln353ArgfsX10 (c.1055delC), p.Gly379AlafsX45 (c.1135delG), p.Tyr451X (c.1353C>A) and a large deletion of 17,990 bp removing BAG3 exons 3–4. Analysis of mutation positive relatives of the probands from this study pooled with those previously reported showed higher DCM prevalence among those with missense vs. truncating mutations (OR = 8.33, P = 0.0058) as well as a difference in age at disease onset between the former and the latter in Kaplan-Meier survival analysis (P = 0.006). Clinical data from our study suggested that in BAG3 mutation carriers acute onset DCM with hemodynamic compromise may be triggered by infection. Conclusions BAG3 point mutations and large deletions are relatively frequent cause of DCM. Delayed DCM onset associated with truncating vs. non-truncating mutations may be important for genetic counseling.

Long-term Safety and Efficacy of Percutaneous Coronary Intervention With Stenting and Coronary Artery Bypass Surgery for Left Main Disease : Final Five-year Follow-up of the SYNTAX Trial