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BACKGROUND: High-altitude decompression sickness (HADCS) is a rare condition that has been associated with aircraft accidents. To the best of our knowledge, the present paper is the first case report of a patient treated for severe HADCS using recompression therapy and veno-venous extracorporeal oxygenation (VV-ECMO) with a complete recovery.CASE REPORT: After depressurization of a cabin, the 51-yr-old jet pilot was admitted to the Military Institute of Medicine with a life-threatening HADCS approximately 6 h after landing from a high-altitude flight, in a dynamically deteriorating condition, with progressing dyspnea and edema, reporting increasing limb paresthesia, fluctuating consciousness, and right-sided paresis. Hyperbaric oxygen therapy in the intensive care mode was initiated. A therapeutic recompression with U.S. Navy Treatment Table 6 was performed with neurological improvement. Due to cardiovascular collapse, sedation, mechanical ventilation, and significant doses of catecholamines were started, followed by continuous veno-venous hemodialysis. In the face of disturbances in oxygenation, during the second day of treatment the patient was commenced on veno-venous extracorporeal oxygenation. Over the next 6 d, the patient’s condition slowly improved. On day 7, VV-ECMO was discontinued. On day 19, the patient was discharged with no neurological deficits.DISCUSSION: We observed two distinct stages during the acute phase of the disease. During the first stage, signs of hypoperfusion, neurological symptoms, and marbled skin were observed. During the second stage, multiple organ dysfunction dominated, including heart failure, pulmonary edema, acute kidney injury, and fluid overload, all of which can be attributed to extensive endothelial damage.Siewiera J, Szałański P, Tomaszewski D, Kot J. High-altitude decompression sickness treated with hyperbaric therapy and extracorporeal oxygenation. Aerosp Med Hum Perform. 2020; 91(2):106–109.

Over the last twenty years, minimally invasive aortic valve replacement (MIAVR) has evolved into a safe, well-tolerated and efficient surgical treatment option for aortic valve disease. It has been shown to reduce postoperative morbidity, providing faster recovery and rehabilitation, shorter hospital stay and better cosmetic results compared with conventional surgery. A variety of minimally invasive accesses have been developed and utilized to date. This concise review demonstrates and discusses surgical techniques used in contemporary approaches to MIAVR and presents the most important results of MIAVR procedures.

Background: Postoperative clopidogrel use after surgical coronary revascularization may provide short- and long-term reduction of risk of negative cardiovascular events. However, there are not enough data from prospective randomized trials comparing head-to-head monotherapy with either aspirin or clopidogrel. Aim of the study: The aim of the study was to evaluate the safety and effectiveness of aspirin or clopidogrel use in patients after elective coronary artery bypass grafting. Material and methods: The study involved 50 patients who were referred for elective off-pump coronary artery bypass grafting (OPCAB). Preoperatively patients were randomized to postoperative antiplatelet treatment with either aspirin (150 mg per day) or clopidogrel for 6 months (75 mg per day). After 6 months all patients were turned to aspirin. In all patients platelet function on aspirin was checked before surgery. After 1, 6 and 12 months in all cases follow-up was collected in terms of any adverse events. Results: During follow-up 26 negative events occurred, including repeated revascularization, stroke and bleeding. In the clopidogrel arm cumulative risk of negative events was significantly lower (14%) in comparison to the aspirin group (25%, p < 0.05). In patients with preoperative persistent platelet function on aspirin the highest cumulative event risk was observed (35%). The lowest cumulative event risk was observed in aspirin responders randomized to the clopidogrel arm (2%). Conclusions: Clopidogrel therapy provided for 6 months after OPCAB instead of the standard aspirin protocol may reduce the risk of negative adverse cardiovascular events. Occurrence of preoperative persistent platelet function on aspirin is related to worse 1-year outcome after off-pump coronary

Over the last twenty years, minimally invasive aortic valve replacement (MIAVR) has evolved into a safe, well-tolerated and efficient surgical treatment option for aortic valve disease. It has been shown to reduce postoperative morbidity, providing faster recovery and rehabilitation, shorter hospital stay and better cosmetic results compared with conventional surgery. A variety of minimally invasive accesses have been developed and utilized to date. This concise review demonstrates and discusses surgical techniques used in contemporary approaches to MIAVR and presents the most important results of MIAVR procedures.Przez ostatnie 20 lat małoinwazyjna wymiana zastawki aortalnej (MIAVR) stała się bezpieczną, dobrze tolerowaną i skuteczną opcją leczenia chorób zastawki aortalnej. W porównaniu z tradycyjną sternotomią wykazano, że małoinwazyjna chirurgia zastawki aortalnej zmniejsza liczbę powikłań pooperacyjnych, zapewniając szybszą rehabilitację i powrót do zdrowia, krótszą hospitalizację jak również lepsze efekty kosmetyczne. Do chwili obecnej powstało wiele technik operacyjnych z małego dostępu. Poniższy artykuł przedstawia metody operacyjne oraz najbardziej istotne wyniki współczesnej małoinwazyjnej wymiany zastawki aortalnej.

We report case of 58-year-old male patient with severe mitral insufficiency in whom in preoperative angiography anomalous left anterior descending coronary artery arising from pulmonary artery was revealed. Patient successfully underwent mitral valve replacement, ligation and bypass of left anterior descending artery. Eighteen months after surgery control exercise echocardiography and angiography were performed to evaluate coronary flow, valve prosthesis and left ventricle function.

Development of beating heart coronary artery bypass surgery was possible since introduction of heart stabilizing instruments in mid-90's.To summarize available evidence of benefits of beating heart coronary artery bypass surgery in comparison with use of cardiopulmonary bypass during surgery. Methods of heart stabilization during operation without cardiopulmonary bypass allow to performing complete revascularization with lower degree of myocardial damage. The main advantage of beating heart coronary bypass surgery is excluding systemic inflammatory response following cardiopulmonary bypass use. And therefore less incident of renal failure, clotting disturbances, respiratory complications. There is lower incidence of microthrombotic formation and central nervous system complications. Early mortality is significantly lower and it is safer to operate on high risk patients (over 75 years old, female, with acute coronary syndrome, ascending aorta arteriosclerosis).The technique of beating heart coronary artery bypass surgery reduces risk of central nervous system complications, renal failure, respiratory problems and coagulation disturbances. The complete revascularisation is possible. This technique is available to enlarging group of patients, especially the high perioperative risk patients.