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Introduction: Minimally invasive techniques of mitral valve (MV) repair have been increasingly used in recent years. Transapical implantation of artificial chordae on a beating heart under 2D/3D transesophageal echocardiographic guidance with the NeoChord DS1000 device is a new surgical treatment of degenerative mitral regurgitation (MR)., Aim: To evaluate early results of MV repair with the NeoChord DS1000 device in the first group of consecutive patients operated on in Poland., Material and Methods: Twenty-one patients with severe MR due to posterior leaflet prolapse (81% male; mean age: 60.7 ±12.7 years) underwent MV repair with the NeoChord DS1000 system. There were 12 (57.1%) patients with type A (an isolated central prolapse/flail), 8 (38.1%) patients with type B (multisegment disease/flail) and 1 (4.8%) patient with type C (posterior/paracommisural area) MV prolapse. A flail leaflet was present in 12 (57.1%) patients. The median number of neochords was 3 (2-6). We assessed by echocardiography left-sided heart morphology and evaluated MR degree before and 6 months after chords implantation., Results: Early procedural success was achieved in 100% of patients. At the 6-month follow-up nonsignificant MR (trace and mild) was detected in 17 (81.0%) patients, while moderate MR was detected in 4 (19.0%) patients; mean values of left-sided heart dimensions and volumes, mitral E and E' velocity of lateral MV annulus significantly decreased., Conclusions: A novel procedure with the NeoChord DS1000 device is feasible in properly selected patients, and results in a significant reduction of MR degree and left ventricle and left atrium reverse remodeling at the 6-month follow-up., Competing Interests: Katarzyna Kurnicka – echocardiographic consultant for NeoChord, Krzysztof Wróbel – surgical consultant for NeoChord.

Background: Artificial chord implantation to repair a flail or prolapsing mitral valve leaflet requires open heart surgery and cardiopulmonary bypass., Aim: Transapical off-pump artificial chordae implantation is a new surgical technique proposed to treat degenerative mitral valve regurgitation. The procedure is performed using the NeoChord DS1000 system (NeoChord, Inc., St. Louis Park, MN, USA), which facilitates both implantation and lenght adjustment of the artificial chordae under two (2D)- and three (3D)-dimensional transoesophageal echocardiographic (TEE) guidance on a beating heart., Methods: Two male patients aged 60 and 55 years with severe mitral regurgitation due to posterior leaflet prolapse underwent transapical off-pump artificial chordae implantation on September 3, 2015. The procedure was performed by left minithoracotomy under general anaesthesia in a cardiac surgical theatre, using 2D and 3D TEE guidance., Results: Early procedural success as confirmed by 3D TEE was achieved in both patients, with implantation of 6 artificial chordae in the first patient and 3 artificial chordae in the second patient. Both procedures were uneventful, and no postoperative complications were noted. The patients were discharged home on the 8th and 6th postoperative day, respectively., Conclusions: The NeoChord DS1000 system allows both implantation and lenght adjustment of artificial chordae under 2D and 3D TEE guidance on a beating heart. Our initial experience in 2 patients with posterior mitral leaflet prolapse indicates that the procedure is feasible and safe.

Introduction: Patients undergoing coronary artery bypass grafting (CABG) are at risk of strokes and neurocognitive disorders., The Aim of the Study: The aim of the study was to assess the clinical utility of susceptibility-weighted imaging (SWI) MRI in detection of new brain lesions in patients after CABG. We assessed the incidence and types of brain lesions and correlated the data with neurological examinations in groups of patients who underwent on-pump and off-pump CABG., Material and Methods: Patients underwent a neurological examination and MRI before, 6-20 days after and 6 months after the CABG. Fifty-one patients (43 men, mean age 63.12 years) were analyzed., Results: Fifteen (29.4%) patients underwent on-pump CABG, 36 (70.6%) off-pump CABG. On postoperative scans new lesions were detected in 12 (23.5%) patients. Ischemic lesions (visible on diffusion-weighted imaging [DWI]) were detected in 4 patients, in 6 lesions were visible on SWI, in 1 case lesions were visible on SWI and DWI. Hemorrhagic stroke was observed in 1 patient. In the group of patients who underwent on-pump CABG, new brain lesions were observed in 60.0% of patients vs. 8.3% of those who underwent off-pump CABG (p < 0.0001); these changes more frequently were multiple (p < 0.0013) and located infratentorially (p < 0.0218). Lesions visible on SWI were observed only in patients undergoing on-pump CABG (p = 0.00005). In all patients (except for 1 with stroke), lesions visible in MRI were clinically silent., Conclusions: The use of SWI enables one to detect lesions occurring in the brain after CABG, invisible in other sequences. On-pump CABG is associated with a greater risk of clinically silent brain damage compared to off-pump CABG.

Genetic research has elucidated molecular mechanisms of heart failure (HF). Peroxisome proliferator-activated receptors (PPARs) seem to be important in etiology of HF. The aim of study was to find the correlation between PPARγ expression during development of HF in patients and coronary artery disease (CAD) after coronary artery bypass-grafting (CABG). Methods and Results. We followed up 157 patients (mean age 63) with CAD without clinical, laboratory, or echo parameters of HF who underwent CABG. Clinical and laboratory status were assessed before CABG and at 1, 12, and 24 months. During CABG slices of aorta (Ao) and LV were collected for genetic research. HF was defined as LVEF <40% or NT-proBNP >400 pg/mL or 6MWT <400 m. Patients were divided into 2 groups: with and without HF. PPARγ expression in Ao and LV was not increased in both groups at 2-year follow-up. Sensitivity of PPARγ expression in Ao above 1.1075 in detection of HF was 20.5% (AUC 0.531, 95% CI 0.442-0.619). Positive predictive value (Ppv) was 85.7%. Sensitivity and specificity of PPARγ expression in the LV in detection of HF were 58% and 92.9%, respectively (AUC 0.540, 95% CI 0.452-0.626). Ppv was 73.2%. Conclusion. PPARγ expression in Ao and LV was comparable and should not be used as predictive factor for development of HF in patients with CAD after CABG.

Background: Transcatheter aortic valve implantation (TAVI) is a new method for the treatment of aortic stenosis (AS)., Aim: To evaluate early results of TAVI using transfemoral/transsubclavian approach (TFA/TSA) or transapical approach (TAA) in patients with severe AS and high risk for surgical aortic valve replacement., Methods: Between January 2009 and May 2010, 30 high-risk patients underwent TAVI. The primary treatment option was TFA, and TAA was used if contraindications to TFA were present; one patient underwent the procedure using TSA. Reasons for selecting TAA were as follows: small diameter (<7 mm) and/or severe calcification of the iliofemoral arteries, peripheral atherosclerosis, "porcelain" aorta and a horizontal course of the ascending aorta. Edwards-Sapien or CoreValve devices were used in all cases, and procedures were performed without the use of cardiopulmonary bypass in a cardiac catheterisation laboratory., Results: Mean patient age was 82.46 ± 5.79 years, mean NYHA class was 3.23 ± 0.41, and predicted mean surgical mortality using logistic Euroscore was 29.18 ± 16.9% (22.72 ± 12.07% in the TFA/TSA group vs 34.6 ± 15.4% in the TAA group; p = 0.031). Eleven patients were treated using TAA. The valve was implanted successfully in 96% of patients. Inhospital mortality was 3.3%. Mean 30-day mortality was 6.6% in the entire cohort, 0% in the TFA/TSA group and 18% in the TAA group. There were no cases of periprocedural myocardial infarction (MI), cardiogenic shock, stroke/transient ischaemic attack, or need for cardiopulmonary resuscitation. One patient died suddenly three weeks after the procedure; except for this case, there were no major adverse cardiovascular events (MACCE: MI, cerebrovascular accident, re-do procedure) at 30-day follow-up. The TAVI was associated with a significant reduction in the mean maximal aortic gradient in both groups (from 99.6 ± 22.07 mm Hg to 21.83 ± 9.38 mm Hg post-procedure and to 23.25 ± 9.22 mm Hg at 30-day follow up), with no cases of severe aortic valve regurgitation. The NYHA class at 30 days improved from 3.23 ± 0.41 to 1.72 ± 0.52 (p = 0.03)., Conclusions: Our results demonstrate lower 30-day complication rate and mortality in the TFA/TSA group. The availability of several techniques of valve implantation in the group of non-surgical patients with severe AS potentially broadens the patient population with indications for this treatment.

Background: Trans-catheter aortic valve implantation (TAVI) has recently emerged as an alternative to conventional surgery in high-risk surgical patients with haemodynamically significant aortic valve stenosis. However, patients referred for TAVI are usually elderly individuals (> 80 years) who frequently also suffer from renal impairment. Trans-catheter valve therapies require extensive use of contrast injections with a risk of nephrotoxicity., Aim: To evaluate post-TAVI renal function and to determine whether the exposure to contrast injections might cause reduced kidney function and contrast-induced nephropathy., Methods: From January 2009 to September 2010, TAVI was performed in 39 patients (26 women and 13 men). The mean age of the patients was 81.43 ± 7.39 years, and the mean volume of contrast material administered was 187.95 ± 91.34 mL. Serum creatinine and glomerular filtration rate (GFR, acc. to the MDRD formula) were estimated in all patients prior to and 1, 2, and 5-8 days after TAVI., Results: Two female patients died on postoperative day 1. Other patients did not show clinically significant reduction in renal function following the procedure (mean creatinine concentration 104.46 vs 99.77 vs 94.56 vs 93.64 mmol/L, NS and mean GFR 52.37 vs 56.63 vs 60.18 vs 61.34 mL/min/1.73 m², NS)., Conclusions: 1. The TAVI procedure, which includes contrast injection does not seem to cause a clinically significant decrease of renal function. 2. None of our elderly patients with severe aortic valve stenosis, multiple co-morbidities, and pre- TAVI renal compromise developed contrast-induced nephropathy.

Coronary artery fistulas are infrequent congenital malformations. We present the case of a patient with acute coronary syndrome and fistula between the proximal left anterior descending artery (LAD) and the pulmonary artery. The fistula was diagnosed during coronary angiography. Its presence and morphology was confirmed by a 64-slice computer tomography scan. The patient underwent a successful coronary artery bypass grafting procedure with surgical closure of the fistula.

Patients with symptomatic multivessel coronary artery disease rejected for coronary revascularisation have adverse prognosis. We describe a 61 year-old male with non-ST-elevation myocardial infarction who was considered unsuitable for coronary revascularisation based on the conventional angiography findings. Unlike conventional angiography, computed tomography angiography visualised distal coronary segments and the patient underwent successful coronary artery bypass grafting.

Patients with severe symptomatic aortic stenosis, who from November 2008 to March 2009 were treated with Edwards-Sapien transcatheter aortic valve implantation (TAVI) within the POL-TAVI First Polish Registry, were included in the analysis. Nineteen patients aged 78+/-4.8 years with high operation risk and Logistic EuroSCORE 25+/-7.6% were reported (74% were females). In 15 (79%) patients the valve was implanted transapically (TA), in the other four (21%)--via the femoral arterial access (TF). The valve was successfully implanted in 16 (84%) patients, in one patient aortic valvuloplasty alone was performed. During in-hospital period two patients died (one during periprocedural period and another one--two months after the implantation). During the mean follow-up of 5+/-1.5 months (except for one patient who is still in hospital) all patients are in NYHA class I or II. Results of the initial series of 19 TAVI patients in Poland are satisfactory, and the trial will be continued with careful medical and economical analysis.

Rupture of the interventricular septum is a serious complication of myocardial infraction (MI). It occurs in 1-3% of all MI cases, usually within 2 weeks after infraction. In 60% of the cases post-MI ventricular septal defects (VSD) are the result of completely occluded coronary artery supplying anterior wall of left ventricle and subsequent transmural MI. 50% of patients die within the first week after the rupture unless they are surgically treated. In this case report we describe an 87-year-old woman with post-MI VSD who was successfully operated (endocardial patch exclusion technique, proposed by David). In spite of a very high predicted risk (97% by Euroscore), calculated high risk should not be considered as the contraindication for life-saving operation.

A case of a 58-year-old male with acute aortic dissection is presented. A few months earlier the patient underwent transmyocardial laser revascularisation and implantation of venous graft to the left anterior descending coronary artery due to three-vessel disease. Acute aortic dissection was successfully treated by surgery. Therapeutic options in patients with acute aortic dissection and advanced coronary artery disease are discussed.

Background: Metaiodobenzylguanidine (MIBG), a noradrenaline analogue which may be labelled with I-123, has been used in the assessment of pre-synaptic activity of the cardiac adrenergic nervous system (Syst(adren)) in several diseases. The effects of transmyocardial laser revascularisation (TMLR) on Syst(adren) have not yet been established., Aim: To examine whether TMLR-induced changes in Syst(adren) may be one of the mechanisms responsible for clinical improvement in patients undergoing this method of revascularisation., Methods: The study group consisted of 19 patients (mean age 63+/-9 years) who underwent TMLR, by using high-power CO(2) laser; as a single method of cardiac revascularisation. Syst(adren) was assessed before TMLR (STUDY-0), soon after the procedure (mean 13+/-5 days, STUDY-I), and in 12 patients six months after TMLR (STUDY-II). In total, 50 studies using I-123-MIBG SPECT were performed. The regional distribution of tracer was assessed qualitatively, using a 17-segment model of the left ventricle., Results: In 16% of examinations the assessment of the I-123-MIBG uptake was not possible due to the poor quality of images. Thus, 41 SPECT studies (16 - STUDY-0, 16 - STUDY-I, and 9 - STUDY-II) were analysed and compared. In STUDY-0, an impaired uptake of I-123-MIBG was found in 193 of 272 analysed segments. In STUDY-I, the I-123-MIBG uptake increased in 5% of defects (CI(0,95)=3-9%) and deteriorated in 55% (CI(0,95)=48-62%). When STUDY-II was compared with baseline, the uptake was increased in 25% of defects (CI(0,95)=17-34%) and decreased in further 25% of defects. When STUDY-II was compared with STUDY-I, the uptake increased in 67% (CI(0,95)=58-75%) of defects and did not deteriorate in any. The global MIBG uptake in STUDY-I decreased in 15 patients (94%, CI(0,95)=70-100%) when compared with baseline, and increased in all 9 patients with long-term follow-up data available, when STUDY-II to STUDY-I was compared., Conclusions: TMLR significantly deteriorates Syst(adren) activity which, however, improves 6 months after the procedure to the values similar to those assessed pre-operatively. TMLR-induced impairment of Syst(adren) may contribute to the clinical improvement observed shortly (<6 months) after the procedure.

The aim of this study was to establish the indications to use of pulmonary autograft in the treatment of aortic valve disease in the adolescents and adults; early and mid-term an evaluation of autograft's function and function of left ventricle after Ross operation. In this procedure the patient's own pulmonary valve is removed together with the main trunk of the pulmonary artery and used to replace the aortic valve. Pulmonary homograft is used to reconstruction of right ventricular outflow tract. Between February 1994 and march 2001 in 1st Cardiac Surgery Department in 43 patients over 14 years of age Ross operation have performed. Mean age was 24.9 years. Indications for operation were predominant aortic stenosis in 29 patients, aortic incompetence in 7 patients, and complex aortic valve disease in 7 patients. Hospital mortality was 4.6%. In mid-term observation 41 patients left. All survivors remained in New York Heart Association functional class I and were free of complications and medications. In the all patients autograft's valve have functioned excellent (without or small regurgitation). Echocardiographic parameters of left ventricular function improved in the all patients. The indications to pulmonary autograft insertion in the adolescents and adults are small aortic ring, infective endocarditis and contraindications to anticoagulants using. The early and mid-term results confirm a high efficacy Ross operation in this age's group with low mortality. It completely relieves the abnormal loading conditions of the left ventricle, resulting in a complete recovery of left ventricular function.

Background: Surgical open or closed mitral commisurotomy and percutaneous transluminal mitral commissurotomy (PTMC) are the well-established therapies in patients with mitral valve stenosis. However, due to various factors the long-term effects may not be optimal in some patients, so they should undergo surgical mitral valve replacement., Aim: The intra-operative assessment of the morphology of mitral valve and the evaluation of the peri-operative results of surgical treatment in patients with mitral valve disease who previously underwent closed surgical commissurotomy followed by PTMC., Methods: Twenty one patients (20 males, mean age 49 years) who underwent surgery due to mitral valve disease after closed mitral commissurotomy and PTMC, are presented. The time from closed mitral commissurotomy to PTMC was 3-42 years, and the time from PTMC to mitral valve replacement - 9 days to almost 9 years., Results: One patient died on the second day after the operation because of left ventricular failure. The outcome of the remaining patients was good. Advanced changes of the mitral valve and subvalvular apparatus were present in the majority of patients., Conclusions: The results of the implantation of mitral valve prosthesis in patients who previously underwent closed surgical mitral commissurotomy and PTMC are good. In some patients with a history of closed surgical mitral commissurotomy, PTMC delays surgical replacement of the mitral valve. Advanced changes in the mitral valve leaflets and subvalvular apparatus are the causes of PTMC failure.

Background: The immediate result of successful revascularisation of the myocardium is the improvement of perfusion (and in patients with depressed ventricular function, functional recovery is expected as an effect of coronary flow improvement). The main goal of the work was to assess the value of myocardial stress-rest MIBI perfusion scintigraphy in predicting myocardial perfusion state measured early (< 5 months) after CABG., Material and Methods: Forty-three patients (39 males, mean age 52 +/- 9 years) with chronic coronary artery disease underwent prerevascularisation and postrevascularisation stress-rest Tc-99m-MIBI SPECT studies. Eighty-one percent of patients had a history of myocardial infarction, the number of stenosed main coronary arteries was 2.3 +/- 0.6 per patient, and the left ventricle ejection fraction was 18-70% (mean 46 +/- 14%). Preoperative perfusion defects were considered as small, medium or severe (depending upon stress uptake deficiency) and as transient or persistent (depending upon uptake improvement in rest). Changes in perfusion defects (improvement, lack of changes or deterioration) were evaluated very early after CABG (mean 31 +/- 12 days) in all patients and additionally about 3 months later (mean 119 +/- 17 days after CABG) in 36 patients., Results: In transient perfusion defects, the probability of early postoperative perfusion improvement was 80% (in small defects: 89%, CI(0,95) = 80-94%) and was significantly higher than in small persistent defects (51%) and than in medium-and-severe persistent defects (21%). In medium-and-severe persistent defects, the lack of changes in perfusion was observed in 76% of defects (in severe defects: 81%, CI(0,95)= 69-91%) and was significantly higher than in small persistent defects (37%), than in medium-and-severe transient defects (17%), and than in small transient defects (4%). The probability of later postoperative perfusion improvement was 78% in transient perfusion defects (in small defects: 85%, CI(0,95)=74-92%) and was significantly higher than in small, medium, and severe persistent defects (28%). In medium-and-severe persistent defects, the lack of changes in perfusion was observed in 71% of defects (in severe defects: 81%, CI(0,95)=66-91%) and was significantly higher than in small persistent defects (40%), and than in severe, medium, and small transient defects (11%)., Conclusions: 1. The result of preoperative stress-rest Tc-99m-MIBI SPECT myocardial perfusion study is an exact predictor of the state of perfusion measured early (< 5 months) after CABG; the postoperative regional perfusion improvement is most dependent upon reversibility and also upon severity of stress defect. 2. In small persistent defects, changes in perfusion are different than in other types of defects - so they should not be considered together with transient defects (as "viable") or with persistent defects (as "nonviable"). 3. Preoperative viability assessment on the basis of Tc-99m-MIBI study performed solely in rest is unjustified: at the similar perfusion defect at rest, the presence of even minimal inducible ischaemia is associated with increased probability of perfusion improvement after CABG.

The article describes the management of aortic coarctation associated with coronary artery disease by a one stage surgical procedure without cardiopulmonary bypass in a 44-year-old woman. The vascular prosthesis was anastomosed end-to-end to the descending aorta and a venous bypass was subsequently formed between circumflex coronary artery and the anastomosed vascular prosthesis. There were no postoperative complications.

Clinical presentation and course were studies in 45 consecutive patients (p)--39 males, 6 females with angiographically proven left main coronary artery stenosis (LMCA) > 50%. Mean age was 54.7 years. Three (6%) had no history of chest pain, 2 p (4%) had atypical chest pain, and the remaining (90%) had typical angina pectoris. 19 p (42%) had unstable angina, 20 p (44%) had suffered a myocardial infarction in the past. Outside an episode of chest pain most of the patients had an abnormal ECG with ST-T segment depression 2 mm or more in leads V3-6 and ST-T elevation in leads V1 and aVR. No significant differences were found when the abnormalities of the ST-T segment were compared to severity of LMCA obstruction. A symptom limited exercise test was performed in 17 (37%) p. It was abnormal in 13 p (29%). Thirty eight patients (85%) underwent bypass surgery and the mean number of bypass graft was 3.3. Seven patients were treated medically. In the surgical group four p (10.5%) died perioperatively. All of them had subtotal occlusion of LMCA, without significant lesions in the remaining coronary arteries, the ejection fraction (EF) was above 66%. Among thirty four living patients thirty have been asymptomatic. In the medically treated group 3 p (42%) died and only two of four survivors were asymptomatic at a mean follow-up 35.7 months. Left ventricle of all died patients were severely damaged (EF mean 28%), right coronary artery (RCA) was totally occluded and all had rythm disturbances. We conclude, that patients with significant LMCA stenosis had a good prognosis when treated surgically.(ABSTRACT TRUNCATED AT 250 WORDS)

The purpose of this study was to assess the immediate and long-term results of incomplete percutaneous transluminal coronary angioplasty (PTCA) in high-risk coronary artery bypass surgery (CABG) patients. 24 pts (male-22, female-2, age - 39-60 years) were divided into 2 groups: I-8 pts with unstable angina pectoris who were definitely not CABG candidates because of very low ejection fraction (LVEF < 24%) and/or diffuse coronary atherosclerosis; II-16 pts selected for CABG only after failed PTCA. From this group 12 pts with unstable angina pectoris and history of myocardial infarction were at higher CABG risk because of LVEF < 40% and diffuse coronary atherosclerosis. 4 pts were poor surgical candidates because of coexistent medical disorders. The strategy of PTCA was to dilate first the most critical (culprit) lesion, responsible for the patient symptoms, usually situated in the artery supplying large area of viable myocardium. We did not achieve: complete revascularization in all our pts (incomplete revascularization by intent). Initial success rate of the PTCA in both groups was 100%. There were no serious complications. During follow-up (6 months--4 yrs) long-term clinical improvement was observed in 7 pts from group I (87.5%) and 14 pts from group II (87.5%). We conclude, that in most pts with unstable angina pectoris and with high-risk of CABG good immediate and long-term results of incomplete PTCA can be achieved.