Percutaneous mitral balloon valvuloplasty. Beyond classical indications

Background and aim: In patients with mitral stenosis (MS) percutaneous mitral balloon valvuloplasty (PMBV) is used to im-prove symptoms and prognosis. Although there is some evidence for potential long-term benefits from PMBV in asymptomatic patients with mitral valve area (MVA) between 1.0 and 1.5 cm2, there are no follow-up data on patients with symptomatic MS with MVA > 1.5 cm2, who underwent PMBV. Methods: We retrospectively analysed periprocedural results of 113 symptomatic patients who underwent PMBV for MS with MVA > 1.5 cm2 (group 1) and compared them with a control group of patients with MVA ≤ 1.5 cm2 (group 2). Clinical and procedural variables were compared between groups. Results: In group 1, PMBV resulted in a significant increase of MVA as well as a decrease of mean and maximal mitral gradients and mean left atrial pressure (LAP), and a subsequent decrease of mean and systolic pulmonary artery pressures (PAPs). Moreover, 6.3% of patients developed moderate to severe (3+) or severe (4+) post-procedural mitral regurgitation (MR). Post-procedural increase in MVA and decrease of LAP were more pronounced in group 2 than group 1 (∆MVA 0.74 cm2 vs. 0.41 cm2, p < 0.05, and ∆LAP 8.2 mmHg vs. 6.0 mmHg, p < 0.05). Nonetheless, no significant differences were observed for ∆ of mean and systolic PAPs. The grade of post-procedural MR was comparable between groups. Conclusions: PMBV is a feasible procedure in highly selected patients without classic echocardiographic indications. None-theless, it is associated with a small but non-negligible periprocedural risk of developing severe MR.Background and aim: In patients with mitral stenosis (MS) percutaneous mitral balloon valvuloplasty (PMBV) aims to improve both the symptoms and prognosis. Although there is some evidence of potential long-term benefits from PMBV in asymptomatic patients with mitral valve area (MVA) 1.0–1.5 cm2, nonetheless there is lack of follow-up data of symptomatic MS-patients with MVA > 1.5 cm2, who underwent PMBV. Methods: We retrospectively determined peri-procedural results of symptomatic patients who underwent PMBV for MS with MVA > 1.5 cm2 (group 1) and compared it with control group with MVA ≤ 1.5 cm2 (group 2). In 116 patients PMBV was done for MS with MVA > 1.5 cm2. Clinical and procedural variables were compared to control group. Results: Group 1. PMBV resulted in significant increase of MVA as well as decrease of mean and maximal MG's, mean left atrial pressure (LAP) and subsequent decrease of mean and systolic pulmonary artery pressures (PAP). 6.3% of patients developed moderate to severe (3+) or severe (4+) post-procedural mitral regurgitation (MR). Comparison between group 1 and matched control group 2. Post-procedural increase in MVA and decrease of LAP were significantly more pronounced in group 2 compared to group 1 (∆MVA 0.74 cm2 vs. 0.41 cm2, p < 0.05, and ∆LAP 8.2 mmHg versus 6.0 mmHg, p < 0.05). Nonetheless no significant differences were observed for ∆  of mean and systolic PAP between both groups. Grade of post-procedural MR was comparable between groups.  Conclusions: PMBV is feasible procedure in very selected patients, who do not meet the classical echocardiographic indications. Nonetheless PMBV is associated with a small, but non-negligible peri-procedural risk to develop severe MR

Przezskórne zamknięcie uszka lewego przedsionka przy użyciu okludera Amplatzer® Cardiac Plug u pacjentów z migotaniem przedsionków i wysokim ryzykiem udaru mózgu - wczesne doświadczenia

Background: Atrial fibrillation is the most common arrythmia in patients beyond 65 years of age. Several of those patients have contraindications to coumadin treatment. Ninety percent of atrial thrombi related to atrial fibrillation are found in the left atrial appendage. Aim: We present our early experience with the left atrial appendage transcatheter closure using the Amplatzer® Cardiac Plug. Methods: Transcatheter closure was performed in general anaesthesia and under transoesophageal echocardiography control in three patients aged 69, 73 and 61 years (two female). All had atrial fibrillation with high risk of thromboembolic events (CHADS2 score ≥ 2 points). In all of them coumadin treatment was contraindicated. Results: The procedure time was 112, 109 and 60 min (fluoroscopy time: 25, 29 and 12,5 min). The Amplatzer® Cardiac Plugs of 24, 26 and 22 mm were implanted successfully and without complications. The day after, transthoracic echocardiogram revealed proper position of the implant and complete occlusion of the appendage in all patients. The patients were discharged on antiplatelet treatment. Conclusion: Transcatheter left atrial appendage closure with the Amplatzer® Cardiac Plug may be a promissing therapeutic option for patients with atrial fibrillation-related high risk of thromboembolic events and with contraindications to anti-vitamin K treatment

Prognostic value of computed tomography derived measurements of pulmonary artery diameter for long-term outcomes after transcatheter aortic valve replacement

Background: An increase in pulmonary artery diameter (PAD) on multi-detector computed tomography (MDCT) may indicate pulmonary hypertension. We assessed the prognostic value of MDCT-derived measurements of PAD on outcomes after successful transcatheter aortic valve replacement (TAVR).Methods: Consecutive patients treated with TAVR from February 2013 to October 2017, with a 68.8% rate of new generation valves, underwent pre-interventional MDCT with measurements of PAD (in the widest short-axis within 3 cm of the bifurcation) and ascending aortic diameter (AoD; at the level of the PAD). The PAD/AoD ratio was calculated. Patients with high-density lipoprotein cholesterol levels ≤46 mg/dl and C-reactive protein levels ≥0.20 mg/dl at baseline were identified as the frail group. One-year mortality was established for all subjects.Results: Among studied 266 patients (median age, 82.0 years; 63.5% women) those who died at 1 year (n = 34; 12.8%) had larger PAD and PAD/AoD (28.9 [5.0] vs. 26.5 [4.6] mm and 0.81 [0.13] vs. 0.76 [0.13] mm vs. the rest of the studied subjects; P = 0.005 and P = 0.02, respectively) but similar AoD. The cutoff value for the PAD to predict 1-year mortality was 29.3 mm (sensitivity, 50%; specificity, 77%; area under the curve, 0.65). Patients with PAD >29.3 mm (n = 72; 27%) had higher 1-year mortality (23.6% vs. 8.8%, log-rank P = 0.001). Baseline characteristics associated with PAD 29.3 mm were a bigger body mass index, more frequent diabetes mellitus, more prior stroke/transient ischemic attacks and atrial fibrillation, and lower baseline maximal aortic valve gradient with higher pulmonary artery systolic pressure (PASP). PAD >29.3 mm and frailty, but not baseline PASP, remained predictive of 1-year mortality in the multivariable model (hazard ratio [HR], 2.221; 95%CI, 1.038–4.753; P = 0.04 and HR, 2.801; 95% CI, 1.328–5.910; P = 0.007, respectively).Conclusion: PAD >29.3 mm on baseline MDCT is associated with higher 1-year mortality after TAVR, independently of echocardiographic measures of PH and frailty

Potencjał e- i m-zdrowia oraz sprofilowanego do potrzeb i oczekiwań płci podejścia w bardziej efektywnej edukacji zdrowotnej i prewencji chorób sercowo-naczyniowych u kobiet

Cardiovascular disease (CVD) is a leading cause of death worldwide. Only in 2012 it accounted for 17.5 million deaths. Although it affects both sexes, every year more women die due to CVD, more than due to all cancers, tuberculosis, HIV/AIDS and malaria combined. The risk factors, symptoms and course of CVD in women and men often differ, which makes early proper diagnosis and treatment more difficult. Despite being a major threat for women, the level of awareness and knowledge on the gender-specific picture of CVD, both among females and within the medical environment, remains staggeringly low. Introducing a new gender-tailored health education and prevention model, adjusted to the medical, socio-cultural, technological expectations and needs of contemporary women, to their modern lifestyle and pace of life, could constitute an attractive and more effective alternative to initiatives undertaken so far targeting the general population. E- and m-health tools seem to have a promising potential in educating and supporting contemporary women in their everyday health management. Applying Internet-based solutions together with a gender-oriented approach could increase the level of knowledge and CVD awareness among women, lead to improvement of their heart health and contribute to a reduction in the medical-social-economic burden of CVD in women.Choroby sercowo-naczyniowe (ChSN) stanowią najczęstszą przyczynę zgonów na świecie. Tylko w roku 2012 z powodu ChSN zmarło 17,5 miliona osób. Mimo że problem ten dotyczy przedstawicieli obu płci, każdego roku więcej kobiet umiera z powodu chorób układu krążenia. Śmiertelność z powodu ChSN w tej grupie jest wyższa niż z powodu nowotworów, gruźlicy, HIV/AIDS i malarii łącznie. Symptomatyka i przebieg ChSN u mężczyzn i kobiet są często odmienne, w przypadku kobiet objawy są często mniej charakterystyczne i w związku z tym trudniejsze do wczesnego rozpoznania i leczenia. Poziom wiedzy i świadomości na temat specyfiki ChSN u kobiet w Polsce jest wciąż ograniczony i często trudno dostępny – zwłaszcza wśród samych zainteresowanych. Wprowadzenie nowego modelu edukacji i prewencji, skierowanego wyłącznie do kobiet, skrojonego do ich potrzeb: biologicznych, medycznych, technologicznych, estetycznych, uwzględniającego społeczno-kulturowe uwarunkowania i oczekiwania może stanowić wartościową i bardziej skuteczną strategię prewencji ChSN w tej populacji. Ponadto wykorzystanie w tym modelu nowych technologii, w tym narzędzi e- oraz m-zdrowia, bardziej dopasowanych do mobilnego stylu i tempa życia współczesnej kobiety, w profilaktyce ChSN mogłoby przyczynić się do zwiększenia wiedzy i świadomości na temat kobiecego profilu ChSN, poprawy sytuacji zdrowotnej kobiet w Polsce, a tym samym do redukcji medyczno-ekonomicznego i społecznego ciężaru ChSN w tej populacji

Percutaneous mitral balloon valvuloplasty beyond 65 years of age

Background: The profile of subjects undergoing percutaneous mitral balloon valvuloplasty (PMBV) in developed countries has shifted toward the elderly. In the group of elderly patients long-term results after PMBV, as well prognostic factors that may improve patient selection for this procedure have not been fully elucidated. Aim of the study was to evaluate the safety and efficacy of PMBV for the treatment of mitral stenosis in patients older than 65. Methods: The studied group consists of 132 consecutive patients aged > 65, who underwent PMBV. All PMBV procedures were performed by the antegrade transvenous approach using the Inoue balloon system. Results: Procedural success, defined as mitral valve area &#8805; 1.5 cm2 and mitral regurgitation &#163; 2+, was obtained in 105 (79.5%) patients. Mean follow-up was 6.25 &#177; 4.33 years. Echo score > 8 and higher mean mitral valve gradient were significant independent predictors of inadequate immediate result. Survival curves showed that for the whole studied group after PMBV the 3-, 5-, and 10-year overall survival rates were significantly better in patients with left atrium diameter &#163; 5.0 cm before intervention (95.4%, 91.3% and 80.5% vs. 89.6%, 69.5%, and 53.7%, respectively; p = 0.002). Survival free of mitral valve intervention or heart failure &#8805; NYHA III was significantly better for patients with good immediate result and mean pulmonary artery pressure after PMBV < 25 mm Hg. Conclusions: PMBV is safe and efficacious in elderly patients with symptomatic mitral stenosis. Long-term results are good and related mainly to the quality of the procedure

RT-PCR Detection of SARS-CoV-2 among Individuals from the Upper Silesian Region&mdash;Analysis of 108,516 Tests

Background: The COVID-19 pandemic triggered by the novel severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) has left a huge mark on everyday lives, introducing restrictions and plunging the global economy. This study aimed to analyze the available epidemiological data from the register of one of the largest laboratories testing for SARS-CoV-2 in the Silesian voivodship of Poland. Methods: This analysis is based upon the epidemiological records collected between 30 March 2020, and 30 April 2021, by the Silesian Park of Medical Technology Kardio-Med Silesia (Zabrze, Poland). In addition, we performed SARS-CoV-2 variant detection in samples from patients reinfected with SARS-CoV-2. Results: Our results confirm that SARS-CoV-2 infections are more common in urban areas. Laboratory-confirmed COVID-19 cases represent 13.21% of all RT-PCR test results during the 13 months of our laboratory diagnostics for SARS-CoV-2 infections. Detection of SARS-CoV-2 variants in samples of potentially reinfected patients showed discrepancies in the results. Conclusions: Due to the higher risk of SARS-CoV-2 infection among the Upper Silesian population, the region is at greater risk of deteriorating economic situation and healthcare as compared to other areas of Poland. RT-PCR methods are inexpensive and suitable for large-scale screening, but they can be untrustworthy so detection of SARS-CoV-2 variants in samples should be confirmed by sequencing

Evaluation of the Tooth Surface after Irradiation with Diode Laser Applied for Removal of Dental Microorganisms from Teeth of Patients with Gingivitis, Using X-ray Photoelectron (XPS) and Optical Profilometry (OP)

Gingivitis is accompanied by microorganisms, including pathogens, which must be eliminated to speed up the treatment of inflammation. Laser irradiation may be one of the safe methods for reducing tissue contamination on the tooth surface. The aim of the study was the assessment of the tooth surface in patients with gingivitis after the use of a diode laser to eliminate microorganisms living there. In the first stage of the research, microorganisms were isolated (Candida albicans, C. guilliermondii, Escherichia coli, Haemophilus parainfluenzae, Klebsiella oxytoca, Neisseria subflava, Rothia dentocariosa, Rothia mucilaginosa, Streptococcus pneumoniae) from three patients with gingivitis, their identification confirmed using the MALDI-TOF MS technique (matrix-assisted laser desorption/ionisation time-of-flight mass spectrometry). Then, the irradiation process with a diode laser was optimized to a wavelength of 810 nm &plusmn; 10 nm in five variants to reduce microorganisms on the tooth. The tooth surface was analyzed by X-ray photoelectron spectroscopy (XPS) and optical profilometry (OP) before and after irradiation. 103 to 106 CFU were detected on a 0.4 cm2 tooth area. Nine types of bacteria and two types of fungi dominated among the microorganisms. The laser at the most effective biocidal dose of 25 W/15.000 Hz/10 &micro;s, average = 3.84 W, with three uses after 15 s, increased the reduction of fungi from 57.97% to 93.80%, and bacteria from 30.67% to 100%. This dose also caused a decrease in the degree of oxidation and in the effect of smoothing on the treated surfaces

In Vitro Comparison of Several Thrombus Removal Tools

Background: Although the routine use of thrombus aspiration is not recommended, the thrombectomy technique still might be considered for a selected population of patients. Therefore, the assessment of the effectiveness of commercially available thrombectomy devices is still clinically relevant. Aim: Here, we present an in vitro comparison of several different types of catheters that can be used for thrombus aspiration or removal. Methods: Through the removal of 6 h and 24 h human blood clots in an in vitro model, four catheters were compared: the Launcher, Pronto V4, Vasco+ and the stent-retriever Catchview. The aspiration efficacy was expressed as a percentage of the initial thrombus weight. The effectiveness of the patient’s aspiration was dependent on the time of thrombus formation and was significantly higher for a thrombus formed over 24 h (58.5 ± 26.5%) than for one formed over 6 h (48.0 ± 22.5%; p < 0.001). In the presented in vitro model, Pronto V4 and Launcher showed the highest efficiency. Conclusions: Large-bore aspiration catheters were found to be more effective than narrow-bore catheters or stent-retrievers in an in vitro model of thrombus removal. The thrombus aspiration efficacy increases with longer thrombus formation times

Analysis of the Microbiome on the Surface of Corroded Titanium Dental Implants in Patients with Periimplantitis and Diode Laser Irradiation as an Aid in the Implant Prosthetic Treatment: An Ex Vivo Study

The paper presents the optimization of diode laser irradiation of corroded dental implants in order to reduce the number of microorganisms associated peri-implantitis. The research included the identification of microorganisms on the surface of removed dental implants in patients with peri-implantitis and the assessment of the biocidal effectiveness of the diode laser against these microorganisms. Laser desorption/mass spectrometry (MALDI-TOF MS) was used to identify microorganisms and metagens were examined by next generation sequencing (NGS). Irradiation was performed with a diode laser with a wavelength of λ = 810, operating mode: 25 W/15.000 Hz/10 μs, average = 3.84 W with the number of repetitions t = 2 × 15 s and t = 3 × 15 s. The structure and surface roughness of the implants were analysed before and after laser irradiation by optical profilometry and optical microscopy with confocal fixation. In total, 16 species of Gram-positive bacteria and 23 species of Gram-negative bacteria were identified on the surface of the implants. A total of 25 species of anaerobic bacteria and 12 species with corrosive potential were detected. After diode laser irradiation, the reduction in bacteria on the implants ranged from 88.85% to 100%, and the reduction in fungi from 87.75% to 96.77%. The reduction in microorganisms in the abutment was greater than in the endosseous fixture. The applied laser doses did not damage, but only cleaned the surface of the titanium implants. After 8 years of embedding, the removed titanium implant showed greater roughness than the 25-year-old implant, which was not exposed to direct influence of the oral cavity environment. The use of a diode laser in an optimised irradiation dose safely reduces the number of microorganisms identified on corroded dental implants in patients with peri-implantitis