Left main disease management strategy: Indications and revascularization methods in particular groups of subjects

Surgical revascularization with coronary artery by-pass grafting is still recommended in vast majority of patients with unprotected left main disease. The aim of the paper was to analyze optimal treatment of left main disease in selected groups of patients, on the basis of current guidelines and information gained from literature data. We focused on data in relation to treatment of elderly patients, diabetics and those hemodynamically unstable. Additionally we discussed the issue of anti-platelet therapy and informed consent. As far as efficacy of treatment is concerned, not only method of revascularization but also general condition of the patient, the factors influencing peri-operative risk and optimal pharmacotherapy should be taken into account. Therefore establishment of the heart team is crucial when choosing the most suitable method of invasive treatment of left main disease

Compliance with pharmacological treatment among patients after minimally invasive coronary bypass grafting

Background: We sought to evaluate patients’ adherence to optimal pharmacotherapy as recommended by the European Society of Cardiology, together with the assessment of potential clinical determinants of medical non-compliance in a large cohort of patients after endoscopic atraumatic coronary artery bypassing (EACAB).Methods: This cross sectional study was conducted in a group of 706 individuals who underwent EACAB between April 1998 and December 2010. Data covering current pharmacological treatment with antiplatelet agents, beta-blockers (BB) (or heart rate lowering calcium channel blockers [CCB] in case of intolerance and/or poor efficacy of beta-blockade), angiotensin-converting enzyme (ACE) inhibitors (or angiotensin receptor blockers [ARB]) and statins was acquired. Mean duration of observation after the surgery was 2132 ± 1313 days.Results: Complete follow-up data has been obtained from 415 living patients (341 males). Amongst them, 353 (85%) received antiplatelet agents, while BB or CCB were routinely ingested by 349 (84%) patients. Statins were used by 310 (74.7%) individuals and 274 (66%) subjects took ACE inhibitors or ARB. Baseline demographic and clinical features, including major co-morbidities had no impact on patients’ compliance with all investigated medications. There was no clear association between adherence to treatment and risk of rehospitalization or occurrence of major cerebral and cardiovascular events.Conclusions: EACAB patients’ compliance with pharmacotherapy guidelines is insufficient and is unrelated to demographic and clinical features of the subjects. Multidisciplinary approach involving health education, enhancement in prescription drug affordability and a better rapport between doctors and patients should be incorporated into clinical practice to overcome therapeutic disobedience

Study of phase transition in Bi3TiNbO9-BaBi2Nb2O9 ceramics

The subject of the paper is lead free bismuth layer structure oxides (1-x)Bi3TiNbO9-xBaBi2Nb2O9 (x=0; 1; 2; 3 mol). The influence of Bi3TiNbO9-xBaBi2Nb2O9 ratio on dielectric and structural properties was studied in a wide range of temperatures. Change in the ratio causes a decrease in the maximum value of dielectric permittivity and shifts the temperature of 'max to low values, leading to linear decreasing of average grain size and linear increasing of ceramics density. These results indicate an augment of the packing degree and the participation of pores are significantly decreased with the increase of BaBi2Nb2O9 compound intake. Moreover, for 0.7Bi3TiNbO9-0.3BaBi2Nb2O9 ceramics the dielectric phase transition is broadened and the properties characteristic for the ferroelectric relaxor appear

Anomalous origin of culprit coronary arteries in acute coronary syndromes

Background: The aim of the study was to describe a series of acute coronary syndrome (ACS) patients in whom anomalous origin of culprit coronary artery (AOCCA) was diagnosed. Percutaneous coronary interventions (PCI) in AOCCA are performed very infrequently. Methods: Electronic databases from three high-volume tertiary cardiac centers were retrospectively searched for the presence of AOCCA in ACS. Results: Different types of AOCCA in ACS were identified in 20 patients. The most frequent AOCCA was left circumflex coronary artery (LCx) originating from right coronary artery (RCA) or directly from the right coronary sinus (RCS), n = 13, followed by high/atypical RCA, n = 3, left coronary artery (LCA) originating from RCS (n = 3) with either RCA-AOCCA (n = 1) or left anterior descending coronary artery (LAD)-AOCCA (n = 1) or RCA originating from left sinus of Valsalva, (n = 1), LAD originating from RCA (n = 1). In 1 ST-segment elevation myocardial infarction (STEMI)-patient RCA-AOCCA cannulation was unsuccessful, in 1 non-STEMI-patient AOCCA was missed, 1 ACS- -patient was treated surgically and 1 ACS-patient was treated conservatively (both patients with non- STEMI). In the remaining patients PCI was successfully performed. Conclusions: The most frequently encountered AOCCA is LCx branching-off from RCA. AOCCA may either be difficult to cannulate and PCI aborted even in STEMI, or missed, especially when the intermediate branch from LCA is mimicking proper LCx

Influence of lanthanum dopant on the structure and electric properties of BaBi2Nb2O9 ceramics

The paper reports the consequences of lanthanum modifications of barium bismuth niobiate (BaBi2Nb2O9) ceramics. The discussed materials were prepared by solid state synthesis and a one-step sintering process. The investigations are focused on dielectric aspects of the modification. The presented results reveal that the trivalent lanthanum ions incorporate twovalent barium ions, which is connected with the creation of A-site cationic vacancies as well as oxygen vacancies. Such a scenario results in significant decreasing in grain boundaries resistivity. The activation energy of grain boundaries conductivity is significantly reduced in the case of lanthanum admixture