SECURE ORGAN TRANSPLANT INFORMATION SYSTEM

The heart of a modern and efficient information system is a computer database that can be accessed from all over the world. The system demands a strong protection and cryptography, due to a large number of threats in the electronic era. In the well organized transplant programs, all transplantation centers have access to the central computer database. In this important database, the transplantation centers enter information of their recipients along with the recipient profile and the donor profile. This is the basic principle of making the best match between donated organ and recipient. This paper elaborates the SetNet information system with potential criminal activities and malpractice regarding central computer database

Identification of preoperative echocardiografic parameters as predictors of simultaneous operation of degenerative stenotic aortic valve and dilated ascendning aorta

Promene u geometriji ventrikulo-aortnog spoja, kod pacijenata sa teškom, degenerativnom stenozom trolisnog aortnog zaliska, mogu da stvore mehanički stres zida aorte, usled izmenjenog prostornog obrasca protoka krvi. Ovaj hemoreološki efekat može da ima za posledicu stvaranje histoloških promena u zidu ascendentne aorte. Novonastale degenerativne promene mogu da oslabe zid aorte, i da učine aortu podložnu dilataciji. Hipotetično, ovaj proces remodelovanja ascendentne aorte može da se nastavi čak i nakon izolovane zamene aortnog zaliska, stvrajući rizik za razvoj udaljenih komplikacija, poput aneurizme ascendentne aorte, rupture ili disekcije. Cilj. Histopatološke promene u zidu ascendentne aorte kod pacijenata sa teškom stenozom trikuspidnog aortnog zaliska su gradirane i korelirane sa ehokardiografskim parametrima. Cilj ove studije je da poveže pragovne vrednosti ehokardiografskih parametara sa različitim strukturnim defektima zida ascendentne aorte, i da omogući alatku koja će olakšati donošenje odluke kada treba razmatrati simultanu zamenu aortnog zaliska i ascendentne aorte. Pacijenti sa dilatiranom ascendentnom aortom su upoređeni sa pacijentima sa nedilatiranom, sa namerom da se definiše indikacija za simultanu hirurgiju. Meterijal i metode. Na uzorcima uzetim od 37 pacijenata kojima je urađena hirurška zamena aortnog zaliska i kod pacijanata kontrolne grupe (30 operisanih pacijenata i 7 kontrola), izvršena je morfološka analiza. Biopsije uzete od 108 pacijenata kojima je učinjena hirurška zamena aortnog zaliska, su gradirane prema težini promena u zidu ascendentne aorte, korišćenjem Schlatmann i Becker sistema za gradaciju. Sledeći ehokardiografski parametri su izmereni preoperativno, i korelirani sa gradusom, starosnom dobi, polu i faktorima rizika: dijametar ventrikuloaortnog spoja (AA), dijametar sinusa Valsalvae (SV), dijametar sinotubularnog spoja (STJ) i najveći dijametar vizualizovane intraperikardne ascendentne aorte (AscA)...The geometric changes in the ventriculoaortic junction, in patients with severe, calcific tricuspid aortic valve (TAV) stenosis, could induce aortic wall stress due to alliterated blood flow pattern. Consequently, this hemorrheologic effect could lead to histopathological changes in the ascending aorta wall. Degenerative wall changes could weaken aortic wall, and make it susceptible to dilation. Hypothetically, this remodeling process in ascending aorta could persist even after isolated aortic valve replacement (AVR), creating the risk for late development of aortic aneurysm, rupture and dissection. Aim. Histopathological changes of the ascending aorta in patients with TAV stenosis were graded and correlated to echocardiographic parameters. The aim of this study was to associate threshold values of echocardiographic parameters with various structural defects of the ascending aorta, providing a tool to improve surgical decision-making process in cases when simultaneous AVR and ascending aorta replacement is considered. Patient with dilated ascending aortas were compared with nondilated, searching the indication for the simultaneous surgery. Methods. Samples from 37 patients subjected to (AVR) and from the control group were analyzed morphologically (30 study group and 7 autopsy controls). Biopsies from 108 TAV stenosis patients subjected to AVR were graded into three grades according to severity of aortic wall changes, by applying Schlatmann and Becker grading system. Following echocardiographic parameters were obtained preoperatively and correlated to grade, age, gender and risk factors: diameters of ventriculo-aortic junction (AA), sinus Valsalva (SV) and sinotubular junction (STJ), the largest diameter of the visualized ascending aorta (AscA) as well as indexes of sinus Valsalva (SVI), sinotubular junction (STJI), AscA/AA and STJ/AA..

Successful resuscitation from two cardiac arrests in a female patient with critical aortic stenosis, severe mitral regurgitation and coronary artery disease

Introduction. The incidence of sudden cardiac death in patients with severe symptomatic aortic stenosis is up to 34% and resuscitation is described as highly unsuccessful. Case report. A 72-year-old female patient with severe aortic stenosis combined with severe mitral regurgitation and three-vessel coronary artery disease was successfully resuscitated following two in-hospital cardiac arrests. The first cardiac arrest occurred immediately after intraarterial injection of low osmolar iodinated agent during coronary angiography. Angiography revealed 90% occlusion of the proximal left main coronary artery and circumflex branch. The second arrest followed induction of anesthesia. Following successful open-chest resuscitation, aortic valve replacement, mitral valvuloplasty and three-vessel aortocoronary bypass were performed. Postoperative pericardial tamponade required surgical revision. The patient recovered completely. Conclusion. Decision to start resuscitation may be justified in selected patients with critical aortic stenosis, even though cardiopulmonary resuscitation in such cases is generally considered futile

Identification of preoperative echocardiografic parameters as predictors of simultaneous operation of degenerative stenotic aortic valve and dilated ascendning aorta

Promene u geometriji ventrikulo-aortnog spoja, kod pacijenata sa teškom, degenerativnom stenozom trolisnog aortnog zaliska, mogu da stvore mehanički stres zida aorte, usled izmenjenog prostornog obrasca protoka krvi. Ovaj hemoreološki efekat može da ima za posledicu stvaranje histoloških promena u zidu ascendentne aorte. Novonastale degenerativne promene mogu da oslabe zid aorte, i da učine aortu podložnu dilataciji. Hipotetično, ovaj proces remodelovanja ascendentne aorte može da se nastavi čak i nakon izolovane zamene aortnog zaliska, stvrajući rizik za razvoj udaljenih komplikacija, poput aneurizme ascendentne aorte, rupture ili disekcije. Cilj. Histopatološke promene u zidu ascendentne aorte kod pacijenata sa teškom stenozom trikuspidnog aortnog zaliska su gradirane i korelirane sa ehokardiografskim parametrima. Cilj ove studije je da poveže pragovne vrednosti ehokardiografskih parametara sa različitim strukturnim defektima zida ascendentne aorte, i da omogući alatku koja će olakšati donošenje odluke kada treba razmatrati simultanu zamenu aortnog zaliska i ascendentne aorte. Pacijenti sa dilatiranom ascendentnom aortom su upoređeni sa pacijentima sa nedilatiranom, sa namerom da se definiše indikacija za simultanu hirurgiju. Meterijal i metode. Na uzorcima uzetim od 37 pacijenata kojima je urađena hirurška zamena aortnog zaliska i kod pacijanata kontrolne grupe (30 operisanih pacijenata i 7 kontrola), izvršena je morfološka analiza. Biopsije uzete od 108 pacijenata kojima je učinjena hirurška zamena aortnog zaliska, su gradirane prema težini promena u zidu ascendentne aorte, korišćenjem Schlatmann i Becker sistema za gradaciju. Sledeći ehokardiografski parametri su izmereni preoperativno, i korelirani sa gradusom, starosnom dobi, polu i faktorima rizika: dijametar ventrikuloaortnog spoja (AA), dijametar sinusa Valsalvae (SV), dijametar sinotubularnog spoja (STJ) i najveći dijametar vizualizovane intraperikardne ascendentne aorte (AscA)...The geometric changes in the ventriculoaortic junction, in patients with severe, calcific tricuspid aortic valve (TAV) stenosis, could induce aortic wall stress due to alliterated blood flow pattern. Consequently, this hemorrheologic effect could lead to histopathological changes in the ascending aorta wall. Degenerative wall changes could weaken aortic wall, and make it susceptible to dilation. Hypothetically, this remodeling process in ascending aorta could persist even after isolated aortic valve replacement (AVR), creating the risk for late development of aortic aneurysm, rupture and dissection. Aim. Histopathological changes of the ascending aorta in patients with TAV stenosis were graded and correlated to echocardiographic parameters. The aim of this study was to associate threshold values of echocardiographic parameters with various structural defects of the ascending aorta, providing a tool to improve surgical decision-making process in cases when simultaneous AVR and ascending aorta replacement is considered. Patient with dilated ascending aortas were compared with nondilated, searching the indication for the simultaneous surgery. Methods. Samples from 37 patients subjected to (AVR) and from the control group were analyzed morphologically (30 study group and 7 autopsy controls). Biopsies from 108 TAV stenosis patients subjected to AVR were graded into three grades according to severity of aortic wall changes, by applying Schlatmann and Becker grading system. Following echocardiographic parameters were obtained preoperatively and correlated to grade, age, gender and risk factors: diameters of ventriculo-aortic junction (AA), sinus Valsalva (SV) and sinotubular junction (STJ), the largest diameter of the visualized ascending aorta (AscA) as well as indexes of sinus Valsalva (SVI), sinotubular junction (STJI), AscA/AA and STJ/AA..

A comprehensive morphometric analysis of the internal thoracic artery with emphasis on age, gender and left-to-right specific differences

Aims of the study. The aim of this analysis was the morphometric description of the internal thoracic artery (ITA) with an emphasis on age, gender and left-to-right specific differences, as well as on age and atherosclerosis related changes of the elastic skeleton. Methods. Forty eight arteries were obtained during forensic autopsies from 32 persons who had died of non-vascular causes. The following morphometric parameters were analyzed: thickness of the intima, the medial layer and the wall, the intima-to-media ratio and the elastic skeleton parameters. Results. The intima thickness increases significantly with aging (ANOVA F=34.061, p<0.001), as does the intima-to-media ratio (ANOVA F=10.831, p<0.001). With aging, there is a significant increase in the thickness of the media (F=56.519; p<0.001) and of the wall (F=34.094; p<0,001). There is a significant increase in the media thickness during the development of atherosclerosis in the ITA (ANOVA F=11.848, p<0.001). No significant difference was found when these data were analyzed based on the left-to-right principle or depending on gender of the patients. However, the analysis of the elastic skeleton parameters indicated that the combined effects of aging, atherosclerosis and male gender lead to the degeneration of the elastic skeleton of the ITA. Conclusion. The grade of atherosclerosis gradually increases with aging as shown by morphometric analysis. The increase in the medial layer thickness suggests the potential for positive remodeling of the ITA during aging and atherosclerosis. The left/right position has no influence on morphometric parameters of the ITA, while male gender affects parameters of the elastic skeleton

The internal thoracic artery as a transitional type of artery: a morphological and morphometric study

Coronary artery by-pass grafting (CABG) with arterial grafts is widely accepted as the procedure of choice in the treatment of coronary ischemic disease. It brings back focus on morphological studies of arteries used as conduits in this procedure. One of the most frequently used CABG grafts is the internal thoracic artery with an excellent graft prognosis and patency rate. The aim of the study was a detailed morphological and morphometric description of the internal thoracic artery with an emphasis on its basic histological structure and its changes in aging and atherosclerosis. Therefore, 42 full-length arteries were obtained during forensic autopsies from 27 persons, aged between 20 and 81 years, who had died from non-vascular causes. The arteries were classified into three different age groups. Analysis of the serial arterial segments has shown that the internal thoracic artery is an artery of the transitional type whose media is organized into two layers: the internal, muscular layer and the external layer with spirally oriented elastic lamellae and smooth muscle cells in between. The number of elastic lamellae progressively decreases throughout the length of the examined arteries. As opposed to previous assumptions, we have proven that the grade of atherosclerosis is independent of the number of elastic lamellae in the external media. Perfectly formed elastic lamellae are not a persistent feature of the internal thoracic artery, as previously claimed. We have confirmed that the thickness of elastic lamellae decreases, while the number and the size of their fenestrations steadily increase with agin

Correlation of structural defects in the ascending aortic wall to ultrasound parameters: benefits for decision-making process in aortic valve surgery

Abstract Background Histopathological changes in the ascending aorta wall in patients with severe tricuspid aortic valve (TAV) stenosis were graded and correlated to echocardiographic parameters. Objective was to associate threshold echocardiographic values with structural defects in the ascending aorta providing a tool to improve decision-making process in cases when simultaneous aortic valve replacement (AVR) and ascending aorta replacement is considered. Methods Biopsies from 108 TAV stenosis patients subjected to AVR were graded into three grades according to severity of aortic wall changes. Echocardiographic parameters obtained preoperatively and correlated to grade, age, gender and risk factors, were diameters of ventriculo-aortic junction (AA), sinus Valsalva (SV), sinotubular junction (STJ), the largest diameter of the visualized ascending aorta (AscA) as well as indexes: sinus Valsalva (SVI), sinotubular junction (STJI), AscA/AA and STJ/AA. Results Two echocardiographic parameters portrayed grades with statistical significance: STJ (F = 5.417; p = 0.006 (p  3.3 cm, while Grade 3 is identified in patients with values of AscA > 3.5 cm, STJ > 2.9 cm and STJI > 1. Conclusions Hemodynamic stress induced by TAV stenosis leads to elastic lamellae disruption in the aortic wall. Those changes could be graded and correlated with echocardiographic parameters of the aortic root and ascending aorta, providing a tool for decision to replace ascending aorta concomitantly with AVR

Structural features of arterial grafts important for surgical myocardial revascularization: Part I - Histology of the internal thoracic artery

[Projekat Ministarstva nauke Republike Srbije, br. 175005, 175061, III41002, III45005 i 41022

Natural history of the aortic wall changes in adults with the degenerative tricuspid aortic valve stenosis: The morphometric proofs and implications for echocardiography

Background/Aim. So far, no study has been focused exclusively on the tricuspid aortic valve stenosis (TAV) in the aorta without severe dilatation and none has aimed at correlating the high mycroscopy findings with the echocardiographic parameters. This research was conducted on the postulate that detecting the histopathological changes of different severity in the aortic wall could tailor decision about an aortic surgery. The aim of this study was to grade the histopathological changes in the wall of the nonseverely dilated ascending aorta in patients with the severe, calcific TAV stenosis and to correlate them with the echocardiographic parameters in order to analyze when the ascending aorta should be replaced simultaneously with the aortic valve replacement (AVR). Methods. The samples from 37 patients subjected to the AVR and the samples from the control group were analyzed morphologically. The echocardiographic parameters obtained in the TAV stenosis patients were preoperatively correlated with the morphological data, age and gender, diameters of the ventriculo-aortic junction (AA), the sinus Valsalvae (SV) and sinotubular junction (STJ), the largest diameter of the visualized ascending aorta (AscA), the sinus Valsalvae index (SVI) and AscA/AA index. Results. We confirmed morphometrically the exact region of the hemodynamic stress influence with the mathematical distinction in comparison to the controls. In this region, the gradual elastic lamellae disruption was proved by a statistically significant difference through the 3 grades. The elastic skeleton alterations were potentiated with aging and in females. The morphometric parameters of the ascending aorta wall statistically significantly correlated with the echocardiographic parameters: AA, SV, AscA and SVI. The echocardiographic parameters tended to be higher in the most severe grade 3, in the patients younger than 65 years of age. The AscAof more than 4.5 cm was associated with the irreversible morphological defects in these patients. Conclusion. The hemodynamic stress induced by the TAV stenosis leads to the ascending aorta elastic lamellae disruption that could be histopathologically graded and correlated with the echocardiographic parameters of the ascending aorta providing a potential tool for decision-making process in cases when the ascending aorta replacement is considered simultaneously with the AVR. [Projects of the Serbian Ministry of Education, Science and Technological Development, Grant no. 175005, Grant no. 175061, Grant no. III45005, Grant no. III41002, Grant no. III41022