Operacja metodą TAVI w leczeniu degeneracji implantowanej protezy biologicznej

The authors report case of 84-year-old male with degeneration of biological aortic prosthesis treated successfully with transapical TAVI valve in valve procedure.The authors report case of 84-year-old male with degeneration of biological aortic prosthesis treated successfully with transapical TAVI valve in valve procedure

Transaortic transcatheter aortic valve implantation: Results of the Polish arm of the ROUTE registry

Background: Transaortic (TAo) transcatheter aortic valve implantation (TAVI) is an alter­native approach in patients considered to be at high risk for classical open surgery with poor peripheral vessel access. The purpose of this study was to determine the feasibility of using TAo access for TAVI procedures employing the Edwards SAPIEN transcatheter heart valve. The primary objective was to determine overall 30-day mortality. Methods: A total of 32 patients with severe aortic valve stenosis underwent TAo-TAVI using Edwards SAPIEN bioprostheses. Postoperative results were collected according to the Registry of the Utilization Of the TAo-TAVI approach using the Edwards SAPIEN Valve (ROUTE) study protocol. Complications were assessed using Valve Academic Research Consortium- 2 (VARC-2) criteria. Results: The mean age of the population was 80.9 ± 5.2 years, with 53.1% being female. All patients received either the SAPIEN XT or the SAPIEN 3 bioprosthesis (Edwards Lifesciences). Device success was achieved in 100% of cases. One (3.25%) patient subsequently suffered an aortic dissection and required ascending aorta replacement. Paravalvular leakage was absent or mild in 26 (81%) patients, and moderate in 6 (19%) patients. Other complications included permanent pacemaker implantation in 2 (6.5%), and transient post operative delirium in 2 (6.5%) patients. The total hospital stay was 6.7 ± 2.4 days. New York Heart Association class decreased significantly on follow-up. Thirty-day mortality rate was 2 (6.5%) patients. Conclusions: Use of TAo access for TAVI procedures has a reasonable clinical outcome and is a safe alternative to the transfemoral and transapical approaches, especially for patients with high-risk peripheral vessel access

Masywna hemoliza wewnątrznaczyniowa po interwencyjnym leczeniu ubytku w przegrodzie międzyprzedsionkowej

We present a case of a 55 year-old female, who survived a complication of percutaneous closure of atrial septal defect never described before. Within the first day after treatment the device has dislodged and got stuck in the mitral valve apparatus. This has caused mitral insufficiency and massive haemolysis which resolved after interventional removal of the device. Kardiol Pol 2012; 70, 1: 58–5

Exercise stress test and comparison of ST change with cardiac nucleotide catabolite production in patients with coronary artery disease

Background: Uridine (Ur) and hypoxanthine (Hx) are the major end products of ischemic nucleotide breakdown in the human heart. Hypoxanthine is further metabolized to uric acid (UA). The aim of the study was the evaluation of whether changes in nucleotide concentrations during exercise correlate with electrocardiography (ECG) changes, and the severity of coronary artery disease (CAD). Methods: Twenty-nine males with CAD and 11 controls without CAD (mean age 56.1 vs. 51.45) were subjected to treadmill exercise. The test was considered positive if ECG showed more then 1 mm ST segment depression. Venous blood samples taken before and 10 minut after the exercise were analysed by high performance liquid chromatography. Results: Twenty-two out of 29 patients with CAD and 6 of 11 in the control group had abnormal exercise stress tests according to ECG criteria only. Mean &#8710;Ur was positive in the CAD group and negative in the control group (0.45 SEM &#177; 0.09 &#181;M/L vs. -0.43 SEM &#177; 0.21 &#181;M/L, p < 0.0001). &#8710;UA was positive in the CAD group (15.31 SEM &#177; 5.52 &#181;M/L) and negative in the control group (15.31 SEM &#177; 5.52 &#181;M/L vs. -48.18 SEM &#177; 13,8 &#181;M/L, p < 0.00001); Hx increased in both groups, and the change was not significantly different. Correlations of CAD-index with ST depression, &#8710;Ur and &#8710;UA, were: r = 0.43 (p < 0.005), r = 0.62 (p < 0.001), and r = 0.39 (p < 0.01), respectively. Sensitivity of any increase of uridine was superior to 1.5 mm ST depression during exercise. Conclusions: Blood Ur and UA concentration changes during exercise correlate with severity of CAD. We observed slightly greater accuracy of uridine change in comparison to ST changes, thus being a possible new tool in diagnosis of CAD. (Cardiol J 2007; 14: 573-579)

Transcatheter closure of left atrial appendage as an alternative to oral anticoagulants in patients with end-stage renal disease with atrial fibrillation

Migotanie przedsionków jest najczęstszym zaburzeniem rytmu serca u pacjentów z przewlekłą chorobą nerek. Skuteczną metodą prewencji powikłań zakrzepowo-zatorowych w populacji ogólnej pacjentów z migotaniem przedsionków jest doustne leczenie przeciwkrzepliwe, jednak u znacznego odsetka pacjentów ze schyłkową przewlekłą chorobą nerek terapia ta nie jest skuteczna i wiąże się z licznymi powikłaniami krwotocznymi, a także przyczynia się do rozwoju zwapnień w układzie sercowo-naczyniowym. Celem niniejszego opracowania jest podsumowanie wiedzy na temat leczenia przeciwkrzepliwego u pacjentów z migotaniem przedsionków i przewlekłą chorobą nerek oraz przedstawienie alternatywnej metody leczenia — przezcewnikowego zamknięcia uszka lewe­go przedsionka.Atrial fibrillation is the most common arrhythmia in patients with chronic kidney disease (CKD). Effective method for prevention of thromboembolic complications in the general population of patients with atrial fibrillation is oral anticoagulation, however, in a substantial proportion of patients with end-stage CKD this therapy is not effective and is associated with numerous bleeding complications, it also contributes to the development of calcifications in the cardiovascular system. The aim of this study is to summarize the knowledge of anticoagulation in patients with atrial fibrillation and CKD and to provide an alternative method of treatment — transcatheter closure of left atrial appendage

Trancatheter closure of left atrial appendage in patient with end-stage renal disease, chronic atrial fibrillation and heart failure

Zabiegi hemodializy, a także sama schyłkowa niewydolność nerek są czynnikami predysponującymi do wystąpienia migotania przedsionków. W grupie pacjentów ze schyłkową niewydolnością nerek i migotaniem przedsionków istnieją poważne wątpliwości co do zasadności wdrażania leczenia przeciwkrzepliwego w ramach prewencji udarów mózgu. Jest to spowodowane szczególnie wysokim w tej grupie chorych ryzykiem powikłań krwotocznych oraz niekorzystnym wpływem stosowania antagonistów witaminy K na proces wapnienia tętnic. Alternatywą dla leczenia przeciwkrzepliwego może być leczenie interwencyjne, czyli przezcewnikowe zamknięcie uszka lewego przedsionka. Poniżej opisano przypadek 68-letniego chorego ze schyłkową niewydolnością nerek i migotaniem przedsionków, u którego wykonano zabieg przezcewnikowego zamknięcia uszka lewego przedsionka. Dodatkowo na podstawie przypadku omówiono niekorzystny wpływ przetoki tętniczo-żylnej na układ sercowo-naczyniowy u chorych ze schyłkową niewydolnością nerek i współistniejącą niewydolnością serca.Hemodialysis, as well as the end-stage renal disease are the main factors predisposing to atrial fibrillation. Serious concerns exist regarding the use of anticoagulation in patients with end-stage renal disease and atrial fibrillation. This is due to a particularly high risk of bleeding and the adverse effect of vitamin K antagonist therapy on arterial calcification process. An alternative option in these patients may be interventional treatment, namely transcatheter closure of left atrial appendage. The following article describes the case of 68 year old man with end-stage renal disease and chronic atrial fibrillation who underwent transcatheter closure of left atrial appendage. Additionally, the adverse effect of arteriovenous fistula on the cardiovascular system in patients with end-stage renal disease and concomitant heart failure was discussed