Treatment of Terminal Heart Failure in Grown Up Congenital Heart Disease.

Srčano zatajivanje vodeći je uzrok smrti u odraslih pacijenata s prirođenim srčanim bole- stima, no taj se problem često može previdjeti zbog dobre tolerancije simptoma i niskih očekivanja o funkcionalnom kapacitetu kod većine. Premda neurohormonalna aktivacija prati isti obrazac kao i u zatajivanju srca kod stečene bolesti, temeljni pristupi u medicinskoj terapiji nisu uspjeli pružiti značajnu korist u smanjenju smrtnosti, najvjerojatnije zbog velikog raspona različitih uzroka srčanog popuštanja prisutnih u različitim morfologijama prirođenih srčanih bolesti, kao i onih povezanih s posebnim kirurškim zahvatima. Presađivanje srca moguće je izvesti u pacijenata s terminalnim zata- jivanjem srca, no njihovo pravodobno otkrivanje i određivanje optimalnog trenutka za zahvat problematični su zbog niske osjetljivosti trenutačno postojećih metoda funkcijskog testiranja na otkrivanje promjene između stabilnog stanja niskoga funkcionalnog kapaciteta i pogoršanja. Moždani natriuretski peptid pokazao se kao dobar pokazatelj prognoze i detektor pogoršanja te bi u takvih pacijenata trebao biti redovito kontroliran tijekom praćenja.Heart failure (HF) is the leading mortality cause in adult congenital heart disease patients, but this problem is very often overlooked in these patients due to good tolerance of symptoms as well as low expectations for functional capacity in many of those patients. Although neurohormonal activation follows the same pattern as does HF in acquired disease, the cornerstones of medical therapy have failed to provide signi cant bene ts in mortality reduction, most probably due to a very diverse range of causes for HF that are present in different morphologies of congenital heart disease, as well as connected to speci c surgical treatments. Heart transplantation can be performed in patients with terminal HF, but detecting those and determining the optimal moment for enlisting is problematic due to the low sensitivity of currently applied functional testing methods to detect change between a steady state of low functional capacity and deterioration. B-type natriuretic peptide blood test is a good marker of prognosis and deterioration and should be monitored on a regular basis in these patients

Virtual Bronchoscopy and 3D Spiral CT Reconstructions in the Management of Patient with Bronchial Cancer – Our Experience with Syngo 3D Postprocessing Software

Multislice helical CT generated virtual bronchoscopy (VB) represents one of the most recent developments in three-dimensional computer aided visualisation techniques. VB allows non-invasive and relatively accurate 3D evaluation of tracheobronchal tree. We performed virtual bronchoscopy and in-space 3D volume analysis on CT-data set acquired from sixty-four-year old male with bronchial cancer in order to demonstrate advantages and disadvantages of these methods in diagnostics and preoperative management of metastatic bronchial cancer. Siemens Somatom Emotion 16 helical CT scanner was used for data acquisition. Data post-processing was done with 3D Syngo 2006G software package from Siemens medical systems. CT scanning of the thorax was performed in heavy smoker with an expansive T4N1M1 malignant process in a superior lobe of the right lung accompanied with large metastatic lesion attached on the right lateral chest wall. Metastatic lesions were also found in vertebral column. In-space 3D analysis followed with virtual bronchoscopy had revealed obstruction of apical branch of superior lobe segmental bronchus. External compression done by tumor to the superior segmental and right main bronchus was found. We concluded that multi-slice CT in connection with VB became a possible non-invasive alternative to bronchoscopy, if tissue samples are not required

Cardiac Arrest in a Patient with Ebstein’s Anomaly without Accessory Pathways

We describe a case report of a patient with cardiac arrest and Ebstein’s anomaly. This case report shows us necessity for arrhythmia evaluation and sudden death risk stratification even in asymptomatic patients. Prophylactic ICD im- plantation in this patient population is limited to observational studies and the selection of patients is impeded by the absence of randomized trials and weak predictors

Decision day – A retrospective analysis of COVID-19 patients treated with high PEEP non-invasive ventilation

Background and objectives. This retrospective analysis investigates the effect of high levels of Positive End-Expiratory Pressure (PEEP) during Non-Invasive Ventilation (NIV) in patients with COVID 19 Acute Respiratory Distress Syndrome (ARDS). Materials and methods. In the University Hospital Center Zagreb from October 2021 to February 2022, the study analyzed data from 97 patients who received NIV for acute respiratory support during ICU stay. The effect of NIV on survival, the length of stay in the ICU as well as the duration of the support itself was investigated. Results. Results show that despite low mortality in patients with NIV support, mortality is quite high in patients who required intubation. There is also a divergence of the respiratory support level parameter after the 3rd day on NIV, which suggests that moment as pivotal for assessing the continuation of NIV support. Conclusions. The results show that high level PEEP is a viable option for starting respiratory support in ARDS, but also the importance of timely assessment to optimize patient outcomes