Wegetacje na zastawce dwudzielnej u 16-letniej dziewczynki leczone chirurgicznie metodą małoinwazyjnej rekonstrukcji

Infective endocarditis in children is rare and is most often a complication of dental interventions, it is also favored by congenital or acquired heart defects and previous cardiac surgery. For six months, a 16-year-old girl had significant weakness, low-grade fever, lack of appetite with a weight loss of 5 kg, apathy, and enlargement of the spleen. There was also a systolic murmur above the tip of the heart. Admitted to a general pediatric ward and then, after confirming vegetation on the mitral valve, further treatment was carried out in the pediatric cardiology ward. The blood cultures revealed Streptococcus Gordoni infection, and intensive antibiotic treatment was initiated under the control of blood cultures, which were negative after 7 days of treatment. A team of specialists (endocarditis team) was appointed, treatment was continued and transesophageal echocardiography was performed with the assessment of valve changes. After consultation with cardiac surgeons, it was decided to transfer the patient to the adult cardiosurgery ward, despite the fact that she was not of age, where a minimally invasive valve reconstruction was performed using artificial tendon threads and an artificial CE Mc Carthy-Adams 26 mm mitral ring. The postoperative course was uneventful and the girl was returned to the care of pediatric cardiologists. Currently, she is in good condition and is under constant control.Infekcyjne zapalenie wsierdzia rzadko występuje u dzieci, najczęściej jest powikłaniem interwencji stomatologicznych, sprzyjają mu także wrodzone lub nabyte wady serca oraz wcześniejsze operacje kardiochirurgiczne. U 16-letniej dziewczynki od pół roku występowało znaczne osłabienie, stany podgorączkowe, spadek masy ciała o 5 kg spowodowany brakiem apetytu, apatia i powiększenie śledziony. Pojawił się także szmer skurczowy nad koniuszkiem serca. Została przyjęta na oddział ogólnopediatryczny, po stwierdzeniu wegetacji na zastawce dwudzielnej dalsze leczenie obywało się na oddziale kardiologii dziecięcej. W posiewach z krwi stwierdzono zakażenie Streptococcus Gordoni i włączono intensywne leczenie antybiotykami kontrolowane posiewami krwi, które po 7 dniach leczenia były ujemne. Powołano zespół specjalistów (Endocarditis Team), kontynuowano leczenie oraz wykonano echokardiografię przezprzełykową z oceną zmian na zastawce. Po konsultacji z kardiochirurgami zadecydowano o przeniesieniu pacjentki na oddział kardiochirurgii dla dorosłych (pomimo nieosiągnięcia wieku pełnoletniego), gdzie wykonano małoinwazyjną rekonstrukcję zastawki z użyciem sztucznych nici ścięgnistych i sztucznego pierścienia mitralnego Carpentier–McCarthy–Adams 26 mm. Przebieg pooperacyjny był niepowikłany, dziewczynkę ponownie przekazano pod opiekę kardiologów dziecięcych. Aktualnie jest w dobrym stanie i pozostaje pod stałą kontrolą lekarzy

State-of-the-art of transcatheter treatment of aortic valve stenosis and the overview of the InFlow project aiming at developing the first Polish TAVI system

Initial experience of transcatheter aortic valve implantation (TAVI) or replacement (TAVR) has ap-peared as a promising minimally invasive technology for patients disqualified from surgical treatment (SAVR). Safety and efficacy of TAVI has been analyzed and assessed through numerous registries and trials. Furthermore, results obtained from comparative TAVI vs. SAVR trials proved that both treat¬ments can be considered equal in terms of post-procedural mortality and morbidity in high-risk, as well as lower risk patients. However, there are still some issues that have to be addressed, such as higher chance of paravalvular leakage, vascular injuries, conduction disturbances, malpositioning and the yet unmet problem of insufficient biological valves durability. Recent technological developments along with the learning curve of operators prove a great potential for improvement of TAVI and a chance of surpassing SAVR in various groups of patients in the near future. In pursuit of finding new solutions, the CardValve Consortium consisting of leading scientific and research institutions in Poland has been created. Under the name of InFlow and financial support from the National Center for Research and Development, they have started a project with the aim to design, create and implement into clinical practice the first, Polish, low-profile TAVI valve system, utilizing not only biological but also artificial, polymeric-based prosthesis. This review focuses on current developments in TAVI technologies including the InFlow project

Safety and feasibility of minimally invasive coronary artery bypass surgery early after drug eluting stent implantation due to acute coronary syndrome

Background: The evidence of performing minimally invasive coronary artery surgery early after drug eluting stent (DES) implantation due to acute coronary syndrome (ACS) is limited. Aim: The aim of the study is to determine the safety and feasibility of this approach. Methods: This registry includes 115  (78% male) patients from 2013‒2018, who underwent non-LAD percutaneous coronary intervention (PCI) due to ACS with contemporary DES implantation (39% diagnosed with myocardial infarction at baseline), followed by endoscopic atraumatic coronary artery bypass (EACAB) surgery within 180 days, after temporary P2Y12 inhibitor discontinuation. Primary composite endpoint of MACCE (Major Adverse Cardiac and Cerebrovascular Events), defined as death, myocardial infarction (MI), cerebrovascular incident and repeat revascularization was evaluated in long- term follow-up. The follow-up was collected via telephone survey and with National Registry for Cardiac Surgery Procedures. Results: Median (interquartile range [IQR]) time interval separating both procedures was 100.0 (62.0‒136.0) days. Median (IQR) follow-up duration was 1338.5 (753.0‒2093.0) days and was completed from all patients with regard to mortality. Eight patients (7%) died; 2 (1.7%) had a stroke; 6 (5.2%) suffered from MI and 12 (10.4%) required repeat revascularization. Overall, the incidence of MACCE was 20 (17.4%). Conclusions: EACAB is a safe and feasible method of LAD revascularization in patients who received DES for ACS within 180 days prior to surgery, despite early dual antiplatelet therapy discontinuation. The adverse event rate is low and acceptable

Investigating the Effects of Statins on Cellular Lipid Metabolism Using a Yeast Expression System

In humans, defects in lipid metabolism are associated with a number of severe diseases such as atherosclerosis, obesity and type II diabetes. Hypercholesterolemia is a primary risk factor for coronary artery disease, the major cause of premature deaths in developed countries. Statins are inhibitors of 3-hydroxy-3-methylglutaryl-CoA reductase (HMGR), the key enzyme of the sterol synthesis pathway. Since yeast Saccharomyces cerevisiae harbours many counterparts of mammalian enzymes involved in lipid-synthesizing pathways, conclusions drawn from research with this single cell eukaryotic organism can be readily applied to higher eukaryotes. Using a yeast strain with deletions of both HMG1 and HMG2 genes (i.e. completely devoid of HMGR activity) with introduced wild-type or mutant form of human HMGR (hHMGR) gene we investigated the effects of statins on the lipid metabolism of the cell. The relative quantification of mRNA demonstrated a different effect of simvastatin on the expression of the wild-type and mutated hHMGR gene. GC/MS analyses showed a significant decrease of sterols and enhanced conversion of squalene and sterol precursors into ergosterol. This was accompanied by the mobilization of ergosterol precursors localized in lipid particles in the form of steryl esters visualized by confocal microscopy. Changes in the level of ergosterol and its precursors in cells treated with simvastatin depend on the mutation in the hHMGR gene. HPLC/MS analyses indicated a reduced level of phospholipids not connected with the mevalonic acid pathway. We detected two significant phenomena. First, cells treated with simvastatin develop an adaptive response compensating the lower activity of HMGR. This includes enhanced conversion of sterol precursors into ergosterol, mobilization of steryl esters and increased expression of the hHMGR gene. Second, statins cause a substantial drop in the level of glycerophospholipids

Long-term echocardiographic evaluation of asymptomatic patients undergoing minimally invasive valve repair for severe primary mitral regurgitation

Background: Asymptomatic patients with newly diagnosed severe primary mitral regurgitation (MR) may not be candidates for surgery according to clinical guidelines. Aims: We aimed to determine whether asymptomatic patients with severe primary MR benefit from minimally invasive mitral valve repair. Methods: This prospective registry study assessed consecutive asymptomatic patients who underwent mitral valve repair using right minithoracotomy. Left ventricular ejection fraction, end‑diastolic and end‑‑systolic volumes, end‑diastolic and end‑systolic diameters, as well as left atrial (LA) area and volume were measured. Major adverse cardiovascular and cerebrovascular events (MACCEs) were assessed at 6, 12, and 24 months after surgery. Results: The study included 114 patients, of whom 16 (14%) were lost to follow‑up (except the endpoint of death). No deaths were reported during follow‑up. A comparison of median echocardiographic parameters at baseline and 24 months revealed significant reverse remodeling: left ventricular ejection fraction, 68% vs 60% (P < 0.001); end‑diastolic volume, 165 cm3 vs 107.5 cm3 (P < 0.001); end‑systolic volume, 51 cm3 vs 43.5 cm3 (P = 0.02), end‑diastolic diameter, 58 mm vs 49 mm (P < 0.001); end‑systolic diameter, 35 mm vs 30 mm (P < 0.001); LA area, 26 cm2 vs 18 cm2 (P < 0.001); and LA volume, 96 cm3 vs 49.5 cm3(P < 0.001). There were 9 MACCEs (9.2%): 2 reoperations (2%), 1 hospitalization for heart failure (1%), and 6 cases of new‑onset atrial fibrillation (6.1%). Conclusions: Minimally invasive mitral valve repair is safe and effective in asymptomatic patients with severe primary MR. It should be recommended regardless of ventricular and atrial dimensions

Need for repeat revascularisation in hybrid coronary revascularisation vs. percutaneous coronary intervention

Hybrid coronary revascularisation (HCR), being a treatment path combining both coronary artery bypass grafting and percutaneous coronary intervention (PCI) approaches, offers the advantages of both methods in patients with multi-vessel coronary artery disease. Since available literature provides few studies comparing the need for repeat revascularisation (RR) after HCR in comparison to PCI, our review aimed at summarising the latest data on this topic from the last 5 years (2018–2023). The search was conducted within the PubMed and Embase databases, followed by application of inclusion and exclusion criteria and providing a summary of data and characteristics of eligible studies. On the basis of 7 records included in the final analysis, RR and/or follow-up target vessel revascularisation (TVR) were significantly less frequently required in the case of HCR than in PCI in 3 out of 7 records, whereas the remaining four provided no significant differences in analysed rates between the 2 therapeutic pathways. When it comes to lowering the necessity for follow-up TVR and/or RR in a fraction of instances, HCR demonstrates a significant advantage over PCI. The complexity of outcomes associated with these therapies is emphasised by the fact that no statistically significant differences were observed between the 2 methods in the remaining 4 records

The impact of the coronavirus pandemic on patients hospitalized due to acute coronary syndrome

The coronavirus disease 2019 (COVID-19) pandemic significantly increased mortality worldwide. However, only part of the excess mortality is related directly to the infection. Local healthcare accessibility, time to reach medical care and patients’ reluctance to seek medical aid strongly affected the treatment results in many fields. The current report aims to analyze mortality and morbidity in patients who suffered from acute coronary syndrome (ACS) during the COVID-19 pandemic, as well as to investigate the factors that may have a significant impact on their baseline characteristics and outcome. Multiple reports were evaluated. Most of them point to reluctance and longer time to reach medical care, longer pre-hospital delay, lower overall number of ACS admissions, greater percentage of ST-elevation myocardial infarction patients and complications. Younger and less ill patients were more likely to suffer from ACS than in the pre-pandemic period. They presented with more prominent biomarker elevation. Further, the number of invasive procedures dropped significantly, which was most prominent in the field of surgical revascularization. Consequently, a higher number of adverse events and greater mortality during the COVID-19 pandemic were noted, which was valid for both patients with and without coronavirus infection. In summary, the pandemic had a great impact on overall populational mortality and morbidity, which was greatly pronounced in patients with cardiovascular disease, particularly in ACS cases. They differed in baseline characteristics, underwent different treatment and their outcome was worse as compared with the period prior to the pandemic