Use of the radial artery in cardiac surgery

Potencjalne korzyści z zastosowania tętniczych konduitów w porównaniu z żylnymi graftami w chirurgii wieńcowej wpłynęły na znaczny wzrost zainteresowania ich przydatnością w celu osiągnięcia kompletnej rewaskularyzacji. Biologiczna budowa ścian tętnic wpływa na lepszą drożność w porównaniu z drożnością pomostów żylnych. Przedstawiono rys historyczny zastosowania tętnicy promieniowej, anatomię w aspekcie chirurgicznym, histologię oraz wskazania i przeciwwskazania dotyczące zastosowania tętnicy promieniowej. Omówiono profilaktykę antyspazmową i możliwe komplikacje dotyczące miejsca pobrania graftu oraz funkcji przedramienia po pobraniu tętnicy promieniowej.The potential advantages of arterial conduits compared with venous graft in coronary operations resulted in their increased use, with the aim of achieving complete myocardial revascularization. The biological characteristics of the vascular wall account for the better patency observed in arterial conduits compared with the patency of the saphenous vein. We briefly present a historical note regarding the radial artery (RA): the surgical anatomy of the vessel, as well as the histology, indications, contraindications and results regarding the use of the radial artery. Antispasm prophylaxis and donor site complications of RA harvest and forearm function after RA harvest are presented

Brak pnia lewej tętnicy wieńcowej a operacja korekcji wady zastawki aortalnej

Heart valve surgery demands cardiac arrest with concomitant cardiac protection against ischaemia and reperfusion. Anomalousorigin of left coronary artery (LCA) system require different approach to the infusion of cardioplegia into coronary ostia. Wepresent a case of a patient suffering from severe aortic stenosis with concomitant aortic insufficiency and double ostium LCAwith left artery descending and circumflex arteries originating separately from the left sinus of Valslava. During the procedurea retrograde, intermittent, cold — crystalloid cardioplegia was applied with moderate hypothermic arrest of 32°C. Antegradecardioplegia in patients presenting with anomalous origin of left coronary system when direct coronary intubation is requiredremains controversial. In such cases retrograde cardioplegia serves a valid option for the operating surgeon

Chorzy trudni nietypowi Endarterektomia czterech naczyń wieńcowych wykonana w czasie zabiegu rewaskularyzacji wieńcowej bez zastosowania krążenia pozaustrojowego – opis przypadku

Coronary endarterectomy is a controversial procedure. It has got many supporters and enemies among cardiac surgeons. It is very rare, particularly while performing off pump coronary artery bypass grafting. We present a case of a 50-year-old man who underwent coronary artery stenting and than has been admitted to surgery because of the restenosis in coronary arteries. During the surgery four arteries have been grafted. At the same time we performed four endarteriectomies in these vessels. No major problem was observed. We describe our technique and briefly present current literature regarding this problem

Duży śluzak lewego przedsionka o przebiegu sugerującym początkowo zatorowość płucną

Cardiac myxomas are rare. They usually appear as a sporadic isolated mass in the left atrium of women with no other pathology. Our patient had symptoms which may suggest pulmonary embolism (PE)-TTE, D-dimers, ECG, laboratory findings seemed to confirm acute PE. Physical examination was unremarkable. Signs of pulmonary hypertension and shortened acceleration time also suggested PE. However, angio-CT excluded it. The patient was transfered to surgical department. During the operation the big myxoma filling the whole space of the left atrium and blocking the entrance to the left ventricle was found and easily removed. Kardiol Pol 2010; 68, 6: 695-69

Unchanged plasma levels of the soluble urokinase plasminogen activator receptor in elective coronary artery bypass graft surgery patients and cardiopulmonary bypass use.

The soluble urokinase plasminogen activator receptor (suPAR) has been recently recognized as a potential biological marker of various disease states, but the impact of a major surgical intervention on the suPAR level has not yet been established. The aim of our study was to investigate if the induction of a systemic inflammatory reaction in response to cardiopulmonary bypass would be accompanied by an increase in the plasma suPAR level.Patients undergoing coronary artery bypass grafting under cardiopulmonary bypass (CPB) were added. Based on the baseline suPAR level, patients were divided into group 1 (suPAR within normal range) or group 2 (suPAR above range). Blood was collected before the induction of anesthesia and 6 and 24 hours after surgery. Plasma suPAR, IL-6, IL-8, TNF-α, troponin I, NT-proBNP, and NGAL were quantified to assess the impact of surgical trauma on these markers.The baseline suPAR level was within the normal range in 31 patients (3.3 ng/mL), and elevated in 29 (5.1 ng/mL) (p<0.001). Baseline mediators of systemic inflammatory reaction concentrations (IL-6, TNF-α, and IL-8) and organ injury indices (troponin I, NT-proBNP, and NGAL) were low and increased after surgery in all patients (p<0.05). The surgery did not cause significant changes in the suPAR level either at 6 or 24 hours after, however the difference between groups observed at baseline remained substantial during the postoperative period.There was no change in the suPAR level observed in patients subjected to elective cardiac coronary artery bypass surgery and CPB, despite activation of a systemic inflammatory reaction

St. Thomas Modified Cardioplegia Effects on Myoblasts&rsquo; Viability and Morphology

Background and Objectives: The cardioplegic arrest of the heart during cardiosurgical procedures is the crucial element of a cardioprotection strategy. Numerous clinical trials compare different cardioplegic solutions and cardioprotective protocols, but a relatively small number of papers apply to in vitro conditions using cultured cells. This work aimed to analyze whether it is possible to use the rat heart myocardium cells as an in vitro model to study the protective properties of St. Thomas cardioplegia (ST2C). Methods: The rat heart myocardium cells-H9C2 were incubated with cold cardioplegia for up to 24 h. After incubation, we determined: viability, confluency, and cell size, the thiol groups&rsquo; level by modifying Ellman&rsquo;s method, Ki67, and Proliferating Cell Nuclear Antigen expression (PCNA). The impact on cells&rsquo; morphology was visualized by the ultrastructural (TEM) study and holotomograpic 3D imaging. Results: The viability and confluency analysis demonstrated that the safest exposure to ST2C, should not exceed 4h. An increased expression of Ki67 antigen and PCNA was observed. TEM and 3D imaging studies revealed vacuolization after the longest period of exposure (24). Conclusions: According to obtained results, we conclude that STC can play a protective role in cardiac surgery during heart arrest