Paradoxical brain embolism in a young man: Is it only a patent foramen ovale?

Paradoxical embolism is considered the major cause of cerebral ischemic events in young patients. The most common cause of paradoxical embolism, which has been widely described, is right-to-left shunting (RLS) at cardiac level through a patent foramen ovale (PFO). Rarely paradoxical embolism can also be caused by RLS at pulmonary level due to pulmonary arteriovenous fistula (PAVF). Herein, we present a case of a young man, who experienced transient ischemic attack (TIA) due to paradoxical embolism, in whom both abovementioned abnormalities coexisted. This coincidence is very rare (noted in only 1% of patients with cryptogenic stroke or TIA), but it highlights the importance of searching for extracardiac RLS in patients with cryptogenic stroke, even if a PFO has been detected

Procreation and pregnancy in patients with congenital heart disease

Background: Improvement in the treatment of congenital heart defects (CHD) prolongs survival time and provides the prospect of a better quality of life. The study was prompted by the increase in the CHD population of procreative age and the uncertainity related to procreation in CHD patients. Methods: We analysed 98 pregnancies of women with CHD and compared the results with demographic data. Analysis was made of educational level, work capacity, fertility, deterioration in the clinical state and the percentages of labour at term and of vaginal births. Results: CHD occurred in different forms as follows - ASD: 35%, ToF: 17.5%, VSD: 13%, AS: 11%, others: 24%. Surgical treatment was performed on 56% of cases. A total of 15 pregnancies were terminated by abortion. 78% of deliveries were at term. Vaginal births accounted for 76% of deliveries and caesarean section for 24%. The high-risk pregnancies accounted for stood at 36%. In all 85 children were born and 46% underwent cardiological examination. Fertility measured as the number of live births in the relation to the number of women was 1.82. Women with ToF and AS had the lowest fertility and others with ASD II had 2.5, which exceeds that indicated by the demographic data. Conclusions: Patients with CHD have a higher educational level than average and 33% of them are active at work. There is no difference in the fertility of our group in comparison with the demographic data. The rate of cardiological examination of the neonates of the mothers with CHD remains low. The nature of CHD involved in each case is the main factor that influences the fertility, course of the pregnancy and mode of delivery

Trudne ubytki w przegrodzie międzyprzedsionkowej — kiedy zamykamy, a kiedy nie?

The first percutaneous closure of atrial septal defect (ASD) was performed in 1975. Since that time some modifications of the devices for ASD closure were performed. Actually the percutaneous closure is the method of choice for patient with ASD. More than 80% of patients with ASD can be closed with this technique. The rest of the patient because of the size, anatomy or location of ASD are dedicated for surgical closure. Some of the technique modification, device selection or tricks can help to close such types of ASD percutaneously. It has been presented the issue of “difficult “ ASD and useful modification of implantation technique. We present how ASD with deficient aortic rim, increased pulmonary artery pressure, atrial septal aneurysm, large or not perfect localization ASD can be closed percutaneously.Pierwszy zabieg przezskórnego zamknięcia ubytku w przegrodzie międzyprzedsionkowej (ASD, atrial septal defect) został wykonany w 1975 roku. Od tego czasu zmodyfikowano implantystosowane do zamykania ASD. Obecnie przezskórne zamknięcie jest metodą z wyboru w leczeniu pacjentów z ASD. Ponad 80% pacjentów można leczyć z zastosowaniem tej metody. Pozostali pacjenci z powodu anatomii, rozmiaru lub lokalizacji ubytku kierowani są do leczenia kardiochirurgicznego. Modyfikacje technik implantacji, dobór zestawu zamykającego lub triki mogą być pomocne w zamykaniu tego typu ubytków. W pracy przedstawiono problem tak zwanych trudnych ASD i zmodyfikowanych technik implantacji. Omówiono, jak ubytki z brakiem rąbka aortalnego, podwyższonym ciśnieniem w tętnicy płucnej, tętniakiem przegrody międzyprzedsionkowej, ubytki duże lub o niekorzystnej lokalizacji można zamknąć przezskórnie

Does the electrocardiogram grow with an adolescent?: a 3-year follow-up study

Background: Human heart’s growth and development are followed by gradual changes on the electrocardiogram. The study was conducted to analyse changes in the resting electrocardiogram of 10-year-olds in relation to their somatic growth. Methods: 120 students (62 male) aged 10.8 (+/-0.49) years were examined. The study consisted of a resting electrocardiogram and anthropometric measurements repeated in 3-year interval. Statistical analysis of changes in electrocardiographic parameters (PR, QRS, QTc, QRS axis, wave amplitudes) and corresponding changes in height, weight and BMI was conducted. Results: Through time, a substantial elongation of PR (p &lt; 0.001), ORS (p &lt; 0.001) and QT (p &lt; 0.001) lengths was observed while the QRS axis and corrected QT time remained stable (p=0.320 and 0.857 respectively). In girls PR elongation correlated with an increase in BMI (r=0.33). Right axis deviation corresponded with height gain in boys (r=0.45). R and S amplitudes in limb leads did not change significantly except for lead I. There was a considerable decline in R and S wave voltages in precordial leads in adolescent girls that corresponded with weight and BMI increase. In boys the increase in BMI was related to greater R waves in left precordial leads. Conclusion: Adolescent growth has an influence on some electrocardiographic variables. There are significant differences between boys’ and girls’ electrocardiograms regarding QRS amplitudes.Background: Human heart’s growth and development are followed by gradual changes on the electrocardiogram. The study was conducted to analyse changes in the resting electrocardiogram of 10-year-olds in relation to their somatic growth. Methods: 120 students (62 male) aged 10.8 (+/-0.49) years were examined. The study consisted of a resting electrocardiogram and anthropometric measurements repeated in 3-year interval. Statistical analysis of changes in electrocardiographic parameters (PR, QRS, QTc, QRS axis, wave amplitudes) and corresponding changes in height, weight and BMI was conducted. Results: Through time, a substantial elongation of PR (p < 0.001), ORS (p < 0.001) and QT (p < 0.001) lengths was observed while the QRS axis and corrected QT time remained stable (p=0.320 and 0.857 respectively). In girls PR elongation correlated with an increase in BMI (r=0.33). Right axis deviation corresponded with height gain in boys (r=0.45). R and S amplitudes in limb leads did not change significantly except for lead I. There was a considerable decline in R and S wave voltages in precordial leads in adolescent girls that corresponded with weight and BMI increase. In boys the increase in BMI was related to greater R waves in left precordial leads. Conclusion: Adolescent growth has an influence on some electrocardiographic variables. There are significant differences between boys’ and girls’ electrocardiograms regarding QRS amplitudes