Łącznotkankowe pozostałości po usuniętych elektrodach drogą przezżylną

We present a case report of fibrotic tissue reflecting lead course after percutaneous pacemaker lead extraction. Kardiol Pol 2011; 69, 6: 619–62

Włókniak brodawczakowaty w uszku lewego przedsionka

Primary cardiac tumours are very rare (0.02%). Typically fibroelastoma arises from valvular endocardium, nonvalvular locations occur occasionally. Usually fibroelastoma is asymptomatic, however in some cases it may produce small superficial thrombi with substantial risk of embolisation. We report 59 year-old male with left atrial appendage location of papillary fibroelastoma diagnosed during transesophageal echocardiography. Computed tomography confirmed morphological signs typical for this tumour. Kardiol Pol 2011; 69, 3: 284-28

Tamponada serca po plastyce szewskiej klatki piersiowej

Pectus excavatum is the most common type of congenital chest wall abnormality (90%), occurs in an estimated 1 in 300–400 births, with male predominance (male-to-female ratio of 3:1). The exact mechanism involved in this abnormal bone and cartilage overgrowth is not known, and, to date, no known genetic defect is directly responsible for the development of pectus excavatum. Despite the lack of an identifiable genetic marker, the familial occurrence of pectus deformity is reported in 35% of cases. The main aim of the thesis was to present an ill patient, who was surgically treated because of pectum excavatum.Szewska klatka piersiowa to najczęstsza (90%) wrodzona deformacja ściany klatki piersiowej występująca w przypadku1 na 300–400 urodzeń, częściej u osób płci męskiej (proporcja płci męskiej do żeńskiej wynosi 3:1). Dokładny mechanizm powodujący nieprawidłowy wzrost kości i chrząstek nie jest znany. Nie wykryto dotychczas żadnego defektugenetycznego, który mógłby się bezpośrednio wiązać z rozwojem tej deformacji. Mimo braku określonego wskaźnikagenetycznego dane literaturowe wskazują na rodzinne występowanie szewskiej klatki piersiowej w 35% przypadków.Głównym celem niniejszej pracy jest przedstawienie przypadku chorego poddanego leczeniu chirurgicznemu z powoduszewskiej klatki piersiowej

Difficult dual-stage transcutaneous multiple lead extraction with loss of external silicone tube of broken lead

The extraction of three implanted (18-, 16-, and ten year-old) damaged nonfunctional leads was complicated by a lead breaking and losing its external silicone tube. The missing part of the lead was invisible on X-ray, but was visible in ECHO as a thin, corded, very mobile limp structure without metallic reflection. Incomplete lead extraction did not cease laboratory symptoms of infection. The lost silicone tube was grasped and removed via femoral approach during the subsequent transesophageal echocardiography (TEE)-guided procedure. The presented case indicates that the criterion of full radiological success is not always correct, exposes the utility of ECHO techniques for X-ray-invisible broken lead fragments, and indicates the possibility of success for such TEE-guided procedures

Lead dependent tricuspid dysfunction: Analysis of the mechanism and management in patients referred for transvenous lead extraction

Background: Lead-dependent tricuspid dysfunction (LDTD) is one of important complicationsin patients with cardiac implantable electronic devices. However, this phenomenon isprobably underestimated because of an improper interpretation of its clinical symptoms. Theaim of this study was to identify LDTD mechanisms and management in patients referred fortransvenous lead extraction (TLE) due to lead-dependent complications.Methods: Data of 940 patients undergoing TLE in a single center from 2009 to 2011 wereassessed and 24 patients with LDTD were identifi ed. The general indications for TLE, pacingsystem types and lead dwell time in both study groups were comparatively analyzed. Theradiological and clinical effi cacy of TLE procedure was also assessed in both groups with precisionestimation of clinical status patients with LDTD (before and after TLE). Additionally,mechanisms, concomitant lead-dependent complications and degree (severity) of LDTD beforeand after the procedure were evaluated. Telephone follow-up of LDTD patients was performedat the mean time 1.5 years after TLE/replacement procedure.Results: The main indications for TLE in both groups were similar (apart from isolatedLDTD in 45.83% patients from group I). Patients with LDTD had more complex pacing systemswith more leads (2.04 in the LDTD group vs. 1.69 in the control group; p = 0.04). Therewere more unnecessary loops of lead in LDTD patients than in the control group (41.7% vs.5.24%; p = 0.001). There were no signifi cant differences in average time from implantationto extraction and the number of preceding procedures. Signifi cant tricuspid regurgitation(TR-grade III–IV) was found in 96% of LDTD patients, whereas stenosis with regurgitationin 4%. The 10% frequency of severe TR (not lead dependent) in the control group patients wasobserved. The main mechanism of LDTD was abnormal leafl et coaptation caused by: loop ofthe lead (42%), septal leafl et pulled toward the interventricular septum (37%) or too intensivelead impingement of the leafl ets (21%). LDTD patients were treated with TLE and reimplantationof the lead to the right ventricle (87.5%) or to the cardiac vein (4.2%), or surgery procedure with epicardial lead placement following ineffective TLE (8.3%). The radiological and clinicaleffi cacy of TLE procedure was very high and comparable between the groups I and II (91.7%vs. 94.2%; p = 0.6 and 100% vs. 98.4%; p = 0.46, respectively). Repeated echocardiographyshowed reduced severity of tricuspid valve dysfunction in 62.5% of LDTD patients. The follow--up interview confi rmed clinical improvement in 75% of patients (further improvement aftercardiosurgery in 2 patients was observed).Conclusions: LDTD is a diagnostic and therapeutic challenge. The main reason for LDTDwas abnormal leafl et coaptation caused by lead loop presence, or propping, or impingementthe leafl ets by the lead. Probably, TLE with lead reimplantation is a safe and effective optionin LDTD management. An alternative option is TLE with omitted tricuspid valve reimplantation.Cardiac surgery with epicardial lead placement should be reserved for patients withineffective previous procedures

W poszukiwaniu ognisk na stanowisku piaskowym w Michałowie-Piasce (Rydno). Analiza rozprzestrzenienia przepalonych artefaktów krzemiennych

W artykule przedstawiono analizę rozprzestrzenienia przepalonych artefaktów krzemiennych na stanowisku w Michałowie-Piasce (Rydno). Wśród nakładających się na siebie materiałów ze schyłkowego paleolitu, mezolitu i neolitu przy pomocy typologii i metody składanek wytworów krzemiennych wydzielono poszczególne komponenty osadnicze oraz podjęto próbę korelacji miejsc podwyższonego udziału przepalonych artefaktów z miejscami występowania drobnych fragmentów przepalonych kości zwierzęcych i strefami aktywności domowej w celu ewentualnego zidentyfikowania prehistorycznych ognisk