Pacientų atranka širdies transplantacijai: šiuolaikiniai kriterijai

Vytė Valerija Maneikienė1, Jelena Čelutkienė2, Gitana Žemaitaitytė1, Kęstutis Ručinskas3, Saulius Miniauskas3, Sigitas Čibiras2, Vytautas Jonas Sirvydis3, Aleksandras Laucevičius2 1 Vilniaus universiteto ligoninės Santariškių klinikų Širdies chirurgijos centras, Santariškių g. 2, LT-08661 Vilnius 2 Vilniaus universiteto Širdies ir kraujagyslių ligų klinika, Santariškių g. 2, LT-08661 Vilnius 3Vilniaus universiteto Širdies chirurgijos centras, Santariškių g. 2, LT-08661 Vilnius El paštas: [email protected] Vilniaus universiteto Širdies chirurgijos centre nuo 1987 metų atliekamos širdies transplantacijos operacijos. Per šį laikotarpį recipientų sąrašuose buvo įrašyti 268 pacientai, atliktos 47 širdies transplantacijos. Šiuolaikiniai medikamentinio, elektrofiziologinio ir chirurginio gydymo metodai gerokai padidino pacientų, laukiančių širdies transplantacijos, išgyvenimą, tačiau širdies transplantacija tebėra veiksmingiausias gydymo metodas terminalinėmis širdies nepakankamumo stadijomis. Pastaraisiais metais Vilniaus universiteto Širdies chirurgijos klinikoje įdiegti nauji diagnostikos metodai (spiroergometrija, NT-pro-BNP nustatymas) leidžia praktiškai pritaikyti šiuolaikinius atrankos kriterijus. Šiame straipsnyje remiantis literatūros apžvalga įvardyti pagrindiniai recipientų atrankos širdies transplantacijai kriterijai, taikomi ir Vilniaus universiteto Širdies chirurgijos centre. Pagrindiniai žodžiai: širdies nepakankamumas, recipientų atranka, transplantacija Evaluation at selection of patients for heart transplantation: current criteria Vytė Valerija Maneikienė1, Jelena Čelutkienė2, Gitana Žemaitaitytė1, Kęstutis Ručinskas3, Saulius Miniauskas3, Sigitas Čibiras2, Vytautas Jonas Sirvydis3, Aleksandras Laucevičius2 1 Vilnius University Hospital „Santariškių klinikos“, Heart Surgery Centre, Santariškių str. 2, LT-08661 Vilnius, Lithuania 2 Vilnius University, Heart and Cardiovascular Diseases Clinic, Santariškių str. 2, LT-08661 Vilnius, Lithuania 3 Vilnius University, Heart Surgery Centre, Santariškių str. 2, LT-08661 Vilnius, Lithuania E-mail: [email protected] Heart transplantations at Vilnius University Heart Surgery Centre have been performed since 1987. During all this period, 268 patients were included into the recipients’ list and 47 heart transplantations were performed. The current medical, electrophysiological and surgical methods have obviously increased the survival of patients who are waiting for heart transplantation. However, heart transplantation is still the most effective method in the end-stage heart failure. In recent years, the new diagnostic methods (spiroergometry, NT-pro-BNP) implemented at Vilnius University Heart Surgery Center enable using current selection criteria in practice. In the article, according to a literature review, all the basic criteria of evaluating and selecting recipients for heart transplantation mentioned above are used at our Center. Key words: heart failure, recipients’ selection, transplantatio

Kairiosios širdies hipoplazijos sindromo pirmo chirurginio gydymo etapo pradinė patirtis

Virgilijus Tarutis1, Virgilijus Lebetkevičius1, Kęstutis versockas2, Asta Bliūdžiūtė2, Žydrė Jurgelienė2, Solveiga Umbrasaitė1, Rita Sudikienė3, Daina Liekienė1, Kęstutis Lankutis3, Vidmantas Jonas Žilinskas1, Vytautas Sirvydis11 Vilniaus universiteto Širdies chirurgijos centras, Santariškių g. 2, LT-08661 Vilnius2 Vilniaus universiteto ligoninės Santariškių klinikų Anesteziologijos,intensyviosios terapijos ir skausmo gydymo centras3 Vilniaus universiteto ligoninės Santariškių klinikų Širdies chirurgijos centras,Santariškių g. 2, LT-08661 VilniusEl paštas: [email protected] Įvadas / tikslas Kairiosiosios širdies hipoplazijos sindromas (KŠHS) yra viena sunkiiausių įgimtų širdies ydų. KŠHS turi 1 iš 4000–6000 naujagimių. Negydant mirštamumas pirmaisiais gyvenimo metais būna didesnis kaip 90%. Apžvelgiame pradinę KŠHS chirurginio gydymo patirtį. Ligoniai ir metodai Nuo 2005 m. iki dabar operuoti 9 naujagimiai, turintys KŠHS. 6 pacientai operuoti stabilizavus jų būklę, 3 operuoti nestabilios būklės esant kraujotakos nepakankamumui. 4 pacientams atlikta klasikinė Norwoodo operacija su modifikuota Blalocko ir Taussig jungtimi, likusiems 5 atlikta Norwoodo operacijos Sano modifikacija. Rezultatai Pirmas Norwoodo korekcijų etapas buvo sėkmingas 5 (55,6%) naujagimiams: 3 buvo padaryta modifikuota B-T jungtis, 2 – Sano jungtis. Išvada KŠHS chirurginis gydymas mūsų centre kol kas yra vadinamosios mokymosi kreivės laikotarpio. Norwoodo I etapo korekcijos rezultatai turėtų gerėti padidėjus operacijų skaičiui ir griežčiau atrenkant pacientus, atsižvelgiant į rizikos veiksnius. Pagrindiniai žodžiai: kairiosios širdies hipoplazijos sindromas, Norwoodo operacija Initial experience in first-stage surgical treatment of hypoplastic left heart syndrome Virgilijus Tarutis1, Virgilijus Lebetkevičius1, Kęstutis versockas2, Asta Bliūdžiūtė2, Žydrė Jurgelienė2, Solveiga Umbrasaitė1, Rita Sudikienė3, Daina Liekienė1, Kęstutis Lankutis3, Vidmantas Jonas Žilinskas1, Vytautas Sirvydis11 Vilnius University, Cardiac Surgery Centre, Santariškių str. 2, LT-08661 Vilnius, Lithuania2 Vilnius University Hospital „Santariškių klinikos“,Anesthesiology, Intensive Care and Pain Management Center3 Vilnius University Hospital „Santariškių klinikos“,Cardiac Surgery Centre Santariškių str. 2, LT-08661 Vilnius, LithuaniaE-mail: [email protected] Background / objective Hypoplastic left heart syndrome (HLHS) is one of the most complex congenital heart defects. The incidence of HLHS is 1 in 4000 to 6000 live births. The mortality rate exceeds 90% without treatment in the first year of life. We review the initial experience in the surgical treatment of HLHS at our Centre. Patients and methods There were 9 children operated on for HLHS from the year 2005 till now. Six of them went to operation in hemodinamically stable condition and three had a substantial insufficiency of systemic circulation. Four underwent Norwood I procedure with modified Blalock–Taussig shunt and five had Sano modification. Results The first-stage Norwood procedure was successful in five (55.6%) cases – three with B-T shunt and 2 with Sano. Conclusions Surgical treatment of HLHS remains in the learning curve period at our institution. We expect the rise of survival rate with the increase of case load and a more selective approach considering the risk factors. Key words: hypoplastic left heart syndrome, Norwood procedur

The investigation of the electric vibrators for silage mass thickening

The new way of sillage thickening in the trench is analysed. It was done the analytic rewiew of vibrothickers, which is used for thickening the mass of chopped grass silage. It was done the quest experimental investigations on eccentric vibrothicker. The theoretical model and computer program were created for evaluating the working process of vibrothicker and establishing their main constructive parametersVytauto Didžiojo universitetasŽemės ūkio akademij

The experience of surgery for isolated tricuspid valve infective endocarditis in intravenous drug abusers

Objective. Tricuspid valve infective endocarditis usually affects intravenous drug users. At least 5% of patients with tricuspid valve infective endocarditis have to be treated surgically. Few data exist on surgery for the isolated tricuspid valve infective endocarditis in intravenous drug abusers, and there is no such data in Lithuania. This study summarizes our experience in a surgical treatment of isolated tricuspid valve infective endocarditis in intravenous drug users. Patients and methods. This is a retrospective analysis of 18 patients operated on for isolated tricuspid valve infective endocarditis in our centre in 2000–2010. All the patients were intravenous drug abusers. Results. There were no perioperative deaths. Early complications were observed only in the tricuspid valve replacement group (4/14), but there was no significant difference (p = 0.225) was compared to the reconstruction group. There was a longer hospitalization period (27.7 ± 14.5 d) for tricuspid valve replacement than for tricuspid valve reconstruction (18.7 ± 15.1 d.). Eight patients had late complications, of them seven had undergone initial tricuspid valve replacement and one – reconstruction. Four patients had recurrent endocarditis. Late mortality was in 4 (22 %) patients. Conclusion. For some intravenous drug abusers, tricuspid valve surgery for tricuspid valve infective endocarditis is the only effective treatment. Tricuspid valve replacement with biological prosthesis for intravenous drug abusers is associated with numerous early and late postoperative complications. Tricuspid valve reconstruction is a safe method of treatment in the early postoperative period

Cardiac transplantation in pediatric patients: experience of Vilnius Cardiac Surgery Center

Pediatric heart transplantation is a surgical therapy for dilated cardiomyopathy and for complex congenital heart defects. Endomiocardial biopsies have remained a gold standard to detect the rejection. Echocardiography remains the main noninvasive method of the follow-up. We report the experience of the Vilnius hHeart sSurgery cCenter. Assessment of the diastolic dysfunction by tissue doppler and correlation with biopsy and BNP was assessed. E/E‘ 7 and BNP> 200 pg/ml was related with 2R rejection

Comparison of quality of life and physical condition of heart failure

Background / objective: The survival of patients and recovery of the left ventricle function after coronary artery by-pass grafting and percutaneous transluminar angioplasty are widely analysed; however, changes in the quality of life and physical condition are given less attention. The aim of the study was to evaluate the quality of life and physical condition after coronary artery by-pass grafting and percutaneous transluminar angioplasty in patients with a decreased left ventricle ejection fraction suffering from heart failure. Patiens and methods: The study involved 40 patients with viable myocardium, who showed occlusion of the anterior interventricular artery and a decreased left ventricle ejection fraction on coronarography. Group 1 of patients included 13 subjects (mean age, 67.6 ± 3.97 years, female/male ratio 28.6% vs 71.4%) after coronary artery by-pass grafting; group 2 included 7 patients after percutaneous transluminar angioplasty (mean age, 65.7 ± 2.06 years, female/male ratio 23.1% vs 76.6%), and group 3 consisted of 20 patients who were treated conservatively (mean age, 67.6 ± 4.11 years, female/male ratio 65% vs 35%). The patients were evaluated using the Minnesota University Living with Heart Questionnaire, they underwent a six-minute walking, echocardioscopy, veloergometry, natriuretic peptide tests. Results: A comparison of data in these groups after 24 weeks showed a greater improvement of quality of life, echoscopic findings of the left ventricle, and physical condition in groups 1 and 2. The 6-minute walking distance after 24 weeks in groups 1 and 2 were 442.6 ± 1.68 and 498.6 ± 1.58 m, respectively, corresponding to NYHA functional class I; the walking distance in group 3 was 375.6 ± 174 meters (NYHA functional class II). Patients in groups 1 and 2 after 24 weeks showed a marked decrease of natriuretic peptide plasma levels (NT-proBNP 146.6 ± 3.2 and 138.5 ± 3.13 pg/ml, respectively) in comparison with that of group 3 (NT-proBNP 298.6 ± 3.12 pg/ml) (p < 0.004). This indicates a marked decrease of heart failure in groups 1 and 2. The left ventricle ejection fraction (LVEF) after 24 weeks increased markedly in groups 1 and 2 (48.2 ± 2.41% 49.1 ± 2.53%); it was significantly higher in comparison with that of group 3 (34.8 ± 2.91%) (p < 0.0036). The diastolic diameter after 24 weeks markedly decreased in groups..

Commentary: Primary cardiac lymphoma: Two cases and a review of literature

Primary cardiac lymphoma (PCL) is a rare malignant potentially lethal disease, which only involves the heart. PCL is diagnosed only in 1.3 % of heart tumor patients. PCL belongs to the non-Hodgkin extranodal lymphomas group and comprise 0.5 % of them. To date about 200 cases are published and the most comprehensive review, which includes 197 cases, is written by Petrich et al. The most common histological type of PCL is diffuse large B cell lymphoma1–3. In our article entitled “Primary cardiac lymphoma: Two cases and a review of literature”, we have described two patients that were treated at our center4. Both of the patients were diagnosed with PCL. Both cases were confirmed histologically to be diffuse large B-cell lymphoma

Complete repair of tetralogy of Fallot in the first three years of life

Background / objective: Complete corrections of tetralogy of Fallot (TOF) have been frequently performed for infants and even newborns in the last decade. The discussion vvhether early correction of tetralogy of Fallot influences the survival and the frequency of re-operation due to residual right ventricle outflow tract (RVOT) or pulmonary artery insufficiency rate is still going on. The aim of the present work was to evaluate the early and late results of radical corrections in children less than 3 years of age, performed at Vilnius University Heart Surgery Centre. Patients and methods: During two 5-year periods (1996-2000, 2001-2005) 23 infants underwent repair for TOF. The mean age of the patients during the first period was 25.9 ± 2.8 months and during the second period 16.8 ± 2.9 months. During both periods 10 (43.5%) and 18 (78.3%) primary radical corrections of TOF were performed. A transannular patch was inserted in 22 patients (95.6%) during the first 5-year period: 8 patients underwnt transannulorplasty only, and for 14 patients transannulorplasty using a monocusp patch was performed. During the period 2001 through 2005, only 4 patients underwent RVOTplasty by means of monocusp patch. Results: Two patients (8.7%) died within 30 days postoperatively during the first 5-year period and there were two late deaths. There was one death (4.3%) during the second period. The patients underwent echocardiography evaluation, measurements of pulmonary artery insufficiency and RVOT obstruction grade at late postoperative periods. Pulmonary artery insufficiency grade 2-3 and 3 was revealed in 8 (42.1%) patients operated on during the first 5-year period. For four of them, transannular monocusp patch was used for RVOTplasty. Two patients showed a RVOT gradient higher than 40 mm Hg. For three patients (13.6%) operated on during the second 5-year period, pulmonary insufficiency grade 2-3 and 3 was diagnosed, and a RVOT gradient higher than 40 mHg was found in six patients. Re-operation was required for four patients of the first 5-year period: three patients needed to be operated on because of a marked pulmonary artery insufficiency and one for re-canalization of a ventricle septum defect. Conclusions: Radical correction of tetralogy of Fallot may be safely performed in younger patients. Therefore, the number of primary radical correction of this malformation is increasing. The use of transannular patch increases the risk of re-operations due to pulmonary artery insufficiency. The use of transannular monocusp patch does not prevent pulmonary artery valve insufficiency at a late postoperative period

Vietiškai išplitusių plaučių piktybinių navikų operacijos panaudojant dirbtinę kraujo apytaką

Background. The study objective is to evaluate the efficacy of pump operations in locally advanced IIIB (T4N0-1M0) lung cancer and other thoracic malignancies and the results of treatment. Materials and methods. In the period 2003–2011, 6 patients (pts) with locally advanced thoracic malignancies underwent surgery in the Center of Cardiac Surgery of Vilnius University Hospital Santariskiu Clinics (VUH SC). Patients’ characteristics and stage: lung cancer – 3 pts (50.0%), stage IIIB (T4N0-1M0), sarcoma of mediastinum – 2 pts (33.3%), fibrous tumour of mediastinum – 1 pt (16.7%). Patients according to morphology: squamous cell carcinoma – 3 pts (50.0%), neuroangiosarcoma – 1 pt (16.7%), neurosarcoma – 1 pt (16.7%), solitary fibrous tumour – 1 pt (16.7%). After surgery patients received adjuvant treatment: 3 pts with lung cancer received 4 cycles of chemotherapy Gemcitabine with cisplatinum, 2 pts with angiosarcoma received radiation therapy 66 Gy and 6 cycles of chemotherapy Ifosfamide. Results. We performed pneumonectomy with left atrium resection – 2 pts (33.3%), left pneumonectomy with aorta resection – 1 pt (16.7%), left atrium resection with left upper lobectomy – 1 pt (16.7%), mediastinum resection with chest wall reconstruction – 1 pt (16.7%), left pneumonectomy – 1 pt (16.7%). We had no complications after pump operations. Median survival of patients with lung cancer was 2.5 ± 0.5 years, with angiosarcoma 3.5 ± 1.0 years. Five-year survival was 25%. Conclusions. 1. Pump operations are safe and possible in locally advanced thoracic malignancies. 2. Pump operations and adjuvant treatment may prolong median survival in IIIB (T4N0-1M0) lung cancer patients by 2.5 ± 0.5 years and in angiosarcoma patients by 3.5 ± 1.0 years