The anatomy of the tendon of infundibulum

The heart, as we know, is a muscular tissue supported by collagenous structures forming the fibrous skeleton of the heart. A structure by the name of the tendon of infundibulum appeared in the literature with no definite information about its structure or even its existence. The tendon of infundibulum was described as a strip of fibrous tissue structure situated between the aortic root and pulmonary trunk. Our study involved 30, formalin fixed, adult human hearts ranging from 18 to 81 years. Classical macroscopic anatomical methods were applied to observe macroscopically all the connections between the aorto-pulmonary trunk, together with serial transverse histological sections, through roots of the aorta and pulmonary trunk, using eosin-hematoxylin and van Gieson staining. All the hearts seemed to encompass many fascial bands attended by connective tissue. However these fascial bands are not concrete structures and cannot be termed tendons. In our investigation we have been unable to demonstrate macroscopically or histologically any structure which could be significantly approximating to the initial description of the literature. However, as far as we are able to judge, the term tendon of infundibulum has erroneously been introduced into many medical textbooks since the literature cannot still prove its existence

Bifocal pacing in the right ventricle: An alternative to resynchronization when left ventricular access is not possible in end-stage heart failure patients

Background: It has been reported that bifocal pacing (BiF) in the right ventricle might be an alternative to unsuccessful left ventricular lead implantation. This case report presents an assessment of the clinical and hemodynamic parameters during a three month follow-up in patients implanted with right ventricular BiF. Methods: Eight patients who underwent unsuccessful left ventricular lead implantation were implanted with a bifocal system in the right ventricular. Leads were implanted in the right atrium appendage, the apex and the right ventricular outflow tract and connected to the cardiac resynchronization therapy pacemaker. All patients performed a sixminute walking test and underwent echocardiography after the implantation and after the three month follow-up. Results: We found a significant performance increase in the six minute walking test and reduction in New York Heart Association class and mitral regurgitation in echocardiography study, as well as a significant increase in left ventricular ejection fraction, and cardiac output directly after the implantation, as well as at threemonth follow-up in patients after BiF implantation. Conclusions: Right ventricular bifocal pacing in patients with cardiac resynchronization therapy indication and unsuccessful left ventricular lead placement seems to be a beneficial treatment for heart failure. Satisfactory hemodynamic and clinical results were observed directly after BiF implantation and during the three month follow-up. (Cardiol J 2010; 17, 1: 35-41

Transbronchial lung cryobiopsy guided by radial "mini-probe" endobronchial ultrasound in interstitial lung diseases - a multicenter prospective study

Introduction: Transbronchial lung cryobiopsy (TBLC) is commonly used in diagnosing interstitial lung diseases (ILDs). Ageneral anesthesia with endotracheal intubation, balloon blockers and fluoroscopy control is the most common modality. Simplifying the procedure without decreasing it’s safety could result in wider use. Prospective, observational study was conducted in three Polish pulmonology centers to evaluate safety and diagnostic yield of TBLC under conscious sedation, without intubation and bronchial blockers and with radial-EBUS guidance instead of fluoroscopy. Material and methods: In patients suspected of ILD, in accordance with high resolution computer tomography (HRCT) selected lung segments were examined with radial-EBUS mini probe without aguide sheath. If the lung infiltrations were visible this locations were preferred. If not, specimens were taken from two different segments of the same lobe. Two to five biopsies with freezing time 5–8 seconds were performed. Moreover ultrasound examination was used to avoid injury of lung vessels. Results: From March 2017 to September 2019 — 114 patients (M: 59, F: 55) of mean (SD) age 54 (14) years were included to the study on the basis of medical history and HRCT. Histopathology was conclusive in 90 (79%) patients and included 16 different diagnoses (sarcoidosis, EAA, COP predominantly). 24 inconclusive biopsies of unclassifiable pulmonary fibrosis were followed up. Complications included five cases (4.4%) of pneumothorax requiring achest tube drainage and aminor and moderate bleeding in few cases. There was no need for use of balloon bronchial blockers. Conclusions: TBLC under conscious sedation guided by radial EBUS mini-probe is novel, reasonable and safe technique for histological diagnosis of ILDs

Transbronchial lung cryobiopsy guided by radial mini-probe endobronchial ultrasound in interstitial lung diseases — a multicenter prospective study

Introduction: Transbronchial lung cryobiopsy (TBLC) is commonly used in diagnosing interstitial lung diseases (ILDs). A general anesthesia with endotracheal intubation, balloon blockers and fluoroscopy control is the most common modality. Simplifying the procedure without decreasing it’s safety could result in wider use.Prospective, observational study was conducted in three Polish pulmonology centers to evaluate safety and diagnostic yield of TBLC under conscious sedation, without intubation and bronchial blockers and with radial-EBUS guidance instead of fluoroscopy. Material and methods: In patients suspected of ILD, in accordance with high resolution computer tomography (HRCT) selected lung segments were examined with radial-EBUS mini probe without a guide sheath. If the lung infiltrations were visible this locations were preferred. If not, specimens were taken from two different segments of the same lobe. Two to five biopsies with freezing time 5–8 seconds were performed. Moreover ultrasound examination was used to avoid injury of lung vessels.Results: From March 2017 to September 2019 — 114 patients (M: 59, F: 55) of mean (SD) age 54 (14) years were included to the study on the basis of medical history and HRCT. Histopathology was conclusive in 90 (79%) patients and included 16 different diagnoses (sarcoidosis, EAA, COP predominantly). 24 inconclusive biopsies of unclassifiable pulmonary fibrosis were followed up. Complications included five cases (4.4%) of pneumothorax requiring a chest tube drainage and a minor and moderate bleeding in few cases. There was no need for use of balloon bronchial blockers.Conclusions: TBLC under conscious sedation guided by radial EBUS mini-probe is novel, reasonable and safe technique for histological diagnosis of ILDs

Naczyniakomięsak serca — pułapki diagnostyczne

Primary tumours of the heart are extremely rare. Sarcomas are considered to be the most frequent histological type. This study presents two cases with a two-week and two-month history of fatigue, fever and shortness of breath. In both cases, cardiac tumours with pericardial effusion were diagnosed by means of echocardiography, being responsible for the above-mentioned symptoms. At the beginning of the diagnostic process, sarcomas seemed to be the likeliest cause of these symptoms. Establishment of the histopathological diagnosis based on the tumour biopsy turned out to be very difficult, and this delayed further therapeutic procedures

Different MET gene alterations in lung adenocarcinoma patients

Introduction. In this study, we attempted to detect selected abnormalities in the MET gene using various molecular techniques.  Material and methods. Twenty-six lung adenocarcinoma patients had a diagnosis of abnormalities in the genes: EGFR, ALK, ROS1, MET, and RET. They were diagnosed using various techniques and assessment of PD-L1 expression using immunohistochemistry. Copy number variation of MET gene was assessed by qPCR and FISH techniques, MET exon 14 mutation by RT-PCR method, and MET mRNA expression by the RT-qPCR technique. Statistical analyses were performed using Statistica v. 13.1 and MedCalc 15.8.  Results. Most patients (57.7%) had a high MET gene copy number in the qPCR method, which was not confirmed by the FISH method. A significant positive correlation (R = +0.573, p = 0.0022) between the MET gene copy number assessed with the qPCR method and the relative MET mRNA expression was found.  Conclusions. The positive correlation between the MET mRNA expression and the MET gene copy number in the qPCR test indicates that these methods could complement each other. The performance of these two tests simultaneously increases the reliability of the MET gene assessmen

What has changed in the treatment of patients with pacemaker implantation indication in the last five years?

Introduction: The aim of the following study was a comparison of the types of the implanted cardiac pacemakers (PM) and the changes which took place in the guidelines for the implantation of the PM being used in 2004 and 2009. Methods: The study was performed based on the data from the Łódzki Rejestr Elektrostymulacji (LRE). Comparison of epidemiological data, PM types and modes and types of the performed procedures in 2004 and 2009 was assessed. Results: The final study included 711 patients (pts): 281pts in 2004 and 430pts in 2009. In 2004 234 new implantations were performed wheras in 2009 – 280. In 2009 the number of reimplantations increased and constituted 34.9% of all the procedures (in 2004 – 16.7%). Atrioventricular blocks (2nd and 3rd degree) were the main indication for the implantation of PM both in 2004 and 2009 (exceeding 40%). In 2009, more than 90% of pts with the BTS were being applied the physiological type of the DDDR stimulation. In chronic Atrial Fibration (AF), both in 2004 and 2009, PM VVI were implanted – in the 2009 group only the PM “rate adaptive” were used. In the 2009 in 6% of pts cardiac resynchronization PM were implanted as the heart failure indication.Wstęp: Celem pracy było porównanie typu i rodzaju implantowanych stymulatorów serca (PM) oraz zmian jakie dokonały się we wskazaniach do implantacji obowiązujących w roku 2004 i w 2009 roku. Metodyka: Badanie przeprowadzono w oparciu o dane Łódzkiego Rejestru Elektrostymulacji (LRE). Porównywano: dane epidemiologiczne, ilość i rodzaj wykonanych zabiegów, wskazania do implantacji, rodzaj implantowanego PM w roku 2004 (grupa 04) i 2009 (grupa 09). Wyniki: Do analizy włączono 711 pacjentów (pts): 281 pts w grupie 04 i 430 pts w grupie 09. W roku 2004 wykonano 234 implantacji, w roku 2009 - 280. W grupie 09 zwiększyła się ilość reimplantacji - 34,9% wszystkich zabiegów (2004 r. - 16,7%). Blok przedsionkowo-komorowy (p-k) II i III stopnia zarówno w 2004 r. i w 2009 r. był głównym wskazaniem do implantacji PM (ponad 40%). W 2009 r. ponad 90% pts w przebiegu zespołu bradykardia-tachykardia (BTS) miało zastosowany fizjologiczny tryb stymulacji DDDR. W utrwalonym migotaniu przedsionków w roku 2004 jak i 2009 implantowano PM VVI, ale w 2009 roku były to wyłącznie stymulatory „rate adaptive”. W 2009 roku 6% pts miało implantowany stymulator jako metodę leczenia niewydolności serca

Leczenie ECMO u chorych z COVID-19 w Centrum Terapii Pozaustrojowej Kliniki Kardiochirurgii CSK MSWiA w Warszawie

ECMO (extracorporeal membrane oxygenation) is a method ofextra-systemic blood oxygenation. It involves the oxygenationof venous blood in an oxygenator with the simultaneous eliminationof carbon dioxide in the extracorporeal system. Thismethod is used in the treatment of acute circulatory failure(veno-arterial configuration) as well as in acute respiratoryfailure (veno-venous configuration). The pandemic caused bythe COVID-19 coronavirus resulted in the need to quickly gatherand summarize knowledge and introduce new data to existingguidelines. One such document is the recommendations of ELSO(Extracorporeal Life Support Organization). The following paperpresents the current summary of recommendations of both ELSOand polish national experts panel dealing with ECMO treatment.Metoda ECMO polega na pozaustrojowym utlenowaniu krwi żylnej w oksygenatorze z jednoczasową eliminacją dwutlenku węgla. Jest stosowana w leczeniu ostrej niewydolności krążenia (konfiguracja żylno-tętnicza) oraz ostrej niewydolności oddechowej (konfiguracja żylno-żylna). Pandemia wywołana koronawirusem COVID-19 wymusiła szybkie zgromadzenie i podsumowanie wiedzy oraz wprowadzenie nowych zaleceń do istniejących już wytycznych. Jednym z takich dokumentów są zalecenia Extracorporeal Life Support Organization (ELSO). W niniejszej pracy przedstawiono aktualne podsumowanie zaleceń ELSO oraz zaleceń polskiej grupy eksperckiej zajmujących się leczeniem i strategią ECMO