Peripheral tissue oxygenation during standard CPB and miniaturized CPB (direct oxymetric tissue perfusion monitoring study).

Aim: The aim of this study was to compare the impact of standard cardiopulmonary bypass (CPB) with mini CPB on peripheral tissue perfusion.

Methods: 24 patients with ischemic heart disease scheduled for CPB were randomised to two groups: Group A (12 patients, standard CPB) and Group B (12 patients, mini CPB). Oxygen tension was measured with an optical multiparametric sensor inserted into the patient's deltoid muscle.

Direct oxymetric peripheral tissue perfusion monitoring during open heart surgery with the use of cardiopulmonary bypass: preliminary experience.

Background: Regional hypoperfusion has been associated with the development of postoperative organ dysfunction in cardiac surgery involving cardiopulmonary bypass (CPB). Direct tissue oxymetry is a potentially new method for monitoring the quality of the peripheral tissue perfusion during CPB. The aim of this study was to assess the effects of CPB in skeletal muscle oxygenation when measured in the deltoid muscle by direct oxymetry during perioperative period.

No clear clinical benefit of using mini-invasive extracorporeal circulation in coronary artery bypass grafting in low-risk patients.

Background: Current research is engaged in innovative technologies of extracorporeal circulation (ECC) systems in an effort to eliminate negative effects. Some studies have shown that, due to the complexity of technical settings of mini-ECC, they invoke a weaker immune response compared to classic ECC. The clinical benefits of using these systems have not been clearly proven yet.

[The effect of preoperative administration of heparin on the heparin resistance development].

Background: Heparin resistance is relatively frequent problem in cardio surgery. We were try to determine real occurrence heparin resistance before operation.

Aim Of The Study: Purpose of the project--to find the real frequency of heparin resistance in patients who will undergo a cardio surgical operation.

[Results of open valvotomy in congenital stenosis of the aortic valve].

Between 1977 and 1992 at the Cardiosurgical Clinic of the Faculty Hospital in Hradec Králové on account of congenital valvular aortic stenosis 142 patients were subjected to catheterization. Valvotomy of a stenotic aortic valve was performed in 69 patients. The submitted paper evaluates the progression of aortic stenosis based on investigations of the aortic gradient and the area of the aortic orifice in repeatedly catheterized patients before and after valvotomy and evaluates also the results of surgery after a 1-15-year interval after surgery.

[Surgery in mitral stenosis].

Commissurotomy of a stenotic mitral valve on the closed heart was the beginning of the cardiosurgery. It helped hundreds of thousands of patients. At present in mitral stenosis surgery with extracorporeal circulation is recommended.

[Valve replacement in congenital aortic stenosis].

Background: Hemodynamically significant congenital aortic stenosis is usually surgically solved by valvotomy, infrequently aortic valve replacement is necessary. The aim of this retrospective study (period 1979-1995) is to find reasons for valve replacement, frequency of these procedures and early and long term results after aortic valve replacement for congenital aortic stenosis.

Methods And Results: Congenital aortic stenosis was solved by aortic valvotomy in 82 patients and by aortic valve replacement in 18 patients.

Contribution to technique of endarterectomy of the right coronary artery.

We present our technique of performing endarterectomy of coronary arteries by means of injecting cardioplegic solution into the plane of dissection of the endarterium. This simple and gentle technique in combination with manual endarterectomy helps in separation of the core far into the periphery of the diseased vessel and thus helps to perform revascularization in patients with diffuse atherosclerotic changes. During the last 6 years (1991-1996) endarterectomy in coronary revascularization was used in 116 cases (it was 5.

[Results of pericardiectomy in the treatment of constrictive pericarditis].

Between 1981 and 1990 at the Cardiosurgical Clinic in Hradec Králové pericardectomy on account of chronic constrictive pericarditis was performed in 20 patients. The authors evaluated the duration of complaints, preoperative symptomatology, surgical procedure and results of the operation. Symptoms of right-sided cardiac congestion were recorded in 80% of the patients.

[Results of surgical treatment of aortic coarctation].

The authors summarize the results of surgical treatment of coarctation of the aorta in 98 patients. Te group comprised 70 children aged 3 to 15 years and 28 adults. The most frequently used technique was resection of the coarctation with a direct end-to-end anastomosis.

[Successful treatment of the superior vena cava syndrome caused by thrombosis and a fibrous septum in a patient with a permanent cardiac pacemaker].

A patient with a ten-year permanent implantation of a pacemaker was admitted on account of a clinically serious syndrome of the vena cava superior. The cause of the syndrome was an angiographically confirmed extensive thrombosis and after its dissolution a fibrous septum in the area of the orifice of the vena cava superior into the right atrium. The septum caused by a fibrous strip at the orifice of the vena cava superior into the right atrium was removed by surgical operation during thoracotomy by dilatation of the original opening in the fibrous septum by a Broca dilator and digitally.

[Serum levels of oxacillin and cephalothin in patients with extracorporeal circulation during surgery].

The authors investigated the oxacillin and cephalotine serum levels in patients operated under conditions of extracorporeal circulation. They found that the time for which the patients are adequately protected against staphylococcal infection is in oxacillin cca 180 mins. and in cephalotine 150 mins.

[Mediastinal inflammation as a complication of heart surgery under extracorporeal circulation].

The authors describe mediastinitis in two patients operated on account of ischaemic heart disease. In both patients they used the closed approach which involved suture of the sternum and surgical wound, perfect drainage and the administration of antibiotics (general and local). They describe the applied method of fixation of the sternum.

[Malignant tumors of the heart from the viewpoint of the surgeon].

The authors present three cases of malignant affections of the heart. In two instances a primary haemangiosarcoma was involved which originated in the right atrium, in the third patient a secondary of a left ovarian carcinoma was involved. They draw attention to the similar symptomatology of the disease and the possibility of echocardiographic visualization of intracardiac formations.

[Paravalvular fistulae in implanted heart valves].

The paper reviews causes and treatment of paravalvular fistulae of artificial valves, and demonstrates author's properly managed cases.