Possible extracardiac predictors of aortic dissection in Marfan syndrome.

Background: According to previous studies, aortic diameter alone seems to be insufficient to predict the event of aortic dissection in Marfan syndrome (MFS). Determining the optimal schedule for preventive aortic root replacement (ARR) aortic growth rate is of importance, as well as family history, however, none of them appear to be decisive. Thus, the aim of this study was to search for potential predictors of aortic dissection in MFS.

The role of transforming growth factor-beta in Marfan syndrome.

The starting point, in Marfan syndrome (MFS) appears to be the mutation of fibrillin-1 gene whose deconstructed protein product cannot bind transforming growth factor beta (TGF-b), leading to an increased TGF-b tissue level. The aim of this review is to review the already known features of the cellular signal transduction downstream to TGF-b and its impact on the tissue homeostasis of microfibrils, and elastic fibers. We also investigate current data on the extracellular regulation of TGF-b level including mechanotransduction and the feedback cycles of integrin-dependent and independent activation of the latent TGF-b complex.

Management of ascending aortic aneurysm and valvular incompetence with external remodeling.

Aneurysmatic dilatation of the sinotubular junction may result in aortic valvular incompetence even if the leaflets remain structurally intact. Traditionally, such situations are managed by open techniques of both the ascending aorta and the aortic valve. We present a case of aortic regurgitation, due to a 50-mm diameter ascending aortic aneurysm, which was corrected by sinotubular remodeling and wall-reinforcement without the usage of cardio-pulmonary bypass.

Evidence of nitric oxide produced by the internal mammary artery graft in venous drainage of the recipient coronary artery.

Background: The endothelium of the internal mammary artery produces nitric oxide in greater quantity than other vessels employed in revascularization of the ischemic myocardium. The aim of this study was to measure the concentration of stable metabolite (nitrite) of the endothelium-derived nitric oxide in the venous drainage (anterior interventricular vein) of the recipient coronary artery, which was the left anterior descending branch. The sampling was carried out before and after anastomosis completion.

[Analysis of the stable metabolite of endothelium-derived nitric oxide of internal mammary artery bypass grafts at the venous drainage system of the recipient coronary artery. Morphologic implications and consequences].

Introduction: The internal mammary artery's endothelium continuously produces nitric oxide in a large quantity resulting in local and downstream vasodilatation, inhibition of platelet aggregation and in the tunica media prevents smooth muscle cell proliferation.

Objective: The aim of this study was to measure the concentration of the internal mammary artery bypass graft's endothelium derived nitric oxide's stable metabolite, (nitrite) at the venous drainage site (great cardiac vein) of the recipient coronary artery (left anterior descending), and to prove that the change of the biochemical milieu provides morphological stability (vasodilation and lack of atherosclerosis) in the recipient coronary artery based on recoronarographies.

Method: Authors investigated the levels of endothelium derived nitric oxide in intraoperative settings of 50 off pump, partly heparinized coronary bypass surgery cases sampling from the internal mammary free cut end flow (81.

Quantitative measurement of endothelium derived nitric oxide production of the internal mammary artery bypass graft during extracorporeal circulation.

Objective: This study was undertaken to determine the extent of endothelium derived nitric oxide (EDNO) production of the internal mammary artery (IMA) bypass graft and of the native coronary circulation by measuring its stable metabolite (NO2: nitrite) in different sampling sites: internal mammary free cut end flow, in the coronary sinus prior and after anastomosis completion, and to compare them to the nitrite level of the normal plasma.

Methods: Nitrite level was determined with fluoroscopy using 4 hydroxycoumarin nitrozation in 50 consecutive patient undergoing onpump myocardial revascularization.

Results: Nitrite levels in the normal plasma were found to be 31.

[Alteration of nitric oxide production during arterial myocardial revascularization using extracorporeal circulation. Quantitative measurement of EDNO production by the internal mammary artery bypass graft].

Authors measured the concentration of stable metabolite (NO2: nitrite) of EDNO (endothelium derived nitric oxide) in the internal mammary artery (IMA) bypass graft with the help of a previously reported method (measurement of effective blood flow capacity of the IMA graft in the coronary sinus). Nitrite level in the systemic circulation prior to extracorporeal circulation (ECC)--(68.1 +/- 6.

[Clinical experience with surgical management of atrial myxoma].

Clinical data (symptoms, diagnostic tools, surgical and histological findings, postoperative course and present status) of 26 patients with cardiac myxomas were reviewed. All myxomas were of left atrial localization. The diagnosis was confirmed by cardiac catheterization and angiography (until late seventies) and echocardiography.

Urgent coronary artery revascularization with different arteries.

Authors present the case report of a young man with advanced coronary artery disease of the left main trunk, and the large tributaries of the left coronary system, leading to sudden onset of many ventricular fibrillation, associated with unconsciousness requiring several reanimation. The condition was treated with coronary artery surgery with the use of three different arterial conduits (right radial artery, right gastroepiploic artery as free grafts and the left internal mammary artery in situ) with an additional saphenous vein bypass graft. Details of surgical activity as well as the documents of the early postoperative course and of the 1 month follow-up are described.

[Emergency coronary revascularization using various arteries].

Authors present the case report of a young man with advanced coronary artery disease of the left main trunk and the big branches of the left coronary system leading to sudden onset of many ventricular fibrillations associated with unconsciousness requiring several reanimations. The condition was treated with coronary artery surgery with the usage of three different arterial conduits (right radial artery, right gastroepiploic artery as free grafts and the left internal mammary artery in situ) with an additional saphenous vein bypass graft. Details of surgical procedures as well as the documents of the early postoperative course and of the 1 month follow up are given.

[Incidence of perioperative myocardial necrosis in the course of coronary bypass surgery].

Authors report an analysis of 101 patients' perioperative data in the view of myocardial necrosis development. Perioperative myocardial infarction is defined as simultaneous detection of new Q wave, and myocardial specific enzyme release with concomitant, transient pump failure. They conclude by the data of patients operated upon, that the quoted criteria were detected simultaneously in 9 patients.

Coronary artery bypass surgery on the beating heart.

Authors report their experiences with coronary artery bypass surgery without cardiopulmonary bypass. Between January 1993 and June 1995, 151 patients were operated upon by the same surgeon for ischaemic heart disease (IHD); 7 were of them without extracorporeal circulation (ECC). Patients were selected for the procedure on the following criteria: (1) symptomatic patient with proximally occluded, anteriorly located, major subepicardial artery(ies) unsuitable for, or after failed, PTCA; (2) presence of associated disease (like hypertension, diabetes mellitus, chronic obstructive pulmonary disease) enhancing a possible deleterious effect of cardiopulmonary bypass; (3) favourable response to beta-blocking agent pretreatment without side effects.

Stable myocardial performance at clamped aorta based solely on the internal mammary artery graft flow: a functional test.

Authors report their experiences with arterial revascularization of the heart using the internal mammary artery (IMA). A method of intraoperative measurement of the free cut end and the effective graft flow of the IMA after meticulous anatomical dissection is described. Free cut end IMA flow was measured both at systemic and extracorporeal pump perfusion pressure and was found as 145+/-26 ml/min and 135+/-16 ml, respectively.

[Simultaneous surgery for trivalvular and ischemic heart disease as well as calcification of the ascending aorta].

Authors present a case report about the surgical management of trivalvular and ischemic heart disease. The strategy of surgery: venous, arterial revascularisation, valve replacements, valvular plasty is discussed in conjunction with the management of the calcified ascending aorta. The details of the procedure and data of the early follow up period (6 months) are presented.

[Surgical treatment of ischemic heart disease and unstable angina pectoris caused by intramyocardial descending coronary artery in a young patient].

Authors present a case report about the surgical management of a genetically predisposed ischemic heart disease occurred in young age with rare anatomical variation causing unstable angina pectoris. Besides the description the type of surgery, emphasis is made on the importance of whole scale cardiological investigations and--as in the described case--on the role of nearly ideal cooperation between the cardiologist and heart surgeon, which finally could prevent a larger size of myocardial infarction to occur.

[Arterial revascularization of the heart and intraoperative balloon angioplasty].

Authors report a combined method currently introduced in their practice in surgical treatment of ischemic heart disease. Besides the solely arterial revascularisation of the heart, successful intraoperative balloon dilatation of the recipient LAD stenosis was carried out. Main steps of the method's history, indication and the required tools are described.

[Coronary revascularization in post-infarction patients].

Authors report the type of revascularization, the result of noninvasive and invasive investigations carried out 6-9 months after surgery, improvement of functional status of 56 postinfarction patients with recurrent angina pectoris. They conclude, that recoronarography performed in 12 patients revealed diminished patency rate compared to the estimated predictive one, especially in those, where complete revascularization was considered to have been carried out. Ejection fraction, wall motion score by ventriculography and echocardiography did not seem to improve significantly.

Coronary artery revascularization after myocardial infarction.

Authors report on the revascularization resulted by noninvasive and invasive interferences carried out 6-9 months after surgery and on the improvement of functional status of 56 postinfarction patients with recurrent angina pectoris. They conclude that recoronarography performed in 12 patients revealed diminished patency rate as compared to the estimated rate, especially in those cases, where complete revascularization was considered to have been carried out. Ejection fraction, wall motion score by ventriculography and echocardiography did not seem to improve significantly.

[Surgical management of aneurysm of the ascending aorta associated with aortic valve insufficiency].

Out of 318 aortic valve replacements performed between July 1, 1984 and June 30, 1989, aneurysm of the ascending aorta was found in 17 cases. In 7 of these cases employment of conduit was required due to the dimension of the aneurysm. In 5 cases they performed Bentall procedure: aortic valve replacement combined with conduit of the ascending aorta with the replantation of the coronaries.

Endocavital cooling in intraoperative myocardial protection during extracorporeal circulation.

The possible protective effect of endocavital cooling with a balloon left ventricular vent was studied by post cross clamp time rhythm, ECG, DC shock need, dynamics of temperature changes in the interventricular septum, and positive inotropic support requirement in 60 extracorporeal operations (18 aortic valve replacement, 26 aortocoronary bypass and 16 combined procedures) performed by the same team of surgeons with an identical technique and anaesthetic protocol. The results were compared to the data of 60 similar procedures carried out earlier by the same team but without the balloon technique. We conclude that endocavital cooling may have certain additive effects to chemical cardioplegia, especially in cases with left ventricular hypertrophy, multiple coronary stenoses, and in combined procedures.