["Debranching" -- a new surgical option for the aortic arch and thoracoabdominal aorta hybrid interventions].

Introduction: Endovascular techniques in vascular surgery are frequently applied to treat aortic diseases. These minimally invasive procedures changed aortic interventions remarkably. We have to be familiar with new terminology and methods.

[Late complications and treatment options of aortic coarctation operated in childhood].

Introduction: The prevalence of congenital aortic coarctation is 4 in 10 000 live birth. Aortic coarctation is typically located in the aortic isthmus, but it may occur at atypical sites. Treatment options include both surgical and endovascular interventions.

[Penetrating atheromatous ulcer of the thoracic aorta. Treatment options].

Introductions: Atherosclerosis is a generalized degenerative disease of arteries. A rare manifestation of that is the penetrating atheromatous aortic ulceration of the aortic wall which may be complicated by subintimal hematoma, dissection, false aneurysm and rupture (acute aortic syndrome).

Aim: The aim of the authors was to analyse their experience with this rare disease.

[Anticoagulation with hirudin for repeat cardiac surgery in a patient with heparin induced thrombocytopaenia].

Unlabelled: The authors present the case of a patient with heparin induced thrombocytopaenia who needed anticoagulation during the perioperative period of a third repeat cardiac operation without transfusions. Prostacyclin pretreatment was contraindicated because of critical aortic stenosis, heparinoids could not have been used due to necessity of postoperative anticoagulation. Recombinant hirudin was applied and its effect was monitored with ekarin coagulation time.

[Our experience with recombinant activated factor VII (NovoSeven) in the high risk cardiosurgical patients with bleeding complication].

Haemorrhagic complications significantly increase mortality and cost of treatment in cardiac surgery. A few years ago recombinant activated factor VII has been introduced to decrease such complications. In our department recombinant activated factor VII has been used in 11 patients between 2004 and 2007.

Activation of the poly(ADP-ribose) polymerase pathway in human heart failure.

Poly(ADP-ribose) polymerase (PARP) activation has been implicated in the pathogenesis of acute and chronic myocardial dysfunction and heart failure. The goal of the present study was to investigate PARP activation in human heart failure, and to correlate PARP activation with various indices of apoptosis and oxidative and nitrosative stress in healthy (donor) and failing (NYHA class III-IV) human heart tissue samples. Higher levels of oxidized protein end-products were found in failing hearts compared with donor heart samples.

Open-heart surgery and Jehovah's Witnesses.

The religious community of Jehovah's Witnesses holds that blood transfusion is against God's law. Therefore, surgical treatment of Jehovah's Witnesses is a great challenge for every surgeon, especially for cardiac surgeons because blood transfusion is frequently needed during such operations. In this study we summarize the experience with Jehovah's Witnesses who have undergone open-heart surgery in Debrecen from 1989 to 1999 due to various cardiac diseases.

Calpain-1-sensitive myofibrillar proteins of the human myocardium.

Calpain-1 is a ubiquitous intracellular Ca2+-activated protease, which has been implicated in the pathogenesis of reversible myocardial depression (i.e. myocardial stunning) that follows ischemia and reperfusion via myofibrillar protein degradation.

99mTc-MIBI SPECT assessment of the effects of aneurysm resection on the left ventricular morphology.

Objective: 99mTc-MIBI SPECT is a widely used myocardial perfusion investigation technique, but few data are available concerning its use to assess the morphological characteristics of a left ventricular aneurysm (LVA) before and after LVA resection.

Methods And Results: Pre- and postoperative rest 99mTc-MIBI SPECT images were analysed in order to characterize the features of LVAs and the changes in the 3D scintigraphic parameters after apical LVA resection in 6 patients. In the middle horizontal slice an angle was defined to quantify the apical divergence associated with the LVA.

[Two years experience with the Pericarbon stentless valve in Hungary].

Objective: In 1999 stentless heart valves were introduced for treatment of the aortic valve disease in elderly patients at the Department of Cardiac Surgery of the University of Debrecen.

Patients, Methods: Between December 1999 and November 2001 63 patients underwent aortic valve replacement with Sorin Pericarbon stentless valve. The mean gradient was 80 +/- 11 mmHg, the left ventricular wall thickness was 15.

Five-year experience with a suture annuloplasty for mitral valve repair.

We present five years' experience with mitral plication annuloplasty, performed with a semicircular buttressed suture around the posterior leaflet in 130 patients (mean age 58 +/- 11 years) with primary mitral valve disease (n = 71) or functional mitral regurgitation (n = 59). In 65 cases the mitral valve itself was also repaired. Concomitant myocardial revascularization was performed in 40 cases and aortic valve replacement in 43.

[Open-heart surgery in Jehovah's witnesses].

The religious community Jehovah's Witnesses was founded in 1870. They hold that blood transfusion is against God's law. Surgical treatment of a Jehova witness is a great challenge for every surgeon, especially for cardiac surgeons because blood transfusion is frequently needed during such operations.

[Prevention of atrial fibrillation by atrial-based pacemaker implantation].

A large number of studies have demonstrated the long term disadvantage of single lead ventricular pacing in sick sinus syndrome. Ventricular pacing mode predicts chronic atrial fibrillation in patients with preimplant paroxysmal atrial fibrillation. The goal of the report was to study the effectiveness of single atrial and dual chamber (atrio-ventricular sequential) pacemaker treatment in the prevention of atrial fibrillation for patients with sick sinus syndrome complicated with paroxysmal atrial fibrillation.

[Improvement of myocardial perfusion following left ventricular resection].

Left ventricular aneurysm had detected at the 55-year-old woman after extensive anterior myocardial infarction in association with progressive ventricular dilatation and symptoms of heart failure. Coronary angiogram revealed a serious lesion in the proximal segment of the left anterior descending coronary branch with a poor run off tract. 18FDG-PET and 99mTc-MIBI-SPECT investigation were performed in order to differentiate the scarred regions from the viable myocardial segments.

[Surgical treatment of mitral insufficiency using annuloplasty suture technic].

In 1991 a simple and cheap technique was introduced for mitral valve repair at our department. After repairing the mitral leaflets, where indicated a posterior leaflet annuloplasty was performed with a semicircular suture and the annulus fixed for the appropriate size by tying the stitch. Between July 1991 and December 1995 86 patients underwent the above procedure (average age 56.

[Alternatives to heart transplantation].

This paper is about the alternatives of curing the drug-refractory heart failure with the exception of cardiac transplantation. It includes even the newest methods mostly being in the phase of animal experiment in the meantime. The authors give a review on the different possibilities of skeletal muscle autotransplantation for cardiac support, such as cardiomyoplasty which has already been done in Hungary too, externally powered mechanical devices for long-term support, molecular and cellular cardiomyoplasty.

Morphological damage to the central nervous system (CNS) following open heart surgery.

We investigated 40 patients who had died following open heart surgery between January 1990 and May 1992. Between this time, 703 open heart procedures were carried out at the University Medical School of Debrecen, 2nd Department of Surgery's Cardiac Surgery Unit with a mortality rate of 8.3%.

[Unstable angina pectoris associated with surgically treated coronary artery atresia].

A case report of a rare, presumably congenital form of "single coronary artery", is presented. The authors review the classification and clinical significance of the entity with special emphasis with regard to anginal symptoms and the so called sudden unexpected death syndrome. Details and result of surgical intervention (conventional aorto-coronary saphenous bypass) are discussed.

Granulated sugar treatment of severe mediastinitis after open-heart surgery.

Fifteen cases of mediastinitis developing after 1,164 open-heart operations (incidence 1.3%) were analyzed. Closed mediastinal irrigation was used as primary therapy in ten cases and led to complete healing in five.

[Topical treatment using granulated sugar in advanced mediastinitis following open heart surgery].

The complications caused by infection were examined prospectively in the case of 1164 patients who had undergone open heart operation. Postoperative mediastinitis occurred in 15 cases (1.3%).

[Direct revascularization of the myocardium using the internal mammary artery].

The best graft in coronary bypass operations is the internal mammary artery (IMA) as its rate of staying open for long term is better than that of the vena saphena magna. The authors present the operative and postoperative results of their first 161 patients who were subjected to IMA grafting. 126 were men and 35 women of the patients and the average age was 50.

Valve surgery combined with myocardial revascularisation. Report of 62 cases.

Combined valvular and coronary bypass surgery was performed in 1984-1988 in 62 patients. Their age range at operation was 38-75 (mean 59) years and more than 90% were in NYHA class III or IV. Valve replacement was performed in 55 cases--mitral in 13, aortic in 33, tricuspid in one and combined valve procedures in eight cases--and valvular correction in seven cases.

Successful surgical repair of a congenital subvalvular left ventricular aneurysm.

Subannular left ventricular aneurysms are rare in white persons. Six white patients have been reported in the literature who underwent surgical repair because of subaortic left ventricular aneurysm. The authors report on a further case, a 41 year-old woman who was operated on at their clinic.