Background: Tricuspid valve lesions due to blunt chest trauma are rare. Tricuspid regurgitation and clinical signs may develop after some time, and in order to avoid overlooking the diagnosis, ...specially in cases of polytrauma, an appropriate diagnostic protocol is needed. Methods: Retrospectively we analysed our 11 years' experience. Frequency of injury, time from injury to diagnosis, time from diagnosis to surgery, diagnostic procedure, type of surgery and treatment results were taken into account. Results: From 3 November 1999 to 15 May 2011, 9229 open-heart surgeries were done at our institution. In 14 cases (0.15 %), not counting endocarditis, isolated tricuspid procedures were performed. There were 6 injuries, 2 penetrating and 4 blunt (0.43 %). Two 36-year old men were operated on 4 months and 11 years, respectively, after a car accident, a 48-year old man 31 years after being hit by a heavy object, and a 16- year old girl 2 months after a horse kick to her chest. In the first three cases, the diagnosis was established 4 days, 26 years and 11 years respectively after the injury, and in the last case immediately after the event. In all cases diagnosis was confirmed by ultrasound. In three patients, the valve was replaced with mechanical prosthesis, while in the last one it was repaired. In the last three cases the result was good. Considering a low probability of heart injuries in the blunt chest trauma (10 %) and 1 % reported tricuspid lesions in cases of such heart injuries, among 3564 patients with blunt chest trauma recorded at our center in the same period, 3-4 cases of tricuspid injury would be expected. Only 2 of our operated on patients had an accident in the analysed period. Conclusion: Our data support the fact that an injury of the tricuspid valve due to blunt chest trauma is rare and easily overlooked. Therefore, ultrasound of the heart should be done in all cases of blunt chest trauma. If negative, it should be repeated. Transoesophageal approach is more reliable than the transthoracic one. The gold standard for therapy is a valve repair, which should be done early enough to prevent further morbidity and mortality.
Summary
Early postoperative prosthetic valve endocarditis due to
Stenotrophomonas maltophilia
was diagnosed in seven patients (two men) aged from 68 to 84 years (mean age 78.1 years) over a ...three-year period. All patients had undergone aortic valve replacement.
S. maltophilia
was isolated from at least two blood cultures per patient. Four patients experienced CNS embolic complications. Three patients died. All patients were treated with ceftazidime, one in combination with amikacin, one with ciprofloxacin and one with levofloxacin. Because a common source of infection in the operating theater was suspected, 24 environmental samples were taken, of which two contained
S. maltophilia
. Six of the seven clinical isolates from the patients and two isolates from the environment were analyzed using molecular typing by pulsed-field gel electrophoresis (PFGE). The patients' isolates were resistant to gentamicin, ciprofloxacin, trimethoprim/sulfamethoxazole and, except in one case, to amikacin and piperacillin/tazobactam and susceptible to ceftazidime and levofloxacin. In contrast, the environmental isolates were resistant to ceftazidime, showed intermediate susceptibility to ciprofloxacin, and were susceptible to trimethoprim/sulfamethoxazole. PFGE demonstrated indistinguishable or closely related (1–3 band difference) PFGE patterns in isolates from the patients, but a different pattern in the environmental isolates. No common source of infection was found despite intensive investigation. Extensive cleaning and other measures of infection control were carried out and no new cases were recorded in the two year follow-up period.
Mechanical aortic valve dysfunction is a very rare event and is usually due to thrombosis, pannus overgrowth, or both. BioGlue as a cause for such a complication has been reported only occasionally. ...We describe a case of a 63-year-old woman who underwent operation for symptomatic tight aortic stenosis. After implantation of an aortic valve (AGN-751, size 19; St. Jude Medical, St. Paul, MN, USA) because of a transverse tear of the aortic wall above the annulus occurring during the suturing of the aortotomy, a triangular Vascutek Dacron patch (Vascutek/Terumo, Inchinnan, Scotland, UK) was included. To secure hemostasis, BioGlue (CryoLife, Kennesaw, GA, USA) was applied. A transthoracic echocardiography (TTE) examination performed after signs of ischemia appeared in the electrocardiogram on postoperative day 5 revealed an aortic transvalvular gradient of 74/38 mm Hg and a functional valve area of 1.0 cm2. No coronary lesions were revealed in a coronarography evaluation, but cinefluoroscopy (CF) examination revealed immobility of 1 valve leaflet. The reoperation revealed a thick, rough layer of the glue on the inner side of the patch. This glue had run down to the valve, blocking a mechanical leaflet. Cleaning the valve was not possible, and the valve had to be changed. The subsequent postoperative course was uneventful. The transvalvular gradient was 39/20 mm Hg, and the functional valve area was 1.2 cm2. We believe that the use of BioGlue and other surgical sealants is justified to secure complex suture lines and for maintaining hemostasis in cardiac surgery, but some precautionary rules must be respected. Authors have indicated that the glue enters through the needle holes in such cases, but our findings suggest it can also pass to the Dacron patch itself. CF is superior to TTE and transesophageal echocardiography for analyzing movement of the mechanical valve leaflet, and cardiac catheterization is rarely needed.
The aim of this retrospective analysis was to investigate VDD mode survival, development of atrial tachyarrhythmias (AT), and long-term atrial sensing performance of VDD pacing systems.
We implanted ...single-lead VDD pacemakers in patients with isolated atrioventricular block and performed a retrospective analysis of 307 patients who had their devices implanted between May 1994 and September 2001. In 39 patients (12.7%), the pacing mode had to be reprogrammed to a single-chamber ventricular pacing mode, mostly due to permanent AT. In 16 of these patients, the atrial sensing safety margin was less than 150%. The atrial sensing safety margin was insufficient, i.e. less than 100% in only seven patients. Although only 12 (3.9%) of the patients had a history of paroxysmal AT at the time of pacemaker implantation, 200 (65%) patients presented with AT during follow-up. The mean AT burden at the last follow-up was 2.5%.
These data illustrate that single-lead VDD pacemakers can be applied without serious complications in a highly selected group of patients. Our main concern is the development of AT in a large part of our population. Over a 10-year period, two thirds of our patients presented with AT.
Background: Adequate detection and treatment of acute allograft rejection is one of the most important predictors of post-transplant survival of cardiac transplant recipients. Recently, a number of ...novel, non-invasive tools have allowed for earlier detection and better treatment of rejection episodes.Methods: Using the signal from a special pacemaker implanted during the transplant procedure, the intraventricular electrograms can be obtained. The amplitude and the conduction time of the intraventricular electrogram provide information on electrophysiological properties of ventricular myocardium. Due to edema and inflammation during acute rejection, the amplitude of the signal decreases and the conduction time is prolonged.Results: In Ljubljana Medical Center Transplantation Programme the measurement of intramyocardial electrograms has been shown to represent a reproducible and reliable methodology which led to fewer cardiac biopsy procedures and earlier and better treatment of cardiac allograft rejection.Conclusions: The analysis of intramyocardial electrograms is an important non-invasive tool which allows for better follow-up of cardiac transplant recipients and earlier detection and treatment of allograft rejection episodes.
It is now a scientifically proven fact that implantable cardioverter defibrillator (ICD) therapy is the therapy of first choice for patients at high risk of life-threatening ventricular ...tachyarrhythmias. A significant contribution to the accelerating acceptance of ICD therapy comes from the technological advances, which have reduced the morbidity and enhanced programming and diagnostics very similar to pacemaker therapy. In Medical Centre Ljubljana ICDs have been implanted since 1989, altogether 207 pieces in 153 patients. We evaluated the indications, pacing mode, ejection fraction, number of shocks and the concomitant pharmacological treatment.
Background: Permanent cardiac pacing has since the very rudimentary beginnings in 1950. evolved into an autonomous field. Miniaturization of pacemakers and electrodes paved the way toward the ...application of less invasive implantation techniques, implementation of computer technology, broadened the list of indications for implantation, increased reliability and longevity and finally, enabled followup and reprogramming of pacemakers to better tailor pacing to the patients’ needs. Evidently, the electrostimulation of the heart resulted in nearly physiologic functioning of the heart greatly improving the quality of life. The aim of the following review is to present the development of electrostimulation of the heart in Ljubljana from the very beginnings in 1965 till today. We present the current state-of-the-art indications for pacemaker and cardioverter-defibrillator implantations, that have widely broadened over years, the types of pacemakers, their clasification and internationally recognized coding as well as some of possible complications after implantation.Methods and results: The first permanent pacemaker implantation in Slovenia was performed by cardiac surgeon M. Košak, cardiologist A. Jagodic and colleagues on April 16th 1965 in Ljubljana. The recipient suffered from complete atrioventricular block that clinically presented with numerous syncopes. Retrospective analysis included all the patients with re/ implanted pacemaker or cardioverter-defibrillator and accompanying electrodes. Patients’ characteristics, indications and types of the devices implanted were compared in the two representative periods: early period from 1965 –74 and recent data collected from 2001 till 2005. In Slovenia, there are 450 pacemakers and 50 cardioverter-defibrillators per million annualy performed in Maribor General Hospital and Medical Centre Ljubljana.Conclusions: The current state-of-the-art and the most recent technological advances in the field of electrostimulation of the heart, cardioversion and defibrillation enables us to better detect and cure various cardiac rhythm disturbancies including bradycardia, tachycardia and fibrillatig episodes as well as help recognizing acute allograft rejection episodes after heart transplantations. The procedures have become simple imposing lesser and lesser burden to the patients. Taking into account all the revised and ever broadening indications, recent implantation technique implementations, optimising the choice of a pacemaker device, best suited to the patient and the initial arrhythmia and securing follow-up that enables continuous improvements and reprogramming of pacing modes, the number of pacing/defibrillating devices constantly increases. The complication rate has decreased over years and is within reasonable limits nowadays. The electrostimulation of the heart has become one of the most significant achievements of modern medicine. It is widely applied, based on scientific data, however, it is largely dependent on the actual state of the public health system and its financial resources.
To evaluate the acute inflammatory response and cardiac output in children after surgery for ventricular septal defect.
Prospective, observational study in a level III multidisciplinary neonatal and ...pediatric intensive care unit.
Ten children undergoing open-heart surgery for ventricular septal defect.
All children received methylprednisolone (30 mg/kg) in cardiopulmonary bypass (CPB) prime.
Before and after cardiopulmonary bypass, plasma interleukin-10 and tumor necrosis factor alpha were measured by enzyme-linked immunosorbent assay, and lymphocyte subsets in peripheral blood by flow cytometry. Relative values (post-/pre-CPB) of interleukin-10 and tumor necrosis factor alpha were calculated. The cardiac index (CI) was measured continuously beat-to-beat by a pulse contour analysis (PiCCO). Children above the cutoff value (median cardiac index value 3.0 l min(-1) m(-2)) were designated as the normal CI group and those below this value as the low CI group. In the normal CI group the relative values of interleukin-10 remained almost seven times higher than pre-CPB values at 24 h while in the low CI group they decreased almost to pre-CPB values. Furthermore, the normal CI group, but not the low CI group, exhibited more than threefold decrease in T-lymphocytes (lymphocyte T-cells, T-helper cells, and cytotoxic T-cells) 24 h after CPB.
Children operated on for ventricular septal defect developed either a normal or low CI. The higher relative values of interleukin-10 and lower counts of lymphocyte T-cells, T-helper and cytotoxic T-cells differentiated the normal CI group from the low CI group at 24 h after cardiopulmonary bypass.
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