Right atrial diverticulum in an adult patient

Right atrial diverticula are rare clinical findings and thus this possibility is usually omitted in the differential diagnosis of right atrial pathologies. Only 105 cases of right atrial anomalies were reported in medical journals in years 1955-1998, of which only 13 cases referred to a single diverticulum of the right atrium. The presented case is a 65-year-old patient with a right atrial diverticulum whose presence was confirmed intra-operatively.     

Causes of redo procedures in patients with an implantable cardioverter-defibrillator--long-term follow-up results

BACKGROUND: Implantation of a cardioverter-defibrillator (ICD) is a well-established method to prevent sudden cardiac death (SCD). Due to the expanding indications for this type of treatment and increasing survival of these patients, the ICD population is growing rapidly. AIM: To assess the rate and causes of reoperations in patients with ICD over a long-term (at least 4 years) follow-up period. METHODS: Between 1995 and 2006, an ICD was implanted in 598 patients. This study included all patients with a follow-up duration of at least 4 years and only those who underwent a repeat procedure later than 6 weeks after the index ICD implantation. RESULTS: The study group consisted of 174 patients with a mean age of 51+/-18 years who were followed for a mean of 6+/-1.7 years. Coronary artery disease (CAD) was diagnosed in 92 (53%) patients, and non-ischaemic cardiomyopathy in 82 (47%) patients. Prophylactic ICD therapy was instituted in 11 (6%) patients, whereas 163 (94%) patients received ICD for secondary prophylactics. During the follow-up period, 10 deaths occurred: 6 of all deaths (60%) in patients with CAD and 4 of all deaths (40%) in the non--ischaemic group. A total of 211 redo procedures in 139 patients were performed. Indications for repeat procedures included battery depletion in 136 patients, ICD malfunction in 37 cases, infection related to the implanted system in 5 patients, problems with leads in 19 cases, an upgrade to the dual-chamber system in 5 or to the biventricular system in 3 patients, and the revision of an ICD pocket in 6 patients. CONCLUSIONS: Repeat procedures in ICD recipients are frequent. The most common cause is battery depletion and ICD replacement indicated by a manufacturer. Improvement in ICD technology is essential to increase ICD longevity and decrease the redo-procedure rates. Patients with ICD should be regularly followed in experienced centres in order to detect ICD system failure early.     

Wide QRS complex tachycardia in a patient after inferior myocardial infarction and CABG -- the role of electrophysiological study and RF ablation

We present a case of 53-year-old patient who experienced paroxysms of wide QRS complex tachycardia at a rate of 150 bpm and LBBB morphology 6 years after inferior myocardial infarction and CABG. Anamnesis and morphology of tachycardia could suggest ventricular tachycardia. However during electrophysiological study we observed AVRT with LBBB and "regularly irregular" AVRT with normal QRS complex and changing entrance to the AV node (through slow and fast pathway). In this paper we present our approach and try to explain why the tachycardia using concealed bypass tract appeared so late in life.     

Remodeling of human transplanted myocardium in ten-year follow-up: a clinical pathology study

Remodeling taking place in transplanted myocardium leads to a change in the number of cardiocytes. Ultrasound measurements and biopsy evaluation should reflect their loss and compensation. We sought to evaluate the morphology of the transplanted heart upon long-term follow-up. MATERIAL AND METHODS: Myocardial biopsies were obtained in the first week, first month, and then annually for 10 years from transplantation that did not show rejection (grade "0" ISHLT, 122 biopsies). The control group encompassed 7 donor heart fragments. Proliferation in biopsies was evaluated with Ki67 (M7240, DAKO), cardiocyte hypertrophy by measuring their diameter, the surface area of the nuclei, nuclear-sarcoplasmic index, and stromal fibrosis evaluated as the surface area fraction. Ultrasound measurements included diastolic thickness of the interventricular septum, posterior wall of the left ventricle, and left ventricular mass. The correlation of measurements with time from transplantation was evaluated using Spearman's test. RESULTS: A positive Ki67 reaction was observed in fibroblasts and endothelial cells. The increased cardiocyte nuclear area correlated with the time elapsed since transplantation (r = 0.2; P < .05) with a simultaneous decrease in cardiocyte thickness (r = -0.3; P < .05), without changes in the nuclear-cytoplasmic index (r = 0.02; P > .05). Stromal fibrosis also increased (r = 0.1; P < .05). Ultrasound measurements of the left ventricle showed a decreased tendency with the passage of time (r = -0.2 to -0.3; P < .05). CONCLUSION: A transplanted heart does not undergo hypertrophy but rather fibrous atrophy with apparent compensatory hypertrophy of the cardiomyocytes.     

Use of sildenafil in heart transplant recipients with pulmonary hypertension may prevent right heart failure

PURPOSE: We performed a short-term outcome analysis of orthotopic heart transplantation (OHT) in patients with pulmonary hypertension (PH) treated perioperatively with oral sildenafil. METHODS: PH (pulmonary vascular resistance > 2.5 Wood units, and/or transpulmonary gradient > 12 mmHg) was diagnosed in 6 of 25 (group A) heart transplant recipients operated in 2006. This group of patients underwent a modified medication protocol including perioperative administration of oral sildenafil: 50 mg before followed by 50 or 25 mg TID after heart transplantation. Sildenafil treatment was discontinued 10 to 14 days post OHT, after stepwise dose reduction. During the ICU stay all patients underwent circulatory monitoring of pulmonary and systemic pressures and resistance as well as transthoracic echocardiogram (TTE) evaluation. RESULTS: Perioperative oral sildenafil administration in PH patients undergoing OHT was associated with good short-term outcomes in the majority of transplanted patients (4/6). Sildenafil treatment reduced pulmonary resistance and pressures with a low rate of hemodynamic instability among OHT patients. CONCLUSIONS: Pharmacologic perioperative reduction of PH improves the short-term prognosis for successful OHT. One may speculate whether sildenafil treatment transplant recipients with PH would be associated with long-term improvement of pulmonary vascular status, therefore leading to extended life-expectancy and improved outcomes.     

Pivotal Karyometric Measurements in Different Types of Cardiomyopathic Morphology: Study of Hearts Explanted From Transplant Recipients

Background

Morphometric studies based on the measurement of cardiocyte nuclei have focused on progressive hypertrophy rather than shape, which is a deciding factor for the diagnosis of hypertrophy in myocardial diseases. The aim of this research was to demonstrate how the digital morphology of cardiocyte nuclei change correlated with the type of myocardial pathology.

Materials and Methods

The study groups encompassed 7 hearts with dilated cardiomyopathy (DCM) and 8 hearts with ischemic heart disease (IHD) which were explanted. A comparative group consisting of myocardial hypertrophy was contrasted with a control group of donor heart fragments. Cardiocyte nuclei were evaluated morphometrically on histologic slides. We calculated the nuclear area, length, breadth, perimeter, roundness, elongation, fullness factors, and nuclear chromatin mean gray level. The results were subjected to discriminant analysis.

Results

All karyometric measurements analyzed by backward discriminant analysis showed only 2 powerful factors: nuclear breadth and chromatin mean gray level. The Mahalanobis distance showed the proximity of control and hypertrophy groups, whereas differences between IHD and DCM were nonsignificant.

Conclusion

The lack of karyometric differences between IHD and DCM suggested a common morphologic response for long-lasting progressive injury. The main morphologic differences were dependent on nuclear chromatin activity/stainability and nuclear breadth, suggesting darker and thinned nuclei in normal and adaptative stages and irregular brighter nuclei in cardiomyopathies.     

Awake heart valve surgery in a patient with severe pulmonary disease

Cardiac operations may be performed in a conscious, spontaneously breathing patient, but it is difficult to justify an awake technique in patients undergoing coronary artery procedures with low operative risk. We describe an elderly patient with severe chronic obstructive pulmonary disease in whom general anesthesia was contraindicated. A valve procedure was performed under thoracic epidural anesthesia alone, thus avoiding intubation and mechanical ventilation. The patient had an uneventful postoperative course and excellent recovery.     

Decreased level of recent thymic emigrants in CD4+ and CD8+T cells from CML patients

Background  

T-cell immunodeficiency is a common feature in cancer patients, which may relate to initiation and development of tumor. Based on our previous finding, to further characterize the immune status, T cell proliferative history was analyzed in CD4+ and CD8+ T cells from chronic myeloid leukemia (CML) patients.     

Synthesis, crystal structures and antibacterial activity studies of aza-derivatives of phytoalexin from cotton plant – gossypol

Using Gossypol (GOS) extracted from cotton seeds, a series of its Schiff bases (1–18) and hydrazones (19–27) have been synthesized and evaluated for their antimicrobial activities against Gram-positive bacteria, Gram-negative bacteria and yeast-like organisms. Of the 27 aza-derivatives of gossypol, 11 have been found active against the microorganisms tested, similar to gossypol. Crystal structures of the new Schiff base (compound 7) and hydrazone (compound 25) of gossypol reveal the presence of two different tautomers within two types of the aza-derivatives studied. The newly synthesized aza-derivatives of gossypol are characterized by the FT-IR, NMR and MS methods.