Erzsébet Paulovich

Acute Type A Aortic Dissection Complicated by Aortic Stent Graft Collapse

A 57-year-old man complaining of chest pain presented with signs of lower limb ischemia 1 year after implantation of a stent graft at the aortoiliac bifurcation. A computed tomography scan revealed the presence of a type A aortic dissection and complete collapse of the stent graft by bulging of the false lumen. The patient underwent emergency surgical reconstruction of the aortic root and arch, which allowed reexpansion of the previously collapsed stent graft. Stenting of residual stenoses distal to the stent graft and of an occluded left renal artery was also successful.

A levoszimendán perioperatív alkalmazása a szívsebészetben. Magyar ajánlás

Low output syndrome significantly increases morbidity and mortality of cardiac surgery and lengthens the durations of intensive care unit and hospital stays. Its treatment by catecholamines can lead to undesirable systemic and cardiac complications. Levosimendan is a calcium sensitiser and adenosine triphosphate (ATP)-sensitive potassium channel (IK,ATP) opener agent. Due to these effects, it improves myocardium performance, does not influence adversely the balance between O2 supply and demand, and possesses cardioprotective and organ protective properties as well. Based on the scientific literature and experts opinions, a European recommendation was published on the perioperative use of levosimendan in cardiac surgery in 2015. Along this line, and also taking into consideration cardiac surgeon, anaesthesiologist and cardiologist representatives of the seven Hungarian heart centres and the children heart centre, the Hungarian recommendation has been formulated that is based on two pillars: literature evidence and Hungarian expert opinions. The reviewed fields are: coronary and valvular surgery, assist device implantation, heart transplantation both in adult and pediatric cardiologic practice. Orv Hetil. 2018; 159(22): 870-877.Low output syndrome significantly increases morbidity and mortality of cardiac surgery and lengthens the durations of intensive care unit and hospital stays. Its treatment by catecholamines can lead to undesirable systemic and cardiac complications. Levosimendan is a calcium sensitiser and adenosine triphosphate (ATP)-sensitive potassium channel (IK,ATP) opener agent. Due to these effects, it improves myocardium performance, does not influence adversely the balance between O2 supply and demand, and possesses cardioprotective and organ protective properties as well. Based on the scientific literature and experts opinions, a European recommendation was published on the perioperative use of levosimendan in cardiac surgery in 2015. Along this line, and also taking into consideration cardiac surgeon, anaesthesiologist and cardiologist representatives of the seven Hungarian heart centres and the children heart centre, the Hungarian recommendation has been formulated that is based on two pillars: literature evidence and Hungarian expert opinions. The reviewed fields are: coronary and valvular surgery, assist device implantation, heart transplantation both in adult and pediatric cardiologic practice. Orv Hetil. 2018; 159(22): 870-877.

Migration of an epicardial pacemaker into the abdominal cavity

Migration of a permanent pacemaker generator from their intramuscular pocket to the abdominal cavity is a less frequent, but potentially life-threatening complication. The authors present the case of a 69-year-old woman, who visited the emergency department of the clinic, with complains of non-specific abdominal symptoms. Her past medical history included a complete atrioventricular block diagnosed in 2009 during the mitral valve replacement and since then she had an epicardial permanent pacemaker; the pulse generator was placed into an intramuscular pouch created in the left subcostal region. Surprisingly, radiologic examinations showed that the generator migrated into the pouch of Douglas. Considering patient safety, first a new intracardiac pacemaker was implanted and then the migrated device was removed surgically. The patient was discharged on the seventh postoperative day.Az epicardialis pacemakerek ritka, de akár életet veszélyeztető szövődménye a generátortelepnek a subcostalisan kialakított zsebből a hasüregbe történő elvándorlása. A szerzők 69 éves nőbetegük esetét ismertetik, aki aspecifi kus hasi panaszokkal jelentkezett a klinika sürgősségi osztályán. Anamnéziséből kiemelendő, hogy korábbi mitralisműbillentyű-műtétét követően kialakult III. fokú atrioventricularis blokkja miatt epigastrialis pacemakert helyeztek be úgy, hogy a pacemakergenerátort a subcostalisan kialakított intramuscularis zsebben helyezték el. Mellkasátvilágítás igazolta, hogy a telep – eredeti helyétől messzire – a Douglas-üregbe vándorolt. A szokatlan helyre és távolságra vándorolt készüléket hasi feltárásból távolították el, közvetlenül azt követően, hogy új endocardialis pacemakerrendszer került beültetésre. A beteg szövődménymentesen, a 7. posztoperatív napot követően otthonába távozott. Orv. Hetil., 2015, 156(4), 154–157.

Migration of an epicardial pacemaker into the pouch of Douglas. Case report

Migration of a permanent pacemaker generator from their intramuscular pocket to the abdominal cavity is a less frequent, but potentially life-threatening complication. The authors present the case of a 69-year-old woman, who visited the emergency department of the clinic, with complains of non-specific abdominal symptoms. Her past medical history included a complete atrioventricular block diagnosed in 2009 during the mitral valve replacement and since then she had an epicardial permanent pacemaker; the pulse generator was placed into an intramuscular pouch created in the left subcostal region. Surprisingly, radiologic examinations showed that the generator migrated into the pouch of Douglas. Considering patient safety, first a new intracardiac pacemaker was implanted and then the migrated device was removed surgically. The patient was discharged on the seventh postoperative day.Az epicardialis pacemakerek ritka, de akár életet veszélyeztető szövődménye a generátortelepnek a subcostalisan kialakított zsebből a hasüregbe történő elvándorlása. A szerzők 69 éves nőbetegük esetét ismertetik, aki aspecifi kus hasi panaszokkal jelentkezett a klinika sürgősségi osztályán. Anamnéziséből kiemelendő, hogy korábbi mitralisműbillentyű-műtétét követően kialakult III. fokú atrioventricularis blokkja miatt epigastrialis pacemakert helyeztek be úgy, hogy a pacemakergenerátort a subcostalisan kialakított intramuscularis zsebben helyezték el. Mellkasátvilágítás igazolta, hogy a telep – eredeti helyétől messzire – a Douglas-üregbe vándorolt. A szokatlan helyre és távolságra vándorolt készüléket hasi feltárásból távolították el, közvetlenül azt követően, hogy új endocardialis pacemakerrendszer került beültetésre. A beteg szövődménymentesen, a 7. posztoperatív napot követően otthonába távozott. Orv. Hetil., 2015, 156(4), 154–157.

Hasüregbe vándorolt epicardialis pacemaker@@@Migration of an epicardial pacemaker into the pouch of Douglas. Case report

Migration of a permanent pacemaker generator from their intramuscular pocket to the abdominal cavity is a less frequent, but potentially life-threatening complication. The authors present the case of a 69-year-old woman, who visited the emergency department of the clinic, with complains of non-specific abdominal symptoms. Her past medical history included a complete atrioventricular block diagnosed in 2009 during the mitral valve replacement and since then she had an epicardial permanent pacemaker; the pulse generator was placed into an intramuscular pouch created in the left subcostal region. Surprisingly, radiologic examinations showed that the generator migrated into the pouch of Douglas. Considering patient safety, first a new intracardiac pacemaker was implanted and then the migrated device was removed surgically. The patient was discharged on the seventh postoperative day.Az epicardialis pacemakerek ritka, de akár életet veszélyeztető szövődménye a generátortelepnek a subcostalisan kialakított zsebből a hasüregbe történő elvándorlása. A szerzők 69 éves nőbetegük esetét ismertetik, aki aspecifi kus hasi panaszokkal jelentkezett a klinika sürgősségi osztályán. Anamnéziséből kiemelendő, hogy korábbi mitralisműbillentyű-műtétét követően kialakult III. fokú atrioventricularis blokkja miatt epigastrialis pacemakert helyeztek be úgy, hogy a pacemakergenerátort a subcostalisan kialakított intramuscularis zsebben helyezték el. Mellkasátvilágítás igazolta, hogy a telep – eredeti helyétől messzire – a Douglas-üregbe vándorolt. A szokatlan helyre és távolságra vándorolt készüléket hasi feltárásból távolították el, közvetlenül azt követően, hogy új endocardialis pacemakerrendszer került beültetésre. A beteg szövődménymentesen, a 7. posztoperatív napot követően otthonába távozott. Orv. Hetil., 2015, 156(4), 154–157.

[Mechanical circulatory support saves lives -- three years' experience of the newly established assist device program at Semmelweis University, Budapest, Hungary].

INTRODUCTIONnSince the celebration of the 20th anniversary of the first heart transplantation in Hungary in 2012 the emerging need for modern heart failure management via mechanical circulatory support has evolved. In May 2012 the opening of a new heart failure and transplant unit with 9 beds together with the procurement of necessary devices at Semmelweis University accomplished this need.nnnAIMnThe aim of the authors was to report their initial experience obtained in this new cardiac assist device program.nnnMETHODnSince May, 2012, mechanical circulatory support system was applied in 89 cases in 72 patients. Indication for support were end stage heart failure refractory to medical treatment and acute left or right heart failure.nnnRESULTSnTreatment was initiated for acute graft failure after heart transplantation in 27 cases, for end stage heart failure in 24 cases, for acute myocardial infarction in 21 cases, for acute postcardiotomy heart failure in 14 cases, for severe respiratory insufficiency in 2 cases and for drug intoxication in one case. Among the 30 survivor of the whole program 13 patients were successfully transplanted.nnnCONCLUSIONSnThe available devices can cover all modalities of current bridge therapy from short term support through medium support to heart transplantation or long term support and destination therapy. These conditions made possible the successful start of a new cardiac assist device program.

A mechanikus keringéstámogatás életet ment – a műszívprogram első három évének tapasztalata a Semmelweis Egyetemen@@@Mechanical circulatory support saves lives – three years’ experience of the newly established assist device program at Semmelweis University

INTRODUCTIONnSince the celebration of the 20th anniversary of the first heart transplantation in Hungary in 2012 the emerging need for modern heart failure management via mechanical circulatory support has evolved. In May 2012 the opening of a new heart failure and transplant unit with 9 beds together with the procurement of necessary devices at Semmelweis University accomplished this need.nnnAIMnThe aim of the authors was to report their initial experience obtained in this new cardiac assist device program.nnnMETHODnSince May, 2012, mechanical circulatory support system was applied in 89 cases in 72 patients. Indication for support were end stage heart failure refractory to medical treatment and acute left or right heart failure.nnnRESULTSnTreatment was initiated for acute graft failure after heart transplantation in 27 cases, for end stage heart failure in 24 cases, for acute myocardial infarction in 21 cases, for acute postcardiotomy heart failure in 14 cases, for severe respiratory insufficiency in 2 cases and for drug intoxication in one case. Among the 30 survivor of the whole program 13 patients were successfully transplanted.nnnCONCLUSIONSnThe available devices can cover all modalities of current bridge therapy from short term support through medium support to heart transplantation or long term support and destination therapy. These conditions made possible the successful start of a new cardiac assist device program.

A mechanikus keringéstámogatás életet ment-A muszívprogram elso három évének tapasztalata a Semmelweis Egyetemen

INTRODUCTIONnSince the celebration of the 20th anniversary of the first heart transplantation in Hungary in 2012 the emerging need for modern heart failure management via mechanical circulatory support has evolved. In May 2012 the opening of a new heart failure and transplant unit with 9 beds together with the procurement of necessary devices at Semmelweis University accomplished this need.nnnAIMnThe aim of the authors was to report their initial experience obtained in this new cardiac assist device program.nnnMETHODnSince May, 2012, mechanical circulatory support system was applied in 89 cases in 72 patients. Indication for support were end stage heart failure refractory to medical treatment and acute left or right heart failure.nnnRESULTSnTreatment was initiated for acute graft failure after heart transplantation in 27 cases, for end stage heart failure in 24 cases, for acute myocardial infarction in 21 cases, for acute postcardiotomy heart failure in 14 cases, for severe respiratory insufficiency in 2 cases and for drug intoxication in one case. Among the 30 survivor of the whole program 13 patients were successfully transplanted.nnnCONCLUSIONSnThe available devices can cover all modalities of current bridge therapy from short term support through medium support to heart transplantation or long term support and destination therapy. These conditions made possible the successful start of a new cardiac assist device program.

Mechanical circulatory support saves lives – three years’ experience of the newly established assist device program at Semmelweis University

INTRODUCTIONnSince the celebration of the 20th anniversary of the first heart transplantation in Hungary in 2012 the emerging need for modern heart failure management via mechanical circulatory support has evolved. In May 2012 the opening of a new heart failure and transplant unit with 9 beds together with the procurement of necessary devices at Semmelweis University accomplished this need.nnnAIMnThe aim of the authors was to report their initial experience obtained in this new cardiac assist device program.nnnMETHODnSince May, 2012, mechanical circulatory support system was applied in 89 cases in 72 patients. Indication for support were end stage heart failure refractory to medical treatment and acute left or right heart failure.nnnRESULTSnTreatment was initiated for acute graft failure after heart transplantation in 27 cases, for end stage heart failure in 24 cases, for acute myocardial infarction in 21 cases, for acute postcardiotomy heart failure in 14 cases, for severe respiratory insufficiency in 2 cases and for drug intoxication in one case. Among the 30 survivor of the whole program 13 patients were successfully transplanted.nnnCONCLUSIONSnThe available devices can cover all modalities of current bridge therapy from short term support through medium support to heart transplantation or long term support and destination therapy. These conditions made possible the successful start of a new cardiac assist device program.

Pericardialis tamponáddal, ST-szakasz-elevációval szövődött akut „A” típusú aortadissectio sikeresen operált esetének ismertetése@@@Successful treatment of an acute type A aortic dissection presented with ST segment elevation on ECG and pericardial tamponade. Case report

Az akut „A” tipusu aortadissectio sikeres kezelesenek kulcsa a gyors diagnosztika es a kesedelem nelkuli műtet. A gyors diagnozis felallitasat szamos szovődmeny (myocardialis ischaemia, akut aortainsufficientia, szervperfuzios zavarok, pericardialis tamponad) es az azokhoz kapcsolodo, a klinikai kepet olykor uralo tunetek nehezithetik. A szerzők egy 72 eves nőbeteg kortortenetet ismertetik, aki ujraelesztes utan kerult intezetukbe ST-elevacios myocardialis infarctus EKG-jeleivel. A kateterasztalon keszitett echokardiografias vizsgalat akut „A” tipusu dissectiot es pericardialis tamponadot igazolt. Akut műtet soran aortaascendens-reszekcio, gyokrekonstrukcio tortent. A beteg korhazba erkezesetől a műtet vegeig 6 ora telt el. A kontrollvizsgalat jo balkamra-funkcio mellett kompetens aortabillentyűt mutatott. A beteg jelenleg jo altalanos allapotban, panaszmentesen, a rehabilitacios kezeles utan, otthonaban tartozkodik. A szerzők feltetelezik, hogy a diagnosztikus es terapias lehetősegek fejlődesevel a jovőb...Successful treatment of type A acute aortic dissection depends on the promptness of diagnostic evaluation and therapy. Fast diagnosis can be challenged by numerous complications such as myocardial ischemia, acute aortic insufficiency, and disturbances in organ perfusion and pericardial tamponade. The authors report the case history of a 72-year-old woman, who was admitted after resuscitation with ST segment elevation. Echocardiography revealed acute type A aortic dissection with signs of pericardial tamponade. An emergency operation consisting of the resection of the ascending aorta and the reconstruction of the aortic root was performed, which took six hours from admission until the end of the operation. Follow-up examinations demonstrated good left ventricular function and competent aortic valve. The authors propose that with the development of diagnostic and therapeutic options, faster and less invasive interventions will be introduced in near future for the treatment of acute aortic dissection, which may reduce the morbidity and mortality rates of this lethal illness.