Jaroslav Špatenka

Myocardial iron content and mitochondrial function in human heart failure: a direct tissue analysis

Iron replacement improves clinical status in iron‐deficient patients with heart failure (HF), but the pathophysiology is poorly understood. Iron is essential not only for erythropoiesis, but also for cellular bioenergetics. The impact of myocardial iron deficiency (MID) on mitochondrial function, measured directly in the failing human heart, is unknown.

Kirschner wire migration from the right sternoclavicular joint to the heart: a case report.

Presented here is a rare case in which Kirschner wires migrated from the right sternoclavicular joint to the heart. A 29-year-old man suffering from sternoclavicular instability due to a motorcycle accident received surgical fixation with Kirschner wires. Six months after the surgery, the chest x-ray showed migration of the 3 broken wires to the anterior mediastinum and to the right hemithorax. The patient was asymptomatic and was scheduled for elective surgical extraction of the migrating wires because of the potential danger of injuring the mediastinal organs.During the surgery, the intracardiac location of all wires was discovered,and the wires were successfully extracted from the extracorporeal circulation. This rare and potentially lethal complication is discussed.

Urinary tract infections in pediatric renal transplant recipients – a two center risk factors study

Abstract:  UTI are common in renal Tx recipients and may significantly impact on the graft function. The aim of our study was to evaluate the prevalence, risk factors, and significance of UTI in Tx children. We performed a retrospective cross‐sectional study of 76 Tx patients, median age at Tx was 13.4 yr. Twenty‐one of 76 (28%) patients developed at least one UTI during the mean follow‐up time of 3.3 ± 2.0 yr post‐Tx. The first UTI occurred at a median of 160 days post‐Tx. The RR of having UTI was significantly higher in patients with the primary diagnosis of obstructive uropathy (RR = 2.6, 95th CI = 1.1–6.0, p = 0.032), history of PN pre Tx (RR = 2.7, 95th CI = 1.3–5.4, p = 0.009) and pre Tx VUR (RR = 2.2, 95th CI = 1.1–4.5, p = 0.045). These three factors also significantly decreased the infection‐free survival time to the first UTI. Most UTI caused reversible acute allograft dysfunction, but the long‐term graft function could not be reliably assessed with SCr. In conclusion, UTI occurred in 28% of pediatric Tx recipients, mostly during the first year post‐Tx despite antibiotic prophylaxis. The diagnosis of obstructive uropathy, history of UTI and VUR prior to Tx were significant risk factors.

Effect of donor/recipient body weight ratio, donor weight, recipient weight and donor age on kidney graft function in children

BACKGROUND We hypothesized that supplementing a higher mass of renal parenchyma from adult donors, and their younger age, would improve graft function in paediatric recipients. METHODS We calculated estimated glomerular filtration rate (eGFR; Schwartz formula) and absolute glomerular filtration rate (absGFR) in 57 renal-grafted children (1995-2007) aged 3.1-17.9 years, weighing 12.9-85.0 kg, on discharge from the hospital after transplantation (TPL), 1 year after TPL and at the last follow-up (1.5-11.7 years after TPL). We correlated their eGFR with the individual ratio between the donor and the recipient body weight at the time of TPL (donor/recipient body weight ratio; D/R BWR), and we evaluated the effect of the donor and the actual recipient body weight on the eGFR and absGFR. RESULTS The D/R BWR varied from 0.65 to 5.23. We found a significant positive correlation between D/R BWR and eGFR at discharge from the hospital (P < 0.001), 1-year post-TPL (P < 0.001) and at the last follow-up (P < 0.05). Using multiple linear regression analyses, we found that both eGFR and absGFR values were much more determined by the actual recipient weight than by the donor weight (27/6% and 43/4% at discharge, by 24/4% and 57/0% 1 year after TPL, and 0/0% and 20/0% at the end of the follow-up). A tendency for lower eGFR with increasing age of donors was apparent at discharge and 1 year after TPL, but it reached statistical significance only at the last follow-up (r = 0.4254, P < 0.01). CONCLUSION In paediatric renal transplants, the value of D/R BWR directly correlated with eGFR in the early and late posttransplant periods. However, this correlation was mainly influenced by the recipient weight, while the donor weight played only a minor or negligible role.

Extension of Pulmonary Adenocarcinoma into the Left Atrium

A 62-year-old man presented with pulmonary adenocarcinoma that penetrated through the pulmonary vein into the left atrium. The tumor in the left atrium was removed via a right lower lobectomy under cardiopulmonary bypass. In selected cases, radical removal of a tumor in patients without mediastinal lymph node involvement may improve the prognosis. The use of cardiopulmonary bypass extends the possibilities of radical tumor removal.

Coronéo extra-aortic annuloplasty ring could stabilize even the pulmonary autograft annulus in a Ross operation

The Ross procedure is an alternative technique to mechanical prosthesis and recent evidence suggests that it is associated with improved long-term survival and quality of life. However, late pulmonary autograft failure can occur more frequently in patients with significant dilation of the aortic annulus. Here, we present a technical modification of the Ross procedure--a case report of a patient who underwent a Ross procedure in which the gross dilation of the aortic annulus was reduced by implantation of an extra-aortic Coronéo annuloplasty ring. Before discharge, we performed a multidetector computed tomography (MDCT) to verify the effect of extra-aortic annuloplasty on the geometry of the neoaortic root and particularly on the dimension of the aortic annulus. The result of the MDCT demonstrated that the ring sits in the optimal position at the level of aortoventricular base and that aortic annulus is significantly reduced.

Malignant Wegener's granulomatosis with fibrosing mediastinitis and vena cava superior syndrome.

A 47-year-old man was admitted to hospital for migratory joint pain, fatigue, and cough with bloody sputum and proteinuria with increased serum creatinine level. Diagnosis of Wegener’s granulomatosis was established. During follow-up, the vena cava superior syndrome developed. The patient died of respiratory failure after 12 years of follow-up. The autopsy revealed rigid, whitish, 12 mm thick tissue, which embedded and compressed the large vessels upwards from their origin in the heart, thus causing vena cava superior syndrome. This tissue was composed of fibrous material without inflammatory cellulization. We consider this fibrous tissue as a manifestation of fibrosing mediastinitis that may or may not share pathogenesis with Wegener’s granulomatosis.

The composition and biomechanical properties of human cryopreserved aortas, pulmonary trunks, and aortic and pulmonary cusps

Human cryopreserved allografts of pulmonary and aortic heart valves, aortas and pulmonary trunks are used for valve replacement. However, it is unknown how the composition of these allografts relate to their mechanical properties. Our aims were to correlate the histological compositions and passive mechanical properties of aortic and pulmonary valves and to observe the microcracks of aortas and pulmonary trunks. The following parameters were quantified: ultimate stress; ultimate strain; Youngs modulus of elasticity; valve cusp wall thickness; pulmonary and aortic intima-media thickness; area fraction of elastin, collagen and calcification; and length density of elastic fibres. The propagation of experimentally induced microcracks avoided elastic fibres. Ultimate strain was negatively correlated with the area fraction of calcification (r=-0.4) in aortas. Ultimate stress (r=0.27) and Youngs modulus in small deformation (r=0.29) and in large deformation (r=0.32) correlated with wall thickness in valve cusps. Youngs modulus (r=0.34) and ultimate strain (r=0.31) correlated with intima-media thickness. Ultimate strain correlated with the area fraction of elastin (r=-0.40) and collagen in the arteries (r=0.31). As conventional histology does not fully explain the mechanical properties of cryopreserved grafts, both morphological and biomechanical tests should be used complementarily when characterizing the ageing of the grafts.

Histological Composition and Mechanical Properties of Cryopreserved Samples of Aortic and Pulmonary Valves

Human cryopreserved allografts of pulmonary and aortic valves are routinely used as total valve replacement. For successful surgery it is needed to sufficiently preserve biomechanical properties and histological structures of allografts. However, it is not known how the mechanical properties of these allografts relate to their histological composition. The aim of our study was to compare the histological composition and mechanical properties of the valves. From allografts we prepared 2 valve cusps and samples of aorta or pulmonary trunk. In a previous study we had measured following parameters: ultimate stress, ultimate strain, Young’s moduli of elasticity, intima-media thickness, wall thickness, area fraction of elastin and area fraction of collagen in the whole wall. We found weak positive correlation between ultimate stress and Young’s modulus in small and large deformation with wall thickness in the valve cusps. In the arteries we found positive correlation between Young’s modulus in large deformation with intima-media thickness and ultimate strain with intima-media thickness and area fraction of collagen, and negative correlation between ultimate strain with area fraction of elastin. In our study we quantified also the other components of wall with mechanical significance, such as the fraction of smooth muscle cells and chondroitin sulfate, which belong to glycosaminoglycans. We did not find correlation between these components and mechanical properties of these valves. Therefore, it is recommended to perform both mechanical and histological analysis to further characterize cryopreserved allografts.

Allograft Heart Valve in Aortic Valve Surgery

After 60 years of experimental and clinical development of heart valve prostheses, ideal heart valve prosthesis is not available. The chapter tries to review the history as well as the contemporary role of an aortic allograft in aortic valve surgery. It provides the basic information concerning the allograft heart valves procurement, processing, cryopreservation and thawing in general. Current view of surgical techniques of aortic allograft transplantation as well as the indication of that particular aortic valve substitute are summarised, documenting that in many cardiac surgical departments it is still considered as a method of choice for aortic valve, annulus and root infective endocarditis treatment.