Miklós Vaszily

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. However, the target proteins of this degradative process in the human myocardium have not yet been identified. In order to compare the levels of Calpain-1 susceptibility within a set of human myofibrillar proteins (titin, α-fodrin, desmin, troponin T (cTnT), troponin I (cTnI) and α-actinin), crude left ventricular tissue homogenates were incubated for 0.5, 15, 30, 60 or 120 min in the presence of Calpain-1 (1 U or 5 U). Differences in the kinetics and extents of protein degradation were subsequently evaluated by using silver-stained SDS-polyacrylamide gels and Western immunoblot analyses. These assays revealed myofibrillar proteins with high (titin and α-fodrin), moderate (desmin and cTnT), or low (cTnI and α-actinin) relative Calpain-1 susceptibilities. The level of phosphorylation of cTnI did not explain its relatively low Calpain-1 susceptibility. Moreover, the molecular mass distributions of the truncated α-fodrin, desmin and cTnI fragments resulting from Ca2+-dependent autoproteolysis exhibited marked similarities with those of their Calpain-1-clipped products. These in vitro results shed light on a number of structural (titin, α-fodrin, desmin and α-actinin) and regulatory (cTnT and cTnI) proteins within the contractile apparatus as potential targets of Calpain-1. Their degradation may contribute to the development of postischemic stunning in the human myocardium. (Mol Cell Biochem 278: 1–8, 2005)

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. All but three patients were followed up (97.6%). Postoperative echocardiography showed acceptable mitral area (2.28 0.39 cm) and good valve competence in all cases. Inhospital mortality was 3% and late mortality 4.8%. During the follow-up period (22.8 10.9 months) 8 patients (6.6%) required mitral valve replacement because of progression of native valve disease ( n = 4), technical failure (2) or expansion of the annuloplasty suture (2). Mitral annuloplasty thus can be performed simply and with good results, using a strong, non-stretchable buttressed suture. This procedure can be an inexpensive alternative to ring implantation.

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. Granulated sugar treatment was given primarily to four patients and to five others after failure of closed mediastinal irrigation. The sugar treatment was successful in six patients with hospital stay averaging 91.6 +/- 8 days. The three other patients in this group died before discharge from hospital. During 22-month follow-up there was no recurrence of mediastinitis in the granulated sugar group, but reoperation was necessitated by sternal fistula in two of the patients with closed mediastinal irrigation. Granulated sugar treatment is effective in refractory, severe mediastinal infections.

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 Surgerys Cardiac Surgery Unit with a mortality rate of 8.3%. We studied each individuals clinical records, autopsy findings, and histology of defined portions of brain tissue. Clinical information used were: sex, age, clinical stage (according to New York Heart Association (NYHA) classification) at time of surgery, type of procedure performed, and duration of time of extracorporeal circulation. Autopsy records collected and studied focused on the macroscopic and microscopic alterations in the CNS. The most common morphological findings in the CNS for the 40 studies cases were, cerebral edema in all cases, reactive microgliosis and nuclear pyknosis in most cases, and in a minority of the cases focal microscopic hemorrhage or focal microscopic white emolition. Also found were, destructive brain hemorrhage and global cerebral necrosis. Of the 40 cases studied there was only one case in which brain death was diagnosed perioperatively, and which was clinically diagnosed to be caused by global cerebral hypoxia.

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. In patients undergoing surgical or endovascular intervention late complications such as recoarctation or aortic aneurysm may develop. AIM The aim of the authors was to analyse their own experience in late complication and treatment options of aortic coarctation operated in childhood. METHOD Retrospective analysis of data of 32 patients treated between 1980 and 2014 for late complications 8-42 years after surgical treatment of aortic coarctation. RESULTS In 28 patients aneurysm formation after isthmic patch plasty was found. Two patients had aortobronchial fistula, 2 patients showed anastomosis disruption and 2 patients had graft stenosis. During operation hybrid solution was performed in 23 patients, isthmic aorto-aortic inlay graft interposition in 5 patients, aorto-aortic bypass in 2 patients, subclavio-aortic bypass in 2 patients, graft patch plasty in one patient and ilio-renal bypass in one patient. Complications included severe intraoperative bleeding in one patient and pneumothorax in one patient. No early or late mortality occurred. CONCLUSIONS The authors conclude that life long control is mandatory in order to detect late complications in patients who underwent operation of aortic coarctation in childhood.

Giant Pulmonary Aneurysm Associated With Pulmonary Valve Agenesia

A 54-year-old man came to our outpatient department because of ventricular extrasystole. On the basis of chest radiograph (Figure 1A), situs inversus had been diagnosed previously. This possibility was ruled out by fluoroscopy, which showed an intensely pulsating, newborn-head–sized, sharp-edged mass on the right side next to the heart, which was identified by transthoracic echocardiography as a huge, dilated (80 …

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. Hirudin anticoagulation was continued until the proper INR was reached in the postoperative period. There were no intra- and postoperative complications detected, and there was no need for transfusion either. On his long-term follow-up, 6.5 years after the last cardiac surgery the patients was feeling well and had no complaints. CONCLUSION Open heart operation of a patient with heparin induced thrombocythopenia can be performed safely by total anticoagulation with lepirudin if it is conducted by ecarin clotting time.

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. METHOD In the department of the authors 10,212 patients underwent surgery for cardiovascular diseases. Among these, 18 patients were diagnosed with penetrating atheromatous aortic ulceration located in the thoracic aorta (ascending aorta 2, aortic arch 8, descending aorta 6 and thoracoabdominal aorta 2 patients). Severe comorbidities were present in the majority of patients. RESULTS Depending on the localisation the authors used various treatment options such as open surgery (4 patients), hybrid techniques (7 patients) and pure endografting (7 patients). One patient died on postoperative day 3. Two patients had late complications due to endoleaks treated successfully by open surgery. CONCLUSIONS The authors conclude that when this dangerous condition detected in time, a wide variety of open, hybrid and endovascular methods can be applied with good results.

Hirudinnal végzett alvadásgátlás heparin kiváltotta thrombocytopeniában harmadik szívműtét soránr

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. Hirudin anticoagulation was continued until the proper INR was reached in the postoperative period. There were no intra- and postoperative complications detected, and there was no need for transfusion either. On his long-term follow-up, 6.5 years after the last cardiac surgery the patients was feeling well and had no complaints. CONCLUSION Open heart operation of a patient with heparin induced thrombocythopenia can be performed safely by total anticoagulation with lepirudin if it is conducted by ecarin clotting 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. Nine of them underwent a combined (simultaneous CABG and valve replacement) high risk surgery with long aortic cross clamp time and long extracorporeal circulation time. One patient underwent a repeat coronary artery bypass operation and one was operated for aortic dissection. The average dose given was 6.5 mg (2.4-9.6 mg). The average amount of bleeding without NovoSeven given was 5440 ml, however it was only 987 ml when NovoSeven was used. Nine of the patients were completely recovered and discharged from hospital, but two of them died in the postoperative period for delayed use of the recombinant factor VII-a and for severe co-morbidities (bowel ischaemia, cirrhosis of the liver). NovoSeven given in the proper time and dose significantly reduces bleeding following cardiac surgery, even if it cannot be stopped surgically. Using recombinant factor VIIa can save life in case of severe non-surgical diffuse bleeding or in case of suture insufficiency caused by friable soft tissues following high risk combined surgery with extremely long aortic cross clamp time and extracorporeal circulation time. Significant delay in the use of NovoSeven should be avoided because the temporary reduction of bleeding usually does not change fatal outcome.