Vladimir Lonsky

Comparison of functional fibrinogen assessment using thromboelastography with the standard von Clauss method.

AIM To compare assessment of fibrinogen by thromboelastography with the standard von Clauss method. METHODS Observational prospective study. RESULTS Thromboelastography provides direct and complex evaluation of the entire coagulation cascade based upon changes in blood viscosity. It affects both platelets and plasma components. New application of this method measures fibrinogen contribution to coagulation as opposed to fibrinogen antigen levels measured by immunoassay. Paired samples from 117 patients before cardiopulmonary bypass were compared. A moderate correlation was found between fibrinogen and functional fibrinogen with a Spearman correlation coefficient of 0.476. CONCLUSION The functional fibrinogen test is a valid point-of-care method for fibrinogen assay with a moderate correlation to the standard method.

Predictors of Failure Following Restrictive Annuloplasty for Chronic Ischemic Mitral Regurgitation

Abstract  Aim of the Study: We sought to determine the results of restrictive annuloplasty for chronic ischemic mitral regurgitation. Methods: Hospital outcome and serial clinical and echocardiographic (preoperative, discharge, 3 months, 12 months, 24 months) follow‐up assessments were analyzed in 87 consecutive patients with chronic ischemic mitral regurgitation having coronary artery bypass grafting. Persistent/recurrent mitral regurgitation was defined by grade ≥2 at discharge/during follow‐up. Results: Hospital mortality was 5.7% and persistence of regurgitation was present in 8.4%. Mean follow‐up was 24.4 ± 1.7 months and recurrent mitral regurgitation was observed in 32.4% patients. In multivariate analysis only anterior leaflet angle remained an independent predictive factor for regurgitation recurrence with cutoff 27° (sensitivity of 67% and specificity of 76%, p = 0.04). Conclusion: There is high occurrence of early and delayed restrictive annuloplasty failure, particularly in patients with increased anterior leaflet tethering. (J Card Surg 2012;27:6‐12)

Pericardial tamponade: a rare complication of sternal bone marrow biopsy.

Injury of the heart with concomitant pericardial tamponade as a result of sternal bone marrow biopsy is rare. An 80-year-old man was admitted with dehydration and non-specified abdominal pain to the regional hospital. Sternal aspiration biopsy was performed because of anemia and thrombocytopenia. Later on, because of the back pain, general weakness and blood pressure drop, an echocardiography examination was indicated. Pericardial fluid collection was found. Anticipated ascending aortic dissection was excluded on computed tomography scan, but pericardial fluid collection was confirmed. Transfer to our cardiac surgical facility ensued. Limited heart tamponade was affirmed on echocardiography and surgery was immediately indicated. Blood effusion was found in upper mediastinal fat tissue and 300 mL of blood were evacuated from opened pericardial space. Stab wound by sternal biopsy needle at the upper part of ascending aorta was repaired by pledgeted suture. Postoperative course was uneventful.

Aorto-left ventricular tunnel causing severe aortic regurgitation in adult man

A 30-year-old man with history of patent ductus arteriosus ligation since he was 3 years old was referred for examination. He complained of chest pain and mild dyspnoea on exertion. Physical examination revealed diastolic decrescendo murmur with maximum at left parasternal border, blood pressure was 140/50, heart rate 94 b.p.m., and there …

Pseudoaneurysm of the Ascending Aorta Following Bentall Procedure

We report the case of young man with acute aortic dissection type A treated by Bentall operation. Postoperatively the patient was febrile and echocardiography revealed fluid collection around the aortic graft. Indicated surgery revealed sterile perigraft seroma which recurred after reoperation, Corticosteroids were therefore administered. Ten months after the Bentall operation the patient was treated for pneumonia with sepsis and incidentally an asymptomatic aortic pseudoaneurysm was revealed. Successful re-Bentall operation was performed and the patient finally discharged. We presume the postoperative perigraft seroma appearance and subsequent corticosteroid administration predisposed this patient to pseudoaneurysm development, tissue glue usage was also considered.

Metal splinter ejected by circular saw into the left ventricle

We report a case of a metal splinter ejected by a circular saw tooth from a wooden board into the left ventricle of the heart. A 35-year old man was admitted second day after accident attributed to work complaining about general weakness. Only a small non-bleeding wound was found near his sternum. CT scan showed a metal wire entrapped inside his heart. Successful removal was done during surgery.

Pulmonary artery dissection: a potential pitfall of multi-detector tomography.

A 46-year-old woman was referred to our center with a diagnosis of pulmonary artery dissection, incipient pericardial tamponade, and massive left pleural effusion, which was based on non-gated multi-detector computed tomography (Figure 1) and transthoracic echocardiography, performed at a primary care hospital. Because magnetic resonance imaging and transthoracic echocardiography were not feasible due to the patient’s morbid obesity (140 kg), electrocardiogram-gated multi-detector computed tomography was carried out on account of the uncommonness of this diagnosis, prior to considering surgical exploration. This ruled out dissection of the main pulmonary artery trunk (Figure 2). Subsequently, malignant mesothelioma cells were obtained from hemorrhagic pericardial and pleural fluid, and the patient was referred for chemotherapy.

An unusual symptoms caused by huge pseudoaneurysm formation of ascending aorta

We are presenting a 33-year-old patient with huge pseudoaneurysm formation of the ascending aorta, developing after type A acute aortic dissection repair.

Current Challenges in the Treatment of Deep Sternal Wound Infection Following Cardiac Surgery

Median sternotomy due to its technical simplicity and excellent exposure of the heart, great vessels and pulmonary hila is the most common incision performed in cardiothoracic surgery worldwide [1]. Originally described by Julian more than 100 years ago and re-induced by Milton in 1957, median sternotomy replaced gradually thoracotomy or bilateral transverse sternothoracotomy (clamshell incision) for routine access to the heart [2,3]. Even though median sternotomy is still considered to be the gold standard, efforts remain ongoing to use less invasive methods such as partial sternotomy or small thoracotomy to influence the risk of wound healing complications, patient’s satisfaction and better quality of life [4].

Minimally invasive direct coronary artery bypass grafting (MIDCABG) - our experience in Olomouc, Czech Republic

Results Between 2008-2013 (June) a total of 2316 CABGs were performed at our department, out of which 149 (6,4%) were MIDCABs. The mean age of pts was 67 years (±12), male/female ratio 89/60. Indications were as follows isolated LAD stenosis 64, hybrid procedure (combination with PCI) 27, in-stent restenosis 4, palliative single vessel procedure 30, redo after previous cardiac surgery 9, different malignancy 8. Intraoperative conversion to full sternotomy 2 (1,3%), re-exploration for bleeding 2 (1,3%), 30-day mortality 2 (1,3 %).