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Biomedical subjects

Jerzy Sadowski

Publications and source records attributed to Jerzy Sadowski.

At least 19 recordsLinked to original sources
PubMed2006

Lipoma of the aortic valve in a patient with acute myocardial infarction.

We hereby report the first--to the best of our knowledge--case of primary lipoma of the aortic valve. The tumor has been diagnosed by echocardiography supported by magnetic resonance imaging in a 63-year-old man with acute inferior ST-elevation myocardial infarction (STEMI) and one-vessel coronary artery disease. Five weeks from the onset of STEMI, direct implantation of a bare metal stent into the right coronary artery was successfully undertaken and 6 weeks later aortic valve with an encapsulated mass was excised with subsequent artificial valve implantation. Histological examination revealed typical features of lipoma. Three months after the operation the patient was asymptomatic and exhibited a good function of the artificial valve.

Aortic Valve↗
PubMed2006

[Acute aortic dissection in a 34 year old pregnant woman--a case report].

A case of a 34 year old pregnant woman at 38 weeks gestation, who was admitted to the hospital with acute chest pain, is presented. Electrocardiogram showed ST segment changes suggestive of acute myocardial infarction. Echocardiography, however, revealed acute aortic dissection. The patient was transferred to another hospital where caesarean section followed by cardiac surgery were successfully performed. A subsequent one-year follow-up period was uneventful, both for mother and child. Diagnosis and treatment of acute aortic dissection during pregnancy are discussed.

Acute Disease↗
PubMed2006

Atrial septal defect in adults: the influence of age and haemodynamic parameters on the results of surgical repair.

INTRODUCTION: Indications for closure of atrial septal defect (ASD) are well established in children but still unclear in adult patients. There is also a discrepancy regarding the natural history of the defect and benefits of ASD closure and long-term prognosis. AIM: The aim of the study was to evaluate the outcome of surgical closure of atrial septal defect (ASD) with respect to age and selected haemodynamic parameters. METHODS: The study involved 52 patients with ASD, aged 38.6+/-15 years. All patients had a clinical examination, echocardiography, Holter ECG monitoring and cardiopulmonary exercise test (CPX) prior to and at least one year after the surgery. The results were analysed for the entire group of patients and then for the following subgroups of pts.: aged <40 and ł40 years; with right ventricular systolic blood pressure (RVSP) < or =30 and >30 mmHg; and with shunt volume ratio (Qp/Qs) <2.5 and > or =2.5. RESULTS: After repair of ASD, a significant improvement of the clinical status, as defined by NYHA class, was observed. At the same time, a constant or even increased incidence of arrhythmias was found. Repair of the defect resulted in a significant reduction of the right ventricular diameters in all studied subgroups. Among all evaluated parameters, only age at time of the operation was significantly associated with right ventricular diameter after surgery (b=0.598; p <0.001). Exercise capacity was found to have significantly increased after surgery, regardless of age, RVSP and Qp/Qs, but it remained significantly reduced in patients with pulmonary arterial hypertension compared to subjects with normal RVSP before ASD repair. A significant correlation was shown between peak oxygen consumption and RVSP both before (r=-0.68; p <0.001) and after (r=-0.38; p=0.01) surgery. CONCLUSIONS: Patients benefit from surgical closure of ASD regardless of age and previous RVSP and Qp/Qs. Age at the time of surgery and pulmonary arterial pressure determine long-term results and improvement of echocardiographic and ETT parameters.

Adult↗
PubMed2006

[Significant aortic stenosis with a low pressure gradient and depressed left ventricular function. A case report].

A 48-year-old man, not diagnosed before, hardly physically working before admission, was admitted to cardiological ward at a regional hospital in bad condition, with severe heart failure symptoms. Massive calcification of the bicuspidal aortic valve was found during the echocardiography examination. Mean systolic aortic gradient was 32 mmHg. Left ventricular ejection fraction was reduced to 20%. The patient was treated with diuretics, digitalis, dobutamine and dopamine infusion but his condition was getting worse. On the 10th day of hospitalisation, he was transferred to cardio-surgical ward and aortic valve was replaced. On the 15th day following operation the patient came back to the regional hospital in good condition. The echocardiography examination revealed an increase in systolic ejection fraction of the left ventricle up to 48% in one month and to 55% in six months after surgery.

Aortic Valve↗
PubMed2006

[Alcohol ablation of the interventricular septum in a patient with hypertrophic obstructive cardiomyopathy complicated by an increase in the pressure gradient in the left ventricular outflow tract. A case report].

A case of a 70 year old female with hypertrophic obstructive cardiomyopathy who underwent alcohol ablation of the interventricular septum, is presented. Following the procedure, the pressure gradient decreased from 120 mmHg to 80 mmHg. However, 30 minutes after ablation the patients developed hypotension and pulmonary oedema. Echocardiography revealed a significant systolic anterior movement of the anterior leaflet of the mitral valve and elevated pressure gradient up to 200 mmHg. The patient underwent urgent surgery (myectomy), followed by the mitral valve replacement with a favourable outcome.

Aged↗
PubMed2005

Coronary artery superoxide production and nox isoform expression in human coronary artery disease.

BACKGROUND: Oxidative stress plays important role in the pathogenesis of atherosclerosis and coronary artery disease (CAD). We aimed to determine the sources and selected molecular mechanisms of oxidative stress in CAD. METHODS AND RESULTS: We examined basal and NAD(P)H oxidase-mediated superoxide (O2*-) production using lucigenin chemiluminescence, ferricytochrome c and dihydroethidium fluorescence in human coronary arteries from 19 CAD and 17 non-CAD patients undergoing heart transplantation. NAD(P)H oxidase subunits and xanthine oxidase expression were measured. Superoxide production was greater in coronary arteries from patients with CAD, even in vessels without overt atherosclerotic plaques, and was doubled within branching points of coronary arteries. Studies using pharmacological inhibitors and specific substrates showed that NAD(P)H oxidases (60%) and xanthine oxidase (25%) are primary sources of O2*- in CAD. Losartan significantly inhibited superoxide production in coronary arteries. NAD(P)H oxidase activity and protein levels of the NADPH oxidase subunits p22phox, p67phox, and p47phox were significantly increased in CAD, as were mRNA levels for p22phox and nox2, and no NAD(P)H oxidase subunit mRNA levels correlated with NAD(P)H oxidase activity in vessels from individual patients. Activity and protein expression of xanthine oxidase were increased in CAD, whereas xanthine dehydrogenase levels were not changed. CONCLUSIONS: Increased expression and activity of NAD(P)H oxidase subunits and xanthine oxidase, in part mediated through angiotensin II and PKC-dependent pathways, are important mechanisms underlying increased oxidative stress in human coronary artery disease.

Adult↗
PubMed2005

Continuous aortic flow augmentation: a pilot study of hemodynamic and renal responses to a novel percutaneous intervention in decompensated heart failure.

BACKGROUND: Diminished aortic flow may induce adverse downstream vascular and renal signals. Investigations in a heart failure animal model have shown that continuous aortic flow augmentation (CAFA) achieves hemodynamic improvement and ventricular unloading, which suggests a novel therapeutic approach to patients with heart failure exacerbation that is inadequately responsive to medical therapy. METHODS AND RESULTS: We studied 24 patients (12 in Europe and 12 in the United States) with heart failure exacerbation and persistent hemodynamic derangement despite intravenous diuretic and inotropic and/or vasodilator treatment. CAFA (mean+/-SD 1.34+/-0.12 L/min) was achieved through percutaneous (n=19) or surgical (n=5) insertion of the Cancion system, which consists of inflow and outflow cannulas and a magnetically levitated and driven centrifugal pump. Hemodynamic improvement was observed within 1 hour. Systemic vascular resistance decreased from 1413+/-453 to 1136+/-381 dyne.s.cm(-5) at 72 hours (P=0.0008). Pulmonary capillary wedge pressure decreased from 28.5+/-4.9 to 19.8+/-7.0 mm Hg (P<0.0001), and cardiac index (excluding augmented aortic flow) increased from 1.97+/-0.44 to 2.27+/-0.43 L.min(-1).m(-2) (P=0.0013). Serum creatinine trended downward during treatment (overall P=0.095). There were 8 complications during treatment, 7 of which were self-limited. Hemodynamics remained improved 24 hours after CAFA discontinuation. CONCLUSIONS: In patients with heart failure and persistent hemodynamic derangement despite intravenous inotropic and/or vasodilator therapy, CAFA improved hemodynamics, with a reduction in serum creatinine. CAFA represents a promising, novel mode of treatment for patients who are inadequately responsive to medical therapy. The clinical impact of the observed hemodynamic improvement is currently being explored in a prospective, randomized, controlled trial.

Adult↗
PubMed2005

Prognostic value of carotid intima-media thickness in detection of coronary atherosclerosis in patients with calcified aortic valve stenosis.

OBJECTIVE: Aortic stenosis (AS) coexists with coronary artery disease (CAD) in at least 30% of patients. Patients with concomitant CAD may benefit from simultaneous coronary bypass grafting. This study aimed to evaluate the prognostic value of carotid intima-media thickness (IMT) in patients with AS in assessing concomitant CAD. METHODS: Group I consisted of 33 patients (mean age +/- SD, 61.0 +/- 8.2 years; 18 men and 15 women) with AS but without CAD on angiograms. Group II consisted of 34 patients (64.4 +/- 8.0 years; 25 men and 9 women) with AS and CAD confirmed angiographically. A control group included 36 patients (61.2 +/- 4.9 years; 18 men and 18 women) with normal coronary arteries and no AS. Maximal IMT was assessed in all patients at the common carotid artery, bulb, and internal carotid artery and expressed as a mean value. RESULTS: There were no differences among the respective groups with regard to age, sex, frequency of hypertension, diabetes, and smoking habit, although patients with CAD were more often hyperlipemic (P = .038). The IMT of the common carotid artery, bulb, and internal carotid artery was significantly higher in patients with AS and CAD compared with both the control group and patients with AS only. The multivariable regression model revealed that CAD (P < .001), AS (P = .006), male sex (P = .034), age (P < .001), and diabetes mellitus (P = .047) were independent risk factors for IMT thickening. A mean IMT value of greater than 1.2 mm was predictive (sensitivity, 73.5%; specificity, 72.7%) of concomitant CAD in patients with AS. CONCLUSIONS: Intima-media thickness increases in patients with AS. The greatest IMT values are observed in patients with both AS and CAD. Patients with AS might be suspected of having CAD when the IMT value exceeds 1.2 mm.

Aged↗
PubMed2005

[Postinfarction left ventricular pseudoaneurysm].

Left ventricular pseudoaneurysm is a rare complication of heart rupture as a result of acute myocardial infarction, tumour infiltration or infective pericarditis. This pathology is often diagnosed accidentally because of non-specific clinical manifestations such as congestive heart failure or no symptoms at all. Diagnosis of pseudoaneurysm should result in an urgent surgical treatment as the risk of sudden death due to aneurysm rupture is high. In this report we present a patient who underwent successful surgical treatment of left ventricular pseudoaneurysm as a complication of myocardial infarction.

Aneurysm, False↗
PubMed2005

[Can cardiac surgery be deferred when acute myocardial infarction is complicated by interventricular septum rupture? -- two case reports].

Although in patients with interventricular septum rupture complicating acute myocardial infarction urgent cardiac surgery is suggested as a method of choice by current ESC and ACC/AHA guidelines, mortality is high. In some patients, intra-aortic counterpulsation and optimisation of medical therapy may stabilise patients condition and increased the safety of elective cardiac surgery which can be performed a few weeks later. In this report we describe two patients with this condition who were successfully treated using a conservative approach and subsequent elective surgery.

Echocardiography↗
PubMed2005

[Causes of atrial fibrillation early after coronary artery bypass grafting].

UNLABELLED: The aim of the study was to define the frequency of atrial fibrillation early after coronary artery bypass grafting (CABG) and clinical risk factors for the development of atrial fibrillation in the post-operative course. The study population consisted of 1578 patients (1283 men and 295 women ranging in age from 25 to 85 years, mean age 59.373 +/- 8.686 years) undergoing isolated coronary artery bypass grafting in extracorporeal circulation between 1.01.1998 and 21.12.1999. The patients were divided into two groups: group 1 with atrial fibrillation after CABG (193 patients, mean age 62.399 +/- 7.097 years) and group 2 without atrial fibrillation in the postoperative course (1385 patients, mean age 58.952 +/- 9.009 years). Both groups were compared with respect to pre-, intra- and postoperative parameters. Additionally in group 1 the following aspects were taken into account: timing of atrial fibrillation and its relapses in relation to the surgical procedure, serum potassium level, type and efficacy of antiarrhythmic treatment. RESULTS: Postoperative atrial fibrillation developed in 193 patients i.e. 12.23% of the CABG population. The complication occurred most frequently on the third day after the procedure and it recurred in about 60% of the patients. Analysis of clinical pre, intra- and postoperative factors identified those affecting the occurrence of atrial fibrillation in the postoperative course as follows: age, paroxysmal atrial fibrillation occurring before the operation, previous inferior myocardial infarction, type 2 diabetes mellitus, arterial hypertension, left ventricular ejection fraction, left atrial size, volume of cardioplegia used during the procedure, volume of blood lost during the procedure, postoperative ischaemia, timing of postoperative ischaemia, perioperative withdrawal of beta adrenolytics, prolonged intubation after the procedure, low cardiac output syndrome, prolonged administration of pressor amines after CABG, and Intraaortic balloon counterpulsation, especially during the procedure. CONCLUSIONS: (1) Atrial fibrillation is an important clinical problem early after coronary artery bypass grafting. It is poorly tolerated and shows a tendency to recur. (2) Atrial fibrillation after CABG is most strongly correlated with age over 60 years, arterial hypertension and perioperative withdrawal of beta adrenolytics.

Adult↗
PubMed2004

Systemic regulation of vascular NAD(P)H oxidase activity and nox isoform expression in human arteries and veins.

OBJECTIVE: Impaired endothelial function, characterized by nitric oxide scavenging by increased superoxide production, is a hallmark of vascular disease states. However, molecular mechanisms regulating superoxide production in human blood vessels remain poorly defined. METHODS AND RESULTS: We compared endothelial function, vascular superoxide production, and the expression of NAD(P)H oxidase subunits in arteries and veins from patients undergoing coronary bypass surgery (n=86). Superoxide release was similar in arteries and veins. Inhibitor studies revealed that the NAD(P)H oxidase system was a quantitatively and proportionately greater source of superoxide in veins, whereas xanthine oxidase also contributed significantly to superoxide production in arteries. Moreover, NAD(P)H oxidase molecular composition differed in veins and arteries; veins expressed more nox2 and p22phox, whereas the relative expression of nox4 was greater in arteries. However, there were strong correlations between p22phox and nox4 expression and between superoxide production, NAD(P)H oxidase activity, and endothelial function in arteries and veins from the same patient. CONCLUSIONS: In individuals with coronary artery disease, changes in vascular superoxide production, endothelial function, and NAD(P)H oxidase activity and expression are related in veins and arteries. These findings highlight the importance of systemic effects on the molecular regulation of the NAD(P)H oxidases in human vascular disease. Endothelial dysfunction is characterized by increased superoxide production. NAD(P)H oxidase activity and endothelial function are correlated in veins and arteries in coronary artery disease, suggesting regulation by systemic factors. The expression of the NAD(P)H oxidase subunits p22phox and nox4, although different in veins and arteries, are also correlated.

Acetylcholine↗