Biomedical subjects

Jerzy Sadowski

Publications and source records attributed to Jerzy Sadowski.

63 records · Page 4Linked to original sources

PubMed2002

[Management of coexistent advanced coronary artery disease and internal carotid artery stenosis].

We discuss a case of a 60-year old man admitted to our Department with symptoms of unstable angina and stenosis of carotid artery. Coronary angiography revealed three-vessel coronary artery disease. Doppler ultrasound (USG) and multislice spiral computed tomography (MSCT) of carotid and vertebral arteries showed a high-grade stenosis of the left internal carotid artery with a poststenotic aneurysm containing thrombi. Since the risk of a simultaneous coronary artery bypass grafting (CABG) and carotid endarterectomy (CEA) was assessed as high, a two-staged procedure was performed. The CEA was performed first and one month later patient underwent CABG with a good result.

Angina, Unstable↗

PubMed2002

[Comparison of early clinical results after left ventricular aneurysmectomy using classic and modified technique].

INTRODUCTION: In our department left ventricular aneurysmectomy was performed using only classic Cooley technique until 1989. Since then a modified technique was introduced: left ventricular geometry reconstruction modo Stoney simultaneously with the excision of scarred endocardium. AIM: Comparison of early clinical results after left ventricular aneurysmectomy using classic (Group A) and modified technique (Group B). MATERIAL AND METHODS: Retrospective data analysis of early clinical outcome of patients (pts) operated from 1989 to 2000: classic technique 74 pts [63M (85.1%); 11F (14.9%); average age 52.26 +/- 10.35 years], modified technique 86 pts [74M (86%); 12F (14%); average age 55.83 +/- 9.3]. RESULTS: No statistically significant differences between groups considering number of critically stenosed coronary arteries, left ventricular ejection fraction and left ventricular diameters were observed. Mean number of bypass grafts (gr. A 1.55, gr. B 1.69); aortic crossclamping time (gr. A 48.1 (24-77) +/- 12.9; gr. B 50.9 (0-91) +/- 16.1) were not significantly different between groups. In gr. A, 11 (14.8%) pts died: low output syndrome (LOS) 3 pts, LOS and ventricular dysrhythmias (VD) 5 pts, VD 3 pts. In gr. B 4 (4.6%) pts died: LOS 3 pts; LOS and VD 1 pt. Among other complications LOS and VD occurred significantly more frequently in gr. A. In both groups average postoperative ejection fraction increased; twice higher in gr. B than A. CONCLUSIONS: Modified technique: 1. Significantly decreases incidence of ventricular dysrhythmias in comparison to classic technique. 2. Significantly lowers incidence of low output syndrome and mortality rates in comparison to classic technique.

Adult↗

PubMed2002

[False aneurysms after button-Bentall procedure].

Between January 1995 and December 2000, 222 consecutive patients underwent complete aortic root replacement in the Department of Cardiovascular Surgery of the Hertz- und Gefaess- Klinik- Bad Neustadt (Germany). At the exception of 2 cases, all patients received the modified Bentallde Bono procedure with total excision of the ascending aorta and direct reimplantation of the coronary ostia using button technique. During the follow-up period of up to 6 years in 3 patients, a periprosthetic aneurysm was diagnosed. In two patients with clinical symptoms and a fistula between the prosthetic lumen and the spurium aneurysm, a reoperation was performed. Due to the complete absence of clinical symptoms or a fistula connecting the prosthesis and the aneurysm or progress in size of the aneurysm during the follow-up period the third patient was treated conservatively. The choice of proper treatment of this complication is difficult and should be based on continuous investigation of clinical symptoms and various technical examinations.

Aneurysm, False↗

PubMed2002

[Evaluation of patency of coronary artery bypass grafts and stents using multislice spiral computed tomography in comparison with angiography].

UNLABELLED: The aim of the study was to assess usefulness of multislice spiral computed tomography--MSCT (Somatom Plus 4 Volume Zoom, Siemens) in non-invasive assessment of the potency of coronary artery bypass grafts both venous and arterial grafts as well as stents. METHODS: The study was performed using the MSCT method with Heart View Software with retrospective electrocardiographic gating. Nonionic, hypo-osmolar contract media was infused into a peripheral vein to highlight the coronary arteries and bypasses. All patients, due to clinical indications, underwent coronary and bypass angiography. MATERIAL: Two group of patients (82 persons) in total were evaluated: after aorto-coronary bypassing (Group I--57 persons, incl. 40 males and 17 females) and after stent implantation (Group II--25 persons, incl. 19 males and 6 females). The patients were referred to invasive diagnostics for recurrence and aggravation of clinical symptoms. RESULTS: In group I, the patency of 187 bypasses was evaluated (21 arterial and 166 venous). In MSCT, was found in 131 of the bypasses patency (114 venous and 4 arterial). 56 bypasses, (52 venous and 4 arterial) were obstructed. In the bypassography performed were obstructed 53 (5 venous and 3 arterial), 134 bypasses were patent (116 venous and 18 arterial). In the bypass patency assessment using MSCT compared to coronarography, specificity of 94.7% and sensitivity of 92.4% were achieved. In group II, patency was evaluated in 26 stents: 21 implanted to native vessels and 5 in venous bypasses. 19 stents in native vessels were found patent, whereas 2 were obstructed. In the coronary bypasses performed, patency was confirmed in 19 stents and 2 were obstructed. In MST obstruction was demonstrated in 4 stents in coronary bypasses, which was confirmed in bypassography. One stent was assessed patient in both methods. CONCLUSION: The MSCT method is useful for assessment of patency of venous and arterial bypasses as well as stents.

Adult↗

PubMed2002

[Usefulness of magnetic resonance imaging in diagnosis of mitral valve anulus abscess--case report].

Magnetic resonance imaging (MRI) is a non-invasive method characterised by high temporal and spacial resolution that makes it possible to obtain very high-quality pictures. It is a less invasive method than TEE and is very significant in the diagnosis of heart tumours. MRI makes it possible to assess the parameters influencing hemodynamic as well as morphological qualities of the tumour such a its size, its movement, its relation to the surrounding structures and the presence of a capsule. With the use of additional programming, it is possible to evaluate, indirectly, the metabolism of the diagnosed lesion as well as the degree of blood perfusion. Thus, MRI diagnosis of the heart is a valuable complementary technique in the verification of the diagnosis and in the referral to cardiosurgical treatment. The aim of this paper is to present the use of MRI in the diagnosis of an abscess of the mitral valve anulus in a female patient who did not agree to the transoesophageal echocardiography (TEE). In this case, the usefulness of MRI to establish the diagnosis of the anular abscess of the mitral valve was proved. The final diagnosis was confirmed during the operation.

Abscess↗

PubMed2002

[Implants with aortic valve homografts in patients with critical left aortic stenosis].

This case study presents two patients with aortic stenosis and infective endocarditis (IE) who underwent homograft aortic valve replacement. The first patient is a 67 year old practicing surgeon. Twenty one years ago, he was admitted to our department for critical aortic stenosis, infective endocarditis (IE) and heart failure. He underwent homograft aortic valve replacement. After the surgery his condition improved dramatically and he returned to his practice. Current echocardiographic study shows normal function of the left ventricle and normal gradient across homograft aortic valve. The next case, a 33-year old happy mother of 5 children, is particularly interesting. When she was 15 years old, she was referred to surgery, diagnosed with bicuspid aortic valve stenosis, subaortic muscular stenosis and aneurysm of aortic sinus of Valsalva. She underwent homograft aortic valve and root replacement and excision of the sub-aortic muscle bulge. Eleven months later, she required another operation due to active IE. The St. Jude Medical aortic valve was implanted. Two months after the surgery a dysfunction of the implanted artificial valve was diagnosed. She again underwent the homograft aortic valve and root replacement with good long-term results. In the period spanning 1987-1997, she managed to deliver five babies without any complications whatsoever. Seventeen years later, the homograft aortic valve is still functioning fairly well. The homograft aortic valve replacement may be regarded as a viable option for patients with aortic stenosis and IE and for young women suffering from aortic valve disease who intend to be prospective mothers.

Adult↗

PubMed2002

Coronary microcirculation and reperfusion failure. Do we know what diagnostic tools we have?

Almost one in five patient has reperfusion abnormalities despite the type of percutaneous interventional procedure after acute myocardial infarction. It has been shown with myocardial contrast echocardiographic and coronary angiographic studies that infarct related artery patency does not always correlate with the presence of adequate myocardial perfusion in the infarct related artery territory. Therefore, it is necessary to obtain further diagnostic and evaluation tools to assess coronary microcirculation and reperfusion failure. ST segment resolution time, TIMI flow grade, TIMI Frame Count and TIMI Myocardial Perfusion Grade (blush score) are helpful tools to assess myocardial perfusion and diagnosis of reperfusion abnormalities.

Humans↗

PubMed2002

[Surgical treatment of Valsalva sinus aneurysms and fistulas].

INTRODUCTION: Valsalva sinus aneurysms and fistulas (ASV; FSV) are rare aortic pathologies and present in only a few percent of patients with aorta and/or left arterial orifice disease. Etiology of ASV and FVS is congenital and acquired. MATERIALS AND METHODS: 40 patients (pts) were operated on in the Department of Cardiovascular Surgery and Transplantology from 1978 to 2002 due to pathology of Valsalva sinus (< 1% of all operations in ECC). 18 pts were diagnosed with Valsalva sinus aneurysm and 22 with its fistula. Inflammatory etiology was confirmed in 22 pts (5%). Most common pathology was localized in the right and/or coronary lacking Valsalva sinus (30 pts-75%). FSV penetrated into the right atrium or ventricle in 20 pts (91%). Among accompanying pathologies aortic valve insufficiency was most frequently found. In 80% of pts with ASV aortic allografts were implanted. In 70% of pts with FSV, fistula was sutured with interrupted pledgeted mattress sutures. Accompanying anomalies were corrected simultaneously. Mechanical aortic valve was implanted in 9 pts. RESULTS: 2 pts died in the early post-operative period and 3 in the follow up. Reoperation (with good results) was performed in 4 pts. At discharge all pts were in NYHA I/II except 1 pt in NYHA III. Objective estimation of patient's cardiopulmonary sufficiency did not differ from the subjective one. 24 pts performed normal life activities after operation. The echocardiography confirmed effectiveness of surgical treatment. CONCLUSION: 1. ASV and FSV require different surgical techniques. 2. Surgical treatment efficiently reduced symptoms. 3. Allografts were found very useful. 4. Accompanied anomalies should be treated simultaneously.

Activities of Daily Living↗

PubMed2002

[Complete obliteration of false lumen in thoracic aorta after surgical treatment of acute type De Bakey I aortic dissection--a case report].

A case of a 62 year old male with acute type De Bakey I aortic dissection is presented. The ascending aorta, aortic valve and total aortic arch replacement were performed. Additionally the proximal descending aorta was replaced using elephant trunk technique, to close the entrance of the dissection. There was no patent false lumen in distal descending aorta in postoperative findings.

Acute Disease↗