Background: An impairment of standard echocardiographic parameters of right ventricular (RV) function is a known phenomenon in patients undergoing cardiac surgery, but its significance remains unclear.Aims: This study aimed to assess changes in RV function in patients undergoing cardiac surgery using speckle tracking and 3D echocardiography. Methods:The study population comprised 122 patients referred for cardiac surgery. Transthoracic echocardiographic (TTE) examinations were performed: before the surgery (TTE1), 1 week after surgery (TTE2), and 1 year after surgery (TTE 3). Parameters measured during these examinations included both standard and advanced indices of the RV size and function, as well as a new parameter introduced by our team -RV shortening fraction (RV SF).Results: TTE1 was performed on average (standard deviation [SD]) 24 (15) hours before surgery, whereas TTE2 and TTE3 were performed on average 7.2 (3) days and 346 (75) days after the surgery, respectively. A postoperative impairment of parameters of RV longitudinal function was observed (P <0.001). However, neither the RV size assessed by both 2D and 3D techniques changed, nor the global RV function measured with the use of fractional area change and ejection fraction. Additionally, during the postoperative period, an increase in the value of an RV SF by 12.9% was observed. After 12 months we observed an improvement in the parameters of the longitudinal RV function.Conclusions: Uncomplicated cardiac surgery causes transient impairment of the longitudinal systolic RV function, with no influence on the global RV function. The preservation of global function results from increased RV SF. After 12 months, an improvement of the longitudinal function can be observed.

Cardiac lipomas are extremely rare tumors, they usually remain asymptomatic and are detected incidentally, mostly during autopsies. In symptomatic patients, the diagnosis can easily be made by echocardiography, computed tomography, or magnetic resonance imaging. We report a case of pericardial lipoma found unexpectedly during coronary artery bypass grafting (CABG) surgery. The patient underwent a successful resection of the tumor and CABG via a median sternotomy. The patient is currently asymptomatic and has not presented with evidence of recurrence at the 12-month follow-up.

Since the advent of percutaneous coronary intervention there have been increasing numbers of patients with so-called 'full metal jacket' coronary arteries disease. This is creating a challenging problem for the cardiac surgeon. A 73 year-old woman after the implantation of two metal stents to the left anterior descending artery (LAD) and four to the right coronary artery (RCA), with ejection fraction of 28%, significant mitral and tricuspid insufficiency, and high systolic pulmonary pressure, was admitted to our department with unstable angina and with symptoms of pulmonary oedema. Coronary angiogram revealed restenosis in all stents. She agreed to a coronary artery bypass graft (CABG) with mitral and tricuspid valve reconstruction. The RCA was opened just above the postero-lateral branch. Due to lack of space, the metal stent was removed and saphenous bypass graft performed.Six months later, control angiography showed a properly working LITA-LAD graft; the stents in the RCA had been occluded above anasthomosis and the venous graft to RCA had been stenosed. Percutaneous cardiac intervention was performed and the metal stent was implanted with good early effect. After a further six months, coronarography revealed in stent stenosis in the place of venous anasthomosis. The patient was qualified for conservative treatment. Long term results after such procedures are hard to predict;we believe patients should be qualified earlier for CABG and that doctors should avoid implanting too many stents into one artery.

The paper presents a case report of a patient with a superior vena cava occlusion and post-operational (after the implantation of the aortic valve) atrioventricular block, which required constant stimulation. An epicardial VVI pacemaker was implanted through mini-sternotomy in the lower part of the previous operation field with very satisfactory stimulation parameters. Implantation of a screw-in epicardial lead is in some cases the method of choice, which provides efficient and constant heart stimulation.

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