The aim of this study was to test the hypothesis that human thymus maintains its function as the site of early T cell development throughout life, but to a progressively diminishing extent. Mononuclear cell suspensions prepared from the samples of 39 human thymuses were analysed for the total number of cells per gram of thymus tissue, percentage of single marker-positive CD2, CD4 and CD8 cells, percentages of double-positive CD4CD8 and CD2CD8 cells, double-negative CD4CD8 cells, absolute numbers of these cells per gram of tissue, and extent of the in vitro proliferation upon stimulation with concanavalin A (Con A), phytohaemagglutinin (PHA) and pokeweed mitogen (PWM) mitogens. The main outcome measures were flow cytometric data on thymus lymphoid cell composition (according to CD classification), expressed as percentages and numbers of cells per gram of thymus tissue. The total number of mononuclear cells expressed per gram of thymus tissue exponentially decreased with age. The slope of none of the analysed cell subpopulations differed from the slope of the line constructed for age-related decline of the total number of mononuclear cells (-0.024 on a semilogarithmic scale). The thymuses of all ages contained all analysed cell subpopulations in approximately the same proportions: percentages of these cell subpopulations did not change with age, except for all CD4+ (P=0.017) and double-positive CD4+CD8+ (P=0.016) cells, which tended to decrease with age. The extent of proliferation of thymus cells upon stimulation with T and B cell mitogens was unrelated to age. We conclude that the thymus retains its function as the site of differentiation of T lymphocytes throughout life. With respect to the number of involved lymphoid cells, the function exponentially decreases with age.

Between 0.1% and 0.3% of all aortic dissections occur during pregnancy. Arterial hypertension, connective tissue disorders, and congenital cardiovascular anomalies—including bicuspid aortic valves—are well-known risk factors. The causality between pregnancy and aortic dissection is unclear, but there have been some observations that COVID-19 illness may increase the risk. This report describes a pregnant woman at 34 weeks of gestation who had a bicuspid aortic valve and experienced an acute aortic dissection while ill with COVID-19 pneumonia. Computed tomography confirmed a type A aortic dissection and bilateral patchy pulmonary opacities. Cesarean delivery was performed, followed by replacement of the aortic valve with a mechanical aortic prosthesis and reconstruction of the ascending aorta and hemiarch. The intraoperative course was uneventful, and the patient was successfully weaned from mechanical ventilation after 51 hours. COVID-19 during pregnancy seems to increase the risk for aortic dissection, although there is no evidence base for an association. Because guidelines for diagnosis and treatment in such complex cases are lacking, care from a multidisciplinary team is crucial for successful outcomes.

;11(1-2):66.SAŽETAK: Ebsteinova anomalija rijetka je prirođena srčana greška trikuspidnog zalistka i desne klijetke koja se, ovisno o anatomskoj varijanti i stupnju težine trikuspidne regurgitacije, prezentira u različitoj životnoj dobi i različitim simptomima. Ovdje smo prikazali slučajeve dvoje bolesnika u kojih je Ebsteinova anomalija otkrivena u odrasloj dobi, kada su se prezentirali simptomima srčanog zatajivanja. Ehokardiografski je u obama slučajevima verificiran apikalno pomaknut trikuspidni zalistak uz tešku regurgitaciju i znatno dilatiranu desnu stranu srca. S obzirom na to da su unatoč medikamentnoj terapiji bili simptomatski, učinjena je kirurška korekcija trikuspidnog zalistka s implantacijama bioloških proteza. U kontrolama šest mjeseci nakon zahvata, u obama slučajevima, prati se znatno poboljšanje funkcionalnoga statusa. SUMMARY:Ebstein's anomaly is a rare congenital heart defect of the tricuspid valve and the right ventricle that presents at different ages and with different symptoms, depending on the anatomical variant and the severity of the tricuspid regurgitation. We report two cases of Ebstein's anomaly discovered at an adult age when the patients presented with symptoms of heart failure. In both cases, echocardiography verified apical displacement of the tricuspid valve, severe tricuspid valve regurgitation, and significant dilatation of the right side of the heart. Since the patients remained symptomatic despite medication therapy, surgical correction of the tricuspid valve with bioprosthetic valve implantation was performed. At follow-up after 6 months, both patients showed significantly improved functional status.KLJUČNE RIJEČI: Ebsteinova anomalija, prirođene srčane greške. KEYWORDS:Ebstein's anomaly, congenital heart defects. Prikaz slučajaCase report E bsteinova je anomalija malformacija trikuspidnog zalistka i desne klijetke. Postoje različite varijante greške koje uključuju: 1. poremećaj delaminacije trikuspidnog zalistka; 2. apikalni i stražnji pomak funkcionalnoga trikuspidnog prstena (septalni > stražnji > prednji); 3. proširenje "atrijaliziranog" dijela desne klijetke s različitim stupnjem hipertrofije i stanjenja same stijenke; 4. fenestracije, obilatost i napinjanje prednjeg kuspisa; 5. dilatacija pravoga atrio-ventrikulskog spoja (pravog trikuspidnog prstena).Incidencija je približno 1 : 200 000 živorođene djece i čini manje od 1 % svih prirođenih srčanih grešaka. Često su uz nju pridružene druge srčane greške kao npr. otvoreni foramen ovale, atrijski septalni defekt (ASD), ventrikulski septalni defekt, jedan ili više akcesornih provodnih putova. E bstein's anomaly is a malformation of the tricuspid valve and the right ventricle. There is a wide variation of abnormalities that include: 1) failure of delamination of the tricuspid valve; 2) apical and backward displacement of the functional tricuspid junction (septal>back>forward); 3) dilation of the "atrialized" part of the right ventricle with different levels of hypertrophy and thinning of the wall; 4) fenestration, redun...

Total anomalous pulmonary venous return is a congenital heart malformation characterized by anomalous pulmonary venous inflow to the right atrium. Surgical repair typically occurs during the first month of life, and survival beyond that age in untreated patients is unlikely. We report an extreme case of supracardiac total anomalous pulmonary venous return in an infant who survived 7 months despite atypical anomalous inflow without atrial-level communication and with right-to-left shunting only through a patent ductus arteriosus. We stabilized the patient's left-sided heart function before surgically repairing the anomalous venous return 2 months later. Three years postoperatively, the patient was well.

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