IntroductionAlthough myxoma is the most frequent cardiac tumor, other conditions should be taken into consideration in the differential diagnosis. Transthoracic echocardiography (TTE), followed by transesophageal echocardiography (TEE) remain the principal methods for cardiac tumor screening and visualizing. The aim of the study was to compare the diagnostics, surgical treatment and prognosis of malignant and benign cardiac tumors.Material and methodsFrom 1986 to 2009 there were 121 patients with cardiac tumors operated on in the Cardiac Surgery Clinic of the Medical University in Lodz. Patients were referred to surgery mainly on the basis of the TTE and TEE image. In 4 cases valvular prosthesis implantation or valve repair were carried out. Patients remained under long-term observation in the Cardiac Surgery Outpatient Clinic.ResultsMyxoma was diagnosed in 114 cases. Malignancies were discovered in 7 cases. The left atrium was the most frequent localization. The echocardiographic image differed significantly in benign and malignant tumors. The postoperative period was complicated by embolic events or myocardial infarctions. Only malignant tumors were associated with mortality due to cardiovascular events. The survival for malignant tumors was significantly shorter.ConclusionsShort and long-term results of operative treatment are very good for benign tumors in contrast to cardiac malignancies. The TTE and TEE image can be very significant in the final diagnosis.

We present the case of a 28-year-old patient successfully implanted with a subcutaneous implantable cardioverter-defibrillator (S-ICD) in secondary prevention of sudden cardiac death. The patient was resuscitated from out-of-hospital cardiac arrest due to ventricular fibrillation (VF). This was complicated by pneumothorax and respiratory failure that required mechanical ventilation for 5 days. After 2 weeks on the intensive care unit, the patient was transferred to the Cardiology Department. A subsequent medical evaluation revealed no structural heart abnormalities, nor other overt cardiovascular dysfunctions. However, during an invasive electrophysiological study, VF was induced with programmed right ventricular stimulation (Fig. 1). Therefore, the patient was implanted with an ICD. One week after this procedure, he presented symptoms of fever, shivers and chest pain. A fulminant endocarditis and right ventricle perforation was diagnosed. Subsequently, an adequate intravenous antibiotic treatment was introduced and the ICD system was explanted. Nevertheless, the important destruction of the tricuspid valve was revealed in echocardiography, and cardiothoracic surgery with artificial tricuspid valve replacement (Medtronic 29 mm) was performed. The surgery was complicated by intermittent complete atrio-ventricular block, thus the epicardial lead was implanted to the left ventricle and connected to the pacemaker placed in the right subclavian region. After 3 weeks of in-hospital recovery, the patient was consulted by an international board of arrhythmology specialists in order to establish the possibility of S-ICD implantation. The electrocardiography screening to check S-ICD arrhythmia discriminators matching with sensed cardiac signals was completed successfully, as well on the intrinsic rhythm as during pacing. Eventually, the patient was referred to S-ICD implantation. The procedure was performed on oral anticoagulation with acenocoumarol (INR on the day of procedure was 2.1), in volatile and maintenance anaesthesia by a joint team of cardiologist and cardiothoracic surgeon. The S-ICD was positioned in the left lateral region between the 5 th and 7 th intercostal spaces. The subcutaneous defibrillation lead was implanted atypically -in parasternal instead of medial line. The reason for atypical positioning of the lead was to avoid collision with the epicardial lead that had been previously implanted in the substernal region and to avert complications in case of future medial resternotomy. The position of the device and the lead is presented in Figure 2. Considering the high thromboembolic risk, testing of the defibrillator was successfully performed after transoesophageal echocardiography on the 4 th day after the implantation. The post-procedure course was uneventful. We present the first Polish experience of implantation of a S-ICD system. This modern therapy is an option for those patients who cannot have a standard ICD implanted for any reason, e.g. vascular abnormalities or intravascular infection. This pro...

PWD may independently predict postoperative AF in long-term follow-up after surgical correction of ASD t.II.

IntroductionCoronary artery bypass grafting (CABG) is conducted more and more commonly in patients in advanced age.Aim of the studyTo analyze the influence of age and concurrent risk factors on the complications and early mortality after CABG.Material and methodsMedical records of 2194 patients were analyzed retrospectively. A group of 1303 patients who had undergone isolated CABG was selected. 106 (4.8%) patients were excluded due to missing data in their medical records. The remaining 1197 patients were divided into two subgroups by age: 1st group < 65 years (n = 662; 55.3%); 2nd group ≥ 65 years (n = 535; 44.7%).ResultsThe total 30-day mortality was 3.93% and was six times higher in the older group (1.21 vs. 7.29%; p < 0.001). Complications were observed in 176 (14.70%) patients, more often in the older group (10.42% vs. 20.0%; p < 0.001). In this group all kinds of complications were noted more often and in particular: postoperative myocardial infarction (1.96% vs. 5.42%; p = 0.001), respiratory dysfunction (1.36% vs. 4.11%; p = 0.005), neurological complications (1.81% vs. 3.74%; p = 0.04) and multi-organ dysfunction syndrome (0.30% vs. 1.68%, p = 0.03). The older patients required longer time under mechanical ventilation (24.0 ± 27.9 vs. 37.0 ± 74.1 hours; p = 0.004) and stayed longer in the intensive care unit: 2.5 ± 3.0 vs. 4.1 ± 7.84 days; p < 0.001. Independent predictors of death were: female sex [OR (95% CI) = 2.4 (1.2-4.5)], age ≥ 65 years [OR = 4.9 (2.1-11.1)], eGFR < 60 mL/min/1.73 m2 [OR = 2.2 (1.0-4.7)], time at extracorporeal circulation > 72 minutes [OR = 5.5 (2.7-10.9)] and left main stem stenosis (> 50%) [OR = 2.4 (1.3-4.6)].ConclusionsAge still significantly influences postoperative complications and mortality after isolated CABG.

IntroductionThere is no consensus on the length of ECG tracing that should be recorded to represent adequate rate control in patients with atrial fibrillation (AFib). The purpose of the study was to examine whether heart rate measurements based on short-term ECGs recorded at different periods of the day may correspond to the mean heart rate and rate irregularity analyzed from standard 24-hour Holter monitoring.Material and methodsThe study enrolled 50 consecutive patients with chronic AFib who underwent 24-hour Holter monitoring. Mean heart rate (mHR) and the coefficient of irregularity (CI) were assessed from 5- and 60-minute intervals of Holter recordings in different periods of the day.ResultsThe highest correlation in mean heart rate interval within 24 h was found during a 6-hour sample and in the periods 11.00 AM–12.00 PM, 12 PM–1.00 PM, and 1.00 PM–2.00 PM. With respect to irregularity, only the CI measurements based on a 6-hour interval (7.00 AM–1.00 AM) show a correlation > 0.08 compared to data from the 24-hour recording.ConclusionsOnly long-term (6-hour) recordings provide a high correlation within 24 h in mean heart rate interval and coefficient of irregularity. It seems that the mean heart rate interval in 1-hour periods between 11 AM and 2 PM might be predictive for 24-hour data. Short time recordings of the coefficient of irregularity of heart rate in AFib patients at this moment are not useful in clinical practice for long-term prognosis of ventricular irregularity.