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Carotid endarterectomy (CEA) is safe and effective in reducing the risk of stroke in symptomatic severe carotid artery stenosis. Having information about cross-clamping (CC) intolerance before surgery may reduce the complication rate. The purpose of this study was to assess the usefulness of magnetic resonance angiography (MRA) and magnetic resonance angiography perfusion (P-MR) in determining the risk of CC intolerance during CEA. Material and methods: 40 patients after CEA with CC intolerance were included in Group I, and 15 with CC tolerance in Group II. All patients underwent MRA of the circle of Willis (CoW), P-MR with or without Acetazolamide; P(A)-MR in the postoperative period. Results: CoW was normal in the MRA in three cases (7.5%) in Group I, and in eight (53%) in Group II. We found P-MR abnormalities in all patients from Group I and in 40% from Group II. Using a calculated cut-off point of 0.322, the patients were classified as CC tolerant with 100% sensitivity or as CC intolerant with 95% specificity. After evaluating P-MR or MRA alone, the percentage of false negative results significantly increased. Conclusion: The highest value in predicting cross-clamping intolerance is achieved by using analysis of P(A)-MR and MRA of the CoW in combination.

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A 66 – year – old woman, never treated because of any cardiac illnesses in the past, suffering from the chest pain evoked by physical activity, came to the outpatient clinic on January, 12 th 2019 for the diagnostics. Clinical examination, apart from an elevated blood pressure – 180/100 mmHg, showed no changes. In the ECG – SR 55 bpm. Performed TTE revealed an abnormal structure, having the dimensions 41x29 mm. Heart chamber dimensions, except for moderately enlarged LA, were in the normal range; ejection fraction was preserved. The patient was referred to the Department of Cardiology aiming at further diagnostics. In the course of hospitalization CT of the heart was done, during which the presence of hipodensic, mobile tissue change, having irregular borders, coming out of left ventricle wall was confirmed. PET examination excluded the existence of other remote changes. TEE corroborated the diagnosis of a tumor, originating from the inferior wall of left ventricle. Performed angiography ruled out significant changes in coronary arteries. Subsequently, the patient underwent the removal of the left ventricle tumor on February, 2 nd 2019 in the Department of Cardiosurgery. Histopathological examination result after the surgery wasn’t unequivocal – differential diagnosis should have included melanoma, myoepithelial cancer and MPNST ‘high – grade’ sarcoma. Immunohistochemical examination was continued. In the meantime, a control TTE was performed, which detected a tumor 14x10 mm. After the immunohistochemical examination results a woman was qualified to immunotherapy with the usage of pembrolizumab, initiated on March In TTE done on March, 30th 2109 the dimensions of tumor 30x20 mm suggested the disease progression. Therapy was continued. Next echocardiography didn’t visualise the presence of tumor. The patient was after the second cycle of chemotherapy. Abstract 1116 Figure.

Background: Acute peripheral arterial ischemia is a rapidly developing loss of perfusion, resulting in ischemic clinical manifestations. This study aimed to assess the incidence of cardiovascular mortality in patients with acute peripheral arterial ischemia and either atrial fibrillation (AF) or sinus rhythm (SR). Methods: This observational study involved patients with acute peripheral ischemia treated surgically. Patients were followed-up to assess cardiovascular mortality and its predictors. Results: The study group included 200 patients with acute peripheral arterial ischemia and either AF (n = 67) or SR (n = 133). No cardiovascular mortality differences between the AF and SR groups were observed. AF patients who died of cardiovascular causes had a higher prevalence of peripheral arterial disease (58.3% vs. 31.6%, p = 0.048) and hypercholesterolemia (31.2% vs. 5.3%, p = 0.028) than those who did not die of such causes. Patients with SR who died of cardiovascular causes more frequently had a GFR <60 mL/min/1.73 m2 (47.8% vs. 25.0%, p = 0.03) and were older than those with SR who did not die of such causes. The multivariable analysis shows that hyperlipidemia reduced the risk of cardiovascular mortality in patients with AF, whereas in patients with SR, an age of ≥75 years was the predisposing factor for such mortality. Conclusions: Cardiovascular mortality of patients with acute ischemia did not differ between patients with AF and SR. Hyperlipidemia reduced the risk of cardiovascular mortality in patients with AF, whereas in patients with SR, an age of ≥75 years was a predisposing factor for such mortality.