Background: Mechanical heart valves carry signifi cant risk during pregnancy. Aim: To assess the risk of pregnancy and delivery for mother and child in women with mechanical heart valve prosthesis. Methods: Multicenter retrospective observational study of women with mechanical heart valve prosthesis. The regimen with low molecular weight heparin throughout pregnancy (LMWH) was compared to warfarin since the second trimester (W). Results: Out of 419 pregnant women with cardiovascular diseases we assessed 14 women with mechanical heart valve prosthesis (3.3%) who experienced 23 pregnancies. There were 13 pregnancies with aortic valve prosthesis, 8 with prosthesis of atrio-ventricular valves and 2 pregnancies with both aortic and mitral valve prosthesis. LMWH regimen was used in 18 pregnancies, W in 5 pregnancies. Major maternal complications occurred in 65% of pregnancies, including 3 strokes and 3 urgent cardio-surgical procedures, all in women with LMWH regimen. Prosthetic valve thrombosis occurred in 26%, all in the LMWH group; no thrombosis was found in W group, (p = 0.166). Major bleeding occurred in 30% with no difference between LMWH and W groups (p = 0.596). Fetal loss represented 26% of all pregnancies with no difference between LMWH and W group (p = 1). The birth weight was not signifi cantly different between LMWH and W groups (2496 ± 327 g vs. 3132 ± 592 g, p = 0.12). Conclusion:The rate of maternal and fetal complications in pregnant women with mechanical valve prosthesis is still high. The anticoagulation regimen using warfarin since the second trimester appears to be the safest one. The best prevention of complications is to avoid the implantation of mechanical valve prosthesis in girls and women in fertile age.

Background. Surviving pulmonary embolism (PE) brings a risk of thromboembolic disease chronicity. Chronic thromboembolic pulmonary hypertension (CTEPH) develops as a result of one or multiple pulmonary embolic events. It is an incapacitating long-term complication of thromboembolic disease with a negative impact on the patient's quality of life and prognosis. Contemporary pharmacological and especially surgical treatment possibilities offer hope for the patient's full recovery, but an early diagnosis is crucial for success. Methods. In a prospective study cohort of 97 consecutive patients with a proven diagnosis of PE as the first documented thromboembolic event we tried to estimate the incidence of CTEPH during a 2-year follow-up. Results. Four individuals from our study population developed CTEPH, which represents an incidence of 4.2%. Conclusion. Chronic thromboembolic pulmonary hypertension in pulmonary embolism survivors is a not uncommon complication deserving the attention of clinicians. Patients at risk of CTEPH can be identified for effective follow-up according to echocardiographic finding of elevated pulmonary artery systolic pressure and NT-proBNP levels at the time of hospital discharge.

No abstract

Left atrial appendage is the most frequent place of blood clot formation in heart cavities. The thrombus formation increases a risk of a systemic embolism especially in patients with a permanent atrial fibrillation. The standard preventive treatment is the oral anticoagulation therapy. Another possible treatment is an exclusion of a left atrial appendage. We present current overview of risks and benefits of surgical and percutaneous elimination of a left atrial appendage. We present the first experience with AMPLATZER Cardiac Plug system in an elimination of a left atrial appendage. We concluded that an exclusion of left atrial appendage could become a useful possibility of prevention of systemic embolization in patients with an atrial fibrillation, but is not still an alternative therapy for anticoagulation therapy at present. SOUHRNLevá srdeční síň je místo, kde dochází nejčastěji k formování trombu u nemocných s fibrilací síní. Systémová embolizace je pak u těchto nemocných závažnou zdravotní komplikací. V prevenci systémové embolizace u nemocných s fibrilací síní se nejčastěji používá perorální antikoagulační léčba. Další možností pak je eliminace ouška levé síně. V článku je podán přehled současných možností chirurgické a katetrizační eliminace ouška levé síně. Jsou prezentovány první praktické zkušenosti s použitím systému AMPLATZER Cardiac Plug při katetrizačním uzavírání ouška levé síně. Závěr: Dosavadní data a zkušenosti ukazují, že katetrizační uzavření ouška levé síně je dobrou možností prevence systémové embolizace u pacientů s fibrilací síní. Zatím však není alternativou k zavedené perorální antikoagulační léčbě.

Background: Chronic thromboembolic pulmonary hypertension (CTEPH) is a rare, but due to its unfavorable prognosis feared complication of thromboembolic disease. We assessed the incidence and risk factors for pulmonary hypertension (PH) in a cohort of consecutive patients admitted with pulmonary embolism to the tertiary University Hospital. Methods: In our cohort of 120 consecutive patients with proved pulmonary embolism (PE) we studied the course of biochemical and echocardiographic parameters with regards to risk factors predicting pulmonary hypertension at the end of hospitalization. Results: Echocardiographic signs of pulmonary hypertension were present at the time of discharge in more than one half (50.8%) of patients admitted with pulmonary embolism. Predictors of persisting pulmonary hypertension were initial pulmonary hypertension, high initial NT-proBNP levels and age. Conclusion:Residual pulmonary hypertension at discharge was present in 50.8% cases, at this time there was a strong relationship between PH and elevated NT-proBNP on admission. The patients will be followed--up and possible development of CTPEH will be evaluated at 6, 12 and 24 month period. SOUHRNKontext: Chronická tromboembolická plicní hypertenze (CTEPH) je málo častou, ale pro svou prognostickou závažnost obávanou komplikací tromboembolické nemoci. Zaměřili jsme se na stanovení incidence a rizikových faktorů plicní hypertenze (PH) v populaci konsekutivních pacientů přijatých pro akutní plicní embolii na kardiologickou kliniku univerzitní nemocnice. Metody: V našem souboru 120 konsekutivních pacientů s prokázanou plicní embolizací jsme sledovali vývoj biochemických a echokardiografických parametrů s ohledem na možnosti predikce perzistence plicní hypertenze v době propuštění.