Biomedical subjects
Publications and source records attributed to Anna Tomaszuk-Kazberuk.
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A case of a 42-year old man with aortic valve endocarditis with peri-anular multi-chamber abscess formation and fistulous communication between right sinus of Valsalva and right ventricle, is presented. Transthoracic echocardiography revealed abnormal flow through the fistula confirmed at surgery. Intraoperatively the aortic valve was severely damaged with massive calcifications on the leaflets, anulus, right sinus of Valsalva and interventricular septum surrounded by fresh vegetations. Surgical procedure consisted of removal of calcification and infected tissues, followed by reconstruction of interventricular septum and aorta with pericardial patch and aortic valve replacement. Postoperative course was uneventful.
The case of a 73-year-old female with an acute myocardial infarction, treated successfully with primary percutaneous coronary intervention who developed subacute left ventricular free wall rupture, is presented. The diagnosis was established by echocardiography at bedside. She underwent urgent cardiac surgery with patch glue repair of left ventricular free wall rupture and selective revascularisation. The recovery was uneventful and the patient was discharged from the hospital on the 11th postoperative day in good condition. At 6 month follow-up, the patient remained well, without any symptoms.
BACKGROUND: The prognostic significance of early dobutamine echocardiography (DE) after successfully treated acute myocardial infarction (AMI) with primary coronary angioplasty (PTCA) is still unclear. Patients who respond to DE may have better left ventricular function improvement and possibly a better clinical outcome. AIM: To assess whether early DE can predict spontaneous functional recovery in patients treated successfully with primary PTCA and whether responders to DE have a better clinical outcome. METHODS: DE (5 and 10 ug/kg/min) was performed in 110 consecutive patients (61+/-10 years) 4+/-1 days after successful primary PTCA (TIMI 3, stenosis <30%). Left ventricular ejection fraction (LVEF) and wall motion index (WMSI) were measured. Patients underwent clinical assessment and two-dimensional echocardiography at 3 and 6 months. RESULTS: In the DE responders (76 pts), LVEF increased significantly from 41%+/-9% at baseline to 47%+/-10% at 6 months (p<0.0001), whereas the improvement found in nonresponders (34 pts) was insignificant (from 36.3%+/-9% at baseline to 38.8%+/-10% at 6 months, p=0.4). The nonresponders to DE had a higher incidence of subsequent revascularisation (4/34 (11.8%) vs 3/76 (3.9%) p=0.12), reinfarction (5/34 (14.7%) vs 2/76 (2.6%), p=0.28) and death (3/34 (9%) vs 0/76 (0%), p=0.0086). The incidence of combined end-point (revascularisation, reinfarction and death) was significantly lower in the group of responders to early DE (p=0.03). CONCLUSIONS: Early DE can precisely predict functional recovery and the extent of irreversibly damaged myocardium in patients with AMI in whom anterograde flow is fully restored. A positive response to early DE is associated with a better clinical outcome and prognosis.
A case of a 75-year-old male with a history of aortic valve disease hospitalised due to pyrexia of unknown origin is reported. Initially the patient was diagnosed with infective endocarditis due to persistent pyrexia, history of valve disease, single positive blood culture and echocardiographic scan suggesting infective endocarditis. Treatment with two strong antibiotics did not bring expected amelioration. Patient's hemodynamic status remained unchanged. After several weeks of hospitalization X-ray scan revealed involved hilar lymph nodes, which was confirmed by CT scan of the chest. The patient was diagnosed with Hodgkin's disease. He died three months after initiation of chemotherapy.
A case of a 47-year-old female with the aneurysm of the left ventricle is presented. Several days prior to the hospitalization signs of femoral embolism emerged, which was treated with embolectomy. Echocardiographic examination revealed large thrombus in the cavity of the aneurysm with pedunculated surrounding echo. On the second day after the admission the symptoms of renal artery embolism occurred. Due to recurrent symptoms of peripheral emboli and the lack of a consent for the interventional treatment, fibrinolysis (Actilyse) was applied resulting in the reduction of the thrombus mass in the left ventricle. Subsequent Doppler ultrasound of the renal arteries showed normal flow pattern. During hospitalization general condition has gradually improved and the patient was discharged.
BACKGROUND: It has been shown that normalisation of elevated ST segment after primary percutaneous coronary interventions (PCI) is associated with the achievement of reperfusion at the tissue level. AIM: To assess prospectively the return of left ventricular (LV) systolic function and the outcome of patients with acute myocardial infarction (AMI), treated with primary PCI, in relation to the early normalisation of the ST segment. METHODS: The study group consisted of 110 consecutive patients (33 females, 77 males, mean age 56 years) with AMI who were successfully treated with primary PCI (TIMI flow grade 3 and residual stenosis <30%) within 12 hours from the onset of symptoms. The patients were divided into two groups according to normalisation or lack of normalisation of an elevated ST segment. The mean time from the onset of symptoms to the restoration of blood flow in an infarct-related artery (pain-to-balloon time) was similar in both groups. LV echocardiographic parameters (ejection fraction EF and wall motion score index WMSI) and clinical status directly after PCI as well as 3 and 6 months later were assessed. RESULTS: Directly after primary PCI, LV impairment (low EF and high WMSI) was significantly more often present in patients without rather than with ST segment normalisation. Afterwards, LVEF and WMSI improved significantly only in patients with ST segment normalisation whereas in the remaining patients no such improvement was observed. During 6-month follow-up period, major cardiac events (death, new AMI or need for revascularisation) occurred more frequently in patients without rather than with ST segment normalisation (p=0.03). CONCLUSIONS: 1. Rapid resolution of ST segment elevation following effective primary PCI identifies patients with a favourable outcome. 2. ST segment normalisation predicts a return of LV systolic function in patients with AMI treated with primary PCI.
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A case of a 51-year-old male with dilated cardiomyopathy and left atrial mass detected by echocardiography is described. Differential diagnosis between thrombus and myoxoma was difficult. Anticoagulation therapy was initiated and no intra-atrial mass was detected during the control echocardiographic examination. Thus, the diagnosis of intracardiac thrombus was established ex iuvantibus. Difficulties in the diagnosis and treatment of intracardiac masses are discussed.
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BACKGROUND: Early epicardial vessel patency and tissue perfusion limit infarct size, improve survival and are crucial for optimum functional recovery of the ischaemic myocardium in patients with acute myocardial infarction (AMI). Coronary angiography has been considered the "gold standard" in assessment of reperfusion. Restoration of coronary patency is not a guarantee of myocardial cellular perfusion. ST-segment elevation resolution observed in electrocardiogram (ECG) early after initiation of primary PTCA could be potentially correlated with reperfusion. AIM: The aim of the study was the prospective assessment of left ventricular (LV) contractility recovery in patients after primary PTCA for AMI in 3 and 6 month follow-up according to early ST-segment elevation resolution analysis. METHODS: 111 consecutive patients (80 men and 31 women age 36-78) with AMI treated by successful primary PTCA (Thrombolysis in Myocardial Infarction grade 3 flow and residual stenosis less than 30%) within 12 h of chest pain onset were enrolled in the study. 12-lead ECG was performed on admission and 1 hour after the beginning of the PTCA. The patients were divided into 2 groups according to ST-segment elevation resolution in the ECG (> 50% depression of the elevated ST-segment) within 1 hour after the procedure. The mean pain-to-balloon time was not significantly different in both groups. In each patient, global ejection fraction (EF) and wall motion index (WMI) were derived immediately after primary PTCA and after 3 and 6 month follow-up. RESULTS: Of the 111 patients studied, 82 (68%) had early ST-segment resolution and 29 (32%) did not. Contractility disturbances of infarct related ventricular wall, evaluated by EF and WMI, were significantly higher in the group of patients without early ST-segment resolution immediately after primary PTCA. EF and WMI improved significantly after 3 and 6 months in the group of patients with improvement was insignificant ST-segment elevation resolution, while in the group without ST-segment resolution. CONCLUSIONS: 1. Presence of early ST segment elevation resolution after angiographically successful primary PTCA identifies patients who are more likely to benefit from the early restoration of flow in the infarct related artery. 2. TIMI measures greatly overestimate the success of primary PTCA; they only assess vessel patency, not myocardial cellular perfusion. 3. "Electrocardiographic reperfusion" provides a real-time physiologic marker of cellular perfusion and is a significant predictor of LV contractility recovery--more useful than angiographic reperfusion. 4. ST-segment monitoring is a reliable, non-invasive and inexpensive method to evaluate myocardial perfusion.