Biomedical subjects

J Janousek

Publications and source records attributed to J Janousek.

At least 37 records · Page 2Linked to original sources

PubMed1997

Primary repair of interrupted aortic arch and associated heart lesions in newborns.

Primary repair of interrupted aortic arch and associated heart lesions was performed in 13 patients aged from 1 to 85 days. The surgery was performed through the midline sternotomy approach in extracorporeal circulation and deep hypothermia. Hypothermic circulatory arrest at 14 to 19 degrees C was used for reconstruction of the aortic arch. In all patients it was possible to perform a direct anastomosis between the ascendent and descendent aorta. At the same time closure of the ventricular septal defect was performed in 11 patients, closure of the atrial septal defect in 4, correction of persistent truncus arteriosus in 3, resection of subaortic stenosis in 2, arterial switch repair of transposition of the great arteries in 1, correction of double outlet right ventricle in 1 and patch closure of aortico-pulmonary window in 1 patient. Three (23.1%) newborns died in the early postoperative period: two from sepsis and one from multiple organ failure. Ten patients (76.9%) were followed up for 1 to 29 months postoperatively. All of them are in very good condition with a nonrestrictive aortic anastomosis. Primary one-stage repair of interrupted aortic arch and associated heart lesions is preferred to the two-stage repair in all newborns with this critical congenital heart disease.

Aorta, Thoracic↗

PubMed1997

Individualized repair of the left atrioventricular valve in spectrum of atrioventricular septal defect.

From September 1977 to October 1995, 287 patients with atrioventricular septal defect (AVSD) aged from 2 months of 21 years underwent total repair in Kardiocentrum in prague. In 97 patients complete, in 20 transitional and in 170 patients partial form of AVSD was present. The repair consisted of closure of the defect and individually modified reconstruction of two atrioventricular (AV) orifices. In cases with a common orifice a two-patch technique was used. Fixation of undivided anterior and posterior common leaflets to patches in an appropriate level was essential in combination with complete closure of the cleft. Incomplete closure of the cleft was performed if potentially stenotic morphology was present. Commissuroplasty with pladgeted mattress stitches was done in patients with dilated annulus and commissuroplasty with a single stitch was performed if the annulus was not dilated. The methods were similar in cases with two AV orifices. The AV valve repair was difficult in the presence of severe regurgitation in valves with potentially stenotic morphology. Of the 287 operated patients 26 (9.1%) died during the early postoperative period. Mortality was 19.6% in the complete form and 3.7% in the partial and transitional forms. The mortality depended on morphology of the left atrioventricular valve. Potentially stenotic valvar morphology represented an important risk factor for death and reoperation. It was necessary to reoperate on 18 (6.3%) patients for significant "mitral" valve regurgitation. Reconstruction of a competent left AV valve is the most important step of AVSD repair which must always be modified according to individual morphological and functional abnormalities.

Abnormalities, Multiple↗

PubMed1997

[Plication of the diaphragm--a method of surgical treatment of diaphragmatic paralysis in neonates and infants after heart surgery].

The cause of paresis of the diaphragm after cardiosurgery is damage of the phrenic nerve. The diagnosis of paresis is based on X-ray examination, sonography and electromyography of the diaphragm. Plication of the diaphragm is indicated only in those children with paresis of the diaphragm who develop during spontaneous ventilation severe respiratory insufficiency. In the Cardiocentre of the Faculty Hospital Prague-Motol between 1983 and 1996 of 5333 children operated on account of heart disease 29 children were subjected to plication of the diaphragm, incl. five where the operation was made during the neonatal stage (17%), 20 in infant age (69%) and four were older than one year (14%). By the third day after plication 9 children (38%) could be disconnected from the respirator, by the 5th day 20 children (70%) by the 7th day 22 children (75%). In neonates and infants with postoperative paresis of the diaphragm, where spontaneous ventilation cannot be induced, plication of the diaphragm is according to the authors the method of choice. It is a rapid and safe surgical operation which reduces the period of artificial ventilation and its complications.

Cardiac Surgical Procedures↗

PubMed1996

[Radical anatomic correction of transposition of great arteries in neonates. A new program of treatment of critical congenital heart defects].

METHODS AND RESULTS: From the group of 110 neonates born with transposition of the great arteries during 1991-1994 that were referred for the treatment to Kardiocentrum, University Hospital Prague-Motol, 46 neonates with simple transposition were operated on according to the criteria for anatomical correction (arterial switch) at the mean age of 9 days (4-20 days). Fourteen infants with transposition and large ventricular septal defect were corrected with arterial switch at the mean age of 2.5 months (5 weeks-9 months). Fifty neonates that did not meet criteria for arterial switch procedure were indicated for correction at the atrial level (Senning procedure) that has been performed at the mean age of 5 months (1-10 months). Out of 46 operated neonates 10 died following the operation and one child died 2 months later after surgery. There were 2 death out of last 20 neonates (10%). Thirty five children surviving 1-4 years after anatomical arterial correction of transposition are without complaints in excellent condition, NYHA class I. CONCLUSIONS: The procedure of the anatomical correction at the level of the great arteries (arterial switch) according to Jatene, that has been successfully introduced at Kardiocentrum, University Hospital Prague-Motol, has been reproducible and became the method of choice for operations of transposition of the great arteries in neonates with the suitable anatomy.

Cardiac Surgical Procedures↗

PubMed1995

Role of late potentials in identifying patients at risk for ventricular tachycardia after surgical correction of congenital heart disease.

This study evaluates the role of late potentials in identifying patients with sustained ventricular tachycardia (VT) after surgery for congenital heart defects using right ventriculotomy. Nine patients with early (1 to 12 months) or late VT (spontaneous in 7 [induced during electrophysiologic study in 6 of the 7] and induced in 2) and 104 patients without VT were studied. All patients had complete right bundle branch block. Late potentials were quantified by 3 time-domain parameters of the signal-averaged electrocardiogram: total filtered QRS duration, root-mean-square voltage in the last 40 ms, and low-amplitude signal duration of the terminal filtered QRS complex. Root-mean-square voltage filtered at 80 to 250 Hz was lower in patients with than without VT (9 +/- 6 vs 16 +/- 8 microV, p < 0.01). By multivariate analysis, more complex surgery (i.e., insertion of extracardiac conduits, Kawashima operation, etc.), lower root-mean-square voltage, and higher Lown grade (2 to 5) of ventricular arrhythmias on routine postoperative Holter recordings were the only independent predictors of VT (p < 0.001, < 0.05, and < 0.05, respectively). A combination of more complex surgery, root-mean-square voltage < 14 microV, and Lown grade 2 to 5 ventricular arrhythmias was highly predictive of VT (positive predictive value 75%). Conversely, patients without complex surgery and with root-mean-square voltage of > 13 microV were not likely to develop VT (negative predictive value 100%). Late potentials are an independent predictor of VT and may improve the identification of patients at low and high risk of VT after surgery for congenital heart defects using right ventriculotomy.

Action Potentials↗

PubMed1995

[Tactics and technique of primary correction of aortic arch interruption using a median sternotomy].

Primary correction of an interrupted aortic arch was performed in seven neonates aged 2 to 26 days. The operation was performed from median sternotomy with extracorporeal circulation using hypothermic arrest of the circulation for reconstruction of the aortic arch. In all neonates it proved possible to make a direct anastomosis of the ascendent and descendent aorta. At the same time in six children a defect of the ventricular septum was closed, in two the common arterial trunk was corrected, in one resection of subaortic stenosis was performed and in another child correction of the aortopulmonary window. After the operation three neonates died from sepsis and multiorgan failure. At present four patients are alive who, 10 to 20 months after operation, are in a good condition. All have a non-restrictive anastomosis of the aorta. Primary correction of an interrupted aortic arch and associated defects is preferred by the authors to two-stage surgery.

Aorta, Thoracic↗

PubMed1995

[Anatomic correction of transposition of the great arteries in the neonatal period].

In Cardiocentrum of the University Hospital in Prague-Motol in 1988-1994 anatomical correction of transposition of the great arteries (arterial switch) was performed in 47 neonates aged 4 to 20 days. The aorta and pulmonary artery were transferred into the appropriate ventricle concurrently with reimplantation of the coronary arteries. The surgical technique was modified with regard to the anatomy of the coronary arteries and the presence of associated cardiac defects. Eleven of the 47 neonates (23%) died during the early postoperative period, one patient died two months after operation. Of the last 20 operated neonates only two died (10%) and both had an abnormal insertion of the coronary arteries. Thirty-five children are followed up for 2-45 months following anatomical correction. All are in a very good clinical condition without serious residual findings. The authors describe the protocol of the diagnostic and therapeutic procedure in transposition of the great arteries. They consider anatomical arterial correction in the neonatal period as the method of choice for this disease. The optimal age for anatomical correction in isolated transposition is between the 7th and 14th day and in transpositions with a major defect of the ventricular septum at the age of one month. The surgical results are steadily improving with accumulating experience. The medium-term results of anatomical correction of transposition of the great arteries are very favourable.

Cardiac Surgical Procedures↗

PubMed1994

[A female patient with near-tetraploid acute myeloid M4 leukemia].

BACKGROUND: Acute myeloid leukemias (AML) are a heterogeneous group of diseases, several types of them are well characterized by typical morphologic, immunologic and cytogenetic features of their leukemic blasts in the MIC classification. We have recently described 2 patients with a new AML type--poorly differentiated near-tetraploid AML L0. The occurrence of very large blasts in a heterogeneous blast population seemed to be a morphological sign of this new type of AML. RESULTS: The same morphologic characteristics were observed by us when we studied blasts of another 80-year-old patient with a near-tetraploid karyotype. However, 34% of blasts were positive for myeloperoxidase and they exhibited in 24-33% surface myelomonocytic markers CD11b, CD13, CD15 and CD14. The illness was classified as acute myelomonoblastic leukemia M4 without significant dysplastic changes in erythroid and megakaryocytic lineages. The growth of granulocyte-macrophage bone marrow progenitors CFU-GM was low. The patient refused cytotoxic chemotherapy and expired 3 months later on supportive treatment. CONCLUSIONS: The finding of very large blasts is a typical sign in cases of near-tetraploid AML. Precise classification of leukemia type is essential for successful therapy.

Aged↗

PubMed1994

Atrial baffle procedures for complete transposition of the great arteries: natural course of sinus node dysfunction and risk factors for dysrhythmias and sudden death.

359 patients after the Mustard (275) or Senning (84) operations for transposition of the great arteries were followed-up for a mean of 103.7 (range 0.4 to 204) months. 259 patients had postoperative 24-h Holter recordings. In 129 Mustard children serial (mean 4.4) postoperative Holter recordings were available for evaluation. Criteria based on Holter and scalar electrocardiograms at normal sinus node functions were used for rhythm analysis. Postoperative dysrhythmias appeared in 70% of the patients: sinus node dysfunction in 62.8%, second or third degree atrioventricular block in 3.2%, sustained atrial tachycardia or atrial flutter in 4.5%, and significant ventricular arrhythmia (Lown 2-5) in 21.4%. The prevalence of sinus node dysfunction increased slightly from 50.8% during the first 2 postoperative years to 64.4% in patients more than 10 years postoperatively. Fifteen patients (4.2%) died suddenly during follow-up. By multivariate analysis severe tricuspid regurgitation and/or right ventricular dysfunction and uncontrolled supraventricular tachydysrhythmias were identified as the two significant risk factors for sudden death.

Adolescent↗

PubMed1994

[Total cavopulmonary anastomosis in the surgical treatment of congenital heart defects with a functional single ventricle].

Total cavopulmonary connection (TCPC) allows surgical treatment of patients with complex univentricular heart disease. Between 1991 and 1993 this operation was performed in 15 cyanotic children with complex heart defects. Age range was 3.5-14 (median 8.3) years. In 5 children with increased operative risk a calibrated interatrial fenestration was created intraoperatively to allow systemic venous decompression. Three patients (20%) died. In remaining 12 patients a significant increase in arterial oxygen saturation and decrease of polycythemia was encountered. All patients remain in a good clinical condition 1-25 months after operation. Noninvasive investigation including echocardiography confirmed good function of the heart.

Adolescent↗

PubMed1993

Purification of murine Kupffer cells by centrifugal elutriation.

Procedures to reproducibly obtain pure preparations of murine Kupffer cells are described. Pure Kupffer cell preparations obtained following collagenase digestion, metrizamide separation and centrifugal elutriation remained viable and maintained their phagocytic functions for at least 4-5 days in vitro. Furthermore, we determined the feasibility of extracting RNA from Kupffer cells obtained immediately following elutriation and after 2 and 4 days of culture in vitro. These RNA extracts were used to determine the level of cytokine gene expression in Kupffer cells.

Animals↗

PubMed1993

Usefulness of propafenone for supraventricular arrhythmias in infants and children.

The relation between propafenone dose, serum level, electrocardiographic parameters, antiarrhythmic drug efficacy and adverse effects was studied in 47 children with symptomatic supraventricular arrhythmias aged 1 day to 10.3 years (median 2.2 months) with a mean follow-up of 14.3 months. Propafenone trough serum levels were measured using gas chromatography. Oral propafenone (mean dose 353 mg/m2/day) was effective in 41 of the 47 patients (87.2%). Serum levels did not differ between patients responding and not responding to propafenone (0.45 +/- 0.40 vs 0.36 +/- 0.41 mg/liter). PR interval and QRS complex duration increased more significantly with propafenone dose increments (p < 0.001), than with propafenone serum levels (p < 0.05). At successful treatment PR interval and QRS complex were prolonged by a mean of 19.2 and 20.5% compared with pretreatment status. Five patients exhibited unexpected marked QRS complex prolongation (50 to 200%) despite low propafenone dosage (< 300 mg/m2/day) and level ranging from 0.05 to 1.33 mg/liter. Three patients (6.1%) were suspected of being "poor" metabolizers of propafenone. Mild chronic elevation of serum liver enzymes was observed in 5 patients treated with a larger dose (mean 448 mg/m2/day, p < 0.001). No proarrhythmia was noted on serial Holter monitors. One patient with Wolff-Parkinson-White syndrome and a normal heart had cardiac arrest after aspiration. Serial monitoring of PR interval and QRS complex duration was more useful for proper dosage adjustment than propafenone serum levels. Serum liver enzymes should be closely monitored when using higher propafenone doses. Malignant proarrhythmia could not be excluded in the 1 patient with cardiac arrest.

Administration, Oral↗

PubMed1993

[Bidirectional cavopulmonary anastomosis in palliative surgical treatment of complex congenital heart defects].

Bidirectional cavopulmonary anastomosis was used during the past six years for palliative treatment of 34 children with complex cardiac disease with a low pulmonary blood flow and a functional common ventricle. The age at the time of operation was 5 months to 16 years (median 55 months). Two children (5.9%) died soon after operation and one patient died in conjunction with reoperation seven months later. After operation a significant increase of saturation and decrease of the haematocrit occurred in all patients. The condition of 31 patients during an out-patient check-up 2-64 months after operation was satisfactory and postoperative examinations revealed a satisfactory function of the anastomosis.

Adolescent↗

PubMed1992

Efficacy and safety of propafenone in congenital junctional ectopic tachycardia.

OBJECTIVES: Class IC antiarrhythmic drugs have recently been shown to be effective in some patients with atrial ectopic tachycardia. We therefore studied the efficacy of these drugs in patients with congenital junctional ectopic tachycardia. BACKGROUND: Follow-up data on patients with junctional ectopic tachycardia suggest that this potentially lethal arrhythmia may cease spontaneously in a significant proportion of affected children. Therefore, temporary antiarrhythmic treatment appears to be the therapy of choice. METHODS: The efficacy of propafenone was prospectively assessed in four infants with junctional ectopic tachycardia (ventricular rate 180, 185, 210 and 320 beats/min, respectively). The diagnosis of junctional ectopic tachycardia was established before the age of 2 months in all four infants. Propafenone was given orally in a mean dose of 350 (300 to 500) mg/m2 body surface area per day. Success of therapy was determined by serial electrocardiograms (ECGs) and Holter ambulatory ECG monitoring. RESULTS: In two patients, junctional ectopic tachycardia was completely suppressed. In the remaining two patients, the tachycardia rate decreased to less than 150 beats/min. Serum propafenone levels did not correlate with efficacy of treatment. The mean duration of therapy was 18 months (range 3 to 36). No chemical or clinical side effects were noted. CONCLUSIONS: Because of its effectiveness, safety and lack of side effects, propafenone appears to be a valuable drug in the treatment of junctional ectopic tachycardia in newborns and infants.

Drug Evaluation↗

PubMed1992

Correlation between knee roentgenogram changes and clinical symptoms in osteoarthritis.

The main purpose of this study was to analyze the relationship between clinical symptoms and roentgenographic changes in patients with incipient osteoarthritis of the knees (OA). One hundred and sixty-two patients (126 women, 36 men, mean age 59 years) with established osteoarthritis of the knee were examined. Patients performed subjective self-assessment using Lequesne's questionnaire (index of severity for OA of the knee) and had frontal and lateral roentgenograms of both knees. Validity of the indices as reflections of individual symptoms was documented. A statistically significant correlation was found between clinical and patient indices (r = 0.327, p < 0.0001) as well as a very weak correlation between the clinical and roentgenogram indices (r = 0.196, p = 0.286). However, there was no correlation between the patient index and roentgenogram index (r = 0.065, p = 0.47). For the assessment of severity and progression of the disease, items reflecting acute irritation (swelling, effusion, increased joint temperature, pain during passive motion) were more reliable than items reflecting chronicity (muscular atrophy, decreased range of motion, crepitus). This study confirmed that Lequesne's questionnaire is a suitable tool for assessing subjective symptoms as well as for generating a condensed measure of disease severity. In addition, sclerosis, narrowing and osteophytes were proved to be important features characterizing the OA process.

Female↗

PubMed1990

[Serum amyloid A protein--a general acute phase reactant].

Apoprotein SAA is analyzed from the aspect of its function of a general reactant of the acute stage--an indicator of the laboratory activity. The authors give general characteristics of this protein incl. the incidence and probable genesis of different isotypes. On several examples he demonstrates the lack of dependence between the incidence of isotypes and the development of amyloidosis or the basic pathological cause leading to laboratory activity. The simple relationship between the circulating precursor of SAA protein and the deposited AA amyloid fibrils is not unequivocal. Factors leading to the deposition of amyloid are, however, mentioned only liminally. The author discusses in more detail the induction of SAA protein formation at the level of genetic information which makes possible a potent acute response expressed by a rapid and brisk rise of plasma levels.

Humans↗

PubMed1990

[Diagnosis and therapy of heart rhythm disorders after surgery of congenital heart defects].

The article summarizes the present state of view on the causes, risks and possible prevention and treatment of dysrhythmias after surgery for congenital heart disease. Various surgical procedures and their contribution to postoperative dysrhythmias are discussed. Literary data on the incidence of rhythm disturbances after closure of ventricular septal defect, total correction of Fallot tetralogy and Mustard or Senning operation for transposition of the great arteries are reviewed and compared with own findings. Special attention is paid to proved and possible risk factors for sudden cardiac death. A brief review of various therapeutic options (pacing, drugs and surgery) follows.

Arrhythmias, Cardiac↗

PubMed1990

[Heart involvement in Lyme borreliosis. Case report].

Lyme disease is a systemic illness with skin, neurologic, joint, and cardiac involvement. Absence of typical skin lesion--erythema chronicum migrans--during the first period of disease may cause the diagnosis difficult. Syncope due to complete atrioventricular block was the first symptom of disease in our patient, but no tick bite anamnestic data were available. Quick changes on EKG tracing during cardiac pacing were present. Echocardiography revealed left ventricular dysfunction. Specific immunological tests confirmed the diagnostic suspicion. Cardiac pacing, digitalis and antibiotic treatment ensued in complete recovery. No other systemic lesion appeared. Lyme carditis may be the only manifestation of the disease. Temporary cardiac pacing may be necessary.

Child↗