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Biomedical subjects

J Spatenka

Publications and source records attributed to J Spatenka.

At least 19 recordsLinked to original sources
PubMed2006

Allograft semilunar cardiac valves processing and cryopreservation - morphology in scanning electron microscope.

OBJECTIVE: The most important factors of long term clinical performance of biological heart valve prostheses are methods of processing and cryopreservation. That is why we decided to evaluate the impact of current Allograft Heart Valves (AHV) Bank protocol on valve tissue morphology. Scanning electron microscope (SEM) is a valuable tool for investigation of biological surfaces. In case of cardiac valves it is especially suitable for detection of fine changes in endothelial covering and underlying layers. MATERIAL AND METHODS: "Fresh" aortic and pulmonary AHV samples, harvested from "heart-beating" cadaveric donors, were compared with (1) tissue from AHV obtained from non heart-beating donors, (2) samples stored in 4 degrees C saline for 24 h, (3) antibiotic treated tissue for 24 h at 37 degrees C and finally (4) cryopreserved valves, stored in liquid nitrogen (-196 degrees C) for 6-38 months. All samples were dissected, dried with hexamethyldisilazane (HMDS), gold coated, studied and photographed by SEM (Tesla BS 301). RESULTS: Our alternative method of drying samples by the HMDS method proved to be suitable for thin membranes of human semilunar valves. We were able to detect early changes in the endothelium after harvesting, and denudation of the endothelial covering during preservation with and without freezing. CONCLUSION: SEM (using HMDS drying) along with other methods may be helpful for the morphological control of processing, cryopreservation and liquid nitrogen storage of AHV. According to the current findings we have to avoid washing of AHV in saline after harvesting.

Cryopreservation↗
PubMed2006

[Simultaneous cardiac and thoracic operations].

BACKGROUND: Optimal surgical strategy in patients with combined disease of heart (mainly ischemic heart disease or critical valve disease) and other thoracic organs (mainly pulmonary carcinoma) is still controversial. METHODS: From 1997 to 2004, 13 simultaneous cardiac and thoracic operations were performed in 13 patients. Most of them were necessary for combinations of symptomatic coronary artery disease (CAD) and bronchogenic carcinoma (BCA). PATIENT CHARACTERISTICS: 11 patients showed CAD, mean preoperative LVEF was 44 %. SURGICAL PROCEDURE: Surgical exposure was performed via sternotomy in 10 patients, the rest of the patients underwent thoracotomy. Seven patients were operated on cardiopulmonary bypass, the others underwent an off-pump procedure. Eleven patients underwent CABG, mean number of anastomoses were 2.1 (range 1-4), two patients underwent aortic valve replacement. One patient underwent radical removal of pulmonary adenocarcinoma with local expansion into the left atrium. For the lung cancer lobectomy was necessary in 8, pneumectomy in 1, extirpation of multiple metastases in 1, resection of the trachea in 1 patient. Histological diagnosis was epidermoid carcinoma in 6, adenocarcinoma in 3, undifferentiated carcinoma in 1, metastasis of Grawitz tumor in 1, pneumoconiosis in 1 patient. RESULTS: No patient died in hospital. One patient had to be re-explored for bleeding. Mean blood loss, duration of intubation and length of hospital stay were not different from other patients who underwent cardiac operation only. CONCLUSION: In accordance with the majority of the data published in the literature, combined procedures did not negatively influence hospital morbidity and mortality. Simultaneous operations eliminate the necessity of a second operation and do not delay the postoperative oncological therapy. Long-term results are primarily determined by histological diagnosis and by the extent of the tumor.

Aged↗
PubMed2006

Implantation of cryopreserved mitral allograft into the tricuspid position in an experimental study in sheep: technical aspects of implantation and immediate results evaluated by epicardial echocardiography.

AIMS: Cryopreserved mitral allograft valve (MAV) offers theoretical advantages over conventional mechanical or biological prostheses in tricuspid position, especially in infectious endocarditis patients. MAV processing and tricuspid valve (TV) replacement in a sheep model is described. METHODS AND RESULTS: In 20 adult sheep, MAV were harvested, processed and cryopreserved. One month later, recipient's TV were excised and the MAVs were transplanted into the tricuspid position in 13 sheep, under general anaesthesia, via a right thoracotomy, with an extracorporeal circulation (ECC) and cardioplegic heart arrest. Both MAV papillary muscles were anchored into the right ventricular wall by transmural stitches and the MAV anulus was sewn into the recipient's tricuspid anulus. After weaning from ECC, the anatomy and function of the MAV in the tricuspid position was assessed by epicardial echocardiography. The average duration of the ECC was 58 minutes (42-88), the cardioplegic heart arrest was 36 minutes (28-45). Weaning from EEC was always uneventful. Right atrial & pulmonary artery pressure measurements and epicardial echocardiography documented good function of all MAVs. CONCLUSION: MAV remained mechanically strong enough for implantation into the tricuspid position. Reproducible technique of MAV transplantation into the tricuspid position with excellent early postoperative haemodynamic performance was developed.

Animals↗
PubMed2006

[Resection of metastatic nondifferentiated carcinoma of sternum with thoracic wall reconstruction and simultaneous myocardial revascularization for ischemic heart disease--case report].

Authors offer the case report of a patient with metastatic non differentiated carcinoma of sternum simultaneously suffering from ischemic heart disease. The patient underwent actinotherapy & hyperthermia followed by resection of sternum and coronary artery bypass grafting in one session. Chest wall defect was closed by means of latissimus dorsi muscle rotation. Postoperative palliative chemotherapy started 16 weeks postoperatively. Primary tumor was not found, neither preoperatively nor during the 36 months' postoperative remission.

Bone Neoplasms↗
PubMed2005

[Ischemic mitral regurgitation. Clinical review emphasizing the surgical treatment].

Ischemic mitral regurgitation represents comparatively frequent complication of the myocardial infarction. Presence of the ischemic mitral regurgitation has a negative effect on the immediate mortality after the myocardial infarction and on the long-term survival. Ischemic mitral regurgitation is a functional, not structural impairment of the mitral valve and it is caused by altered geometry of the left ventricle. The article deals with the development and pathophysiology namely of the chronic ischemic mitral regurgitation and with the contemporary potential of surgical treatment of that serious complication of the ischemic heart disease.

Chronic Disease↗
PubMed2005

[Resection of the trachea with extracorporeal circulation as a simultaneous procedure during coronary artery bypass grafting--a case report].

The authors describe their surgical management of a female patient with a symptomatic coronary artery disease, who had developed a postintubation stenosis of the trachea. The patient sufferred from a rest dyspnoea with stridor. The unusual combination of the both cardiac and tracheal disorders were managed employing a one-step cardio-thoracic surgical procedure. The tracheal resection was conducted in the extracorporeal circulation condition together with the myocardial revascularization. The case shows how, in indicated cases, availability of the extracorporeal circulation can widen a spectrum and limits of the standard chest surgery.

Aged↗
PubMed2002

Possibilities of using vena cava filters in pregnant women with venous thromboembolism. Case reports.

Two cases of venous thromboembolism (VTE) (26th week and 35th week of pregnancy) are described. The standard anticoagulation therapy (Fraxiparine) with vena cava (IVC) filter insertion was applied with successful result and uneventful post partial period. The indications of IVC filters (permanent x retrievable x temporary) and timing of insertion and/or extraction are discussed. IVC filters are an effective and safe method in the prophylaxis and therapy of VTE in pregnancy. This method is justified to be used for a defined group of high-risk patients where benefit predominates potential complications.

Adult↗
PubMed2000

[Renal transplantation in children in the Czech Republic].

The aim of the study is to review results of pediatric renal transplantation in center in Prague, Czech Republic. Results are compared with the registry data from Europe and United States. Patients, who underwent RTx at the University Hospital Motol, Prague (Czech Republic) between 1977 and the end of 1999, were analyzed. Since 1977 128 Rtx from cadaveric donors were performed in children in mean age 12.8 +/- 4.1 years. In 1977-1987, patients were treated with prednisone and azathioprine, and since 1988, cyclosporine A, added to prednisone and azathioprine. Sequential quadruple immunosuppression was used only in few highly sensitized patients. Acute graft rejections were treated with methylprednisolone pulses, antithymocyte globulin and monoclonal antibodies OKT3, in selected cases. In 1988 and 1999 cyclosporine A was replaced by tacrolimus as initial immunosuppression in some patients. The number of Tx ranged between 5 and 13 per year. Patients and graft survival were significantly lower in the first time period 1977-1987 with a median patients 5-year survival rate of only 50% and graft survival 30%. In the last period (1988-1999) 5-year patients survival is 90% and 5-year graft survival is 68% (p = 0.01). Two cases of posttransplant lymphoproliferative disease were diagnosed so far. One of them died several months after RTx, the other received cytostatic therapy for Hodgkin tumor and graft function was maintained. Main causes of graft failure were chronic rejection followed by acute steroid resistant rejections, severe cytomegalovirus infections, noncompliance, vascular thrombosis, and recurrence of original disease.

Adolescent↗
PubMed2000

[Experimental ischemic renal injury--effect of surgical technique and the protective effect of a nonpeptide angiotensin II antagonist (losartan)].

Experimental renal ischaemic injuries are typically produced by temporary closure of the renal artery. In rats, two different methods of such temporary closure of the renal artery were compared: snaring of the artery by tourniquet, and clamping by a microsurgical bulldog clamp. The consequences of ischaemic periods 60, 90 and 120 minutes were evaluated. In different experimental series, the potential protective effect of non-peptic AT1 angiotensin II receptor antagonist losartan on postischaemic renal injury was evaluated. The seven-day survival and the degree of functional renal damage (according to the plasma levels of creatinine and urea) were analyzed 24 hours and 7 days after experimental renal ischaemia. Ischaemia, produced by the tourniquet led to a more significant renal damage than ischaemia caused by clamping of the renal artery by a microclamp (higher 7-day mortality rate, higher postischaemic plasma levels of creatinine and urea). Losartan decreased the consequences of renal ischaemia caused by the tourniquet, but did not change the outcome of renal ischaemia produced by microsurgical bulldog clamps. We found, that not only the duration of ischaemia and pharmacology, but even the surgical technique of producing renal ischaemia are important factors in experimental studies evaluating ischaemic renal damage. These findings provide evidence of the role of angiotensin II in postischaemic renal injury by a renal tourniquet. This particular mechanism is probably not involved, when renal artery is gently temporarily closed by a bulldog microclamp.

Angiotensin II↗
PubMed2000

[Aortic reconstruction in neonates with hypoplastic left heart syndrome] .

The surgical technique and tactics of the Norwood operation in neonates with hypoplastic left heart syndrome represent a surgical challenge. The Norwood operation was performed from the midline sternotomy approach, in extracorporeal circulation and deep hypothermic circulatory arrest was used for reconstruction of the hypoplastic aorta. Operation consisted of reconstruction of the "neoaorta" and the aortic arch from the original hypoplastic ascendent aorta, pulmonary trunk and a patch cut from a pulmonary homograft or pericardium, excision of the atrial septum and an arterial shunt from a Goretex vascular graft 3.5 or 4 mm in diameter. In patients with well developed aortic arch it was possible to reconstruct the aorta using Damus-Kaye-Stansel operation without circulatory arrest. Out of 12 operated patients with this defect, two (16.7%) died during the early postoperative period, one patient died late. The postoperative course was often complicated. In 6 (50.0%) patients the second step of Norwood operation, the bidirectional cavopulmonary anastomosis, was performed without mortality. According to our experience, it was necessary to prepare patients adequately before the first surgery. Perfect reconstruction of the aorta and a well functioning shunt had the crucial significance.

Aorta↗
PubMed1998

[Thromboelastography--an instrument for the researcher or clinician?].

Thromboelastography is a method which is used experimentally since 1948. Since the end of the eighties it is experiencing a certain revival also in clinical medicine. The submitted case-record presents this technique as a very useful aid in the differential diagnosis of postoperative haemorrhagic conditions in cardiosurgery. Its application can facilitate aimed treatment of some typical disorders of haemocoagulation.

Aged↗
PubMed1997

[Harvesting the heart for preparation of heart valve allografts].

Allograft heart valves (AHV) are believed to be optimal prosthetic material for surgical aortic valve and/or root replacement and an ideal valved conduit for repair of some complex congenital heart defects. At the University Hospital Motol AHV were clinically used since 1983 (annually no more than twenty were collected). 1991 the Paediatric Transplant Centre was established and was entrusted to organise cadaveric hearts harvesting and to introduce the standard technology of AHV processing and banking. The results of co-operation with other Transplants Centres, as well as with coroners and forensic medicine specialists in 1992-1995 are presented. For the AHV processing 274 cadaveric hearts were collected in the Czech and Slovak Republics, 32 of them (11.7%) came from routine post-mortem and 242 (88.3%) were retrieved from multiorgan harvesting, 14 hearts were excluded for technical reasons and another five for the seropositivity of the donor (three HBSAg, one HCV and one VDRL). Another 14 AHV were not suitable for clinical use because of a congenital lesion (bicuspid aortic valve) or acquired pathology found during the AHV processing (advanced atherosclerosis) or retrospectively diagnosed at donors post-mortem (in vivo undiagnosed malignancy). The technology of processing, cryopreservation and banking of AHV as well as the clinical use of the tissue will be discussed separately.

Cadaver↗
PubMed1997

[Preparation, storage, transportation and use of heart valves for allotransplantation].

UNLABELLED: Thanks to the co-operation with Czech and Slovak Transplant Centres and with some of the Departments of Pathology and Forensic Medicine 274 hearts were collected for allograft heart valves (AHV) processing during 1992-1995. The Cardiac surgeon dissected the aortic valve with the root and the pulmonary artery trunk with the valve. Tissues were antibiotically (ATB) sterilised in cultivation medium E 199 (24 hours at 37 degrees C). ATB concentrations (mg/ml): Cepharin 0.2, Azlocilin 0.2, Tobramycin 0.08 and Amphotericin B 0.1 for harvesting at post-mortem (P) or Miconazol 0.05 for sterile retrieval during multiorgan harvesting (MOH). After sterilisation AHV were stored at 4 degrees C. 49 AHV were infected even after ATB treatment-15 of 35 collected at P (43%) and 35 of 218 procured during MOH (16%)-(p < 0.01-ch2 test). After serological screening of the donor and microbiological testing the AHV were released for clinical use. Most AHV were programmed cooled to the temperature of liquid nitrogen (-196 degrees C), in which they were stored at the Allograft Heart Valves Cryobank. Cryoprotection was achieved by 10% dimethylsulphidoxide. CONCLUSION: A technology of harvesting, processing, storage and transportation of AHV, was introduced. It enabled the routine use in many cardiac surgical units. The AHV Cryobank was established. 131 AHV were used clinically between 1992 and 1995 (transportation as far as 1300 km). 108 AHV (82.4%) were used for repair of complex congenital heart defects, while 23 (17.6%) were used for aortic valve and/or root replacement.

Heart Valves↗
PubMed1996

[The effect of electrostimulation with the Rebox apparatus on ischemic renal injury in rats].

BACKGROUND: With developing transplantation programmes the problem of protection against ischaemic renal damage had become important. The results of experimental pharmacological protection of the kidneys are not quite conclusive. The objective of the presented paper was to assess the effect of electrostimulation by means of a Rebox apparatus (generator of direct rectangular impulses at a frequency of 1 to 10 kHz), on the development of ischaemic damage of the renal parenchyma induced experimentally in rats. METHODS AND RESULTS: The experiments were made on Wistar strains rats (n = 15) which were subjected to dextrolateral nephrectomy and the left renal artery was closed by a clamp which was released in the tested and the control group after 30 minutes. In the rebox group electrostimulation with the Rebox apparatus was implemented immediately after release of the clamp. In rats which were in metabolic cages the following parameters were assessed: diuresis, period of survival, endogenous creatinine clearance, plasma creatinine level, urea level and excretion, as well as sodium and potassium urinary excretion. No significant difference in the survival time of the rats was found nor in the plasma levels of creatinine, urea and urinary excretion of potassium and urea between the control and the Rebox group. In the Rebox group, as compared with the control group, a significantly higher diuresis was found 22.8 vs 5.6 (p < 0.001) and natriuresis 0.44 vs 0.11 (p < 0.01). CONCLUSIONS: Electrostimulation by rebox currents in rats increases significantly the diuresis and natriuresis of the solitary kidney exposed to 30-minute ischaemia but has no impact on other parameters. The mechanism of action is not quite clear, apparently the reabsorption of sodium in the proximal tubule is inhibited.

Animals↗
PubMed1996

[Minimally invasive myocardial revascularization. Initial experience with myocardial revascularization without extracorporeal circulation].

The authors present an account on the first phase of application of minimally invasive techniques of revascularization of the heart into clinical practice at their department. Since December 1994 to the end of January 1995 in selected 15 patients from a total of 240 patients with IHD 16 arterial and 8 venous grafts were sutured on the beating heart from median sternotomy. None of the patients died and none need reoperation. All patients are free from anginous complaints after operation and their clinical condition is satisfactory. Revascularization of the heart by means of arterial and venous grafts on the beating heart from median sternotomy is a technically reproducible method which enables us to elaborate further minimally invasive procedures for the treatment of IHD. The presented paper is a preliminary communication without claims of statistical validity of the achieved results.

Aged↗
PubMed1996

[Minithoracotomy in cardiac surgery. Initial experience with closure of an atrial septal defect with a minithoracotomy].

The authors describe their own modification of closure of an atrial septal defect (ASD) from right anterolateral minothoracotomy. This minimally invasive approach was selected in girls and women. Right anterolateral thoracotomy was used in 1987 to 1994 in twelve female patients. With regard to the general trend towards aesthetic surgery the authors use at present minimal anterolateral right-sided thoracotomy which with regard to its close relationship with the right atrium makes a safe surgical access to the atrial septum possible. Extracorporeal circulation is implemented by cannulation of the iliac artery in the groin, venous return is ensured by cannulas inserted into the venae cavae in the surgical field (by the auricle of the right atrium into the vena cava superior and the right atrial wall into the vena cava inferior). The operation itself is performed with electric fibrillation of the heart and tightening of the venous tourniquets. Between January 1995 till March 1996 the authors made by the thus modified approach a closure of the ASD type secundum in four female patients age 17, 29, 35 and 40 years. ASD was located always in the fossa ovalis and was repaired by direct suture. The duration of the extracorporeal circulation was on average 30 minutes. The length of the skin incision was 8-10 cm. The operation was free from complications. The cosmetic result is excellent and is consistent with principles of aesthetic surgery. If an arterial cannula is inserted into the groin minithoracotomy can be recommended for closure of ASD with extracorporeal circulation as a safe method.

Adolescent↗