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Biomedical subjects

M Sliwiński

Publications and source records attributed to M Sliwiński.

At least 19 recordsLinked to original sources
PubMed2001

Assessment of myocardial perfusion and viability with stress Tc-99m-MIBI SPECT before surgical revascularisation. Correlation with postoperative perfusion improvement.

BACKGROUND: The immediate result of successful revascularisation of the myocardium is the improvement of perfusion (and in patients with depressed ventricular function, functional recovery is expected as an effect of coronary flow improvement). The main goal of the work was to assess the value of myocardial stress-rest MIBI perfusion scintigraphy in predicting myocardial perfusion state measured early (< 5 months) after CABG. MATERIAL AND METHODS: Forty-three patients (39 males, mean age 52 +/- 9 years) with chronic coronary artery disease underwent prerevascularisation and postrevascularisation stress-rest Tc-99m-MIBI SPECT studies. Eighty-one percent of patients had a history of myocardial infarction, the number of stenosed main coronary arteries was 2.3 +/- 0.6 per patient, and the left ventricle ejection fraction was 18-70% (mean 46 +/- 14%). Preoperative perfusion defects were considered as small, medium or severe (depending upon stress uptake deficiency) and as transient or persistent (depending upon uptake improvement in rest). Changes in perfusion defects (improvement, lack of changes or deterioration) were evaluated very early after CABG (mean 31 +/- 12 days) in all patients and additionally about 3 months later (mean 119 +/- 17 days after CABG) in 36 patients. RESULTS: In transient perfusion defects, the probability of early postoperative perfusion improvement was 80% (in small defects: 89%, CI(0,95) = 80-94%) and was significantly higher than in small persistent defects (51%) and than in medium-and-severe persistent defects (21%). In medium-and-severe persistent defects, the lack of changes in perfusion was observed in 76% of defects (in severe defects: 81%, CI(0,95)= 69-91%) and was significantly higher than in small persistent defects (37%), than in medium-and-severe transient defects (17%), and than in small transient defects (4%). The probability of later postoperative perfusion improvement was 78% in transient perfusion defects (in small defects: 85%, CI(0,95)=74-92%) and was significantly higher than in small, medium, and severe persistent defects (28%). In medium-and-severe persistent defects, the lack of changes in perfusion was observed in 71% of defects (in severe defects: 81%, CI(0,95)=66-91%) and was significantly higher than in small persistent defects (40%), and than in severe, medium, and small transient defects (11%). CONCLUSIONS: 1. The result of preoperative stress-rest Tc-99m-MIBI SPECT myocardial perfusion study is an exact predictor of the state of perfusion measured early (< 5 months) after CABG; the postoperative regional perfusion improvement is most dependent upon reversibility and also upon severity of stress defect. 2. In small persistent defects, changes in perfusion are different than in other types of defects - so they should not be considered together with transient defects (as "viable") or with persistent defects (as "nonviable"). 3. Preoperative viability assessment on the basis of Tc-99m-MIBI study performed solely in rest is unjustified: at the similar perfusion defect at rest, the presence of even minimal inducible ischaemia is associated with increased probability of perfusion improvement after CABG.

Journal Article↗
PubMed2000

[Pulmonary thrombendarterectomy in treatment of patients with chronic thromboembolic pulmonary hypertension].

20 consecutive patients with thromboembolic pulmonary hypertension underwent pulmonary thromboendarterectomy. Mean pulmonary artery pressure decreased from mean 49.9 +/- 9.8 to 25.1 +/- 8.8 mm Hg (p < 0.0001), pulmonary vascular resistance decreased from mean 5.58 +/- 2.58 to 1.62 +/- 0.79 mm Hg/l*min-1 (p < 0.0001) and cardiac output increased from 3.71 +/- 1.18 to 6.92 +/- 1.64 l/min. Sixteen patients had marked clinical improvement. Two patients died in early and 2 patients in late postoperative period due to unrelieved pulmonary hypertension and postoperative complications.

Adult↗
PubMed2000

Evaluation of the impact of transmyocardial laser (CO2) revascularisation on myocardial perfusion--6-months observations.

BACKGROUND: Transmyocardial laser revascularisation (TMLR) is a relatively new surgical approach to symptomatic coronary artery disease patients otherwise inoperable by classical revascularisation methods. Perfusion improvement after TMLR is considered as one possible mechanism causing alleviation of symptoms in a significant percentage of operated patiens. The goal of this work was to assess the history f myocardial perfusion during the first 6 month after sole TMLR operation. METHODS: TMLR was performed by using high-power (800 W) CO(2) laser. Tc-99m-Sestamibi single photon emission computed tomography (SPECT), both in rest and stress, was performed 4 times: before TMLR [SPECT-0], very early (mean: 3 weeks) after TMLR [SPECT-I], 3 months after TMLR [SPECT-II] and 6 months after TMLR [SPECT-III] in every patient. The group consisted of 25 patients, including 21 patients with previous myocardial infarctions. The patients subjected to the operation were those suffering from angina in spite of pharmacological therapy, with diffuse changes in the peripheral parts of coronary arteries, with left ventricle (LV) ejection fraction not lower than 0.30 and with at least one transient or small persistent defect in preoperative SPECT. Perfusion was assessed in 13 of 17 segments of the LV (after exclusion of 4 septal segments). Only a history of transient or small persistent perfusion defects ('viable' segments) detected in SPECT-0 is discussed. RESULTS: In comparison to SPECT-0: in SPECT-I perfusion did not change in 52% of segments, improved--in 31%, and deteriorated--in 17%: in SPECT-II perfusion did not change in 48% of segments, improved--in 34%, and deteriorated--in 18%; in SPECT-III perfusion did not change in 52%, improved--in 25%, and deteriorated--in 22% of segments. No significant difference in the number of segments with perfusion preservation, improvement or deterioration in comparison to SPECT-0 was found in SPECT-I,-II or III. In SPECT-II in comparison to SPECT-I, no changes in perfusion were found in 66% of segments, perfusion improved in 20% and deteriorated in 14%. In SPECT-III in comparison to SPECT-II, no changes in perfusion were found in 79% of segments, perfusion improved in 5% and deteriorated in 15%. CONCLUSIONS: Our evaluation of the history of segments with preoperatively transient or small persistent ('viable') defects indicates that during the first 6 months after TMLR: 1) perfusion is better than before the operation in about one third of the segments, and 20 in some of these segments there are dynamic perfusion changes (improvement or deterioration) from one to the next postoperative moment of observation.

Journal Article↗
PubMed1995

[Psychological adaptation of patients after cardiosurgery on the mitral valve].

Authors present results of their own study concerning psycho-sociological functioning in patients after mitral valvuloplasty or mitral valve repleasment. A sourse of data was information obtained from mail questionnaire in 60 persons. We have made an analysis of phenomena which influence on subjects' occupational activity. During the hospitalisation period, before and after surgical treatment, patients had hemodynamicly exam (with effort) to hold in estimation their condition. The results of this study shown that most of the subjects don't resume their occupational work. This is caused by psychological or psychosociological reasons (anxiety, fear before effort, no acceptation by employer at person after cardiosurgical treatment, etc). Authors underline necessity of the intensive psychotherapeutic action during the hospitalisation and just after it at ambulatory course.

Adaptation, Psychological↗
PubMed1995

[Evaluation of changes in pulmonary vein compliance in prognosis of clinical results after mitral valve replacement].

Irreversible decrease in pulmonary venous compliance (PVcomp) can influence on the clinical results of mitral valve replacement (MVR). The study has been aimed at assessing whether changes in the PVcomp after the application of isosorbiddinitrate (ISDN) can be of prognostic significance in pts with mitral stenosis (MS). Right heart catheterization was performed with 34 pts with MS using a Swan-Ganz catheter in supine position, before and after the application of ISDN. Pulmonary artery pressure (PAP), pulmonary wedge pressure (PWP), stroke volume index (SVI), pulmonary vascular resistance (PVR) and heart rate (HR) were calculated according to standard formulas: PVcomp was calculated according to Hirakawa equation. The whole group was divided into 2 subgroups: I--increase of PVcomp after ISDN > 15% (19 pts), II--decrease or no change of PVcomp after ISDN (15 pts). ISDN increased PVcomp from 5.27 to 8.08. ml/m3 in group I, and decrease from 6.74 to 6.31 ml/m3 in group II. There were no differences between both groups during rest and effort before MVR. Six months after MVR decrease in PAP, PWP, PVR and increase in SVI was observed in both groups, but more significant in group I. However during effort (25 W), significant increases in PAP (21.9 vv 36.5 mmHg), PWP (12.9 vs 24.5 mmHg) and HR (80 vs 98 beat/min) with no improvement of PVcomp (5.82 vs 5.68 ml/m2) were recorded in most of pts from group II as opposed to group I. As can be concluded, significant increase in PVcomp after ISDN in pts with MS can be a prognostic of good clinical results after MVR.

Cardiac Catheterization↗
PubMed1993

Pulmonary hemodynamics at rest and effort, 6 and 12 months after mitral valve replacement: a slow regression of effort pulmonary hypertension.

An analysis of pulmonary hemodynamics in 22 patients with postrheumatic mitral valve disease using a floating Swan-Ganz type catheter at rest and effort in supine cycloergometer test was done before, 6 and 12 months after mitral valve replacement. Pulmonary hemodynamics data were recorded and calculated at rest and during effort. The most significant changes in almost all analyzed parameters occurred between preoperative and 6 month examination values. However further modest changes mainly during effort were observed between the 6-month and 1-year follow-ups. The mean workload during the bicycle ergometer test rose significantly from 22 +/- 26 W before to 48 +/- 20 W at 6 months and 57 +/- 22 W at 12 months after mitral valve replacement (P < 0.005). We noted a significant improvement in functional class 6 months after mitral valve replacement and a further slight improvement 12 months after. There was a small statistically insignificant decrease in systolic pulmonary pressure between 6 and 12 month measurements. Systolic pulmonary pressure at rest dropped slightly from 39.0 +/- 9.4 to 34.6 +/- 9.4 mmHg. During the bicycle test after 3 min (25 W) the decrease of systolic pulmonary pressure between the 6- and 12-month measurements was statistically significant. Systolic pulmonary artery pressure dropped from 61 +/- 12.4 to 50 +/- 12.3 mmHg. At the same time the drop in pulmonary wedge pressure was smaller and statistically not significant. Pulmonary wedge pressure at rest 6 months after mitral valve replacement was 14.3 +/- 6 mmHg, and after 12 months was 12.7 +/- 4.5; at 25 W, 24.6 +/- 6 vs. 22.1 +/- 5.5, respectively.(ABSTRACT TRUNCATED AT 250 WORDS)

Catheterization, Swan-Ganz↗
PubMed1993

[Surgical treatment for mitral valve defects with preponderance of mitral stenosis and high pulmonary vascular resistance. Clinical and hemodynamic observations 6 months after valve replacement].

10 patients with isolated or predominant mitral stenosis (mean mitral valve area 0.9 cm) and high preoperative values of pulmonary vascular resistance (mean 7.2 Wood units) were chosen for further hemodynamic postoperation evaluation. The patients had normal function of the aortic valve and no significant stenosis of coronary arteries. Hemodynamic evaluation was done by floating Swan-Ganz catheter preoperatively at rest and 6 months after mitral valve replacement at rest and during bicycle cycloergometer test in the supine position. Significant improvement in NYHA class was noted. Preoperatively 6 patients were in NYHA III class, 4 in NYHA IV class. After mitral valve replacement 4 patients were in class III and 6 in class II. Before mitral valve replacement only 3 patients were able to perform 25 Watt test. After surgery all except one performed at least 25 W. There was a significant decrease of pulmonary vascular resistance from 7.2 +/- 2.2 preoperatively to 3.1 +/- 1.9 Wood units at rest after the operation. Post operation during exercise pulmonary vascular resistance attained 4.2 +/- 1.9 Wood units. These changes were due to a fall in mean pulmonary artery pressure 49 +/- 13 at rest preoperatively to 25 +/- 6 mm Hg (rest) and 43 +/- 14 mm Hg (23 W) postoperatively and a rise in stroke volume index from 24 +/- 7 ml (m2) beat preoperatively to 32 +/- 9 at rest and 33 +/- 6 (25 W) postoperatively. Despite clinical and hemodynamic improvement there was no full recovery of pulmonary hemodynamics.

Adult↗
PubMed1992

[Constriction of the left main coronary artery. Early and long term treatment outcome].

Clinical presentation and course were studies in 45 consecutive patients (p)--39 males, 6 females with angiographically proven left main coronary artery stenosis (LMCA) > 50%. Mean age was 54.7 years. Three (6%) had no history of chest pain, 2 p (4%) had atypical chest pain, and the remaining (90%) had typical angina pectoris. 19 p (42%) had unstable angina, 20 p (44%) had suffered a myocardial infarction in the past. Outside an episode of chest pain most of the patients had an abnormal ECG with ST-T segment depression 2 mm or more in leads V3-6 and ST-T elevation in leads V1 and aVR. No significant differences were found when the abnormalities of the ST-T segment were compared to severity of LMCA obstruction. A symptom limited exercise test was performed in 17 (37%) p. It was abnormal in 13 p (29%). Thirty eight patients (85%) underwent bypass surgery and the mean number of bypass graft was 3.3. Seven patients were treated medically. In the surgical group four p (10.5%) died perioperatively. All of them had subtotal occlusion of LMCA, without significant lesions in the remaining coronary arteries, the ejection fraction (EF) was above 66%. Among thirty four living patients thirty have been asymptomatic. In the medically treated group 3 p (42%) died and only two of four survivors were asymptomatic at a mean follow-up 35.7 months. Left ventricle of all died patients were severely damaged (EF mean 28%), right coronary artery (RCA) was totally occluded and all had rythm disturbances. We conclude, that patients with significant LMCA stenosis had a good prognosis when treated surgically.(ABSTRACT TRUNCATED AT 250 WORDS)

Adult↗
PubMed1992

[Analysis of remission of pulmonary hypertension after mitral valve replacement].

In a group of 32 patients with mitral valve disease and extreme pulmonary hypertension, the efficacy of mitral valve replacement (MVR) was analysed. In all patients hemodynamic and clinical data were obtained and compared before and after operation. After surgery a statistically significant differences (p < 0.01) of the pressure was observed in right atrium and ventricle, pulmonary artery and capillaries, the pulmonary resistance was decreased, the cardiac index was increased. The improvement of hemodynamic parameters correlated well with clinical data. But it has not influenced for return to the job.

Adult↗
PubMed1992

[Early results of surgical treatment of patients with Wolff-Parkinson-White syndrome].

Successful dissection of accessory pathways (AcP's) was performed in 19 of 20 patients. 15 pts had single, 4 double and 1 patient had 3 accessory pathways (AcP's). The patient with 3 AcP's was operated twice. During the first operation two AcP's were eliminated. The third one was revealed during the postoperative electrophysiologic study. Verapamil facilitated its manifestation and localisation. No patient had syncope or atrio-ventricular tachycardia after the operation. In 3 of 10 patients who had atrial fibrillation before the operation, episodes of AF occurred in the early postoperative period. Conduction to the ventricles was through the normal conduction system. Dissection of AcP's prevented extremely fast ventricular response and syncope. After discontinuation of amiodarone more frequent ventricular premature beats occurred in patients with long history of cardiac arrhythmias, on drugs for a long time and in patients who had heart dilatation. Several months after the operation VEB were less frequent, probably because tachycardias did not occur, left ventricle geometry improved, and cardiodepressant drugs were discontinued. Previously these patients had been treated usually with combination of 2-3 such drugs. After the successful dissection of AcP's the patients lost the feeling of illness and do not feel being imperilled. Children can attend schools normally and some adult patients resumed their professional activities.

Adolescent↗
PubMed1992

[Clinical and electrophysiological indications for surgical treatment in patients with Wolff-Parkinson-White syndrome].

20 patients with WPW syndrome and recurrent tachyarrhythmias were studied clinically and electrophysiologically. The localization and electrophysiological properties of accessory pathways and other heart structures were estimated before the surgical treatment. 13 patients (pts) suffered syncope in the course of atrial flutter or atrial fibrillation with heart rate greater than 300/min, often proceeding into ventricular fibrillation or atrioventricular tachycardia greater than 260/min, which sometimes proceeds into atrial/ventricular fibrillation. 6 pts experienced dizziness or fainted during tachyarrhythmias or rhythm changes. In 15 pts antiarrhythmic drugs in monotherapy or various combinations did not prevent recurrence of tachyarrhythmias. In 4 of 5 other pts only amiodarone was effective but the drug was discontinued due to serious adverse effects. The lack of good effect of antiarrhythmic drug therapy can be based on mutually unfavorable electrophysiologic properties of the accessory pathways and other heart structures. Pts who experienced syncope had a particularly short effective refractory period (ERP) of the accessory pathways in ante- and retro-grade direction and short ERP of the ventricle muscle. Additionally, there were multiple accessory pathways, heart muscle impairement and frequent ventricular premature beats--factors triggering the tachyarrhythmias.

Adolescent↗
PubMed1991

[Indications for emergency surgical treatment of ectopic atrial tachycardia].

Recurrent automatic atrial tachycardia can induce dilated cardiomyopathy. We present clinical and therapeutic problems of 16 years old male with ectopic left atrial tachycardia refractory to pharmacological therapy. In this patient long periods of atrial tachycardia 200-240/min due to lack of effective medication caused cardiac failure. Uncontrolled taking of various antiarrhythmic drugs and persistent tachycardia led to cardiogenic shock. The electrophysiologic study revealed focus of the tachycardia localized in the area of left cardiac auricle. The rate of the tachycardia was changing from 84 to 240/min, with periods of Mobitz I block in the AV node. In periods of 1:1 AV conduction the tachycardia had sometimes LBBB QRS morphology. The atrial tachycardia provoked unsustained ventricular one. The patient was operated. Resection of left auricle and mitral valvuloplasty were performed. After the operation the patient regained undisturbed sinus rhythm and symptoms of heart failure disappeared.

Adolescent↗
PubMed1991

[Indications for emergency cardiovascular surgery at the Institute of Cardiology].

Between 1981 and 1989 73 patients (46 males, 27 females aged 15-69; mean 42) underwent emergency cardiac operation in the I Clinic of Cardiosurgery. There were 39 (53%) patients with valvular disease, 18 (25%) with prosthetic valve dysfunction and endocarditis, 9 (12%) with acute aortic dissection (2 of them had Marfan's syndrome), 5 (7%) with atrial myxoma and 2 (3%) with malignant pericardial mesothelioma. All of them were treated in C.C.U. before surgery. 27 urgent operations were performed within the first 24 hours after the admission to C.C.U. 30 of 73 patients died (41%). The IV NYHA functional class was stated as the most significant predictive factor for in-hospital mortality. The greatest mortality was observed in the group of patients with valvular disease (53%). In hospital survival rate reached 50% after reoperations as a procedure of choice in prosthetic valve dysfunction. Good early results were observed in patients with aortic dissection (survival rate--66%). The presence of Marfan's syndrome was associated with a poor surgical prognosis. There were no deaths after atrial myxoma removal, but all patients with malignant mesothelioma died. The most common cause of all deaths was congestive heart failure.

Adolescent↗
PubMed1991

[Recurrent episodes of Morgagni-Adams-Stokes syndrome due to degeneration of atrio-ventricular tachycardias into atrial fibrillation in a patient with Wolf-Parkinson-White syndrome].

We present clinical problems and the therapy of a 52 year old patient with Wolf-Parkinson-White syndrome and numerous episodes of Morgagni-Adams-Stokes syndrome. In that patient atrio-ventricular tachycardia caused atrial fibrillation. Short refractory period of the accessory pathway and the ventricular muscle allowed for extremely fast ventricular rate with haemodynamic collapse and syncope. Long-term treatment with propafenone or amiodarone did not prevent the arrhythmias. Electrophysiological study pre- and intraoperation including the epicardial mapping were performed several weeks after discontinuation of therapy with amiodarone. The studies revealed left free wall accessory pathway. Dr. A. Biederman and al. performed dissection of the accessory pathway. There were no evidence of conduction through the accessory pathway during the post operation electrophysiologic study. The patient has neither reentrant tachycardias nor atrial fibrillation episodes.

Adams-Stokes Syndrome↗
PubMed1990

[Dissection of the accessory conduction pathways with simultaneous mitral valve surgery].

The case of surgical treatment of a 44-years old female with a double atrio-ventricular accessory pathway and mitral stenosis was described. Fast ventricular rates due to conduction through the accessory pathways during atrial fibrillation in course of mitral stenosis caused severe heart failure, occasionally with deep hypotonia. Combined treatment with prajmaline and propafenone blocked conduction through accessory pathways. The ventricular rate slowed from approx. 200/min to 150/min. Addition of digoxin slowed the ventricular rate down to approx 80-100/min. There were no signs of preexcitation. Treatment with diuretics and vasodilators was continued. The state of patient improved. Echocardiographic and hemodynamic evaluation revealed: mitral stenosis (orifice - 75 mm2) with moderate regurgitation, small aortic and tricuspid regurgitation. The coronary arteries were normal. On the base of the ECG recordings during atrial fibrillation both accessory pathways were localized on lateral and posterior parts of the left free wall. The patient was operated on. Both atrio-ventricular by-pass tracts were dissected using Sealy's method in Cox modification and then mitral valve prosthesis Medtronic-Hall 27 mm was implanted. Prajmaline and propafenone were discontinued and preexcitation did not recovered. The sinus rhythm was restored by electroversion. The patient had no overt heart failure on discharge from the Institute.

Adult↗