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Biomedical subjects

P Firt

Publications and source records attributed to P Firt.

At least 19 recordsLinked to original sources
PubMed1992

Left main coronary artery stenosis.

Between 1 January, 1989, and 28 April, 1990, a total of 888 selective coronary arteriographies were performed at the Institute for Clinical and Experimental Medicine in Prague. Of that number, 58 findings were assessed as at least 50% stenosis of the left main coronary artery (LCA). Having applied exclusion criteria, 50 patients (i.e., 5.63% of all those examined) were entered into a retrospective study. They were 45 men (90.0%) and 5 women (10.0%) with significant cumulation of risk factors for IHD; more than half on them had a history of coronary event. The patients had marked symptomatology--NYHA Class III and higher angina pectoris was present in 96%, a low tolerance of exercise was found in 26 patients undergoing ergometry (average workload of 13 kJ and heart rate of 111/min); exercise testing was invariably evaluated as positive. Coronary angiography regularly revealed multiple coronary artery lesions; the right coronary artery was also involved in 90%; a collateral circulation was present in as little as 34%. The localization of coronary stenoses and the mostly preserved left ventricular mechanical function allowed operative management of IHD in 84% of cases. In the group of patients undergoing surgery, hospital mortality was 4.8%. On long-term follow-up (mean 6.2 months) of the group of patients operated on, 59.9% were free of problem, 31% had NYHA Class II angina pectoris, and there was no improvement at all in one patient only (2.4%). In the group provided conservative therapy (not operated on primarily for severe left ventricular dysfunction), one patient died of recurrent myocardial infarction and cardiogenic shock, 2 have NYHA Class IV angina pectoris, and the remaining subjects continue experiencing NYHA Class III problems.

Adult↗
PubMed1992

[Personal experience with heart transplantation].

During the period from 1984-1991 in the Institute of Clinical and Experimental Medicine 72 orthotopic transplantations of the heart were performed in 71 patients with irreversible cardiac failure. Indication for transplantation in 39 patients was IHD, in 28 cardiomyopathy, in 3 RHD and in one instance a tumour. The mean age of the patients was 41 years, the youngest patient was 17 and the oldest 62 years old. Immunosuppression involved a combination of three preparations Azathioprine, corticoids and Cyclosporine A. Nineteen patients died within one month after operation. The most frequent cause of death was cardiac failure. As to postoperative complications, renal failure was most frequent. Fifty patients were followed-up on a long-term basis. The longest survival period was 8 years and 2 months. The most frequent cause of death in the long-term follow-up was sudden death caused in the majority most probably by rapid development of coronary disease.

Adolescent↗
PubMed1991

[Heart surgery in Czechoslovakia].

In 1985, the cardiovascular Section of the Society of Surgery decided to start a registry of cardiac surgery procedures. Since then, basic data on surgical treatment of patients with heart disease have been collected each year. The following conclusions have been drawn from the data available: 1. The situation in cardiac surgery in Czechoslovakia is catastrophic. Czechoslovakia ranks among nations with the lowest numbers of operations per population in Europe. The most critical situation exists in IHD. 2. The standard of care provided to patients in individual areas of Czechoslovakia is about the same. 3. The critical lack of funds led to a decrease in the number of operations performed in 1990. 4. Organization of health care is poor, as indicated by length of hospital stay longer than that in the industrialized nations. 5. It is crucial to allocate more money to departments of cardiac surgery.

Cardiac Surgical Procedures↗
PubMed1991

[Selection of correct treatment in patients with low cardiac output after open-heart surgery].

In operations of the open heart inadequate cardiac output can lead to the so-called syndrome of a low cardiac output. The main indicator of cardiac function is the cardiac index. In patients in a critical state reduction of the cardiac index below 1.9 l/min q.m. suggests the presence of this syndrome. The submitted paper deals with the early detection of a low cardiac output which makes it possible to select optimal treatment before clinical signs of failure as well as further complications develop. The submitted paper deals with a group of 115 operated patients incl. 53 operated on account of IHD and 62 on account of rheumatic heart disease. Treatment was according to haemodynamic values divided into four groups: 1. Insurance of an optimal intravascular volume without pharmacological support, 2. pharmacological support of vasodilatating agents (nitroglycerine, sodium nitroprusside), 3. positive inotropic support by dobutamine, 4. support by a combination of vasodilatating agents and positive inotropic pharmaceutical preparations (dobutamine, dopamine). The favourable effect of treatment in the above groups is apparent already after four hours, and after 20 hours the investigated values shift to an optimal zone. The authors emphasize the high diagnostic value of comprehensive extensive monitoring which influences and controls therapy by retrospective informations.

Cardiac Output, Low↗
PubMed1990

[Surgical treatment of heart valve defects in infectious endocarditis].

The study makes an assessment of the results of surgical treatment of infectious endocarditis in 25 patients operated in 1982-1988 at the Institute of Experimental and Clinical Medicine. At the active stage of the disease, surgery was performed on 15 patients (60%), while prior to the operation, 16 persons' condition (64%) corresponded to the IIIrd and IVth degree of the NYHA functional classification. In infectious endocarditis, early mortality after valve replacement was 8%, late mortality--9% with an average of two-year post operative follow-up. Re-infection occurred in 12% patients, paravalvular regurgitation was found in 20 percento, out of whom 8% were haemodynamically significant and associated with the infection. Clinical post-operative improvement was observed in 76% patients, out of whom one half was totally asymptomatic and one third resumed their jobs. The results show that early surgical treatment of infectious endocarditis helps to reduce mortality. The post-operative risk of re-infection or of other complications was not high and the long-term post-operative functional effect was favourable in most patients.

Adolescent↗
PubMed1990

The mobilized omentum and muscle flaps in the treatment of infectious complications in cardiovascular surgery.

Infection in cardiovascular surgery invariably constitutes a very serious complication that cannot be controlled by antibiotics in all cases. Improved blood supply to the tissue affected by infection largely helps to control these complications. The article reports on three cases in which mobilized muscle and omental flaps helped essentially to heal infectious complications following heart transplantation, aortic valve replacement, and reconstruction of arteries of the lower limb.

Adult↗
PubMed1990

[Complications of percutaneous transluminal coronary angioplasty].

The most frequent complication of percutaneous transluminal coronary angioplasty is acute obstruction of the artery to be dilated. The authors present their experience with the solution of this situation. In a group of 154 consecutive patients with chronic stable angina pectoris a sudden occlusion was observed in 7.7%, infarction in 5.8% and the necessity of operation arose in 5.2%. A significant position in the solution if these complications is held by cardiosurgical revascularization. As to pharmacological treatment, it is useful to administer a combination of nitrates, calcium channel antagonists and thrombolytic treatment.

Angioplasty, Balloon, Coronary↗
PubMed1990

[Supravalvular aortic stenosis].

The authors describe the case of an inborn supravalvular aortal stenosis in an adult patient who was successfully treated by a plastic operation of the stenotic portion of the ascendent aorta by means of a synthetic patch. At the same time also a plastic operation of an incompetent mitral valve was made.

Adult↗
PubMed1989

[Pseudoaneurysm of the heart. Report on 4 patients].

A cardiac pseudoaneurysm (PA) is a rare complication of myocardial infarction. It may occur isolated, after cardiosurgery or after an accident. Echocardiography is of fundamental importance in its diagnosis. Coronarography provides important data on the state of the coronary arteries which is essential for planning further, in particular surgical treatment of the condition. The authors describe from four patients with PA.

Adult↗
PubMed1989

[Successful use of amrinone in combination with dobutamine in the treatment of severe heart failure].

The paper reports on a 46-year old man in the terminal stage of congestive cardiomyopathy who was referred to our department to have intraaortic balloon contrapulsation performed. Significant improvement in the cardiac output as well as in the clinical state and haemodynamic stabilization was achieved after the application of amrinone (bolus 0.75 mg/kg, initial dosis of 10 micrograms/kg/min. in continual infusion, later reduced to 6 micrograms/kg/min.) in combination with dobutamine and dopamine. The intraaortic balloon contrapulsation did not have to be applied, and after an 8-day therapy, the patient underwent biological heart transplantation which proved successful. The patient was discharged and is under home treatment.

Amrinone↗
PubMed1989

Cardiac tumours.

Most patients with cardiac mass have clinical signs mimicking mitral stenosis. As this tumorous mass carries the risk of obstructing the systemic circulation, the physician must consider the possibility of a cardiac tumour in differential diagnosis. That's why all patients presenting with clinical symptoms and a physical finding of mitral stenosis--even those without a history of rheumatic fever--should have routine echocardiography performed. All patients with a documented mass in cardiac chambers should be treated surgically and without delay, if possible.

Adult↗
PubMed1989

[The results of a questionnaire on the status of vascular surgery in Czechoslovakia].

In 1985 an enquiry by means of questionnaires was made at all surgical departments of the CSR. Its aim was to assess the state of vascular surgery, conditions under which it is performed and to compare quantitative and qualitative data with the actual needs. In 1984 in the CSR a total of 2564 vascular operations were performed, incl. 751 urgent ones and 1813 planned operations. With regard to the estimated need of cca 500 operations per 1 million population (comparable data from Scandinavian countries), the 248 operations per 1 million population are quite inadequate. In contrast to this, 82 surgeons claim to be concerned with active vascular surgery which is almost twice the number needed to ensure an adequate number of vascular surgical operations. The authors analyze the causes of the inadequate development of vascular surgery which ensued from the enquiry and indicate possibilities of future development.

Czechoslovakia↗
PubMed1988

[Experience with orthotopic transplantation of the heart].

The improvement of cardiac transplantation outcomes has resulted, since early eighties, in a considerable annual increment in the number of the operations. Original experience with orthotopic heart transplantation is reported. Eleven transplantations were performed between 31.01.84 and 25.09.86. Two patients died in the early postoperative period, 9 patients were discharged from hospital. Two patients died during the late postoperative period. The 7 surviving patients are in a satisfactory condition. According to reports in the literature, supported by the authors' own experience, heart transplantations in carefully selected cases have become a method of treatment. However, they should only be performed at clinical departments with adequate skills in cardiosurgery and organ transplantation.

Adult↗
PubMed1987

Experience with orthotopic heart transplantation.

Improving results of heart transplantation have led to a substantial increase in the number of transplantations performed each year ever since the early 1980s. The paper offers a review of our own experience with orthotopic heart transplantation. In the period between January 1984 and October 1986, a total of 11 transplantations has been carried out. Two patients died in the early postoperative period, nine were discharged from the hospital. There were two deaths in the late postoperative period. The seven surviving patients are in a satisfactory condition. Experience gathered hitherto in the world, and confirmed by our own results, shows that heart transplantation has become a therapeutic modality in patients selected on the basis of stringent criteria. The procedure, however, must be performed only in centres having a sufficient body of experience in cardiology, cardiac surgery, and transplantation of other organs.

Adult↗