Biomedical subjects

Piotr Podolec

Publications and source records attributed to Piotr Podolec.

At least 19 recordsLinked to original sources

PubMed2003

Reoperation after fresh homograft replacement: 23 years' experience with 655 patients.

OBJECTIVE: Through a retrospective study on the use of fresh homografts in 655 aortic valve replacement patients over a period of 23 years, we aimed to assess the reasons for eventual reoperation and causes of valve dysfunction. METHODS: Between January 1980 and December 2002, 655 patients received fresh homografts. All homografts were antibiotic sterilized and stored at 4 degrees C. During this time, 139 patients (116 male and 23 female) with a mean age of 46.7 years (range 18-72) required reoperation. RESULTS: The 30-day hospital overall mortality was 2.87%. The mean durability for all homografts was 12.4+/-4.54 years (1 month to 23 years). The cumulative rates for freedom from reoperation for any cause were 94.09+/-2% at 5 years and 87.9%+/-4% at 10 years, 76.6 at 15 years, 49.55 at 20 years. The major cause of valve dysfunction and indication for reoperation was degeneration in 111 patients (79.8%). Predominant aortic valve insufficiency in 87 patients (62.5%) and predominant stenosis in 24 patients (17.26%). Endocarditis occurred in 21 patients (15.1%). Early endocarditis was diagnosed in five patients (3.59%), late endocarditis in 16 patients (11.5%). Additional causes for reoperation included ascending aortic aneurysm, mitral valve insufficiency and congestive cardiomyopathy. Seventeen patients (12.2%) required concomitant procedures. Coronary artery bypass grafting was performed in six cases (4.3%), mitral valve replacement in five cases (3.59%), mitral valve annuloplasty in six (4.3%). The primary reoperative procedure was artificial/mechanical aortic valve implantation. In five cases, St. Jude Medical conduit grafts were implanted due to ascending aortic aneurysms. Homograft reimplantation was performed in four cases. One patient underwent mitral valve replacement and one patient received a heart transplant. CONCLUSION: The results of the study suggest that reoperation in patients with aortic homografts is a low-risk procedure as compared to alternative therapies. Primary allograft aortic valve replacement can give acceptable results for up to 23 years. The major cause of valve dysfunction and indication for reoperation was degeneration. Cumulative rates for freedom from reoperation for any cause in age groups suggest careful selection and indications in homograft implantation in the younger patients. Young age is a risk factor for an early homograft structural deterioration (degeneration).

Adolescent↗

PubMed2003

Prognostic value of nitrate enhanced Tc99m MIBI SPECT study in detecting viable myocardium in patients with coronary artery disease.

BACKGROUND: Assessing the viability in akinetic myocardium is vital for predicting functional recovery after therapeutic management in patients with chronic coronary artery disease (CAD) and depressed left ventricular (LV) function. The present study aimed to evaluate the efficacy of Tc99m MIBI SPECT enhanced with nitroglycerine infusion in detecting myocardial viability, as well as to asses the relationship between the myocardial viability and the subsequent treatment and outcome of patients. METHODS AND RESULTS: Sixty-seven consecutive patients with CAD and LV dysfunction (LV ejection fraction 36.6 +/- 8.4%) underwent Tc99m MIBI imaging--at rest and during intravenous nitroglycerine infusion--for viability assessment. Fourteen patients were treated pharmacologically (Group I), and fifty-three (Group II) were submitted to coronary revascularization (PTCR or CABG). Fifteen major cardiac events were observed during 25 months of the follow-up. A significantly worse event-free survival was registered in the subjects of Group I than in Group II subjects. The prognostic predictors of cardiac events were: (1) the number of viable, non-revascularized segments in perfusion imaging (p < 0.001), (2) the severity of the disease assessed by coronary angiography (p < 0.05). CONCLUSIONS: Viability detection in nitroglycerine infusion enhanced Tc99m MIBI imaging offers significant prognostic value in patients with CAD after myocardial infarction. Patients with preserved viability showed better prognosis after revascularization than those treated pharmacologically.

Coronary Artery Disease↗

PubMed2003

Impact of Chlamydia pneumoniae infection on survival rate after heart transplantation.

BACKGROUND: As Chlamydia pneumoniae (Cp), a common cause of respiratory infection, is of vasotropic character, chronic infection may be associated with the development of coronary disease, although there have been few reports on the impact of Cp infection on the post-orthotopic heart transplantation (OHT) survival rate. MATERIAL/METHODS: A total of 41 patients (4 females) were followed up for one year after OHT. Serology investigations for IgM, IgG and IgA antibodies against Cp were performed using the enzyme immunoassay (EIA) method. Univariate and multivariate analyses were carried out with respect to IgA, IgG, gender and type of cardiomyopathy. The IgA-IgG joint effect was also studied. RESULTS: The one-year survival rate was reported for patients with IgA < 8 EIU to be 72.2%, whereas those with IgA >or= 8 EIU accounted for only 43.5% (Kaplan-Meier analysis, p = 0.0548). In multivariate analysis IgA /IgG status proved to be a highly significant factor in survival. IgA positive outcome combined with IgG negative outcome showed that the relative risk of death equaled 12.08 versus other combinations of IgA/IgG status. In the Cox multivariate model ischemic cardiomyopathy showed a relative risk of 2.79 (p=0.0594), although it was not significant in univariate CONCLUSIONS: Chronic Cp infection, as expressed through a high IgA level, seems to have adverse impact on the survival rate in one-year follow-up after OHT. IgA titers against Cp in heart transplant recipients should therefore be assessed, as the high values might be a predictive risk factor within the first post-operative year.

Adult↗

PubMed2002

Cardiorespiratory response to exercise in children after modified fontan operation.

OBJECTIVE: Examination of exercise function of Fontan patients and comparison with healthy control subjects. DESIGN: Fourteen patients (6 males, 8 females; age: 5.7-17 years, mean 8.1 years) after Fontan repair in New York Heart Association (NYHA) class I with rest O(2)sat > 85% requiring no cardiovascular medications performed graded exercises on a treadmill 0.5-3.2 years postoperatively (mean 1.8 years). During the tests the heart and respiratory rate, blood pressure, oxygen uptake, carbon dioxide production, minute ventilation, tidal volume and O(2)sat were recorded. Spirometry was performed before and during exercise. RESULTS: The peak VO(2)max in Fontan patients was significantly reduced compared with controls (p = 0.0002). Other parameters: anaerobic threshold (p = 0.0001); pulsO(2) (p = 0.00005); peak minute ventilation (p = 0.0014); physiological dead space to tidal volume ratio at peak exercise (p = 0.0004); maximal work rate (p = 0.00008); exercise time (p = 0.00003) were significantly reduced in univentricular patients. The heart rate at peak exercise was lower in the patients (p = 0.0003) and O(2)sat dropped significantly (p = 0.003). CONCLUSION: The aerobic capacity, work and ventilatory parameters in Fontan patients are markedly reduced compared with controls. The anaerobic threshold was significantly lower. The decreased O(2)sat at peak exercise may suggest intrapulmonary shunting.

Adolescent↗

PubMed2002