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Surgical treatment of mortal complications of acute myocardial infarction as basis of secondary ischemic heart disease prevention
Kačer, Petr ; Adámková, Věra (advisor) ; Táborský, Miloš (referee) ; Velemínský, Miloš (referee)
Cardiovascular disease (CVD) represents the leading cause of death in the Czech Republic. The principles of the secondary prevention of CVD are well-known, precisely elaborated and highly effective. Myocardial infarction may be accompanied with mechanical complications. One of the later is a post-infarction rupture of the free wall of the left ventricle (FWR) resulting in high mortality rates during hospitalization (60-90%) and surgery (11.8-61%). Due to the rarity of the diagnosis, the surgical treatment and its secondary preventive effect on the patients' life have not been described sufficiently. The aim of the work presented was to describe and evaluate the methods of surgical treatment of FWR as a basis of prevention of secondary FWR by means of analyzing a set of FWR patients (comprising two groups as per the actual FWR form) concentrated on the patients' performance evaluated by the ejection fraction (EF) of the left ventricle (LV) and self-sufficiency, and suggesting an optimum FWR treatment strategy emphasizing the function preservation of LV - the tertiary prevention of the rupture of the free wall of the LV. The study comprises a set of 19 patients, i.e. 11 (57.9 %) males and 8 (42.1 %) females, who underwent surgery in the IKEM Heart Center between 01. 01. 2006 and 31. 12. 2012. The RLK...
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Surgical treatment of atrial fibrillation: prospective randomized study PRAGUE-12 and EndoMAZE procedure (toracoscopic ablation of atrial fibrillation)
Budera, Petr ; Straka, Zbyněk (advisor) ; Táborský, Miloš (referee) ; Šetina, Marek (referee)
Surgical treatment of atrial fibrillation: prospective randomized study PRAGUE-12 and EndoMAZE procedure (toracoscopic ablation of atrial fibrillation) Abstract (English) First part of our research project is focused on surgical treatment of atrial fibrillation in patients who undergo a cardiac surgery for some other primary diagnosis (ischaemic heart disease and/or valve disease). Concomitant surgical ablation procedures are widely used with expected positive long-term clinical impact on patients. However, this assumption has never been confirmed by enough powerful randomized studies with long-term follow up. Our PRAGUE-12 trial is the biggest, prospective, multicenter, randomized trial conducted to date. Its results demonstrated that surgical ablation improves the likelihood of SR presence post-operatively without increasing peri-operative complications. However, the higher prevalence of SR did not translate to improved clinical outcomes at 1 year. Related publications describe in detail its design and its one-year results. Second part of our research project is focused on surgical ablation of lone atrial fibrillation. In 2006, as a first cardiac surgery clinic in the Czech republic, we performed a completely toracoscopic ablation of this arrhythmia. More than thirty patients underwent this procedure in...
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Studium of the clinical impact of different forms of cardiac resynchronisation therapy by patients with chronic heart failure
Burianová, Lucie ; Kautzner, Josef (advisor) ; Janoušek, Jan (referee) ; Táborský, Miloš (referee)
Studium of the clinical impact of different forms of cardiac resynchronization therapy by patients with chronic heart failure MUDr. Lucie Burianová ABSTRACT: Introduction: Biventricular (BiV) pacing decreases mortality and improves quality of life of patients with severe heart failure. Haemodynamic and short time clinical studies suggest that isolated leftventricular pacing could have the same effect. Aims: Compare the effect of BiV and leftventricular pacing by subjects with dilated cardiomyopathy and severe heart failure with the attention to signs of dyssynchrony and remodelation of the left chamber. In methodical substudy compare the results of left chamber volumes and ejection fraction (EF LK) measured by CT angiography and 2-dimensional echocardiography with use of contrast agent (K-ECHO). Methods: Patients indicated for cardiac resynchronization therapy were randomized for either BiV or leftventricular pacing. After implantation of the device they were examinated clinically and by echocardiography every 3 months in the period of one year. Four years from the onset of the study the major adverse events in both groups were evaluated. The results of left chamber volumes and EF LK measured by K-ECHO and CT angiography were compared. Results: We enrolled 33 patients. We found clinical improvement in both...
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Clinical Manifestations of Infective Endocarditis Depending on Infectious Agent
Pazderník, Michal ; Vojáček, Jan (advisor) ; Táborský, Miloš (referee) ; Vítovec, Jiří (referee)
Introduction: Despite more recent advances in both medical and surgical therapies, the syndrome of infective endocarditis (IE) continues to be characterized by serious complications, and remains a life-threatening infection. According to data from the World Health Organization, the Czech Republic has one of the highest mortality rates due to this disease worldwide. Aims and methods: A study of local IE cases was conducted in two leading Cardiac centres in the Czech Republic. The main objective was to analyse the features of this disease and, at the same time, to identify predictors that are associated with the development of acute complications and worse survival of patients with IE. Results: Infection of the aortic prosthesis was a significant predictor of paravalvular spread of infection (OR 6.706). Infection caused by Staphylococcus aureus (OR 8.459) and smoking (OR 8.403) were associated with a more frequent development of septic shock (OR 8.403). The most potent risk factors of possible embolization were mitral valve vegetation ≥ 13 mm (OR 3.59) and IE caused by Staphylococcus aureus (OR 3.24). The size of the vegetation was not only associated with the risk of embolization itself but also with a local destructive effect in the form of a new prolapse/perforation of the valve (OR 1.055). The importance...
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Surgical treatment of atrial fibrillation: prospective randomized study PRAGUE-12 and EndoMAZE procedure (toracoscopic ablation of atrial fibrillation)
Budera, Petr ; Straka, Zbyněk (advisor) ; Táborský, Miloš (referee) ; Šetina, Marek (referee)
Surgical treatment of atrial fibrillation: prospective randomized study PRAGUE-12 and EndoMAZE procedure (toracoscopic ablation of atrial fibrillation) Abstract (English) First part of our research project is focused on surgical treatment of atrial fibrillation in patients who undergo a cardiac surgery for some other primary diagnosis (ischaemic heart disease and/or valve disease). Concomitant surgical ablation procedures are widely used with expected positive long-term clinical impact on patients. However, this assumption has never been confirmed by enough powerful randomized studies with long-term follow up. Our PRAGUE-12 trial is the biggest, prospective, multicenter, randomized trial conducted to date. Its results demonstrated that surgical ablation improves the likelihood of SR presence post-operatively without increasing peri-operative complications. However, the higher prevalence of SR did not translate to improved clinical outcomes at 1 year. Related publications describe in detail its design and its one-year results. Second part of our research project is focused on surgical ablation of lone atrial fibrillation. In 2006, as a first cardiac surgery clinic in the Czech republic, we performed a completely toracoscopic ablation of this arrhythmia. More than thirty patients underwent this procedure in...
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Surgical treatment of mortal complications of acute myocardial infarction as basis of secondary ischemic heart disease prevention
Kačer, Petr ; Adámková, Věra (advisor) ; Táborský, Miloš (referee) ; Velemínský, Miloš (referee)
Cardiovascular disease (CVD) represents the leading cause of death in the Czech Republic. The principles of the secondary prevention of CVD are well-known, precisely elaborated and highly effective. Myocardial infarction may be accompanied with mechanical complications. One of the later is a post-infarction rupture of the free wall of the left ventricle (FWR) resulting in high mortality rates during hospitalization (60-90%) and surgery (11.8-61%). Due to the rarity of the diagnosis, the surgical treatment and its secondary preventive effect on the patients' life have not been described sufficiently. The aim of the work presented was to describe and evaluate the methods of surgical treatment of FWR as a basis of prevention of secondary FWR by means of analyzing a set of FWR patients (comprising two groups as per the actual FWR form) concentrated on the patients' performance evaluated by the ejection fraction (EF) of the left ventricle (LV) and self-sufficiency, and suggesting an optimum FWR treatment strategy emphasizing the function preservation of LV - the tertiary prevention of the rupture of the free wall of the LV. The study comprises a set of 19 patients, i.e. 11 (57.9 %) males and 8 (42.1 %) females, who underwent surgery in the IKEM Heart Center between 01. 01. 2006 and 31. 12. 2012. The RLK...
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Studium of the clinical impact of different forms of cardiac resynchronisation therapy by patients with chronic heart failure
Burianová, Lucie ; Kautzner, Josef (advisor) ; Janoušek, Jan (referee) ; Táborský, Miloš (referee)
Studium of the clinical impact of different forms of cardiac resynchronization therapy by patients with chronic heart failure MUDr. Lucie Burianová ABSTRACT: Introduction: Biventricular (BiV) pacing decreases mortality and improves quality of life of patients with severe heart failure. Haemodynamic and short time clinical studies suggest that isolated leftventricular pacing could have the same effect. Aims: Compare the effect of BiV and leftventricular pacing by subjects with dilated cardiomyopathy and severe heart failure with the attention to signs of dyssynchrony and remodelation of the left chamber. In methodical substudy compare the results of left chamber volumes and ejection fraction (EF LK) measured by CT angiography and 2-dimensional echocardiography with use of contrast agent (K-ECHO). Methods: Patients indicated for cardiac resynchronization therapy were randomized for either BiV or leftventricular pacing. After implantation of the device they were examinated clinically and by echocardiography every 3 months in the period of one year. Four years from the onset of the study the major adverse events in both groups were evaluated. The results of left chamber volumes and EF LK measured by K-ECHO and CT angiography were compared. Results: We enrolled 33 patients. We found clinical improvement in both...
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Physiological Mechanisms of Heart Rate Turbulence
Wichterle, Dan ; Kautzner, Josef (advisor) ; Kvasnička, Jiří (referee) ; Táborský, Miloš (referee)
Our papers on HRT physiology covered several electrophysiological phenomena associated with turbulent behaviour of sinus nodal discharge after isolated premature beat. Some observations were fairly novel (AV nodal turbulence, QT-turbulence, and HRT after atrial premature complexes), others were confirmative or complementary to the findings of other authors (impact of left ventricular ejection fraction and coupling interval). All of them were helpful for even deeper understanding the fundamental principles involved in HRT that, consequently, may offer an explanation of why HRT is such a potent postinfarction risk stratifier. From the very beginning we tried to suggest that late deceleration phase of HRT does not simply reflect the vagal function but originates from a complex interplay of both sympathetic and parasympathetic systems. Our paper on HRT hemodynamics (Wichterle et al. 2006) together with the article by Segersen et al. (2007) added perhaps "the last piece to the heart turbulence puzzle", as appreciated in Heart Rhythm editorial by Munich working group (Bauer et al. 2007).
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The effect of biventricular pacing as compared to single - side left - ventricular pacing and bifocal pacing of the right ventricle in patients with chronic heart failure
Riedlbauchová, Lucie ; Kautzner, Josef (advisor) ; Horký, Karel (referee) ; Táborský, Miloš (referee)
Cardiac resynchronization therapy (CRT) represents an accepted treatment modality in patients with advance chronic heart failure, acute and long-term benefit of which was confirmed in several clinical trials. Recently, reduced mortality and rate of hospitalization for heart failure were also demonstrated. However, response to CRT is interindividually highly variable with a substantial proportion of CRT recipients who do not respond to this therapy. Although the identification of suitable candidates is probably the most important factor in the reduction of the rate of non-responders, some other determinants, peri- and post-implant, may substantially affect the final effect of CRT. The present PhD focused on some of these variables: 1/ First of them is a selection of the appropriate pacing mode. This PhD evaluated effect of 3 pacing modalities that have been proposed as alternatives of CRT - biventricular pacing (BiV), single-site left-ventricular pacing (LVP) and rightventricular bifocal pacing (Bif). It was clearly shown that the first two pacing strategies, BiV (it is simultaneous pacing of both ventricles) and LVP, cause comparable acute hemodynamic improvement at rest. Study No.2 of this PhD confirms that the comparable effect of BiV and LVP is preserved also during the exercise. In addition, study No.1...
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