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Catheter-based left atrial appendage closure
Hozman, Marek ; Osmančík, Pavel (advisor) ; Bulava, Alan (referee) ; Havránek, Štěpán (referee)
Transseptal puncture in left atrial appendage closure guided by 3D printing and multiplanar CT reconstruction Abstract Introduction: The presented study investigates the application of bi-atrial 3D printed models to guide transseptal puncture (TSP) in left atrial appendage occlusion (LAAC). The objectives are to (1) test the feasibility of 3D printing (3DP) for TSP guidance, (2) analyse the distribution of the optimal TSP locations, and (3) define a CT-derived 2D parameter suitable for predicting the optimal TSP locations. Methods: Pre-procedural planning included multiplanar CT reconstruction, 3D segmentation, and 3DP. TSP was pre-procedurally simulated in vitro at six defined sites. Based on the position of the sheath, TSP sites were classified as optimal, sub-optimal, or non-optimal. The aim was to target the TSP in the recommended position during the procedure. Procedure progress was assessed post hoc by the operator. Results: Of 68 screened patients, 60 patients in five centres (mean age of 74.68 ± 7.64 years, 71.66% males) were prospectively analysed (3DP failed in one case, and seven patients did not finally undergo the procedure). In 55 patients (91.66%), TSP was performed in the optimal location as recommended by the 3DP. The optimal locations for TSP were postero-inferior in 45.3%, mid-inferior in...
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Nursing care about a patient related to pacemaker implantation
Kazmířová, Jitka ; Zvoníčková, Marie (advisor) ; Osmančík, Pavel (referee)
Pacemaker implantation is a relatively common treatment of bradyarrhythmias today. This work deals with the nursing care about a patient who undergoes this surgery. The theoretical section summarizes the implantation issue, its indications, available devices and describes the typical course of the implantation. The practical part presents a case report. A fifty-six year old female patient undergoes a pacemaker implantation. She suffers from sick sinus syndrome manifested with bradycardia and palpitations, recently states of weakness and dizziness appeared, there were several collapses. The nursing process is handled according to the Model by M. Gordon. Particular attention is paid to mental state of the patient. Education of is also promoted. The patient must properly understand the reason for pacemaker implantation indication. She must also be advised of the necessary regimen after the surgery, which is an essential part of the treatment. Objectives that were set out in the plan of nursing care were achieved. The patient successfully underwent surgery, she was thoroughly educated and we can expect an increase in the quality of her life.
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Platelet reactivity during antiplatelet therapy
Paulů, Petra ; Osmančík, Pavel (advisor) ; Dyr, Jan (referee) ; Ošťádal, Petr (referee)
INTRODUCTION: Dual antiplatelet therapy is the basis of the treatement of patients with coronary artery disease following PCI. It demonstrably reduces the risk of ischemic complications of these patients and thus the morbidity and mortality. Despite all the effort we can see the recurrence of ischemic complications and worsening the prognosis in considerable percentage of patients. Resistance to treatement and resistance to clopidogrel can be marked as reason of therapy failure. AIM: The aim of our study was to a) define the incidence of clopidogrel resistance in real practise b) specify the factors which are associated with clopidogrel resistance c) determine whether the platelet reactivity measured by VerifyNow can be influenced by clopidogrel dose titration d) define the factors which are associated with worse prognosis of patients treated with dual antiplatelet therapy METHODS: We enrolled consecutive patients after PCI who were indicated to dual antiplatelet therapy. The blood samples were drawn within 24 hours after PCI and standart biochemical, hematological and coagulation parametres were determined. Also the serology and genetic analysis and VerifyNow test to determine the platelet reactivity were done. The PRU cut off value 240 was specified as the borderline of ineffective answer to clopidogrel...
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Platelet reactivity during antiplatelet therapy
Paulů, Petra ; Osmančík, Pavel (advisor) ; Dyr, Jan (referee) ; Ošťádal, Petr (referee)
INTRODUCTION: Dual antiplatelet therapy is the basis of the treatement of patients with coronary artery disease following PCI. It demonstrably reduces the risk of ischemic complications of these patients and thus the morbidity and mortality. Despite all the effort we can see the recurrence of ischemic complications and worsening the prognosis in considerable percentage of patients. Resistance to treatement and resistance to clopidogrel can be marked as reason of therapy failure. AIM: The aim of our study was to a) define the incidence of clopidogrel resistance in real practise b) specify the factors which are associated with clopidogrel resistance c) determine whether the platelet reactivity measured by VerifyNow can be influenced by clopidogrel dose titration d) define the factors which are associated with worse prognosis of patients treated with dual antiplatelet therapy METHODS: We enrolled consecutive patients after PCI who were indicated to dual antiplatelet therapy. The blood samples were drawn within 24 hours after PCI and standart biochemical, hematological and coagulation parametres were determined. Also the serology and genetic analysis and VerifyNow test to determine the platelet reactivity were done. The PRU cut off value 240 was specified as the borderline of ineffective answer to clopidogrel...
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Nursing care about a patient related to pacemaker implantation
Kazmířová, Jitka ; Zvoníčková, Marie (advisor) ; Osmančík, Pavel (referee)
Pacemaker implantation is a relatively common treatment of bradyarrhythmias today. This work deals with the nursing care about a patient who undergoes this surgery. The theoretical section summarizes the implantation issue, its indications, available devices and describes the typical course of the implantation. The practical part presents a case report. A fifty-six year old female patient undergoes a pacemaker implantation. She suffers from sick sinus syndrome manifested with bradycardia and palpitations, recently states of weakness and dizziness appeared, there were several collapses. The nursing process is handled according to the Model by M. Gordon. Particular attention is paid to mental state of the patient. Education of is also promoted. The patient must properly understand the reason for pacemaker implantation indication. She must also be advised of the necessary regimen after the surgery, which is an essential part of the treatment. Objectives that were set out in the plan of nursing care were achieved. The patient successfully underwent surgery, she was thoroughly educated and we can expect an increase in the quality of her life.
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