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Technical aspects of aortic root sparing surgery:Structural changes occurring during different thawingprotocols of cryopreserved human aortic root allografts and thereproducibility of external aortic root annuloplasty using Coroneo ring.
Novotný, Róbert ; Hlubocký, Jaroslav (advisor) ; Vojáček, Jan (referee) ; Pirk, Jan (referee)
Aortic valve-sparing procedures treating patients with aortic root aneurysm with or without aortic insufficiency and patients with ascending aortic aneurysm and aortic insufficiency are no longer experimental and unproven procedures. A successful aortic valve-sparing or repair operation aims not only to correct the failing part of the aortic root but also to restore the intro- and the inter-component relationship of the aortic root elements to optimal dimensions and relations. The avoidance of anticoagulation therapy and prosthesis-related complications makes aortic valve repair a tempting procedure. Considering the increasing rate of cusp repair reported in scientific literature, conservative aortic valve surgery seems to be developing into aortic valve repair surgery. This Dissertation Theses are devoted to the study of some specific technical aspects of aortic root sparing surgery, namely to the study of structural changes occurring in cryopreserved human aortic root allografts and the reproducibility of Coroneo ring implantation procedure. The Introduction of these Dissertation Theses deals with the general review of aortic valve- sparing operations in the light of the historical aspects of used surgical technique, dynamic anatomy and the current situation. One part of the Introduction is...
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Comparison of Czech and world superfoods
Soldánová, Lucie ; Vojáček, Jan (advisor) ; Slimáková, Margit (referee)
v angličtině k bakalářské práci na téma "Srovnání českých a zahraničních superpotravin" ,Lucie Soldánová, Karlova Univerzita, 1. lékařská fakulta, obor Nutriční terapeut. This bachelor thesis focuses on the topic of superfoods and aims to discover how our crops differ from those from abroad. The work consists of a theoretical and practical part. In the theoretical part of my thesis, I firstly analyze five most well known foreign (avocado, soy, goji, chia seeds and quinoa) and Czech (various seeds, poppy seeds, walnuts, blueberries and vegetable juices) superfoods. Then I compare them on four levels- a nutritional, economical, ecological and ethical one. In the practical part I asked several questions related to the problematics of superfoods and with the use of sent out questionnaires investigated whether people know superfoods, what is their opinion on them, if they buy them and whether they think about their origin and deeper problematics of the import of exotic crops. I discovered that more than 75 percent of those questioned are aware of superfoods. Whole 40 percent of people were somewhat sceptical of these foods and only 18,5 percent expressed full trust in them. Almost 73 percent of respondents buy superfoods at least once a week, which reflects their more frequent consumption, while the...
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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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Acute Myocardical Infarction with ST Elevation (STEMI), Direct PCI, Times and Lethality
Al Mawiri, Abdulwasya ; Vojáček, Jan (advisor) ; Mates, Martin (referee) ; Fiala, Martin (referee)
In ST-segment elevation myocardial infarction (STEMI), rapid revascularization is of paramount importance, and direct transport to a percutaneous coronary intervention (PCI)-capable center is recommended. Long-term follow-up data comparing both approaches are scarce. The purpose of this study was to compare the long-term outcomes of direct primary transfer (PT) and indirect secondary transfer (ST) in patients with STEMI. Method and study group: We enrolled consecutive patients referred for STEMI within 12 h of symptom onset. The primary endpoint was to compare long-term lethality of direct PT and indirect ST in patients with STEMI. During a two-year period (2008-2009), we prospectively recorded lethality and the door-to-balloon time (DBT) of 869 patients with STEMI from arrival at the first hospital until reperfusion by PCI in the catheterization laboratory. A total of 677 patients (77.9%) were enrolled for the final evaluation, with 192 (22.1%) patients excluded. We divided the patients into two groups: the first group (PT) had been transferred directly from the field to a catheterization laboratory, while the second group (ST) had been transferred from regional hospitals to a catheterization laboratory. The final analysis included 677 patients aged 20 to 96 years; the mean age was 64,04 years,...
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Prevention of ischemic and bleeding complications in patiens with known cardiovascular disease in relation to interruption and re-administration of antithrombotic therapy during non-cardiac surgery
Ondráková, Martina ; Moťovská, Zuzana (advisor) ; Vojáček, Jan (referee) ; Miklík, Roman (referee)
Background. The analysis of the current approaches to antithrombotic treatment of cardiac patients in the perioperative period of major non-cardiac surgery was performed. The incidence of ischemic and bleeding complications in relation to the interrupted antithrombotic was observed. The study investigated the discharge antithrombotic medication in patients with atrial fibrillation (AF) after major non-cardiac surgery and the impact on one-year outcomes. Methods. The subanalysis of multicentre PRAGUE 14 study was performed. A subgroup of 366 patients (mean age 75.9±10.5 years, women 42.3%, acute surgery 42.9%) undergoing major non-cardiac surgery and having any form of AF (30.6% of the total population enrolled in the PRAGUE-14 study) was followed for 1 year. Results. Antithrombotics (interrupted due to surgery) were resumed until discharge in 51.8% of patients; less frequently in men (OR 0.6 (95% CI 0.95 to 0.35); p=0.029), and in patients undergoing elective surgery (OR 0.6 (95% CI 0.91 to 0.33); p=0.021). Patients with AF had significantly higher one-year mortality (22.1%) than patients without AF (14.1%, p=0.001). The causes of death were: ischaemic events (32.6% of deaths), bleeding events (8.1%), others (N = 51; 59.3%). Non-reinstitution of aspirin until discharge was associated with higher...
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Morphological changes in pulmonary vascular bed after pulmonary embolism
Vavera, Zdeněk ; Vojáček, Jan (advisor) ; Staněk, Vladimír (referee) ; Vítovec, Jiří (referee)
Introduction: Chronic thromboembolic pulmonary hypertension (CTEPH) is a relatively common long-term complication of acute pulmonary embolism (PE) with severely negative impact on the patient's quality of life and prognosis. Specific pharmacotherapy and especially mastery of pulmonary endarterectomy (PEA) offer to our patients a hope for eventual full recovery. Early diagnosis determination is crucial. Objective: The aim of our prospective study was to determinate CTEPH incidence in a population of patients after acute pulmonary embolism as the first venous thromboembolic event in the patient`s history, to assess morphological changes in the pulmonary vascular bed with regard to risk of CTEPH development and try to identify some risk factors of CTEPH development. Methods: 120 consecutive patients with acute PE were followed-up for 2 years. On admission patients underwent CT pulmonary angiography (CTA), echocardiography and troponin-T, NT-proBNP and D-dimer assessement. At the time of hospital discharge we performed echocardiography and biomarkers reassessement whether they were elevated initially. After 6 months patients underwent pulmonary CTA, echocardiography and during 12- and 24-months visits echocardiography was performed again. In case of pulmonary hypertension detection CTEPH was confirmed...
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Resistance to antiplatelet therapy in cardiovascular diseases management
Ševčíková, Hana ; Vojáček, Jan (advisor) ; Šochman, Jan (referee) ; Vítovec, Jiří (referee)
Summary: Introduction: Antiplatelet therapy is a cornerstone in the management of cardiovascular diseases. With regard to interindividual variability in platelet reactivity and recurrence of thrombotic events despite therapy the importance of platelet function monitoring seems to be much higher. Objectives: The aim of our study was to describe the prevalence of high on treatment platelet reactivity in our study population. We were looking for the potential relationship between platelet reactivity and comorbidities or medication and tried to assess measurement reproducibility. Methods and results: 207 patients with cardiovascular diseases on ASA treatment (daily dose 100mg) were enrolled. Platelet functions were monitored by optic aggregometry (LTA) with cationic propylgallate as inductor. Residual platelet reactivity was assessed initially and afterwards (median value 9 months) without changes in ASA dose. In 82,1% suppression of platelet reactivity was adequate in both assessments, in 16,9% suppression of platelet reactivity was inadequate in at least one of the measurements. Our results show wide variability in platelet reactivity in time (p=0,67). No statistically significant differences in platelet reactivity were found in subpopulation with acute coronary syndromes (p=0,37), with chronic stable...
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The metabolic response to acute coronary syndrome focusing on tissue factor, metalloproteinases and soluble CD40 ligand
Bis, Josef ; Vojáček, Jan (advisor) ; Mates, Martin (referee) ; Vítovec, Jiří (referee)
The metabolic response to acute coronary syndrome focusing on tissue factor,, metalloproteinases and soluble CD40 ligand Introduction: The cause of acute coronary syndrome is unstable plaque and its rupture. Pathogenesis is complex and requires various mechanisms and depends both on the composition of plaque and thrombotic activity of blood. Objectives: The main goal of this work was to assess local levels of plasma tissue factor (TF), tissue factor inhibitor (TFPI), tissue metalloproteinases (MMP-2, 3 and 9) and inhibitor of metalloproteinases-2 (TIMP-2), a highly selective C-reactive protein (CRP) and soluble CD40 ligand (sCD40L) in patients with acute coronary syndrome and with stable angina pectoris in the systemic circulation, the coronary sinus and to determine the time course of blood levels in patients with acute coronary syndrome. Methods and results: Study population include patients with coronary artery disease (CAD). In 24 patients with stable CAD (SCAD) at time of diagnostic coronary angiography, we withdrew samples from the coronary sinus (CS), femoral vein (VF) and left coronary artery (LMCA). In 29 patients with acute coronary syndrome (ACS) we took samples of venous blood also 24 hours and 7 days from the start. The samples were fixed levels of TF, TFPI, MMP-2, 3 and 9, TIMP-2, CRP, and...
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Contrast-induced acute kidney injury in high risk patients undergoing invasive cardiac procedures
Matějka, Jan ; Vojáček, Jan (advisor) ; Gregor, Pavel (referee) ; Červinka, Pavel (referee)
Contrast-induced acute kidney injury in high risk patients undergoing invasive cardiac procedures Introduction: Acute renal function impairment associated with radiologic procedures, known as contrast-induced acute kidney injury (CI-AKI), is strongly associated with a higher rate of morbidity, in-hospital mortality and diminished long-term survival. CI-AKI prevention focuses mainly on adequate periprocedural hydratation and use of a low amount of contrast media. Previous trials concerning use of adenosine antagonist theophylline revealed contradictory results. Goals: Our interventional trial sought to evaluate the effect of theophylline in CI-AKI prevention in well hydrated elderly patients with chronic kidney disease. Our cross-sectional study focused on CI-AKI in patients undergoing primary PCI for ST segment elevation myocardial infarction (STEMI). Methods: Interventional trial: randomized, double-blind, placebo-controlled trial was performed. 56 patients with estimated glomerular filtration rate bellow 60 60 ml/min/1.73m2 referred for cardiac coronary angiography and/or angioplasty were enrolled. 31 of them were randomly assigned to 200 mg theophylline IV before procedure, and 25 to placebo. Iso- osmolar contrast Iodixanol was used. Trial protocol included mandatory parenteral hydration. The...
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Radial approach to coronary catheterizations and interventions
Bernat, Ivo ; Rokyta, Richard (advisor) ; Vojáček, Jan (referee) ; Ošťádal, Petr (referee)
Radial approach in coronary catheterizations and interventions has been only an alternative of the femoral approach. But due to some important advantages radial approach has a chance to become the first choice in majority of catheterized patients. The most important advantage is the reduction of vascular access site bleeding complications. Additonal benefits are patient satisfaction, cost reduction, shorter hospital stay and possibility of the same-day discharge catheterizations and interventions. The aim of our work was to try to answer three open questions: 1. is it possible to catheterize majority of our patients from the left radial artery when 90% of them are right-handed ? 2. what is the optimal care for the radial artery after the procedure in prevention and treatment of radial artery occlusion? 3. is it effective to implement radial approach in primary PCI as a first approach for STEMI patients? The first part relates the left radial approach. After construction of our special variable support for the left arm and forearm we succesfully used this approach in our studies in almost 90% of patients. The second part of this work contains our randomized trial comparing two different doses of unfractionated heparin in prevention of radial artery occlusion after diagnostic cardiac catheterizations....
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