OBJECTIVES: The efficacy and safety of macitentan, an endothelin receptor antagonist, were assessed in a 52-week, prospective, multicenter, double-blind, randomized, placebo-controlled, parallel-group study assessing the efficacy and safety of macitentan in Fontan-palliated adult and adolescent patients (RUBATO-DB) and an open-label extension trial (RUBATO-OL). METHODS: Patients aged 12 years and older with New York Heart Association functional class II or III underwent total cavopulmonary connection more than 1 year before screening and showed no signs of Fontan failure/clinical deterioration. In RUBATO-DB, the primary efficacy end point was change in peak oxygen consumption from baseline to week 16; secondary end points were change from baseline over 52 weeks in peak oxygen consumption and change in mean count/minute of daily physical activity via accelerometer from baseline to week 16. Safety was assessed throughout both studies. RESULTS: In RUBATO-DB, 137 patients were randomized to macitentan 10 mg (n = 68) or placebo (n = 69); 92.7% completed 52-week double-blind treatment. At week 16, mean ± SD change in peak oxygen consumption was -0.16 ± 2.86 versus -0.67 ± 2.66 mL/kg/minute with macitentan versus placebo (median unbiased treatment difference estimate, 0.62 mL/kg/minute [99% repeated CI, -0.62 to 1.85]; P = .19). No treatment effect was observed in either of the secondary end points. During RUBATO-DB, most common adverse events with macitentan were headache, nasopharyngitis, and pyrexia. Across RUBATO-DB and RUBATO-OL, most common adverse events were COVID-19, headache, and fatigue. RUBATO-OL was prematurely discontinued because RUBATO-DB did not meet its primary or secondary end point. CONCLUSIONS: The primary end point of RUBATO-DB was not met; macitentan did not improve exercise capacity versus placebo in patients with Fontan palliation. Macitentan was generally well tolerated over long-term treatment.

• MeSH
• antagonisté endotelinového receptoru terapeutické užití   škodlivé účinky   MeSH
• časové faktory MeSH
• dítě MeSH
• dospělí MeSH
• dvojitá slepá metoda MeSH
• Fontanova operace * škodlivé účinky   MeSH
• lidé MeSH
• mladiství MeSH
• mladý dospělý MeSH
• paliativní péče MeSH
• prospektivní studie MeSH
• pyrimidiny * terapeutické užití   škodlivé účinky   MeSH
• spotřeba kyslíku účinky léků   MeSH
• sulfonamidy * terapeutické užití   škodlivé účinky   MeSH
• tolerance zátěže účinky léků   MeSH
• vrozené srdeční vady chirurgie   patofyziologie   MeSH
• výsledek terapie MeSH
• Check Tag
• dítě MeSH
• dospělí MeSH
• lidé MeSH
• mladiství MeSH
• mladý dospělý MeSH
• mužské pohlaví MeSH
• ženské pohlaví MeSH
• Publikační typ
• časopisecké články MeSH
• klinické zkoušky, fáze III MeSH
• multicentrická studie MeSH
• randomizované kontrolované studie MeSH

BACKGROUND AND OBJECTIVES: Stereotactic radiosurgery (SRS) with neoadjuvant embolization is a treatment strategy for brain arteriovenous malformations (AVMs), especially for those with large nidal volume or concomitant aneurysms. The aim of this study was to assess the effects of pre-SRS embolization in AVMs with an associated intracranial aneurysm (IA). METHODS: The International Radiosurgery Research Foundation AVM database from 1987 to 2018 was retrospectively reviewed. SRS-treated AVMs with IAs were included. Patients were categorized into those treated with upfront embolization (E + SRS) vs stand-alone SRS (SRS). Primary end point was a favorable outcome (AVM obliteration + no permanent radiation-induced changes or post-SRS hemorrhage). Secondary outcomes included AVM obliteration, mortality, follow-up modified Rankin Scale, post-SRS hemorrhage, and radiation-induced changes. RESULTS: Forty four AVM patients with associated IAs were included, of which 23 (52.3%) underwent pre-SRS embolization and 21 (47.7%) SRS only. Significant differences between the E + SRS vs SRS groups were found for AVM maximum diameter (1.5 ± 0.5 vs 1.1 ± 0.4 cm 3 , P = .019) and SRS treatment volume (9.3 ± 8.3 vs 4.3 ± 3.3 cm 3 , P = .025). A favorable outcome was achieved in 45.4% of patients in the E + SRS group and 38.1% in the SRS group ( P = .625). Obliteration rates were comparable (56.5% for E + SRS vs 47.6% for SRS, P = .555), whereas a higher mortality rate was found in the SRS group (19.1% vs 0%, P = .048). After adjusting for AVM maximum diameter, SRS treatment volume, and maximum radiation dose, the likelihood of achieving favorable outcome and AVM obliteration did not differ between groups ( P = .475 and P = .820, respectively). CONCLUSION: The likelihood of a favorable outcome and AVM obliteration after SRS with neoadjuvant embolization in AVMs with concomitant IA seems to be comparable with stand-alone SRS, even after adjusting for AVM volume and SRS maximum dose. However, the increased mortality among the stand-alone SRS group and relatively low risk of embolization-related complications suggest that these patients may benefit from a combined treatment approach.

• MeSH
• dospělí MeSH
• endovaskulární výkony metody   MeSH
• intrakraniální aneurysma * terapie   MeSH
• intrakraniální arteriovenózní malformace * terapie   chirurgie   MeSH
• lidé středního věku MeSH
• lidé MeSH
• neoadjuvantní terapie * metody   MeSH
• radiochirurgie * metody   škodlivé účinky   MeSH
• retrospektivní studie MeSH
• senioři MeSH
• terapeutická embolizace * metody   MeSH
• výsledek terapie MeSH
• Check Tag
• dospělí MeSH
• lidé středního věku MeSH
• lidé MeSH
• mužské pohlaví MeSH
• senioři MeSH
• ženské pohlaví MeSH
• Publikační typ
• časopisecké články MeSH
• srovnávací studie MeSH

UNLABELLED: Despite significant advances in knowledge and the development of guidelines, the management of hypoplastic left heart syndrome (HLHS) remains highly variable. A structured questionnaire was circulated across European Association of Paediatric & Congenital Cardiology (AEPC) affiliated centres. The aims were to evaluate standards in pre-operative assessment, types of surgery, follow-up and medical practices in children with HLHS. Thirty-one centres from 20 countries completed the survey. Delivery of babies with HLHS occurred in co-located maternity hospitals in 74% of centres; 29% were planned for spontaneous onset of labour, while 54% decided on a case-by-case basis. The preferred initial palliation was a right ventricle-pulmonary artery conduit in 55% of cases, modified Blalock-Thomas Taussig shunt (mBTTS) in 35%, and hybrid in 15% of cases. Timing for Glenn varied from 3 to 6 months of age and preoperative examination varied greatly: 65% performed cardiac catheterization and only 19% performed cardiac magnetic resonance. Stage III palliation was performed at a highly variable interval (2-6 years of age), nearly always employing an extracardiac conduit. Fenestration was routinely performed in 61% and reserved for borderline cases in 39%. All the centers adopted warfarin for the first 3-12 months after Fontan completion, and continued if a fenestration was present, while in non-fenestrated aspirin was left by most centers (e.g. 68%). However, there was a high disparity in the use of heart failure medications (e.g. in interstage I-II 35% use ACE-inhibitors, and only 26% digoxin). Follow-up practice also varied widely with only 60% employing specific protocols. CONCLUSION: This first multi-centre European survey from 31 centres from 20 different European countries highlighted a high practice variation in HLHS management across all the stages of Single Ventricle (Fontan) palliation. Major variations pertained to pre- and post-surgical investigations, surgical strategy for stage I and III, medical treatment regimens, and follow-up programs. WHAT IS KNOWN: • Hypoplastic left heart syndrome (HLHS) remains one of the most complex and challenging congenital cardiac defects to manage. • Investigating the management of children with HLHS across different European centres can facilitate study of the most effective management strategies. WHAT IS NEW: • Significant variation in HLHS management were reported in relation to pre- and post-surgical examinations, surgical strategy at stage I and III, medical treatment regimens, and follow-up programs. • Greater standardisation of imaging and diagnostic evaluation, medical treatment and follow-up surveillance may improve outcomes for these vulnerable patients and warrants further study.

• MeSH
• dítě MeSH
• kojenec MeSH
• lékařská praxe - způsoby provádění * statistika a číselné údaje   MeSH
• lidé MeSH
• novorozenec MeSH
• paliativní péče MeSH
• předškolní dítě MeSH
• průzkumy a dotazníky MeSH
• syndrom hypoplazie levého srdce * chirurgie   diagnóza   terapie   MeSH
• Check Tag
• dítě MeSH
• kojenec MeSH
• lidé MeSH
• novorozenec MeSH
• předškolní dítě MeSH
• ženské pohlaví MeSH
• Publikační typ
• časopisecké články MeSH
• multicentrická studie MeSH
• Geografické názvy
• Evropa MeSH

Syndróm predĺženého QT intervalu (LQT) a rozvoj komorovej tachykardie typu torsades de pointes (TdP) sú nezanedbateľnou príčinou náhlej srdcovej smrti. LQT je zároveň nezávislým rizikovým faktorom celkovej aj kardiovaskulárnej mortality. Najmä u seniorov často dochádza ku kumulácii faktorov favorizujúcich predĺženie QT intervalu. Cieľom našej práce bolo zistiť rizikový profil pre prolongáciu korigovaného QT intervalu (QTc) u seniorov s náhlym nevysvetleným perhospitalizačným úmrtím. V roku 2018 sme na našom pracovisku identifikovali 20 takých prípadov. Analyzovali sme posledný QT interval pred smrťou a viaceré relevantné rizikové faktory LQT. Predĺženie QTc intervalu bolo veľmi frekventované: v 60 % pacientov a klinicky signifikantné predĺženie > 500 ms v 20 %. Zistili sme istú koreláciu medzi dĺžkou QTc intervalu a hypokalciémiou (p = 0,552; ns), slabšie korelovala klesajúca glykémia (p = 0,382; ns), de facto nekoreloval celkový počet užitých rizikových liečiv (p = 0,134; ns). Každý pacient však užíval aspoň jedno „LQT rizikové“ liečivo a takých liečiv sa v súbore vyskytlo 17. Napriek nepitvanosti a absencii zdokumentovania terminálnej TdP predpokladáme, že viacerí z pacientov mohli zomrieť v dôsledku TdP. V klinickej praxi je relevantné identifikovať predĺženie QTc intervalu a znižovať riziká LQT/TdP.

Long QT syndrome (LQT) and the resulting ventricular tachycardia known as torsades de pointes type (dP) are a significant cause of sudden cardiac death. LQT is also an independent risk factor for all-cause and cardiovascular mortality. Especially in the elderly there is often a cumulation of factors favoring the QT prolongation. The aim of our study was to determine the risk profile for prolongation of the corrected QT interval (QTc) in seniors with sudden unexplained death during hospitalization. In 2018, we identified 20 such cases at our department. We analyzed the last QT interval before death and several relevant risk factors of LQT. Prolongation of the QTc interval was very frequent: in 60% of patients and clinically significant QT prolongation > 500 ms in 20%. We found a certain correlation between the length of the QTc interval and hypocalcemia (p = 0.552; ns), decreasing glycemia was more weakly correlated (p = 0.382; ns), the total number of used risky drugs was not correlated (p = 0.134; ns). However, each patient was taking at least one drug with the LQT risk. In total there were 17 such drugs used by our patients. Despite the lack of autopsy and the absence of documentation of terminal TdP, we assume that several of the patients may have died as a result of TdP. In clinical practice, it is relevant to identify prolongation of the QTc interval and reduce the risks of LQT/TdP.

• MeSH
• hospitalizace MeSH
• komorbidita MeSH
• léčivé přípravky klasifikace   MeSH
• lidé MeSH
• morbidita MeSH
• náhlá smrt * etiologie   MeSH
• nežádoucí účinky léčiv MeSH
• rizikové faktory kardiovaskulárních chorob MeSH
• senioři MeSH
• statistika jako téma MeSH
• syndrom dlouhého QT * chemicky indukované   komplikace   mortalita   patologie   MeSH
• torsades de pointes komplikace   MeSH
• Check Tag
• lidé MeSH
• mužské pohlaví MeSH
• senioři MeSH
• ženské pohlaví MeSH
• Publikační typ
• klinická studie MeSH

BACKGROUND: Open surgery is widely regarded as the standard treatment for spinal dural arteriovenous fistulas (SDAVFs). However, endovascular treatment (EVT) with liquid embolic agents has emerged as an alternative. While N-butyl cyanoacrylate is often preferred for its superior penetration into draining vein, this study aims to assess the effectiveness of an embolization-first strategy using Onyx, drawing on 20 years of clinical experience. METHODS: A retrospective analysis included 50 patients treated between 2004 and 2024. Only patients undergoing EVT as the first-line therapy for SDAVF were included. RESULTS: Overall, EVT achieved complete occlusion in 38 (76%) cases, with an additional 6 (12%) requiring adjuvant surgery resulting in definitive cure. In the remaining 6 (12%) patients, embolization of the feeding artery and fistula nidus led to permanent clinical improvement (n = 4, 66%) or stability (n = 2, 33%), supported by indirect fistula signs regression on follow-up magnetic resonance imaging. Onyx was solely used in 84% of EVTs, achieving a complete occlusion rate of 83%. Clinical improvement or stabilization was observed in 46 (92%) patients, with no recurrences in successfully treated patients. There was no EVT-related complication. Follow-up magnetic resonance imagings showed regression of perimedullary varices and regression or stability of myelopathy in all cases (n = 50, 100%). CONCLUSIONS: The embolization-first strategy, with adjuvant surgery when necessary, can achieve outcomes nearing those of purely surgical approaches. Based on our long-term experience, EVT with Onyx can result in complete and permanent cure of SDAVF in more than 80% of cases.

• MeSH
• cévní malformace centrálního nervového systému * terapie   diagnostické zobrazování   MeSH
• dimethylsulfoxid * terapeutické užití   MeSH
• dospělí MeSH
• endovaskulární výkony metody   MeSH
• lidé středního věku MeSH
• lidé MeSH
• mladý dospělý MeSH
• polyvinyly * terapeutické užití   MeSH
• retrospektivní studie MeSH
• senioři MeSH
• tantal * terapeutické užití   MeSH
• terapeutická embolizace * metody   MeSH
• výsledek terapie MeSH
• Check Tag
• dospělí MeSH
• lidé středního věku MeSH
• lidé MeSH
• mladý dospělý MeSH
• mužské pohlaví MeSH
• senioři MeSH
• ženské pohlaví MeSH
• Publikační typ
• časopisecké články MeSH

AIMS: The cardiac conduction system (CCS) is progressively specified during development by interactions among a discrete number of transcription factors (TFs) that ensure its proper patterning and the emergence of its functional properties. Meis genes encode homeodomain TFs with multiple roles in mammalian development. In humans, Meis genes associate with congenital cardiac malformations and alterations of cardiac electrical activity; however, the basis for these alterations has not been established. Here, we studied the role of Meis TFs in cardiomyocyte development and function during mouse development and adult life. METHODS AND RESULTS: We studied Meis1 and Meis2 conditional deletion mouse models that allowed cardiomyocyte-specific elimination of Meis function during development and inducible elimination of Meis function in cardiomyocytes of the adult CCS. We studied cardiac anatomy, contractility, and conduction. We report that Meis factors are global regulators of cardiac conduction, with a predominant role in the CCS. While constitutive Meis deletion in cardiomyocytes led to congenital malformations of the arterial pole and atria, as well as defects in ventricular conduction, Meis elimination in cardiomyocytes of the adult CCS produced sinus node dysfunction and delayed atrio-ventricular conduction. Molecular analyses unravelled Meis-controlled molecular pathways associated with these defects. Finally, we studied in transgenic mice the activity of a Meis1 human enhancer related to an single-nucleotide polymorphism (SNP) associated by Genome-wide association studies (GWAS) to PR (P and R waves of the electrocardiogram) elongation and found that the transgene drives expression in components of the atrio-ventricular conduction system. CONCLUSION: Our study identifies Meis TFs as essential regulators of the establishment of cardiac conduction function during development and its maintenance during adult life. In addition, we generated animal models and identified molecular alterations that will ease the study of Meis-associated conduction defects and congenital malformations in humans.

• MeSH
• akční potenciály MeSH
• fenotyp MeSH
• homeodoménové proteiny * genetika   metabolismus   MeSH
• kardiomyocyty * metabolismus   patologie   MeSH
• kontrakce myokardu MeSH
• myši knockoutované MeSH
• nodus sinuatrialis metabolismus   patofyziologie   MeSH
• převodní systém srdeční * metabolismus   patofyziologie   růst a vývoj   MeSH
• srdeční arytmie patofyziologie   metabolismus   genetika   MeSH
• srdeční frekvence * MeSH
• transkripční faktor Meis1 * genetika   metabolismus   nedostatek   MeSH
• věkové faktory MeSH
• vrozené srdeční vady metabolismus   genetika   patofyziologie   MeSH
• vývojová regulace genové exprese MeSH
• zvířata MeSH
• Check Tag
• zvířata MeSH
• Publikační typ
• časopisecké články MeSH

Long QT syndrome (LQTS) presents a group of inheritable channelopathies with prolonged ventricular repolarization, leading to syncope, ventricular tachycardia, and sudden death. Differentiating LQTS genotypes is crucial for targeted management and treatment, yet conventional genetic testing remains costly and time-consuming. This study aims to improve the distinction between LQTS genotypes, particularly LQT3, through a novel electrocardiogram (ECG)-based approach. Patients with LQT3 are at elevated risk due to arrhythmia triggers associated with rest and sleep. Employing a database of genotyped long QT syndrome E-HOL-03-0480-013 ECG signals, we introduced two innovative parameterization techniques-area under the ECG curve and wave transformation into the unit circle-to classify LQT3 against LQT1 and LQT2 genotypes. Our methodology utilized single-lead ECG data with a 200 Hz sampling frequency. The support vector machine (SVM) model demonstrated the ability to discriminate LQT3 with a recall of 90% and a precision of 81%, achieving an F1-score of 0.85. This parameterization offers a potential substitute for genetic testing and is practical for low frequencies. These single-lead ECG data could enhance smartwatches' functionality and similar cardiovascular monitoring applications. The results underscore the viability of ECG morphology-based genotype classification, promising a significant step towards streamlined diagnosis and improved patient care in LQTS.

• MeSH
• dospělí MeSH
• elektrokardiografie * metody   MeSH
• genotyp MeSH
• lidé MeSH
• strojové učení * MeSH
• support vector machine MeSH
• syndrom dlouhého QT * genetika   diagnóza   patofyziologie   MeSH
• Check Tag
• dospělí MeSH
• lidé MeSH
• mužské pohlaví MeSH
• ženské pohlaví MeSH
• Publikační typ
• časopisecké články MeSH
• srovnávací studie MeSH

The effects of a large arteriovenous fistula (AVF) on pulmonary perfusion remains to be elucidated. We aimed to study, for the first time, the real-time acute effects of a large AVF on regional distribution of pulmonary perfusion in a novel porcine model. Ten healthy swine under general anesthesia were studied. AVF was created by the connection of femoral artery and femoral vein using high-diameter perfusion cannulas. The AVF was closed and after 30 min of stabilization the first values were recorded. The fistula was then opened, and new data were collected after reaching stable state. Continuous hemodynamic monitoring was performed throughout the protocol. The following functional images were analyzed by electrical impedance tomography (EIT): perfusion and ventilation distributions. We found an increased cardiac output and right ventricular work, which was strongly correlated to an increased pulmonary artery mean pressure (r=0.878, P=0.001). The ventral/dorsal ratio of pulmonary perfusion decreased from 1.9+/-1.0 to 1.5+/-0.7 (P=0.025). The percentage of total pulmonary blood flow through the dorsal lung region increased from 38.6+/-11.7 to 42.2+/-10.4 (P=0.016). In conclusion, we have used EIT for the first time for studying the acute effects of a large AVF on regional distribution of pulmonary perfusion in a novel porcine model. In this new experimental model of hyperkinetic circulation caused by AVF, we documented an increased percentage of total pulmonary blood flow through the dorsal lung region and a more homogeneous perfusion distribution. Key words Arteriovenous fistula, Hyperkinetic circulation, Tissue perfusion, Animal model, Pulmonary blood flow.

• MeSH
• arteria pulmonalis diagnostické zobrazování   patofyziologie   MeSH
• arteriovenózní píštěl patofyziologie   diagnostické zobrazování   MeSH
• arteriovenózní zkrat MeSH
• plíce krevní zásobení   diagnostické zobrazování   MeSH
• plicní oběh * fyziologie   MeSH
• prasata MeSH
• vena femoralis diagnostické zobrazování   MeSH
• zvířata MeSH
• Check Tag
• ženské pohlaví MeSH
• zvířata MeSH
• Publikační typ
• časopisecké články MeSH

Představujeme kazuistiku 34leté pacientky, heterozygotky Leidenské mutace, postižené autozomálně dominantní polycystickou chorobou ledvin (AD PCKD), přijaté pro náhle vzniklé symptomy netraumatické inkompletní transverzální míšní léze v úrovni Th4-5. Vstupní zobrazení mozku a celé míchy magnetickou rezonancí (MR) neprokázalo žádné ložiskové změny. Pomocí CT angiografie jsme vyloučili disekci aorty. V likvoru byl normální nález. Třetího dne se na kontrolní MR hrudní míchy vykreslilo ložisko myelopatie přibližně v úrovni Th5. Pátého dne bylo toto ložisko již bez podstatného vývoje. Dle klinického průběhu a výsledků komplementárních vyšetření jsme stav hodnotili jako míšní ischemii. Doplněná transezofageální echokardiografie a bubble test prokázaly high­‐grade permanentní pravo-levý zkrat při otevřeném foramen ovale (FOP). Další laboratorní a zobrazovací vyšetření k objasnění etiologie byla negativní. Byla indikována okluze FOP. Pacientka rehabilitovala a její zdravotní stav se postupně zlepšoval.

We present a case report of a 34-year-old female patient, heterozygote f.V Leiden, affected by autosomal dominant polycystic kidney disease (AD PCKD), admitted for sudden onset of symptoms of a non-traumatic incomplete transverse spinal cord lesion at the Th4-5 level. Initial magnetic resonance (MR) imaging of the brain and whole spinal cord showed no focal changes. CT angiography was used to exclude aortic dissection. The CSF showed normal findings. On the third day, a follow-up MRI of the thoracic spinal cord showed a focus of myelopathy at approximately Th5 level. On the fifth day, this lesion was no longer significantly developed. We assessed the condition as spinal cord ischemia based on the clinical course and the results of complementary examinations. The supplementary transesophageal echocardiography and bubble test revealed a high-grade, permanent right-to-left shunt with a patent foramen ovale (FOP). Further laboratory and imaging investigations to clarify the aetiology of spinal cord infractions were negative. FOP occlusion was indicated. The patient was rehabilitated and her condition gradually improved.

• MeSH
• diferenciální diagnóza MeSH
• dospělí MeSH
• foramen ovale apertum diagnóza   komplikace   MeSH
• lidé MeSH
• magnetická rezonanční tomografie metody   MeSH
• míšní ischemie * diagnóza   etiologie   klasifikace   rehabilitace   MeSH
• polycystické ledviny autozomálně dominantní diagnóza   MeSH
• prednison farmakologie   terapeutické užití   MeSH
• pregabalin farmakologie   terapeutické užití   MeSH
• trombofilie diagnóza   genetika   komplikace   MeSH
• Check Tag
• dospělí MeSH
• lidé MeSH
• ženské pohlaví MeSH
• Publikační typ
• kazuistiky MeSH

Infective endocarditis (IE) is a life-threatening disease, with its mortality rate varying depending on the infectious agent. Streptococci are among the most common causes of infective endocarditis. However, Streptococcus vestibularis has rarely been associated with human infections, typically affecting patients with underlying conditions such as immunosuppressive diseases, valve replacement, rheumatic heart disease, and hemodialysis. We present the case of a 26-year-old man who presented with fever, unanticipated weight loss, and fatigue. Although no typical risk factors for infective endocarditis were identified at admission, transesophageal echocardiography revealed a bicuspid aortic valve with calcification, paravalvular aortic abscess formation, and vegetations on the anterior leaflet of the mitral valve. Blood cultures grew S. vestibularis, which was initially sensitive to benzylpenicillin but developed emergent resistance on the third day of the antibiotic treatment. Subsequently, ceftriaxone therapy was initiated, and blood cultures became sterile on day 10. The patient eventually underwent aortic valve replacement. We report the first known case of native aortic and mitral valve endocarditis caused by S. vestibularis, accompanied by a paravalvular abscess around the native aortic valve, in a patient who had no typical risk factors for infective endocarditis, except for a bicuspid aortic valve.

• MeSH
• antibakteriální látky terapeutické užití   MeSH
• aortální insuficience * mikrobiologie   chirurgie   MeSH
• bakteriální endokarditida * komplikace   diagnóza   farmakoterapie   mikrobiologie   MeSH
• bikuspidální aortální chlopeň * komplikace   chirurgie   MeSH
• cefalosporiny třetí generace terapeutické užití   MeSH
• ceftriaxon terapeutické užití   MeSH
• chirurgická náhrada chlopně MeSH
• dospělí MeSH
• lidé MeSH
• mitrální chlopeň * mikrobiologie   MeSH
• penicilin G terapeutické užití   MeSH
• rezistence na penicilin MeSH
• streptokokové infekce * komplikace   diagnóza   farmakoterapie   mikrobiologie   MeSH
• Check Tag
• dospělí MeSH
• lidé MeSH
• mužské pohlaví MeSH
• Publikační typ
• časopisecké články MeSH
• kazuistiky MeSH