BACKGROUND: Atrial septal defect (ASD) is the most common congenital heart disease (CHD) in adults and pulmonary hypertension (PH) is an established risk factor. A decision whether to perform ASD closure, especially in elderly patients with PH, is a complex dilemma. The aim of our study was to compare long-term survival in patients with closed and open ASD. METHODS: A retrospective cohort study was performed on 427 patients with ASD (median age at diagnosis 38 years, IQR 18-56) out of which 186 patients (44%) manifested PH. ASD closure in patients with PH was only considered in patients without Eisenmenger syndrome with pulmonary vascular resistance < 5 WU. Median follow-up duration was 18 years (IQR 9-31 years). Kaplan-Meier and Cox proportional hazards survival analyses were performed to evaluate 12 potential predictors of survival. RESULTS: Defect closure was associated with improved long-term survival in ASD patients both with (P < 0.001) and without PH (P = 0.01) and this association was present also in patients over 40 years. The 20-year survival since diagnosis was significantly higher in patients with PH and closed ASD compared to those with PH and open ASD (65% vs. 41%). ASD closure was a significant independent predictor of long-term survival (P = 0.003) after accounting for age at diagnosis, PH, NYHA class, Eisenmenger syndrome, and mitral regurgitation. Significant negative independent predictors of survival were older age at diagnosis (P < 0.001), Eisenmenger syndrome (P < 0.001), and PH (P = 0.03). CONCLUSION: ASD closure appears to be associated with improved long-term survival independently of age, PH, and other clinical variables.

• Klíčová slova
• atrial septal defect, congenital heart disease, defect closure, long-term survival, pulmonary hypertension,
• Publikační typ
• časopisecké články MeSH

Pulmonary hypertension (PH) is an established risk factor in patients with atrial septal defect (ASD), and its persistence after ASD closure is associated with increased mortality. Therefore, predictors for PH normalization after defect closure are needed. Multiple hemodynamic types of PH exist, but little is known about their prevalence and prognostic value for PH normalization after ASD closure. We carried out a retrospective study on 97 patients (76% female, median age at ASD closure 58 years) with four types of PH determined predominantly by right heart catheterization: hyperkinetic, pulmonary arterial hypertension, isolated post-capillary, and combined pre- and post-capillary. We investigated the frequency of the PH types and their prognostic significance for PH normalization after ASD closure. Frequency of PH types before ASD closure in our study was: hyperkinetic 55%, pulmonary arterial hypertension 10%, isolated post-capillary PH 24%, and combined PH 11%. Hyperkinetic PH type was positively associated with PH normalization after ASD closure (78% patients normalized), remaining a significant independent predictor when adjusted for age at closure, sex, heart failure, and NYHA. Hyperkinetic PH patients also had significantly better survival prognosis versus patients with other PH types (p = 0.04). Combined PH was negatively associated with PH normalization, with no patients normalizing. Pulmonary arterial hypertension and isolated post-capillary PH had intermediate rates of normalization (60 and 52%, respectively). In summary, all four hemodynamic types of PH are found in adult patients with ASD, and they can be used to stratify patients by their likelihood of PH normalization and survival after ASD closure.

• Klíčová slova
• atrial septal defect, hemodynamic type of pulmonary hypertension, mortality, normalization, pulmonary hypertension, reversibility,
• Publikační typ
• časopisecké články MeSH

Pseudoaneurysm of the ascending aorta is a high-risk complication following cardiac surgery. The present report describes excellent two-year follow-up results after the percutaneous closure of a very large pseudoaneurysm with an Amplatzer atrial septal defect occluder. The original cavity in the anterior mediastinum with maximal diameter 15 cm remained as only a small scar. The patient was without serious health problems both early and after two years.

Le pseudoanévrisme de l’aorte ascendante est une complication à haut risque après une chirurgie cardiaque. Le présent rapport décrit d’excellents résultats après un suivi de deux ans suivant la fermeture percutanée d’un très gros pseudoanévrisme, au moyen d’un dispositif Amplatzer d’occlusion de communication interauriculaire. La cavité originale située dans le médiastin antérieur, d’un diamètre maximal de 15 cm, a laissé place à une petite cicatrice. Le patient n’a présenté aucun problème de santé grave, tant peu après l’intervention que deux ans plus tard.

• MeSH
• angiografie MeSH
• aorta * MeSH
• balónková okluze přístrojové vybavení   metody   MeSH
• defekty srdečního septa komplikace   diagnostické zobrazování   terapie   MeSH
• echokardiografie transezofageální MeSH
• hodnocení rizik MeSH
• lidé středního věku MeSH
• lidé MeSH
• následné studie MeSH
• nepravé aneurysma komplikace   diagnostické zobrazování   terapie   MeSH
• protézy a implantáty * MeSH
• senzitivita a specificita MeSH
• stupeň závažnosti nemoci MeSH
• výsledek terapie MeSH
• Check Tag
• lidé středního věku MeSH
• lidé MeSH
• mužské pohlaví MeSH
• Publikační typ
• časopisecké články MeSH
• kazuistiky MeSH

The authors described a rare case of spontaneous repositioning of an embolised Amplatzer occluder into the left atrium resulting in complete occlusion of a hemodynamically significant atrial septal defect, in the fossa ovalis, in a 70-year-old man. Only a slight central residual shunting was present, as was shown by transesophageal Doppler echocardiography performed immediately after the procedure, with no apparent shunt at 30, 60 and 120 days after the intervention.

• MeSH
• balónková okluze přístrojové vybavení   MeSH
• cévní protézy * MeSH
• defekty septa síní patofyziologie   terapie   MeSH
• design vybavení MeSH
• lidé MeSH
• migrace cizích těles * MeSH
• odstranění implantátu MeSH
• senioři MeSH
• srdeční síně patofyziologie   MeSH
• Check Tag
• lidé MeSH
• mužské pohlaví MeSH
• senioři MeSH
• Publikační typ
• časopisecké články MeSH
• kazuistiky MeSH

The alterations in the clinical symptoms and the pacemaker function of the sinus node following open heart operation were studied in 26 patients suffering from atrial septal defect. The most characteristic electrophysiological change was the prolongation of the sinus node recovery time as consequence of surgical repair of the atrial septal defect. The clinical symptoms of the sick sinus syndrome could be detected in all 26 cases after the open heart surgery. In 16 patients the symptoms of iatrogenic sick sinus syndrome (SSS) were only transitory, while in 10 patients a stable iatrogenic SSS developed after the operation. In the basis of these data the pathological mechanism of the iatrogenic SSS is discussed.

• MeSH
• defekty septa síní chirurgie   MeSH
• dítě MeSH
• iatrogenní nemoci MeSH
• kardiostimulátor * MeSH
• lidé MeSH
• mladiství MeSH
• nodus sinuatrialis patofyziologie   MeSH
• pooperační komplikace etiologie   patofyziologie   MeSH
• syndrom chorého sinu etiologie   patofyziologie   MeSH
• Check Tag
• dítě MeSH
• lidé MeSH
• mladiství MeSH
• mužské pohlaví MeSH
• ženské pohlaví MeSH
• Publikační typ
• časopisecké články MeSH

BACKGROUND: Both over-the-scope clip (OTSC) and KING (endoloop + clips) closures provide reliable and safe full-thickness endoscopic closure. Nevertheless, OTSC clip demonstrated significantly inferior histological healing in the short-term follow-up. AIM: To compare OTSC versus KING closure of a perforation with regard to long-term effectiveness and macroscopic and histological quality of healing. METHODS: We performed a randomized experimental study with 16 mini-pigs (mean weight 43.2 ± 11.2 kg). A standardized perforation was performed on the anterior sigmoid wall. KING closure (n = 8) was attained by approximation of an endoloop fixed to the margins of a perforation with endoclips. OTSC closure (n = 8) was performed by deploying OTSC (OVESCO) over the defect. Pigs underwent a control sigmoidoscopy 8 months after the closure to assess the macroscopic quality of healing. Then, autopsy was performed and the rectosigmoid was sent for histopathological assessment. RESULTS: All closures were completed successfully without air leaks. The duration of closure was similar in both techniques (OTSC 17.8 ± 7.6 min vs. KING 19.6 ± 8.8 min). At autopsy, all KING closures (100 %) were healed with a flat scar without signs of leakage. Microscopically, no inflammatory changes were observed after KING closure. In the OTSC group, microscopic ulcers were present in two pigs (25 %), cryptal abscesses in three pigs (38 %) and significant neutrophil accumulation in all eight pigs (P < 0.01). Giant cell granulomas, dysplasia or abundant scarification was not observed in either group. CONCLUSIONS: Both OTSC and KING closures offer a long-term reliable seal of a gastrointestinal perforation without stenosis or fistulas. KING closure provides long-term histologically superior healing.

• Klíčová slova
• Endoscopic closure, KING closure, NOTES, Over-the-scope clip (OTSC),
• MeSH
• chirurgická rána patologie   MeSH
• chirurgické nástroje * MeSH
• colon sigmoideum patologie   chirurgie   MeSH
• endoskopie MeSH
• hojení ran * MeSH
• longitudinální studie MeSH
• miniaturní prasata MeSH
• náhodné rozdělení MeSH
• prasata MeSH
• sigmoidoskopie metody   MeSH
• Sus scrofa MeSH
• techniky uzavření rány * MeSH
• zvířata MeSH
• Check Tag
• zvířata MeSH
• Publikační typ
• časopisecké články MeSH
• srovnávací studie MeSH

Vacuum-assisted closure (VAC) therapy is a relatively new technique in the field of wound management. It has been increasingly used in treating various types of open wounds with effective results and minimal adverse effects. Digital injuries can occasionally be problematic. We report a new application of vacuum-assisted closure therapy in treating digital pulp defects.

• MeSH
• lidé středního věku MeSH
• lidé MeSH
• nekróza patologie   MeSH
• palec ruky zranění   patologie   chirurgie   MeSH
• terapie ran pomocí řízeného podtlaku metody   MeSH
• Check Tag
• lidé středního věku MeSH
• lidé MeSH
• mužské pohlaví MeSH
• Publikační typ
• časopisecké články MeSH
• kazuistiky MeSH

Transcatheter closure of secundum atrial septal defect has become an alternative to surgery. We present a patient with hemodynamic collapse secondary to cardiac perforation occurring 36 h after the placement of an Amplatzer Septal Occluder and discuss complications of this kind of device.

• Publikační typ
• časopisecké články MeSH

Tetralogy of Fallot, when associated with atrioventricular septal defect permitting shunting at ventricular level, represents a complex cyanotic congenital malformation. Experience with surgical repair is limited, and results vary considerably. Between 1984 and 1996, we repaired 14 consecutive patients with this combination seen in our center. Their ages ranged from 8 months to 21 years (median 7.4 years). Six (42.9%) had Down's syndrome. In eight patients the correct diagnosis was made using echocardiography alone. In the remaining six patients, who had previously-constructed arterial shunts and/or suspected pulmonary arterial stenosis, catheterization and angiocardiography were also performed. The repair consisted of double patch closure of the septal defect, reconstruction of two atrioventricular orifices, and relief of pulmonary stenosis at all levels. In five patients with a hypoplastic pulmonary trunk, a monocusp transannular patch (four patients) or an allograft (one patient) was used for restoration of continuity from the right ventricle to the pulmonary arteries. Patch enlargement of one or both pulmonary arteries was necessary in five patients. One patient (7.1%) died early, and another late. The twelve surviving (85.8%) patients have been followed for 1.2-12.5 years after surgery (median 4.9 years, mean 5.9+/-3.9 years). During the follow-up, reoperation was necessary for repair of residual ventricular septal defect and pulmonary regurgitation in two patients, and closure of an atrial septal defect and alteration to left atrioventricular valvar regurgitation in one patient. Seven patients are in class I of the New York Heart Association, four in class II, and one in class III. Tetralogy of Fallot associated with atrioventricular septal defect can be corrected with low mortality and good long-term results. Residual lesions, however, have a tendency to progress, especially when seen in combination. After surgery, all patients need long-term close follow-up.

• MeSH
• analýza přežití MeSH
• defekty komorového septa komplikace   chirurgie   MeSH
• defekty septa síní komplikace   chirurgie   MeSH
• dítě MeSH
• dospělí MeSH
• Fallotova tetralogie komplikace   chirurgie   MeSH
• kardiochirurgické výkony metody   MeSH
• kojenec MeSH
• lidé MeSH
• mladiství MeSH
• předškolní dítě MeSH
• reoperace MeSH
• výsledek terapie MeSH
• Check Tag
• dítě MeSH
• dospělí MeSH
• kojenec MeSH
• lidé MeSH
• mladiství MeSH
• mužské pohlaví MeSH
• předškolní dítě MeSH
• ženské pohlaví MeSH
• Publikační typ
• časopisecké články MeSH
• práce podpořená grantem MeSH

Upper abdominal wall defects secondary to trauma are not amenable to immediate closure in most cases. After a primary coverage, the definitive reconstruction can be done at a later date, using prosthetic mesh or flap. The majority of these complex procedures is, however, not available in the austere environment. The authors report a clinical case of upper full-thickness defects of the abdominal wall secondary to an explosion in Afghanistan. The patient was managed by a French Forward Surgical Team. The defect was immediately reconstructed in a one-stage surgery using a pedicled myofascial latissimus dorsi flap with good functional results. The pedicled latissimus dorsi flap is commonly used for coverage of both extrathoracic and intrathoracic defects. It is, therefore, possible to extend the harvesting of the muscle to the thoracolumbar fascia and the posterior third of the iliac crest. It provides a very large flap to cover an upper full-thickness abdomen wall defect. The harvest technique is simple, short, and largely accessible to a general surgeon. It provides immediate and definitive closure with a short hospital stay, what is clearly adapted in austere environment.

• MeSH
• bomby * MeSH
• chirurgické laloky transplantace   MeSH
• debridement metody   MeSH
• dítě MeSH
• fascie transplantace   MeSH
• lidé MeSH
• penetrující rány chirurgie   MeSH
• polytrauma chirurgie   MeSH
• poranění břicha chirurgie   MeSH
• povrchové zádové svaly transplantace   MeSH
• techniky uzavření břišních poranění MeSH
• terapie ran pomocí řízeného podtlaku metody   MeSH
• transplantace kůže metody   MeSH
• válka v Afghánistánu 2001- MeSH
• zákroky plastické chirurgie metody   MeSH
• Check Tag
• dítě MeSH
• lidé MeSH
• mužské pohlaví MeSH
• Publikační typ
• časopisecké články MeSH
• kazuistiky MeSH