Browsing by Author "Bojić, M. (7005865489)"

Background: Early surgical treatment is important for successful outcome in selected cases of active, either native (NVE) or prosthetic valve endocarditis (PVE). The aim of this study was to evaluate the early results of the surgical treatment of active NVE and PVE. Methods: During a 3-yr period (January 1 1996-December 31 1998), 57 out of 60 patients (pts) with active, either NVE (46 pts) or PVE (11 pts) underwent surgical treatment. There were 11 women (23.9%), average age of the group being 43.3±9.1yr (18-73). They were operated on 12-35days, mean 17.7±7.5days (for NVE) and 5-33days, mean 13.2±10.1days (for PVE) after the diagnosis of endocarditis was first suspected. All pts had at least one absolute indication for early surgical treatment, the most frequent being (in NVE) worsening heart failure (19 cases) and inability to control the infection (10 cases), while in PVE it was valve dehiscence (8 cases). In 8 cases of NVE and 2 cases of PVE fresh, antibiotic sterilized aortic homograft was used to replace the aortic valve. Results: Operative mortality was 1.8% (1/57) and hospital mortality 5.2% (3/57). Three pts with PVE died before they were operated on, giving an overall mortality of 10% (6/60). Postoperative morbidity included valve dehiscence in two pts (probable late onset recurrent endocarditis - 3.5%), three episodes of acute renal failure (5.3%), four cases of respiratory insufficiency (7.0%) and one chronic pleural effusion (1.8%). All pts that were discharged from the hospital (54/60), are still alive and well 1-35months postoperatively (mean 20.3±9.6months), including pts with recurrent endocarditis and valve dehiscence, after they were successfully reoperated. Conclusions: Along with early diagnosis and appropriate antibiotic treatment, aggressive surgical attitude is of importance for the successful outcome in this group of seriously ill patients. Our data indicate that early surgical treatment in cases of active endocarditis may be associated with low mortality and morbidity. Copyright (C) 2000 The International Society For Cardiovascular Surgery.

Objectives: While partial left ventriculectomy (PLV) may improve functional status, the duration and determinants of this improvement are poorly known. This study sought to assess the relationship between left ventricular (LV) shape and function and functional status in late survivors after PLV for non-ischemic dilated cardiomyopathy (DCM). Methods: We assessed the relations between LV shape and function and functional status in 17 consecutive patients who survived >12 months after PLV for non-ischemic DCM. Invasive diagnostic studies were performed before, early after, at mid-term after, and late after PLV. According to their functional status after >12 months of follow-up, patients were divided into responders (n=10) or non-responders (n=7). Results: After PLV, the LV systolic major-to-minor axis ratio was higher in responders at early, mid-, and late follow-up (P=0.003, P=0.008 and P=0.04, respectively). LV circumferential end-diastolic stress decreased early after PLV, but increased afterwards in non-responders only (P=0.049). LV ejection fraction was similar in the two groups at baseline, and at early and mid-follow-up, but was lower in non-responders at late follow-up (P=0.006). However, LV end-diastolic and end-systolic volumes, and LV end-systolic circumferential stress showed no difference between the two groups. Conclusions: It appears that poor functional capacity in late post-PLV survivors is related to postoperative LV geometry. Copyright © 2001 Elsevier Science B.V.

Aims. This study sought to determine predictors of left ventricular thrombus formation and resolution after acute anterior wall myocardial infarction. Methods and Results. We have analysed clinical, echo-cardiographic and angiographic data in 53 consecutive patients with anterior myocardial infarction. Two dimensional and Doppler echocardiographic examinations were performed on days 1, 2, 3 and 7, after 3 and 6 weeks, and 3, 6, and 12 months following infarction. Coronary angiography was performed in 44 patients before hospital discharge. Left ventricular thrombus was detected in 30/53 patients (29/30 in the first week after infarction). Univariate analysis showed that left ventricular thrombus formation was associated with a higher initial end-systolic volume index (beta = 0.04, P = 0.001), and end-diastolic volume index (beta = 0.03, P = 0.03), a larger infarct perimeter (beta = 0.02, P = 0.01), a lower initial ejection fraction (beta = -0.06, P = 0.001), a higher initial wall motion score index (beta = 1.75, P = 0.023), a higher peak creatine kinase level (beta = 3.90, P = 0 .01), Killip class > 1 (beta = 1.11. P = 0.003), infarct expansion (beta = 0.78, P = 0.03), occluded infarct-related artery (beta = -0.87, P = 0.04) and non-thrombolytic therapy (beta= -0.76, P = 0.047). According to the Cox proportional regression model, independent predictors of thrombus formation after anterior myocardial infarction were high end-systolic volume index (beta = 0.06 , P = 0.01) and high peak creatine kinase level (beta = 5.17, P = 0.046). Thrombus disappeared in 11/30 (36.7%) patients during one-year echo-cardiographic follow-up. The only independent predictor of thrombus disappearance after acute myocardial infarction was the absence of apical dyskinesis 6 weeks after infarction (beta = -1.53, P = 0.045). Conclusions. Our data demonstrate that the best predictor of left ventricular thrombus formation after acute anterior myocardial infarction is a high initial end-systolic volume. Thrombus resolution is more likely to occur in patients without apical dyskinesis at the end of the healing phase of infarction.