Risk of Thrombus Formation in Patients on Mechanical Circulatory Support with POLVAD-MEV

BACKGROUND Congestive heart failure is a challenging problem due to increasing prevalence in developed countries. Patients admitted due to decompensated congestive heart failure symptoms who do not respond to medical treatment require mechanical circulatory support. Patients with biventricular failure are at particularly high mortality risk. MATERIAL AND METHODS We analyzed the function of 49 pumps (POLVAD-MEV, FRK Intra-cordis, Poland) implanted to rescue INTERMACS 1 and 2 profile patients referred to our department due to severe congestive heart failure. All patients were waiting for heart transplantation and were readmitted due to acute decompensations of congestive biventricular heart failure with resistance to medical therapy. RESULTS During the observational period, there were no technical problems in pump function. The mean duration of pump therapy was 30.6±8.3 (5-49) days. The risk for right-sided pump complications included clots formation on the following parts of the pump: outflow tract (1, 2%), membrane (13, 27%), dome (6, 12.5%), and periphery (1, 2%). The overall risk for device thrombosis was 41%. The risk for thromboembolic complications was CRP-dependent regarding conglomerates of fibrin and platelets formation (p<0.05). The risk for left-sided pump complications included clots formation on the outflow tract (1, 2%), membrane (9, 19%) and dome (3, 6%). The overall risk for device thrombosis was 27%. The risk for clots formation on the membrane (P<0.05) and dome of the pump depended on time (P<0.07). CONCLUSIONS Mechanical circulatory support with a paracorporeal pump is a safe option for biventricular heart dysfunction as a bridge to heart transplantation. The risk for thrombi formation is relatively high but acceptable within 30 days after implantation.

Toll-like Receptor 4 Single-Nucleotide Polymorphisms and Heart Transplant Rejection

BACKGROUND

Transplant rejection is one of the major problems after heart transplantation (HTx). The aim of the study was to find possible links between chosen single-nucleotide polymorphisms (SNPs) of Toll-like receptor 4 (TLR4) and heart transplant rejection.

MATERIAL AND METHODS

Blood samples were taken from 24 patients subjected to HTx between 2010 and 2016 at the Clinic of Cardiac Surgery and Transplantation and under the control of I Clinic of Cardiology. All the patients were permanently controlled and had therapeutic levels of immunosuppressants in their blood. Their DNA was isolated and analyzed using the high-resolution melting method according to the Toll-like receptor 4 SNPs rs10983755 A/G, rs4986791 C/T, rs4986790 A/G, rs10759932 C/T, rs1927911 C/T, rs11536889 C/G, and rs12377632 C/T. The analysis of the clinical data of biopsies according to International Society for Heart and Lung Transplantation classification was derived from the patients' medical history, divided into two groups: 0-1b and 2-4. A statistical analysis was then performed.

RESULTS

The results obtained showed no association between analyzed SNPs and rejection. For rs10983755 A/G, P = .85; rs4986791 C/T, rs4986790 A/G, and rs1927911 C/T had P = .35; and rs10759932 C/T, rs11536889 C/G, and rs12377632 C/T had P = 1.

CONCLUSIONS

No association between the SNPs rs10983755 A/G, rs4986791 C/T, rs4986790 A/G, rs10759932 C/T, rs1927911 C/T, rs11536889 C/G, and rs12377632 C/T and heart transplant rejection was found, but further investigation is suggested for TLR4 SNPs with P < .5.

Single nucleotide polymorphism in coronary artery disease as in‑stent restenosis risk factor

In‑stent restenosis (ISR) is a challenging complication of coronary stent implantation in both stable coronary artery disease (CAD) and acute coronary syndrome (ACS). Recent scientific aproach enables looking closely into its genetic background. This article briefly highlights the already known to increase susceptibility of ISR genetic polymorphisms and summarizes which were not proven to increase the risk of ISR and which may seem protective among CAD patients.

Late proarrhythmia on sotalol therapy triggered by emotional stress

We present a case of significant QTc prolongation with torsade de pointes in a female patient with a DDD pacemaker, who had been treated with an established dose of sotalol for two years. The most probable trigger factor of this adverse event was a strong emotional stress. The discontinuation of treatment with sotalol resulted in clinical recovery and QTc normalisation.

[Magnesium protects myocardium during electric cardioversion but does not increase effectiveness]

Transient elevation of serum enzyme level and abnormalities of repolarization following electrical cardioversion (EC) are usually observed. We aimed to alleviate these alterations by pretreatment with magnesium sulfate (MgSO4). The study group consists of 100 patients (aged 19-65 years) who had EC (300 W/sec) for chronic atrial fibrillation after mitral and/or aortic valve surgery. They were randomly divided into two sub groups: 50 patients in whom MgSO4 was administered intravenously (dose 100 m/kg b.w.) and 50 control subjects. Total serum magnesium level and CKMB level were recorded before and 8 hours after EC. Recovery to sinus rhythm, QTc interval, segment shifts were recorded immediately before and after EC. Results (mean +/- SE): [table: see text] Our results suggest that MgSO4 administered before EC has a significant cardioprotective effect and reduces abnormalities of repolarization.

[Unusually large thrombus in the left cardiac ventricle in a patient with a history of anterior wall infarction]

The giant size thrombus like a swallow's nest in the left cardiac ventricle in the patient with a history of anterior infarction was reported. In the autopsy a significant narrowing of the left coronary artery and two critical narrowings of the anterior interventricular artery were revealed. The relation between the localization of the pathological changes in the coronary arteries and the thrombi occurring during cardiac infarction was discussed.

[Preventive pharmacological treatment after cardiac electroversion for atrial fibrillation following surgical treatment of heart defects]

265 patients (168 women, 97 men) after cardiac surgery (mitral valve replacement--74 pts, mitral commissurotomy--158 pts, aortic valve replacement--6 pts, replacement of both valves--16 pts, closure of ASD--11 pts) were randomized after successful electro-conversion of atrial fibrillation to quinidine (63 pts), verapamil (56 pts), amiodarone (50 pts), digoxin (56 pts) or control group (40 pts). The groups were comparable regarding age, sex and mitral valve disease distribution, heart volume, echocardiographic left atrium size and time from cardiac surgery to electro-conversion. After one year sinus rhythm was still present in 43% receiving quinidine, 43% receiving verapamil, 40% receiving amiodarone, 22% receiving digoxin, 20% in the untreated group, and after two years in 14%, 11%, 20%, 0% and 0%--respectively. The treatment was discontinued because of side effects in 13% of pts in the quinidine group, 8% of pts in the amiodarone group and 4% of pts in the verapamil group. It is concluded that quinidine, amiodarone and verapamil compared with control group are significantly (p less than 0.05--after one year) more effective in preventing late relapses of atrial fibrillation. Digoxin is ineffective in preventing recurrence of the arrhythmia. There are no significant differences between quinidine, verapamil and amiodarone regarding its prophylactic efficacy.