Introductory Remarks

doc. MUDr. Vilém Rohn, CSc.

Interv Akut Kardiol 2019; 18(3, Suppl.A): 3  

Coarctation of the aorta in adults

Daniela Žáková, Tomáš Zatočil, Olga Pokorná, Petr Malík, Jiří Ničovský, Jiří Ondrášek, Petra Antonová, Jan Černý, Petr Němec

Interv Akut Kardiol 2019; 18(3, Suppl.A): 6-10 | DOI: 10.36290/kar.2019.043  

Coarctation of the aorta is a generalized involvement of the arterial system leading to premature atherosclerosis with increased mortalityfrom coronary and cerebral events. The diagnosis is established in childhood in most patients, with residual findings such as re-coarctacion,pseudoaneurysm, and hypertension prevailing in adulthood. Patients with coarctation require follow-up in a specialized center.

Tetralogy of Fallot

Petra Antonová, Tomáš Zatočil, Daniela Žáková, Vilém Rohn

Interv Akut Kardiol 2019; 18(3, Suppl.A): 11-14 | DOI: 10.36290/kar.2019.044  

Patients after corrective surgery of tetralogy of Fallot develop residual findings in both early postoperative course and long-term follow-up in adulthood. Most residual findings affect the right ventricular outflow tract and pulmonary arteries and thus indirectly influence the function of the right ventricle. The most frequent residual finding is volume overload of the right ventricle due to severe pulmonary insufficiency. In spite of the fact that guidelines on the correct timing of pulmonary valve replacement exist, there are still a lot of controversies. Preservation of the function of the right ventricle and prevention of arrhythmias arising from...

Right ventricular outflow tract obstruction

Mariia Havova, Petra Antonová, Roman Gebauer, Ondřej Fabián, Václav Chaloupecký, Lukáš Vlk, Ludmila Hornofová, Vilém Rohn

Interv Akut Kardiol 2019; 18(3, Suppl.A): 15-17 | DOI: 10.36290/kar.2019.045  

Reconstruction of RVOT in patients with a congenital heart defect in various age groups still remains a controversial issue in valvedisease surgery. Early identification of RVOT dysfunction, proper timing, and choosing an appropriate method of reconstructionall have an essential effect on postoperative outcomes and long-term survival of the valve replacement used. There are a numberof options for RVOT reconstruction. The use of each prosthesis is associated with the development of various complications.

Transpositions of the great arteries in adulthood

Tomáš Zatočil, Anna Nečasová, Lumír Koc, Petr Kala, Daniela Žáková, Petra Antonová

Interv Akut Kardiol 2019; 18(3, Suppl.A): 18-21 | DOI: 10.36290/kar.2019.046  

Transpositions of the great arteries are a heterogeneous group of complicated congenital heart diseases that vary in terms ofthe management, subsequent complications, and long-term prognosis. In congenitally corrected transposition without surgeryand uncorrected transposition after arterial switch, there is the right ventricle in the systemic position, and in adulthood therepredominate problems with heart failure and/or systemic tricuspid valve regurgitation, with arrhythmias also being frequent. Onthe contrary, uncorrected transposition after arterial switch in childhood has a very favourable course in adulthood.

Fontan circulation: „a common univentricle heart”

Petra Antonová, Tomáš Zatočil, Daniela Žáková, Vilém Rohn

Interv Akut Kardiol 2019; 18(3, Suppl.A): 22-25 | DOI: 10.36290/kar.2019.047  

The Fontan circulation is surgical solution of complicated heart defects in cases when it is not possible to maintain distinct systemic and pulmonary circulations. It involves several consecutive surgical operations, the final step being the attachment of the superior vena cava to a pulmonary artery branch and connection of the vena cava to the pulmonary artery through an intra-atrial or extracardiac tunnel. This gives rise to neoportal circulation comprising two capillary circulations in tandem, dependent on good systolic and diastolic function of the common ventricle, central venous pressure, and low pulmonary vascular resistance. Long-term survival...

The significance of risk stratification in pulmonary arterial hypertension

Pavel Jansa

Interv Akut Kardiol 2019; 18(3, Suppl.A): 26-29 | DOI: 10.36290/kar.2019.048  

Pulmonary hypertension is a syndrome characterized by increased pressure in the pulmonary artery. Pulmonary arterial hypertension (PAH) is a disease of small pulmonary vessels leading to precapillary pulmonary hypertension, to progression when left untreated, and eventually to right heart failure. To assess the prognosis and risk profile of patients with PAH, a number of parameters are used which correspond with the symptoms, exercise capacity, and right ventricular function not only initially at the time of diagnosis, but also during follow-up. In testing novel drugs for the treatment of PAH, major emphasis is currently placed on affecting patient...

Heart failure in congenital heart disease in adults

Petra Antonová, Tomáš Zatočil, Daniela Žáková, Vilém Rohn

Interv Akut Kardiol 2019; 18(3, Suppl.A): 30-32 | DOI: 10.36290/kar.2019.049  

Heart failure is a common complication in adult patients with congenital heart disease, and it significantly increases their mortality. The multifactorial etiology of heart failure in CHD includes not only morphological findings pertinent to particular congenital defects or residua following catheterization and surgical procedures, but also dysfunction of the left or right ventricles in the systemic or subpulmonary positions. When examining patients with heart failure, in addition to conventional examination techniques, it is advisable to perform serial exercise tests and NT-proBNP assessments allowing to monitor the progression of heart failure over...

Resynchronizační léčba selhávající subpulmonální pravé komory u vrozené srdeční vady

Jan Janoušek

Interv Akut Kardiol 2019; 18(3, Suppl.A): 34-35 | DOI: 10.36290/kar.2019.050  

Dysfunkce subpulmonální pravé komory (PK) je přítomna u celé řady vrozených srdečních vad po chirurgické korekci. Je často spojena s blokádou pravého Tawarova raménka (RBBB) jako zdrojem elektromechanické dyssynchronie, která se může podílet na selhání PK. Srdeční resynchronizační léčba pravé komory (RV-CRT) se používá ke zlepšení funkce PK, elektromechanické synchronie a efektivity kontrakce. Je účinná v období bezprostředně po operaci jako dočasná možnost léčby. Omezené množství důkazů rovněž svědčí o účinnosti permanentní RV-CRT. Abychom lépe definovali její roli v léčbě dlouhodobého selhávání PK, bude zapotřebí dalších studií.

Pregnancy in women with congenital heart disease

Jana Rubáčková Popelová

Interv Akut Kardiol 2019; 18(3, Suppl.A): 36-41 | DOI: 10.36290/kar.2019.051  

The risk of pregnancy and giving birth can vary a lot in patients with congenital heart disease (CHD). A low risk is generally found in those in the NYHA I and II functional class, with a maximum oxygen consumption above 25–30 ml/kg/min, with simple CHD after repair with no residual finding, with less significant valvular regurgitations, with well-functioning biological prostheses and native valves after plastic surgery, or with a small shunt defect without pulmonary hypertension. A high risk is found in women in the NYHA III and IV functional class, those with significant stenotic defects, with mechanical valve prostheses, cyanotic CHD with...

Operation and reoperation of congenital heart defects in adulthood

Lukáš Vlk, Petra Antonová, Vilém Rohn

Interv Akut Kardiol 2019; 18(3, Suppl.A): 42-46 | DOI: 10.36290/kar.2019.052  

Surgery for congenital heart defects in adults is a progressively expanding subspeciality. Reoperations are associated with a higher perioperative risk, particularly because of pericardial adhesions after previous surgeries. In the Motol University Hospital, there is a comprehensive centre for adult patients with congenital heart defects where a total of 289 of these operations have been carried out in the past ten years. As for primary operations, atrial septal defects and aortic valve defects were the most frequently operated conditions. The most reoperations were performed in patients with tetralogy of Fallot. More than 15% of patients were operated...