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1.  Sarcomas of the heart as a difficult interdisciplinary problem 
Archives of Medical Science : AMS  2014;10(1):135-148.
Cardiac tumors are assumed to be a rare entity. Metastases to the heart are more frequent than primary lesions. Sarcomas make up the majority of cardiac malignant neoplasms. Among them angiosarcoma is the most common and associated with the worst prognosis. Malignant fibrous histiocytoma comprises the minority of cardiac sarcomas and has uncertain etiology as well as pathogenesis. Transthoracic echocardiography remains the widely available screening examination for the initial diagnosis of a cardiac tumor. The clinical presentation is non-specific and the diagnosis is established usually at an advanced stage of the disease. Sarcomas spread preferentially through blood due to their immature vessels without endothelial lining. Surgery remains the method of choice for treatment. Radicalness of the excision is still the most valuable prognostic factor. Adjuvant therapy is unlikely to be effective. The management of cardiac sarcomas must be individualized due to their rarity and significant differences in the course of disease.
doi:10.5114/aoms.2014.40741
PMCID: PMC3953983
cardiac tumors; angiosarcoma; transthoracic echocardiography; surgery
2.  23-year experience on diagnosis and surgical treatment of benign and malignant cardiac tumors 
Introduction
Although myxoma is the most frequent cardiac tumor, other conditions should be taken into consideration in the differential diagnosis. Transthoracic echocardiography (TTE), followed by transesophageal echocardiography (TEE) remain the principal methods for cardiac tumor screening and visualizing. The aim of the study was to compare the diagnostics, surgical treatment and prognosis of malignant and benign cardiac tumors.
Material and methods
From 1986 to 2009 there were 121 patients with cardiac tumors operated on in the Cardiac Surgery Clinic of the Medical University in Lodz. Patients were referred to surgery mainly on the basis of the TTE and TEE image. In 4 cases valvular prosthesis implantation or valve repair were carried out. Patients remained under long-term observation in the Cardiac Surgery Outpatient Clinic.
Results
Myxoma was diagnosed in 114 cases. Malignancies were discovered in 7 cases. The left atrium was the most frequent localization. The echocardiographic image differed significantly in benign and malignant tumors. The postoperative period was complicated by embolic events or myocardial infarctions. Only malignant tumors were associated with mortality due to cardiovascular events. The survival for malignant tumors was significantly shorter.
Conclusions
Short and long-term results of operative treatment are very good for benign tumors in contrast to cardiac malignancies. The TTE and TEE image can be very significant in the final diagnosis.
doi:10.5114/aoms.2013.38677
PMCID: PMC3832829  PMID: 24273564
transthoracic echocardiography; transesophageal echocardiography; myxoma; sarcoma
3.  Comparison of the clinical application of reactive oxygen species and inflammatory markers in patients with endocarditis 
Introduction
Infective endocarditis (IE) is still connected with high operative mortality. Inflammatory markers are commonly used in monitoring patient clinical condition. Respiratory burst and reactive oxygen species (ROS) are the main way of pathogen elimination. Specificity of this process in the aspect of bacterial infection is the key for correlation assessment between ROS and inflammatory markers in patients with IE. In the study, assessment of ROS as a clinical indicator in IE was conducted.
Material and methods
During 2007/2008 in the Cardiosurgical Clinic of the Medical University in Lodz there were 20 patients operated on for IE. The examined population consisted of 13 men and 7 women, aged from 23 to 74 years. Inflammatory markers – leukocytosis (WBC), C-reactive protein (CRP), procalcitonin (PCT) and erythrocyte sedimentation rate (ESR) – were assessed preoperatively, on the 3rd, 7th, 12th and 21st day. Simultaneously, with the second venous blood sample chemiluminescence (luminal enhanced whole blood chemiluminescence) was carried out and used to assess ROS production. The results were analyzed statistically.
Results
Positive correlation between ESR, CRP and ROS in the preoperative period was confirmed. An increase in ROS and a statistically significant increase in inflammatory markers on the 3rd day were observed. The ROS normalized on the 12th day. Marked individual variability was specific for the inflammatory markers. Despite the significant decrease, not all of them achieved a normal level at the last control point.
Conclusions
Assessment of ROS seems to be a universal parameter with possible application in patients with IE.
doi:10.5114/aoms.2012.28551
PMCID: PMC3361036  PMID: 22661996
infective endocarditis; chemiluminescence; respiratory burst
4.  Infective endocarditis complicated with left atrioventricular fistula in a 20-year-old patient. A case study 
Archives of Medical Science : AMS  2011;7(6):1078-1081.
Intracardiac fistulas are rare complications of infective endocarditis. We report an unusual case of successful surgical repair of intracardiac fistula between the left ventricle and the left atrium in the course of infective endocarditis in a 20-year-old patient. According to this we conclude that timely diagnosis, proper antibiotic treatment, and early surgical intervention should improve the outcomes of infective endocarditis complications.
doi:10.5114/aoms.2011.26623
PMCID: PMC3265003  PMID: 22328894
infective endocarditis; left ventriculo-atrial fistula; cardiac surgery
5.  Removal of the left atrium and left ventricle tumour: a case report 
The heart is the rarest site for neoplasms to be localized. Despite modern diagnostic techniques, cardiac tumours continue to among those discovered latest and with the worst prognoses. We present the case of a 62-year-old woman with a heart tumour and mediastinal lymphadenopathy, who was admitted to the Department of Cardiac Surgery. The patient underwent surgical removal of the tumour with extracorporeal circulation. The left atrium, mitral valve and the left ventricle were occupied by the infiltration. A radical resection appeared to be impossible. A valvular prosthesis was not implanted. The perioperative period was uncomplicated. On the 9th day a local recurrence was confirmed in the transthoracic echocardiography. Further oncological diagnostics revealed the spread of the malignant neoplasm to bones of the pelvis and spine. Chemotherapy was initiated. The authors discuss the most appropriate diagnostic and treatment procedures employed in the above case.
doi:10.5114/aoms.2011.25571
PMCID: PMC3258802  PMID: 22291841
heart tumour; lymphadenopathy; radical resection
6.  Redo surgery risk in patients with cardiac prosthetic valve dysfunction 
Introduction
The aim of the study was to analyse the risk factors of early and late mortality in patients undergoing the first reoperation for prosthetic valve dysfunction.
Material and methods
A retrospective observational study was performed in 194 consecutive patients (M = 75, F = 119; mean age 53.2 ±11 years) with a mechanical prosthetic valve (n = 103 cases; 53%) or bioprosthesis (91; 47%). Univariate and multivariate Cox statistical analysis was performed to determine risk factors of early and late mortality.
Results
The overall early mortality was 18.6%: 31.4% in patients with symptoms of NYHA functional class III-IV and 3.4% in pts in NYHA class I-II. Multivariate analysis identified symptoms of NYHA class III-IV and endocarditis as independent predictors of early mortality. The overall late mortality (> 30 days) was 8.2% (0.62% year/patient). Multivariate analysis identified age at the time of reoperation as a strong independent predictor of late mortality.
Conclusions
Reoperation in patients with prosthetic valves, performed urgently, especially in patients with symptoms of NYHA class III-IV or in the case of endocarditis, bears a high mortality rate. Risk of planned reoperation, mostly in patients with symptoms of NYHA class I-II, does not differ from the risk of the first operation.
doi:10.5114/aoms.2011.22078
PMCID: PMC3258715  PMID: 22291767
prosthetic valve; reoperation; echocardiography
7.  Psychiatric manifestations in a patient after surgical management of aortic stenosis of systemic lupus erythematosus 
Systemic lupus erythematosus is a chronic inflammatory autoimmune disease which damages tissue and organs. Circulation, kidney, lungs, liver, central and peripheral nervous systems, joints and skin may be damaged. It also often involves psychotic syndromes which might even be stimulated by glucocorticoid therapy. In the following article we present the case report of psychotic symptoms in a 26-year old patient after management of aortic stenosis in systemic lupus erythematosus receiving glucocorticoid therapy.
doi:10.5114/aoms.2011.22089
PMCID: PMC3258722  PMID: 22291778
systemic lupus erythematosus; aortic stenosis surgery; psychotic symptoms

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