Pulmonary arterial hypertension is one of the clinical groups of arterial hypertension. It is a rare, chronic disease with a very poor prognosis. Diagnostic procedures ruling out different causes of present symptoms and other forms of pulmonary hypertension are difficult and specific. Current European guidelines recommend combined treatment with endothelin receptor antagonist, prostanoids, and phosphodiesterase type 5 inhibitors.

Background and Objectives: An increase in the incidence of end-stage renal disease (ESRD) is associated with the need for a wider use of vascular access. Although arteriovenous (A-V) fistula is a preferred form of vascular access, for various reasons, permanent catheters are implanted in many patients. Materials and Methods: A retrospective analysis of clinical data was carried out in 398 patients (204 women) who in 2010–2016 were subjected to permanent dialysis catheters implantation as first vascular access or following A-V fistula dysfunction. The factors influencing the risk of complications related to vascular access and mortality were evaluated and the comparison of the group of patients with permanent catheter implantation after A-V fistula dysfunction with patients with first-time catheter implantation was carried out. Results: The population of 398 people with ESRD with mean age of 68.73 ± 13.26 years had a total of 495 permanent catheters implanted. In 129 (32.6%) patients, catheters were implanted after dysfunction of a previously formed dialysis fistula. An upward trend was recorded in the number of permanent catheters implanted in relation to A-V fistulas. Ninety-two infectious complications (23.1%) occurred in the study population in 65 patients (16.3%). Multivariate analysis showed that permanent catheters were more often used as the first vascular access option in elderly patients and cancer patients. Mortality in the mean 1.38 ± 1.17 years (min 0.0, max 6.70 years) follow-up period amounted to 50%. Older age and atherosclerosis were the main risk factors for mortality. Patients with dialysis fistula formed before the catheter implantation had a longer lifetime compared to the group in which the catheter was the first access. Conclusion: The use of permanent catheters for dialysis therapy is associated with a relatively high incidence of complications and low long-term survival. The main factors determining long-term survival were age and atherosclerosis. Better prognosis was demonstrated in patients after the use of A-V fistula as the first vascular access option.

Introduction: Progression of renal failure leads to an increase in the number of patients who require forming dialysis access. Old age and rising morbidity make it impossible to form a native arteriovenous fistula and a permanent catheter becomes the first choice. The presence of a catheter frequently generates complications, including infections, which may result in a higher mortality rate. Material and methods: A retrospective analysis data has been conducted, involving 398 patients who had permanent catheters implanted from 2010 to 2016. Out of this group, 65 patients who suffered infectionrelated complications have been identified. Risk factors for infection and a survival rate of the population have been estimated. Results: Between 2010 and 2016, 495 catheters were implanted for 398 patients aged 68.73 (13.26) years on average. 92 catheter-related infections (23.1%) were recorded in 65 patients. Multivariate logistic regression showed, that the risk factors of infectious complications were: younger age (P = 0.000), coronary artery disease (P = 0.006) and heart failure (P = 0.000). Mortality in the mean 1.38 ± 1.17 years followup period was comparable in infectious and non-infectious subgroups (53.85% vs 49.25%; P = 0.588). A higher risk of death in the infectious population was associated with the presence of additional intravascular and intracardiac implanted materials (P = 0.027) and a severe course of infection with hypotension (P = 0.027), thrombocytopenia (P = 0.029) and a high leucocytes/platelets ratio (0.017). Conclusion: Infectious complications in patients dialyzed with permanent catheters are dangerous especially in patients with severe clinical course. The mortality rate is high, although similar to all dialyzed by permanent catheters.

The random placement of pacing lead in the left ventricle (LV) is a rare and late diagnosed complication of the permanent heart stimulation. In most cases the intracardiac electrode moves through the interatrial septum or through the patent foramen ovale to the LV. On ECG the sets of QRS have morphology of right bundle branch block. The decisive survey used to identify this complication is echocardiography, especially transesophageal study. The malposition of the pacing electrode is associated with the risk of thromboembolic complications. The treatment consists of early lead removal. In case of lack of such a possibility the chronic anticoagulation treatment has to be started. The paper presents a case of incorrect position of pacing electrode in LV in a patient with PFO.Key words: cardiac pacing, inadvertent left ventricular pacing, lead removal, anticoagulation therapy Folia Cardiologica 2016; 11, 6: 535-538 Case reportA 74-year-old male was admitted to the Department of Cardiology, due to atrioventricular arrhythmia (second degree atrioventricular block 2: 1) with MAS syndrome. During hospital admission the patient was secured by a temporary transvenosus pacing electrode. The next day the DDDR pacemaker was implanted. After surgery, on ECG recording right bundle branch block (RBBB) configuration of paced complexes were present ( Figure 1A). The chests X-ray in posterior-anterior (PA) and lateral projections were correct (Figure 2). The transthoracic echocardiography showed wrong location of pacing lead in the left ventricle (pacing electrode passed from the right atrium by the foramen ovale into the left atrium and then through the mitral valve into the left ventricle of the side wall) (Figure 3). To confirm a malposition of the electrode and to exclude possible artifacts, the transesophageal echocardiography was done. It also showed an incorrect position of ventricular electrode (Figure 4), current patent foramen ovale (PFO) and a trace of the left-to-right leak through the interatrial septum around the passage of the lead ( Figure 5). The next day of hospitalization repositioning ventricular electrode was done. After the procedure, the control ECG showed normal right ventricular stimulation with left bundle branch block (LBBB) ( Figure 1B). The echocardiography showed the correct location of the pacemaker electrodes, there was no damage to the structures of the heart or leakage through the septum. Control stimulation parameters were correct. DiscussionThe pacemaker implantation is the most common surgery in the invasive cardiology. Doctors are more often faced

Interruption of long-term therapy with oral anticoagulants in patients undergoing elective surgical procedures is a common problem in clinical practice. A large number of patients are receiving oral anticoagulants due to atrial fibrillation, mechanical prosthetic valves, or thromboembolic disease. Each year many of these patients will undergo an invasive procedure. The most important aspect is the risk-benefit assessment: the general risk of bleeding related to the procedure, additional risk of bleeding during the procedure related to anticoagulants, and on the other hand the risk of thrombotic complications such as ischaemic stroke or coronary stent thrombosis, associated with discontinuation of the antithrombotic therapy. The aim of the article is to present the management of anticoagulant therapy in patients undergoing elective surgical procedures. Streszczenie Wybór odpowiedniego postępowania z pacjentami przyjmującymi doustne leki przeciwzakrzepowe, którzy są poddawani planowym zabiegom chirurgicznym, stanowi częsty problem w praktyce klinicznej. Wielu chorych stosuje doustne leki przeciwzakrzepowe z powodu migotania przedsionków, posiadania mechanicznych protez zastawkowych lub choroby zakrzepowo-zatorowej. Część z tych osób każdego roku poddawanych jest zabiegom chirurgicznym. Istotne jest ocenienie u nich ryzyka krwawienia związanego z procedurą chirurgiczną, ryzyka krwawienia związanego z przyjmowaniem doustnych leków przeciwzakrzepowych, a także ryzyka związanego z odstawieniem tych leków i wystąpieniem niekorzystnych powikłań w okresie okołooperacyjnym, takich jak udar niedokrwienny mózgu lub zakrzepica w stentach w naczyniach wieńcowych. Poniższy artykuł stanowi podsumowanie doniesień na temat zasad odstawiania doustnych leków przeciwzakrzepowych przed planowymi zabiegami chirurgicznymi.

Sudden cardiac death (SCD) is an important clinical problem with a complex and multifactor background. Trends in its prevention have been dynamically developing over the last decades. Patients with ischemic heart disease, especially after myocardial infarction, represent the largest group at an elevated risk of SCD. Many congenital and hereditary diseases are associated with an increased risk of SCD, particularly among young people. Although far from perfect, left ventricular ejection fraction remains the only widely recognized, relatively objective and credible method of assessing the risk of SCD among patients with heart failure. Other methods for assessing the risk are waiting for the final confirmation of their usefulness in clinical trials. The implantable cardioverter-defibrillator (ICD) and its newer version-totally subcutaneous S-ICD-remain the most effective methods of SCD prevention. The only class of drugs with well-proven efficiency in most patients at risk of SCD is β-blockers. Streszczenie Nagły zgon sercowy (sudden cardiac death-SCD) stanowi istotny problem kliniczny o wieloczynnikowym podłożu. W ciągu ostatnich dekad dynamicznie rozwijają się trendy w zakresie zapobiegania SCD. Największą grupą pacjentów o podwyższonym ryzyku wystąpienia SCD są osoby z chorobą niedokrwienną serca, szczególnie po przebytym zawale serca. Wiele wrodzonych i dziedzicznych schorzeń wiąże się z podwyższonym ryzykiem wystąpienia SCD, przede wszystkim wśród osób młodych. U pacjentów z niewydolnością serca pomiar frakcji wyrzutowej lewej komory jest jedyną powszechnie uznaną, względnie obiektywną i wiarygodną, choć daleką od doskonałości, metodą oceny ryzyka SCD. Pozostałe metody wymagają ostatecznego potwierdzenia swojej przydatności w badaniach klinicznych. Najskuteczniejszą metodą profilaktyki jest wszczepialny kardiowerter-defibrylator (implantable cardioverter-defibrillator-ICD) oraz jego nowsza, całkowicie podskórna wersja S-ICD. Jedyną grupą leków o dobrze udowodnionej skuteczności znajdującą zastosowanie u większości chorych zagrożonych SCD są β-adrenolityki.