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IntroductionAbout 30% of patients undergoing cardiac surgery are diabetic, and glycated hemoglobin (HbA1c) is a reliable marker for long-term glucose control. The aim of our study was to examine whether tight glucose control before a cardiac operation results in a better outcome of the surgical treatment.Material and methodsWe performed a retrospective record review of 350 diabetic patients undergoing cardiac surgery in our institution. Preoperative glycemia control was assessed by measurement of the glycated hemoglobin level. The patient population was divided into three groups: group I – patients with HbA1c below 7% (n = 195); group II – patients with HbA1c between 7% and 8% (n = 88); and group III – patients with HbA1c above 8% (n = 67).ResultsThe demographic data and operating risk in all groups of patients were similar. There were 2 deaths (1.02%) in group I, 2 deaths (2.27%, p = 0.78) in group II and 3 deaths (4.47%, p = 0.20) in group III. Cardiac accidents occurred in 9 patients (4.60%) from group I, 7 patients (7.95%, p = 0.20) from group II, and in 6 patients (9.05%, p = 0.40) from group III. Cerebrovascular accidents (CVA) occurred in 7 (3.58%), 5 (5.68%, p = 0.67) and 5 (7.46%, p = 0.61) patients, respectively. Acute renal dysfunction requiring renal replacement therapy occurred in 4 patients from group I (2.05%), 3 patients from group II (3.40%, p = 0.78) and 4 patients from group III (5.97%, p = 0.23).ConclusionsA large percentage of diabetic patients referred for cardiac operations have poorly controlled glycemia. Optimal preoperative glycemia control results in lower postoperative mortality and morbidity. In addition, the preoperative HbA1c level is a good indicator of the risk of postoperative complications in diabetic patients undergoing cardiac operations.

Rationale:Type A aortic dissection (TAAD) usually requires emergency open repair of the ascending aorta. In cases of diffuse dissection that spreads along the descending and abdominal aorta (type I, DeBakey classification), the risk of aneurysmal degeneration varies between 30% and 50% during 5 years and increases even higher during a longer follow-up. Those patients might require complex intervention to prevent aortic rupture. A combination of hybrid arch debranching and the extended provisional extension to induce complete attachment (e-PETTICOAT) technique might be an available alternative in such cases. This is the first report of the successful use of the e-PETTICOAT technique for treating degenerative, diffuse TAAD.Patient concerns:Acute chest pain and syncope were the initial symptoms of diffuse TAAD in our 66-year-old female patient. Open replacement of the ascending aorta followed by surgical arch debranching was performed as a staged procedure. Unfortunately, progressive aneurysmal degeneration was revealed 6 months later in the thoracic, abdominal, and infrarenal aorta with the recurrence of chest and lumbar pain.Diagnoses:Computed angiotomography revealed severe aneurysmal degeneration of aortic dissection in the thoracic and abdominal aorta.Intervention:The e-PETTICOAT enabled good remodeling and stopped degeneration.Outcome:At the 2-year follow-up, good remodeling with complete false lumen thrombosis and a stable aortic size were confirmed.Lesson:Lifelong follow-up in extensive TAAD should be considered. The e-PETTICOAT technique is an available alternative to fenestrated endovascular aortic repair for degenerative TAAD, as it promotes favorable remodeling after successful surgery of the ascending aorta.

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StreszczenieLymphangioma to bardzo rzadki, pierwotny nowotwór serca. Rozpoznawany jest zwykle przypadkowo w badaniach autopsyjnych. Do tej pory wydano zaledwie kilkanaście publikacji dotyczących tego nowotworu. W pięciu przypadkach rozpoznano go przypadkowo, w pozostałych dawał objawy kliniczne. Wynikały one z ucisku na struktury serca lub z zaburzonego przepływu krwi przez serce. Najczęściej były to objawy niewydolności krążenia i zaburzenia rytmu serca. W diagnostyce najbardziej przydatne jest badanie echokardiograficzne przezklatkowe i przezprzełykowe (TTE, TEE), które obrazuje guz wraz z efektem hemodynamicznym. Ostateczne rozpoznanie ustalane jest zwykle na podstawie badania histopatologicznego preparatu po jego operacyjnym usunięciu. Leczeniem z wyboru jest chirurgiczne wycięcie guza. W pracy przedstawiono przypadek lymphangioma, który był zlokalizowany w świetle prawego przedsionka i powodował znaczne utrudnienie napły-wu krwi do prawej komory, co było przyczyną niewydolności krążenia. Omówiono także wszystkie znane opisy przypadków tego nowotworu, które dotyczyły serca. Słowa kluczowe: guz serca, echokardiografia, operacja. Kardiochirurgia i Torakochirurgia Polska 2013; 10 (3) 283 CASE REPORT AbstractLymphangioma is a very rare primary tumor of the heart. It is usually incidentally found during autopsies and there have only been a handful of documented cases of this tumor in the heart. In 5 cases, it was discovered accidentally and the remaining cases gave clinical symptoms. Major symptoms of heart lymphangiomas include compression of surrounding mediastinal structures and/or inadequate blood flow through the heart. Specifically the cardiac disturbances lead to rhythm and circulatory failure. The most useful diagnostic tests for this heart tumor include echocardiography, which shows not only the tumor but also its hemodynamic effects. The following article presents the accidental finding of a lymphangioma, localized in the right atrium. It caused considerable difficulty for the blood flow into the right heart chamber, which then led to circulatory failure. In addition we will also discuss all known cases of cardiac lymphangiomas.

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In this case report, we present the treatment of an acute type A aortic dissection in a Jehovah's Witness patient. In accordance with the will of the patient, blood products were not used. Additionally, the patient had significant hemostatic disorders due to the use of antiplatelet drugs.