Michał Lelek - Academia.edu (original) (raw)

Papers by Michał Lelek

Kardiologia Polska, Oct 1, 2007

Kardiologia Polska, 2010

Wstep: Wspo³czesna terapia zawa³u serca polega na przywroceniu przep³ywu w tetnicy nasierdziowej ... more Wstep: Wspo³czesna terapia zawa³u serca polega na przywroceniu przep³ywu w tetnicy nasierdziowej odpowiedzialnej za zawa³ za pomoc± pierwotnej przezskornej interwencji wiencowej (pPCI). Mimo skutecznego leczenia reperfuzyjnego poprzez pPCI rokowanie po pPCI jest zro?nicowane i dlatego w³a¶ciwa ocena ryzyka ma istotne znaczenie kliniczne. Cel: Ocena czynnikow rokowania odleg³ego u pacjentow po zawale serca ¶ciany przedniej, leczonych pierwotn± przezskorn± angioplastyk± wiencow±. Metody: Do badania w³±czono 127 kolejnych pacjentow z ostrym zawa³em serca ¶ciany przedniej, leczonych przezskorn± angioplastyk± wiencow± wykonan± w ci±gu 12 godzin od pocz±tku objawow. Jako czynniki ryzyka powa?nych zdarzen sercowych (MACE) analizowano: ste?enie troponiny I, CK-MB, kreatyniny, NT-proBNP, funkcje lewej komory w echokardiografii przezklatkowej, perfuzje mie¶nia lewej komory ocenian± za pomoc± echokardiografii kontrastowej, wynik koronarografii, EKG, 24-godzinny zapis EKG metod± Holtera, naprze...

Cardiology Journal, 2013

Background: To describe a series of acute coronary syndrome (ACS) patients in whom anomalous orig... more Background: To describe a series of acute coronary syndrome (ACS) patients in whom anomalous origin of culprit coronary artery (AOCCA) was diagnosed. Percutaneous coronary interventions (PCI) in AOCCA are performed very infrequently. Methods: Electronic databases from three high-volume tertiary cardiac centers were retrospectively searched for the presence of AOCCA in ACS. Results: Different types of AOCCA in ACS were identified in 20 patients. The most frequent AOCCA was left circumflex coronary artery (LCx) originating from right coronary artery (RCA) or directly from the right coronary sinus (RCS), n = 13, followed by high/atypical RCA, n = 3, LCA originating from RCS (n = 3) with either RCA-AOCCA (n = 1) or left anterior descending coronary artery (LAD)-AOCCA (n = 1) or RCA originating from left sinus of Valsalva, (n = 1), LAD originating from RCA (n = 1). In 1 ST-elevation myocardial infarction (STEMI)-patient RCA-AOCCA cannulation was unsuccessful, in 1 non-STEMIpatient AOCCA was missed, 1 ACS-patient was treated surgically and 1 ACS-patient was treated conservatively (both patients with non-STEMI). In the remaining patients PCI was successfully performed. Conclusions: The most frequently encountered AOCCA is LCx branching-off from RCA. AOCCA may either be difficult to cannulate and PCI aborted even in STEMI, or missed, especially when the intermediate branch from LCA is mimicking proper LCx.

Kardiologia Polska, 2021

Background Transfemoral access is the preferred approach for transcatheter aortic valve implantat... more Background Transfemoral access is the preferred approach for transcatheter aortic valve implantation (TAVI), as it is characterized by the lowest complication rate. In the majority of patients ineligible for transfemoral access, the transcarotid approach can be used. aims This study aimed to compare short-term outcomes in 2 groups of patients treated with transcarotid or transfemoral TAVI. methods A retrospective comparison included 265 patients in whom the TAVI procedure was performed between 2017 and 2019 (transcarotid TAVI, n = 33; transfemoral TAVI, n = 232). Preoperative characteristics, procedural and postprocedural outcomes, as well as 30-day mortality were assessed. results Compared with the transfemoral TAVI group, patients undergoing transcarotid TAVI presented with a higher New York Heart Association (NYHA) functional class (median [interquartile range (IQR)], 3 [3-3] vs 2 [2-3]; P <0.001), a higher surgical risk (median [IQR] EuroSCORE II, 6 [4.8-10.7] vs 4.8 [2.8-7.9]; P = 0.003), and a higher incidence of peripheral artery disease (36.4% vs 18.1%; P = 0.035). The median (IQR) procedure duration in the transcarotid TAVI group was shorter than in patients undergoing transfemoral TAVI (65 [60-80] min vs 90 [80-110] min; P <0.001, respectively). In both study groups, we noted a high percentage of procedural success (transcarotid vs transfemoral TAVI, 96.9% vs 97.2%; P = 0.66). We found no significant differences between transcarotid TAVI and transfemoral TAVI in terms of periprocedural and 30-day mortality as well as the number of strokes. Regardless of the access route chosen, echocardiographic parameters and the NYHA class similarly improved compared with preprocedural data. conclusions Despite posing a higher baseline risk and presenting a greater anatomic complexity, transcarotid access is safe and associated with 30-day outcomes similar to those observed for transfemoral access. Importantly, procedural time was short and no periprocedural strokes or vascular complications were reported.

Advances in Interventional Cardiology, 2020

Introduction: Radial access reduces the number of vascular complications. Radial artery spasm (RA... more Introduction: Radial access reduces the number of vascular complications. Radial artery spasm (RAS) can be prevented by the use of spasmolytic agents. However, use of these drugs can be possibly limited to certain groups of patients. Aim: To assess the feasibility and safety of coronary angiography and percutaneous coronary interventions through the radial artery without the routine use of spasmolytic agents. Material and methods: A group of 293 patients (M/F 180/113, mean age: 67 ±10 years) who underwent coronary angiography and interventions through the radial artery approach was studied. Spasmolytic agents were applied in case of RAS. Every patient had ultrasound assessment of the radial artery on the next day to assess its diameter and detect occlusion. Results: RAS was observed in 55 patients (18.8%, M/F 28/27) and radial artery occlusion (RAO) in 47 (16%, M/F: 24/23) cases. RAS was followed by RAO in 17 cases, which constituted 17/55 (30.9%) of all RAS. Two patients had symptomatic occlusion, which required prolonged anticoagulation with complete restoration of patency. The RAS was higher in prolonged procedures (angiography time 32.6 ±12.8 vs. 29 ±13.5 min, p = 0.03; intervention time 40 ±23.5 vs. 26.3 ±25 min, p = 0.0035) and was dependent on time of the local pressure (7.5 ±2.3 vs. 6.5 ±2.8 h, p = 0.03). The RAO increased proportionally to the number of catheters used (p = 0.01) and was dependent on time of the local pressure (8.6 ±3.5 vs. 6.4 ±2.7 h, p < 0.001). Conclusions: Our study showed that angiography and interventions without routine use of spasmolytic agents were feasible and safe. RAS and RAO are related to independent risk factors and comparable to data from the literature when spasmolytics were used.

Advances in Interventional Cardiology, 2019

Interventional Medicine and Applied Science, 2019

A 55-year-old man without any cardiac history has been admitted to Ist Department of Cardiology d... more A 55-year-old man without any cardiac history has been admitted to Ist Department of Cardiology due to anterior wall infarction. In echocardiography (ECG), local anterior wall dysfunction has been observed, with good left ventricle ejection fraction. In angiography performed immediately after transfer to hospital, long lesion in left anterior descending coronary artery has been visualized with high angiographic suspicion of dissection and intramural coronary hematoma. Intravascular ultrasound (IVUS) has been performed and further confirmed the diagnosis of hematoma – LAD was stented using three coronary stents. IVUS has confirmed good position of stents. Integrillin has been used. Periprocedural time was uncomplicated. ECG showed resolution of myocardial infarction pattern and evolution of infarction has been observed. The patient was discharged home in good clinical condition. Coronary dissection and coronary hematoma are the potential cause of infarction and IVUS, despite optical ...

European Heart Journal, 2018

A 66-year-old man with a 2-year history of disseminated carcinoid, treated with somatostatin-anal... more A 66-year-old man with a 2-year history of disseminated carcinoid, treated with somatostatin-analogs, was admitted due to severe dyspnoea with cyanosis. The patient presented NYHA Class III, and resting severe hypoxia, with oxygen saturation of 65% on room air slightly improving with oxygen supplementation (78% with oxygen 5 L/min). Arterial blood gases on room air revealed hypoxemia without hypercapnia and aligned metabolic acidosis (PaO 2 38 mmHg, PaCO 2 25 mmHg, HCO 3À 15 mmol/l, BE À9 mmol/L). Pulmonological disorders were excluded. Transthoracic echocardiography showed an enlarged right atrium with carcinoid-related severe tricuspid regurgitation (lack of coaptation, restriction of leaflets). Transoesophageal echocardiography (TOE) revealed interatrial septal aneurysm with a patent foramen ovale (PFO) and an enormous right-toleft shunt. The right heart catheterization excluded pulmonary hypertension and disclosed the low right atrial pressure. Blood gases obtained in pulmonary veins and aorta excluded any vesicular-capillary barrier (pulmonary veins saturation O 2 99.5%, aortic saturation 70%). Finally, we conclude that the clinical patient's condition was secondary to a right-to-left shunt, due to severe tricuspid regurgitation directed towards PFO. Therefore, PFO was occluded under the TOE monitoring using an Amplatzer 30 mm. Directly after the procedure, the increase in venous and arterial saturation (pulmonary trunk saturation 52%, aortic saturation 88%) and significant reduction of cyanosis were observed (Panel). Carcinoid syndrome may lead to hypoxia in different mechanisms, thus further detailed diagnostic process, including pulmonological evaluation, echocardiography, and right heart catheterization may allow for complex analysis and finding potent reversible causes of hypoxia. Transoesophageal echocardiography mid-position views (Panel A). Transoesophageal echocardiography mid-position views with colour Doppler (Panel B). Transoesophageal echocardiography using contrast agent showing right-to-left shunt (Panel C). Xplane imaging with TOE during implantation of occluder (Panel D). Three-dimensional TOE visualization of Amplatzer (Panel E). Transthoracic echocardiogram, four-chamber view (Panel F).

Nephrology Dialysis Transplantation, 2016

Atherosclerosis, 2017

Novel combined index of cardiometabolic risk related to periarterial fat improves the clinical pr... more Novel combined index of cardiometabolic risk related to periarterial fat improves the clinical prediction for coronary artery disease complexity, Atherosclerosis (2017),

Kardiologia polska, 2015

Conflict of interest: none declared Figure 1. Fluoroscopy and echocardiography; A. Severe aortic ... more Conflict of interest: none declared Figure 1. Fluoroscopy and echocardiography; A. Severe aortic bioprosthesis stenosis; B. Corevalve positioned at bioprosthesis level. Visible bioprosthetic ring (white arrow); C. Partially released Corevalve prosthesis (white arrow). Inappropriate position over bioprosthetic ring; D. Recaptured Corevalve prosthesis; E. Early phase of second deployment; F. Corevalve completely released; G. Visible Corevalve prosthesis in left ventricular outflow track and ascending aorta (white arrows) A A next-generation self-expandable valve implantation in a patient with failed aortic bioprosthesis

Polish Journal of Cardio-Thoracic Surgery, 2013

Zwężenie zastawki mitralnej (mitral stenosis-MS) jest obecnie coraz rzadziej spotykaną nabytą wad... more Zwężenie zastawki mitralnej (mitral stenosis-MS) jest obecnie coraz rzadziej spotykaną nabytą wadą serca. Wśród uczestników rejestru Euro Heart Survey MS występowało u 12,1%, a w większości opisywanych przypadków miało etiologię reumatyczną. Złotym standardem w rozpoznawaniu MS jest kompleksowe badanie echokardiograficzne obejmujące obrazowanie przezklatkowe, przezprzełykowe, a także trójwymiarowe. Dokładna ocena echokardiograficzna ma implikacje terapeutyczne. Leczenie interwencyjne należy rozważyć u chorych mających objawy z klinicznie istotnym-umiarkowanym lub ciężkim-MS (powierzchnia zastawki ≤ 1,5 cm 2). Zalecaną obecnie metodą leczenia MS jest przezskórna komisurotomia mitralna (percutaneous mitral commissurotomy-PMC)-zabieg, którego bezpieczne i skuteczne przeprowadzenie w szczególności zależy od oceny echokardiograficznej. Zgodnie z obecnymi wytycznymi European Society of Cardiology leczenie operacyjne MS stosowane jest głównie w przypadku istnienia przeciwwskazań do przezskórnej walwuloplastyki. W niniejszej pracy przedstawiono aktualne zalecenia w leczeniu zabiegowym wady, w szczególności praktyczne aspekty kwalifikacji do PMC i zasady jej wykonania. Słowa kluczowe: stenoza mitralna, przezskórna walwuloplastyka, echokardiografia.

Circulation: Cardiovascular Interventions, 2008

Coronary Artery …, 2010

Reperfusion therapy, mainly primary percutaneous coronary intervention (PCI), has improved surviv... more Reperfusion therapy, mainly primary percutaneous coronary intervention (PCI), has improved survival and lowered complication rate in patients with ST elevation myocardial infarction (STEMI). Nevertheless, some patients develop left ventricular remodeling (LVR) ...

Kardiologia Polska, Sep 1, 2010

The issue of predicting coronary artery restenosis, especially silent, in patients following prim... more The issue of predicting coronary artery restenosis, especially silent, in patients following primary percutaneous coronary intervention (PCI) has been extensively studied, however, risk factors have not been fully defined. To asses the frequency of silent restenosis and its predictors in patients with anterior ST elevation myocardial infarction (STEMI) treated with primary PCI and implantation of bare metal stents (BMS). We recruited a cohort of 114 patients with first anterior STEMI treated with primary PCI within 12 hours of the onset of symptoms, and with the left anterior descending coronary artery occlusion (TIMI 0) and successful flow restoration (TIMI 3). A 12-lead ECG was performed before and 60 minutes after PCI. Troponin I and CK-MB were measured on admission and after six, 12 and 24 hours. Transthoracic echocardiography (TTE) was performed at discharge. Resting TTE and coronary angiography were performed after a six month follow-up in asymptomatic patients. The frequency of silent restenosis in our study group was 23.9%. The best multivariate models in logistic regression of restenosis prediction were: lower end-systolic volume of the left ventricle assessed two days after infarction longer lesion and smaller reference diameter of the stented vessel. Silent restenosis in patients with first anterior STEMI treated by primary PCI with the use of BMS is still frequent. The best ways to identify patients with silent restenosis at six month follow-up, apart from the lower end systolic volume in the echocardiographic study, are longer narrowing in the infarct-related artery and lower reference diameter of the treated vessel.