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Background and objective: Aspergillus pulmonary infections are potentially life-threatening complications that can occur after heart transplantation. The aim of the study was to find an easily available mortality predictor during Aspergillosis infection therapy following heart transplantation. Materials and methods: This study involved 15 heart recipients with the mean age of 55 ± 6 years who were diagnosed with invasive aspergillosis (IA) in a mean time of 80 ± 53 (19-209) days after orthotropic heart transplantation. Results: Out of fifteen patients diagnosed with IA, five died. The mean time from diagnosis to death in the deceased group was 28 ± 18 days. They were diagnosed with IA in a mean time of 80 ± 53 (19-209) days after orthotropic heart transplantation. During the initial seven days of therapy, the neutrophil to lymphocyte ratio (NLR) significantly differed between the two groups on day three and day seven, with median values of 10.8 [4.3-17.0] vs. 20.2 [17.4-116.8] (p = 0.0373) and 5.2 [3.2-8.1] vs. 32.2 [13.5-49.9] (p = 0.0101) in the survivor and the deceased group, respectively. The NLR was a significant predictor of death both on day three (cut-off point 17.2) and day seven (cut-off point 12.08) of therapy. Conclusions: Findings in our study indicate that NLR may be of predictive value in the estimation of mortality risk or response to treatment among patients with invasive aspergillosis following heart transplantation.

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BACKGROUND Congestive heart failure is a challenging problem due to increasing prevalence in developed countries. Patients admitted due to decompensated congestive heart failure symptoms who do not respond to medical treatment require mechanical circulatory support. Patients with biventricular failure are at particularly high mortality risk. MATERIAL AND METHODS We analyzed the function of 49 pumps (POLVAD-MEV, FRK Intra-cordis, Poland) implanted to rescue INTERMACS 1 and 2 profile patients referred to our department due to severe congestive heart failure. All patients were waiting for heart transplantation and were readmitted due to acute decompensations of congestive biventricular heart failure with resistance to medical therapy. RESULTS During the observational period, there were no technical problems in pump function. The mean duration of pump therapy was 30.6±8.3 (5-49) days. The risk for right-sided pump complications included clots formation on the following parts of the pump: outflow tract (1, 2%), membrane (13, 27%), dome (6, 12.5%), and periphery (1, 2%). The overall risk for device thrombosis was 41%. The risk for thromboembolic complications was CRP-dependent regarding conglomerates of fibrin and platelets formation (p<0.05). The risk for left-sided pump complications included clots formation on the outflow tract (1, 2%), membrane (9, 19%) and dome (3, 6%). The overall risk for device thrombosis was 27%. The risk for clots formation on the membrane (P<0.05) and dome of the pump depended on time (P<0.07). CONCLUSIONS Mechanical circulatory support with a paracorporeal pump is a safe option for biventricular heart dysfunction as a bridge to heart transplantation. The risk for thrombi formation is relatively high but acceptable within 30 days after implantation.

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Cardiac pseudoneoplasms are rare and benign. According to World Health Organization, they are classified as tumor-like lesions. We report two patients with recurrent ventricular tachycardia (VT) in whom magnetic resonance imaging revealed a pathological mass occupying a large part of the left ventricle. The localization of both tumors precluded the possibility of resection; thus, only surgical biopsy was performed. After deducting the prospect of malignancy of the tumors, we treated both patients with amiodarone and implantation of a cardioverter-defibrillator [implanted cardioverter/defibrillator (ICD)]. VT is one of many probable symptoms indicating a tumor within the heart; therefore, treatment with an ICD should only be considered after a more thorough diagnosis.

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AIMS: Hypertrophic cardiomyopathy (HCM) is characterized by left ventricular hypertrophy and impaired diastolic and systolic function. Abnormal sympathetic-parasympathetic balance is a potential stimulus for left ventricular hypertrophy in HCM patients. ß-Blockers are routinely used in HCM for their strong negative inotropic effect; however, these drugs also influence the sympathetic-parasympathetic balance. This study aimed to determine the autonomic control of the cardiovascular system and the autonomic effects of ß-blockers in HCM patients treated or untreated with ß-blockers. METHODS: Among 51 HCM outpatients (18-70 years old; 29 men) there were 19 individuals with no medication and 32 subjects treated with a ß-blocker. Fourteen age- and gender-matched (23-70 years old; nine men) healthy volunteers were enrolled in the control group. Continuous, non-invasive finger blood pressure was recorded during supine rest for 30 min. Autonomic regulation of the cardiovascular system was measured by heart rate variability and spontaneous baroreflex function (cross-correlation sequence method). RESULTS: The mean pulse interval, time domain and spectral measures of heart rate variability and baroreflex sensitivity were comparable between HCM patients, treated or not with ß-blockers, and the control group. However, the delay of the baroreflex was significantly longer in HCM patients who were not treated with ß-blockers [2.0 (1.6-2.3) s] in comparison with HCM patients receiving ß-blockers [1.4 (1.1-1.8) s; P = 0.0072] or control subjects [1.2 (0.8-1.8) s; P = 0.0025]. This delay did not differ between HCM patients treated with ß-blockers and the control group. CONCLUSIONS: Hypertrophic cardiomyopathy not treated with ß-blockers is accompanied by prolonged baroreflex delay. The use of ß-blockers normalizes this delay.

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We present a case of significant QTc prolongation with torsade de pointes in a female patient with a DDD pacemaker, who had been treated with an established dose of sotalol for two years. The most probable trigger factor of this adverse event was a strong emotional stress. The discontinuation of treatment with sotalol resulted in clinical recovery and QTc normalisation.

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