Myocarditis following rAd26 and rAd5 vector-based COVID-19 vaccine: case report.

SARS-CoV-2 vaccines provide a safe solution with a major impact on reducing the spread of the virus and mild side effects. Research has shown rare cases of myocarditis after mRNA vaccines. This study presents a 29-year-old male with chest pain after 48 h of receiving rAd26 and rAd5 vector-based COVID-19 vaccine (Sputnik V vaccine). The electrocardiogram revealed ST-segment elevation. Also, the laboratory screening was remarkable for elevated cardiac Troponin-I level, and leukocytosis; and echocardiography depicted severe left ventricular systolic dysfunction. Overall, endomyocardial biopsy proved lymphocytic myocarditis such that the patient was successfully treated with immunosuppressive and guideline-directed medical treatment.

Association of serum intact fibroblast growth factor 23 with left ventricular mass and different echocardiographic findings in patients on hemodialysis.

OBJECTIVES: To determine the association of fibroblast growth factor 23 (FGF23) with left ventricular hypertrophy (LVH) through the assessment of left ventricular (LV) mass and left ventricular mass index (LVMI) in patients on hemodialysis, this study was done. METHODS: All patients on hemodialysis who are older than 18 years and in whom hemodialysis vintage was at least 6 months were enrolled. All patients were on hemodialysis thrice a week for 4 h using low-flux dialysis filters, polysulfone membranes, reverse osmosis purified water, and bicarbonate-base hemodialysis solution. The exclusion criteria were any respiratory illness or pulmonary infection, cigarette smoking, and the presence of pericarditis or pericardial effusion. Additionally, patients with a known coronary artery disease, any form of cardiac arrhythmias, any cardiomyopathy or severe valvular heart disease diagnosed by echocardiography, acute congestive heart failure (CHF), and acute myocardial infarction were not included. Echocardiography was conducted by an experienced operator for all the enrolled patients using the ACUSON SC2000™ ultrasound system transducer (Siemens), with a frequency bandwidth of: 1.5-3.5 MHz. Patients were considered to have LVH if the LVMI was greater than 134 g/m2 for men and greater than 110 g/m2 for women. RESULTS: A total of 61 patients (19 female and 42 male) were enrolled to the study. Mean (± SD) age of the patients was 59.6 ± 13.1 years. The median duration of hemodialysis was 23 (range: 6-120) months. The median predialysis level of FGF23 was 1,977 pg/mL (range: 155-8,870). LVH was seen in 73.8% of the patients (n = 45) and of them 66.7% were male. There was a statistically significant direct correlation between FGF23 and left ventricle diameter in end systole (LVDs) (r = 0.29, P = 0.027). However, the association of FGF23 with LV mass, LVMI, and left ventricular ejection fraction (LVEF) was not significant. CONCLUSION: This study does not show the correlation between FGF23 and LV mass in stable hemodialysis patients.

Ultra fast-track extubation in heart transplant surgery patients.

BACKGROUND: Heart transplant surgeries using cardiopulmonary bypass (CPB) typically requires mechanical ventilation in intensive care units (ICU) in post-operation period. Ultra fast-track extubation (UFE) have been described in patients undergoing various cardiac surgeries. AIM: To determine the possibility of ultra-fast-track extubation instead of late extubation in post heart transplant patients. MATERIALS AND METHODS: Patients randomly assigned into two groups; Ultra fast-track extubation (UFE) group was defined by extubation inside operating room right after surgery. Late extubation group was defined by patients who were not extubated in operating room and transferred to post operation cardiac care unit (CCU) to extubate. RESULTS: The mean cardiopulmonary bypass time was 136.8 ± 25.7 minutes in ultra-fast extubation and 145.3 ± 29.8 minutes in late extubation patients (P > 0.05). Mechanical ventilation duration (days) was 0 days in ultra-fast and 2.31 ± 1.8 days in late extubation. Length of ICU stay was significantly higher in late extubation group (4.2 ± 1.2 days) than the UFE group (1.72 ± 1.5 days) (P = 0.02). In survival analysis there was no significant difference between ultra-fast and late extubation groups (Log-rank test, P = 0.9). CONCLUSIONS: Patients undergoing cardiac transplant could be managed with "ultra-fast-track extubation", without increased morbidity and mortality.

Pulmonary artery stenosis shortly after lung transplantation: successful balloon dilation and stent insertion in one case.

BACKGROUND: Pulmonary artery stenosis after lung transplantation is a rare complication. It usually requires surgical correction but even after that the outcome is not favorable.
CASE REPORT: The patient was a 53-years-old woman who was candidate for lung transplantation surgery due to pulmonary fibrosis. After 7 months on waiting list, with severe limitations in daily living activities, she received a single lung transplant in 2007. The surgery was performed without any complication. One day after surgery and after extubation, the patient needed oxygen supplementation through mask with reservoir bag. In bronchoscopy, black-and-white exudate and black membrane that blocked the main bronchus in the transplanted lung was observed. By bronchial lavage the membrane and exudate were successfully removed and patient received antibiotics for documented Aspergillus infection and methylprednisolone pulse therapy for evidences of graft rejection. Despite success in treatments of the mentioned complications, the condition of the patient deteriorated and she became totally dependent to supplemental oxygen. Oxygen consumption level had increase and pulmonary artery pressure was increasing gradually. With suspicion to pulmonary artery stenosis, bronchial CT-Scan with contrast was performed 13 days after transplantation surgery which showed a 50% stenosis. Trans-esophageal echocardiography also showed a stenosis with 40 mmHg gradient. 18 days after transplantation surgery, percutaneous balloon angioplasty was performed which was initially successful but re-stenosis occurred. Seven days later, another balloon angioplasty with stent insertion was performed. After the procedure, the gradient has been removed. Patient was discharged 30 days after transplantation. Follow-up after 10 months revealed no stenosis and the stent was working properly.
CONCLUSIONS: Stent angioplasty can be performed with no problem or complication if pulmonary artery stenosis is seen after lung transplantation.