Takotsubo syndrome following mitral valve replacement and left anterior descending coronary artery bypass grafting.

Takotsubo syndrome (TTS) is rarely diagnosed following valvular and nonvalvular cardiac surgery. Only several such cases, including 12 after mitral valve replacement (MVR) or plasty (MVP) and 2 after coronary artery bypass grafting (CABG) have been reported so far. A CASE REPORT: The authors describe a case of a 75-year-old female in whom TTS occurred on the first postoperative day after elective combined surgery: MVR (with bioprosthesis) and CABG (of the left anterior descending coronary artery). Echocardiography revealed left ventricular (LV) dysfunction in the form of apical ballooning with markedly decreased ejection fraction (EF) and global longitudinal strain (GLS): 28 % and -9.3 %, respectively; there were no signs of prosthesis dysfunction. Due to circulatory and concomitant respiratory failure, she was transferred to the intensive care unit; however, an intra-aortic balloon pump was not necessary. Normalization of LV function (EF 60%, GLS -18.5%) was observed after 2 weeks. The authors compare the clinical data of the case presented with those of the remaining 14 TTS patients after MVR, MVP or CABG described in the literature and emphasize the coexistence of multiple triggering factors (e.g. additional procedures, catecholamines use, protamine use, pleural or pericardial drainage, blood transfusion, rapid heart rate). The authors suggest that TTS should be routinely included in differential diagnosis of post-cardiac surgery heart failure decompensation.

Gigantic aneurysm of a venous bypass graft causing superior vena cava syndrome.

A case of a 66-year-old patient 13 years after coronary artery bypass grafting (CABG) admitted to hospital with typical ischemic chest pain and symptoms of superior vena cava syndrome (SVCS) is described. Non-invasive diagnostics confirmed acute coronary syndrome: non-ST-elevated myocardial infarction (ACS NSTEMI). Trans-thoracic echocardiography (TTE) revealed a gigantic tumor mass modeling the right atrium, causing chronic cardiac tamponade. Angiography showed that the tumor mass was in fact the aneurysmatically changed venous bypass graft to the right coronary artery (RCA). Computed tomography angiography (CT-angio) confirmed venous aneurysm size (the longest diameters were 10.2 cm × 8.7 cm). We also present treatment planning and the aneurysmal surgical removal procedure of this very rare case.

The oxygen stress index and levels of circulating interleukin-10 and interleukin-6 in patients with chronic heart failure.

OBJECTIVES: We sought to study circulating levels of pro- and anti-inflammatory cytokines together with the oxygen stress index in patients with chronic heart failure (CHF). BACKGROUND: Patients with CHF exhibit elevated levels of inflammatory and anti-inflammatory cytokines but the relative level of these cytokines with the oxygen stress index have not been reported. METHODS: Twenty-two patients with CHF and 10 control subjects were studied. Plasma levels of IL-6 and IL-10 were determined and the oxygen stress index was evaluated by urine 8-iso-PGF2alpha estimations. RESULTS: Plasma levels of IL-6 and IL-10 in CHF patients were significantly higher than those observed in the control subjects. Patients with more advanced disease (higher NYHA class) showed higher concentrations of IL-10 and IL-6 than those with less serious disease. 8-iso-PGF2alpha urine concentration (and therefore the oxygen stress index) was significantly higher in patients with CHF in comparison with control subjects. IL-6 plasma levels, but not IL-10 concentrations, correlated significantly with 8-iso-PGF2alpha levels in urine. CONCLUSIONS: Inflammatory and anti-inflammatory cytokine levels, as well as the oxidative stress index, are increased in patients with chronic heart failure. Inflammatory cytokine IL-6, but not anti-inflammatory cytokine Il-10, levels correlated significantly with the oxygen stress index.