Cardiac valve surgery and myocardial damage: the role of cardiac troponin I.

AIM: The study investigated the release of cardiac Troponin I (cTnI) levels in heart valve surgery and in coronary artery bypass grafting (CABG). The aims of the research were 1) to evaluate the ability of cTnI to detect the myocardial damage; and 2) to demonstrate possible causative factors of the cTnI release after valve surgery. METHODS: A prospective, single-center study. Ninety consecutive patients were operated on for different types of cardiac surgery; 45 patients underwent cardiac valve surgery - The VALVE group. 45 patients underwent CABG surgery - the CABG group. CTnI levels were measured preoperatively, on the day of operation and the 7 days postoperatively. The diagnosis of damaged myocardium classically performed through the measurement of cTnI, twelve-lead electrocardiograms (ECG) and echocardiographics according to the protocol of the study. RESULTS: Although more elevated cTnI release was noticed in valve group early after operation, no occurrence of cardiac events was found in that group. Statistically significant occurrence of cardiac events was found in CABG group (P=0.015). No relationship was shown between the peak of cTnI and the presence of cardiac events in valve group. A statistically significant correlation was observed between cardiac events and peak cTnI in CABG group (P=0.05). Possible correlations were investigated between the peak of cTnI and perioperative parameters in both two groups. CONCLUSION: The absence of cardiac events and the association of valve surgery with higher early release of cTnI compared to CABG suggest that the type of surgery strongly affects the induction of myocardial damage.

The systemic inflammatory response in coronary artery bypass grafting: what is the role of the very low ejection fraction (EF < or = 30%)?

AIM: Patients with depressed left ventricular function are more susceptible to develop postoperative complications after cardiac surgery. The aim of the present study was to examine the effect of severe left ventricular dysfunction on the activation of systemic inflammatory reaction during and after coronary artery bypass grafting (CABG). METHODS: Clinical prospective study; 32 selected patients underwent CABG; 16 patients had depressed left ventricular function before the operation (low ejection fraction [EF] <30%)--Low EF group (study group). Sixteen patients had normal left ventricular function (normal EF, >50%)--Normal EF group (control group). The levels of inflammatory mediators TNF-alpha, IL-6, IL-8 and IL-10 were measured preoperatively, during and after cardiopulmonary bypass (CPB) and 24 hours postoperatively. RESULTS: Higher levels of almost all of inflammatory mediators were detected in patients with depressed left ventricular function compared with patients of normal EF group. IL-6 levels were found statistically significant higher in Low EF group before the induction of anesthesia (P=0.039) and after the administration of protamine (P=0.02). IL-8 levels were found statistically significant higher in Low EF group before the induction of anesthesia (P=0.05), 30 min after the start of CPB (P=0.02), after the administration of protamine (P=0.015) and 24 hours after the end of the operation (P=0.05). No statistically significant differences were demonstrated between the 2 groups of study relative to TNF-alpha and IL-10. CONCLUSION: A greater activation of systemic inflammatory reaction occurred in patients with depressed left ventricular function than in patients with normal cardiac function when they underwent CABG with extracorporeal circulation.

Intrathoracic cancer of the splenic flexure.

Blunt traumatic rupture of the diaphragm is a well known but uncommon event of thoracoabdominal traumatic injuries. It occurs in 1-5% of polytrauma patients and requires a high degree of suspicion for a rapid diagnosis. The frequency of delayed diagnosis is difficult to be estimated and up to 30% of blunt diaphragmatic ruptures present late. A case of herniated splenic colic flexure through a defect in the left hemidiaphragm and the subsequent development of colon cancer in this area are presented. We emphasize the importance of making a prompt diagnosis in order to avoid further morbidity and mortality in this rare clinical entity.