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Aoki K, Kajiyama T, Matsumiya G, Kobayashi Y. Bacterial Pericarditis With Underlying Severe Aortic Stenosis and Myelodysplastic Syndrome. Cureus 2024; 16:e58290. [PMID: 38752068 PMCID: PMC11094529 DOI: 10.7759/cureus.58290] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/08/2024] [Indexed: 05/18/2024] Open
Abstract
We herein describe a case of a 79-year-old male who presented with severe aortic stenosis with myelodysplastic syndrome. He was hospitalized to undergo presurgical evaluation and puncture of pericardiocentesis. After the placement of pericardial drainage, he developed bacterial pericarditis. His heart failure had worsened due to new onset of atrial fibrillation and pericardial constriction. Methicillin-sensitive Staphylococcus aureus was identified as the pathogen from the puncture. A pericardial windowing was performed so that his circulatory status was stabilized. An aortic valve replacement as well as resection of pericardial fibrosis was finally performed, and he was discharged without any sequela.
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Affiliation(s)
- Kaoruko Aoki
- Department of Cardiovascular Medicine, Chiba University Graduate School of Medicine, Chiba, JPN
| | - Takatsugu Kajiyama
- Department of Advanced Cardiorhythm Therapeutics, Chiba University Graduate School of Medicine, Chiba, JPN
| | - Goro Matsumiya
- Department of Cardiovascular Surgery, Chiba University Graduate School of Medicine, Chiba, JPN
| | - Yoshio Kobayashi
- Department of Cardiovascular Medicine, Chiba University Graduate School of Medicine, Chiba, JPN
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Ntsekhe M. Pericardial Disease in the Developing World. Can J Cardiol 2023; 39:1059-1066. [PMID: 37201721 DOI: 10.1016/j.cjca.2023.05.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2023] [Revised: 05/10/2023] [Accepted: 05/10/2023] [Indexed: 05/20/2023] Open
Abstract
Pericardial disease in the developing world is dominated primarily by effusive and constrictive syndromes and contributes to the acute and chronic heart failure burden in many regions. The confluence of geography (location in the tropics), a significant burden of diseases of poverty and neglect, and a significant contribution of communicable diseases to the general burden of disease is reflected in the wide etiological spectrum of causes of pericardial disease. The prevalence of Mycobacterium tuberculosis in particular, is high throughout much of the developing world where it is the most frequent and important cause of pericarditis and is associated with significant morbidity and mortality. Acute viral/idiopathic pericarditis, which is the primary manifestation of pericardial disease in the developed world is believed to occur significantly less frequently in the developing world. Although diagnostic approaches and criteria to establish the diagnosis of pericardial disease are similar throughout the globe, resource constraints such as access to multimodality imaging and hemodynamic assessment are a major limitation in much of the developing world. These important considerations significantly influence the diagnostic and treatment approaches, and outcomes related to pericardial disease.
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Affiliation(s)
- Mpiko Ntsekhe
- The Division of Cardiology, Groote Schuur Hospital and University of Cape Town, Cape Town, South Africa.
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Abdelsalam M, Nathanial C, Elmarzouky Z, Dulal S, Habib U, Ahmed M, Ashiq A, Nanda N. Two-dimensional transthoracic echocardiographic demonstration of reduction in fibrin content in purulent pericarditis following intrapericardial fibrinolytic agent administration. Echocardiography 2021; 39:146-148. [PMID: 34913191 DOI: 10.1111/echo.15282] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2021] [Accepted: 11/23/2021] [Indexed: 11/27/2022] Open
Abstract
We describe an adult patient who presented with purulent pericarditis (PP) in whom two-dimensional transthoracic echocardiography demonstrated a marked decrease in the area of the right ventricular (RV) wall together with the overlying fibrin following intrapericardial administration of a fibrinolytic agent. Documentation of this decrease by measurements performed and illustrated on two-dimensional images has not been reported previously in an adult patient with PP, to the best of our knowledge.
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Affiliation(s)
- Mahmoud Abdelsalam
- Department of Medicine, Conemaugh Memorial Medical Center/Temple University, Johnstown, Pennsylvania, USA
| | - Cyril Nathanial
- Division of Cardiology, Department of Medicine, Conemaugh Memorial Medical Center, Johnstown, Pennsylvania, USA
| | - Zeyad Elmarzouky
- Division of Cardiology, Department of Medicine, University of Alabama at Birmingham, Birmingham, Alabama, USA
| | - Subash Dulal
- Division of Cardiology, Department of Medicine, University of Alabama at Birmingham, Birmingham, Alabama, USA
| | - Usama Habib
- Department of Medicine, Conemaugh Memorial Medical Center/Temple University, Johnstown, Pennsylvania, USA
| | - Maram Ahmed
- Faculty of Medicine, Ain Shams University, Cairo, Egypt
| | - Amir Ashiq
- Department of Medicine, Conemaugh Memorial Medical Center/Temple University, Johnstown, Pennsylvania, USA
| | - Navin Nanda
- Division of Cardiology, Department of Medicine, University of Alabama at Birmingham, Birmingham, Alabama, USA
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Mikrani R, Li C, Naveed M, Li C, Baig MMFA, Zhang Q, Wang Y, Peng J, Zhao L, Zhou X. Pharmacokinetic Advantage of ASD Device Promote Drug Absorption through the Epicardium. Pharm Res 2020; 37:173. [DOI: 10.1007/s11095-020-02898-6] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2020] [Accepted: 07/28/2020] [Indexed: 01/03/2023]
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Reznikoff CP, Fish JT, Coursin DB. Pericardial Infusion of Tissue Plasminogen Activator in Fibropurulent Pericarditis. J Intensive Care Med 2016; 18:47-51. [PMID: 15189667 DOI: 10.1177/0885066602239124] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
A 61-year-old man developed a loculated fibropurulent pericarditis, a rare complication of bacteremia. This occurred as a complication of a Staphylococcal aureus bacteremia from a head and neck abscess following self-extraction of a tooth. Despite surgical intervention and placement of 2 pericardial drains, a refractory, inadequately drained infected pericardial effusion persisted. Although there is limited experience with thrombolytic therapy to dissolve a fibrin clot in the pericardium, break down loculated adhesions, and facilitate free drainage of infected material, lysis is well described in the management of exudative pleural effusions. After infusion of 30 mg of tissue plasminogen activator in 100 cc normal saline through the pericardial drain of the patient, a large amount of infected serosanginous material subsequently drained during the next 2 days. The patient became afebrile and culture negative, remained hemodynamically stable, and had resolution of his pericarditis and pericardial effusion on electrocardiogram and echocardiogram, respectively.
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7
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Abstract
The pericardium serves many important functions but is not essential for life. Pericardial heart disease comprises only pericarditis and its complications, tamponade and constriction, and congenital lesions. However, the pericardium is affected by virtually every category of disease. Thus the critical care physician is likely to encounter the patient with pericardial disease in a variety of settings, either as an isolated phenomenon or as a complication of a variety of systemic disorders, trauma, or certain drugs. Despite exhaustive etiological lists, the cause of pericardial heart disease is often never identified. This article reviews the diagnosis and management of acute and chronic pericarditis with an emphasis on those areas of greatest interest to the intensivist.
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Affiliation(s)
- Brian D. Hoit
- From the Division of Cardiology, University of Cincinnati, Cincinnati, OH
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Natrajsetty HSS, Vijayalakshmi IB, Narasimhan C, Manjunath CN. Purulent pericarditis with quadruple valve endocarditis. AMERICAN JOURNAL OF CASE REPORTS 2015; 16:236-9. [PMID: 25904083 PMCID: PMC4410722 DOI: 10.12659/ajcr.893072] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
Patient: Male, 7 Final Diagnosis: Purulent pericarditis with quadruple valve endocarditis Symptoms: — Medication: (4S,4aS,5aR,12aS)-9-[2-(tert-butylamino)acetamido]-4,7 bis(dimethylamino)-1,4,4a,5,5a,6,11,12aoctahydro-3,10,12,12a-tetrahydroxy-1,11-dioxo-2 naphthacenecarboxamide Clinical Procedure: Pericardiocentisis Specialty: Cardiology
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Affiliation(s)
| | - Ishwarappa B Vijayalakshmi
- Department of Cardiology, Sri Jayadeva Institute of Cardiovascular Sciences and Research, Bengaluru, Karnataka, India
| | - Chitra Narasimhan
- Department of Cardiology, Sri Jayadeva Institute of Cardiovascular Sciences and Research, Bengaluru, Karnataka, India
| | - Cholenahalli N Manjunath
- Department of Cardiology, Sri Jayadeva Institute of Cardiovascular Sciences and Research, Bengaluru, Karnataka, India
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Actinomyces odontolyticus: Rare Etiology for Purulent Pericarditis. Case Rep Med 2014; 2014:734925. [PMID: 25580131 PMCID: PMC4279256 DOI: 10.1155/2014/734925] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/03/2014] [Accepted: 12/01/2014] [Indexed: 02/05/2023] Open
Abstract
Purulent pericarditis is one of the most common causes of cardiac tamponade and if left untreated has a mortality of 100%. Staphylococcus aureus and Streptococcus pneumonia have been implicated as the main etiology of purulent pericardial effusion followed by fungi and anaerobic sources. Actinomyces odontolyticus pericardial involvement has been reported in the literature only once. To our knowledge, this is the first fatal case of A. odontolyticus purulent pericarditis in the absence of periodontal disease.
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Successful treatment of a patient with purulent pericarditis by daily intrapericardial washouts. Ann Thorac Surg 2014; 98:1451-4. [PMID: 25282211 DOI: 10.1016/j.athoracsur.2013.11.072] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/30/2013] [Revised: 10/26/2013] [Accepted: 11/11/2013] [Indexed: 11/24/2022]
Abstract
Purulent pericarditis in adults is rare, but once it develops, it carries a high mortality rate. Adequate pericardial drainage and proper antibiotic treatment are essential in the successful management of purulent effusions, for which percutaneous catheter drainage is the most commonly performed technique. We herein report the case of a 75-year-old woman with purulent pericarditis attributable to methicillin-resistant Staphylococcus aureus. Although percutaneous pericardial drainage by catheter was used, the drainage was insufficient because of hyperviscous effusion. We performed surgical subxiphoid pericardial drainage, and a piece of a purulent stone was found in the pericardial cavity with purulent effusion. Additionally, daily intrapericardial washouts with physiologic saline alone were used as adjunct therapy. Five weeks later, the patient had a decreasing inflammatory reaction and symptom relief. She was discharged with no complications such as constrictive pericarditis.
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Ideh RC, Pollock L, Sanneh A, Garba D, Anderson STB, Corrah T. Management of persistent purulent pericarditis using streptokinase for intrapericardial fibrinolysis. Paediatr Int Child Health 2014; 34:220-3. [PMID: 24621239 DOI: 10.1179/2046905513y.0000000109] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/31/2022]
Abstract
Purulent pericarditis (PP) is a very serious condition with almost 100% mortality if untreated. Intrapericardial fibrinolysis is a preferred alternative to pericardectomy in the treatment of persistent PP, but there are no consensus guidelines on the standard protocol for this procedure in children. A 9-year-old boy was referred to the Medical Research Council Unit in The Gambia (MRC). He had been unwell for 18 days with a high continuous fever, cough, fast breathing, and dyspnoea on exertion. Prior to referral he had been treated for malaria and pneumonia with no improvement. At the MRC, he was diagnosed with purulent pericarditis caused by Staphylococcus aureus and after admission he was managed for 4 weeks with intravenous antibiotics, pericardial aspirations followed by saline lavage of the pericardium and intrapericardial antibiotic instillation. Despite these measures, massive re-accumulation of the purulent pericardial effusion continued. Once daily intrapericardial instillation of streptokinase at a dose of 18,000 i.u/kg diluted in 50 ml of normal saline, and saline washout of the pericardium after 2 hours was commenced on the 29th day of admission, in addition to the antibiotics. This technique of fibrinolysis employed for 2 days was effective in managing the persistent purulent pericarditis when pericardial aspiration and intravenous and intrapericardial antibiotics failed.
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Pericardioscopy and epi- and pericardial biopsy - a new window to the heart improving etiological diagnoses and permitting targeted intrapericardial therapy. Heart Fail Rev 2013; 18:317-28. [PMID: 23479317 DOI: 10.1007/s10741-013-9382-y] [Citation(s) in RCA: 43] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/15/2023]
Abstract
The etiology of pericardial effusions remains unresolved in many cases because not the full spectrum of diagnostic methods including cytology, histology, immunohistology and PCR on cardiotropic agents, which are currently available, used in many institutions. After comprehensive clinical workup and use of imaging methods, such as echocardiography and cardiac MRI, pericardiocentesis and epicardial and pericardial biopsy were carried out under pericardioscopical control of the biopsy site. Biopsies and fluid were evaluated by cytological, histological, immunological and molecular (PCR) methods in 259 patients of our tertiary referral center following an identical clinical pathway, diagnostic and therapeutic algorithm in all cases. A standard clinical pathway and the same diagnostic and therapeutic algorithms were used in all cases. When all methods are applied to patients with pericardial effusions, "idiopathic" pericardial effusion is no longer a relevant diagnosis. Autoreactive and lymphocytic pericardial effusions are the leading diagnosis in 35 % of patients in the prospective Marburg registry, followed by malignant effusions in 28 % of cases. Viral genome was assessed in fluid and epi- as well as pericardial biopsies in 12 %, followed by post-traumatic/iatrogenic effusions in 15 % and purulent/bacterial effusions in only 2 %. Pericardioscopy permits the macroscopic inspection of the pulsating heart and its disease-associated macroscopic alterations. It also permits safe and targeted biopsy for further investigations of the tissue. Therapy, tailored to the individual etiology, can be selected such as intrapericardial instillation in autoreactive effusions with triamcinolone and with cisplatin or thiotepa in neoplastic effusions. With this approach the recurrence of pericardial effusion can be avoided effectively. A comprehensive approach to the diagnosis of pericardial effusions in conjunction with pericardioscopy for targeted tissue sampling is the prerequisite for an etiologically based intrapericardial and systemic treatment, which improves outcome and prognosis.
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Augustin P, Desmard M, Mordant P, Lasocki S, Maury JM, Heming N, Montravers P. Clinical review: intrapericardial fibrinolysis in management of purulent pericarditis. CRITICAL CARE : THE OFFICIAL JOURNAL OF THE CRITICAL CARE FORUM 2011; 15:220. [PMID: 21575282 PMCID: PMC3219308 DOI: 10.1186/cc10022] [Citation(s) in RCA: 52] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 01/14/2023]
Abstract
Purulent pericarditis (PP) is a potentially life-threatening disease. Reported mortality rates are between 20 and 30%. Constrictive pericarditis occurs over the course of PP in at least 3.5% of cases. The frequency of persistent PP (chronic or recurrent purulent pericardial effusion occurring despite drainage and adequate antibiotherapy) is unknown because this entity was not previously classified as a complication of PP. No consensus exists on the optimal management of PP. Nevertheless, the cornerstone of PP management is complete eradication of the focus of infection. In retrospective studies, compared to simple drainage, systematic pericardiectomy provided a prevention of constrictive pericarditis with better clinical outcome. Because of potential morbidity associated with pericardiectomy, intrapericardial fibrinolysis has been proposed as a less invasive method for prevention of persistent PP and constrictive pericarditis. Experimental data demonstrate that fibrin formation, which occurs during the first week of the disease, is an essential step in the evolution to constrictive pericarditis and persistent PP. We reviewed the literature using the MEDLINE database. We evaluated the clinical efficacy, outcome, and complications of pericardial fibrinolysis. Seventy-four cases of fibrinolysis in PP were analysed. Pericarditis of tuberculous origin were excluded. Among the 40 included cases, only two treated by late fibrinolysis encountered failure requiring pericardiectomy. No patient encountered clinical or echocardiographic features of constriction during follow-up. Only one serious complication was described. Despite the lack of definitive evidence, potential benefits of fibrinolysis as a less invasive alternative to surgery in the management of PP seem promising. Early consideration should be given to fibrinolysis in order to prevent both constrictive and persistent PP. Nevertheless, in case of failure of fibrinolysis, pericardiectomy remains the primary option for complete eradication of infection.
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Affiliation(s)
- Pascal Augustin
- Département d'Anesthésie et Réanimation Chirurgicale, Hôpital Bichat Claude Bernard, Assistance Publique - Hôpitaux de paris, Paris 7 University (Denis Diderot), 46 rue Henri-Huchard, 75877 Paris Cedex 18, France.
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Parikh SV, Memon N, Echols M, Shah J, McGuire DK, Keeley EC. Purulent pericarditis: report of 2 cases and review of the literature. Medicine (Baltimore) 2009; 88:52-65. [PMID: 19352300 DOI: 10.1097/md.0b013e318194432b] [Citation(s) in RCA: 90] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/16/2023] Open
Abstract
Purulent pericarditis, a localized infection within the pericardial space, has become a rare entity in the modern antibiotic era. Although historically a disease of children and young adults, this is no longer the case: the median age at the time of diagnosis has increased by nearly 30 years over the past 6 decades. Despite advances in diagnostic and treatment modalities, purulent pericarditis remains a life-threatening illness. Unfortunately, the diagnosis is made postmortem in more than half the cases. Thus, a high index of clinical suspicion is crucial. We present 2 cases of purulent pericarditis, and provide an updated review of other case series published over the past 60 years.
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Affiliation(s)
- Shailja V Parikh
- From the Departments of Internal Medicine, Divisions of Cardiology at University of Texas Southwestern Medical Center (SVP, JS, DKM), Dallas, Texas; Washington University (NM), St. Louis, Missouri; Duke University (ME), Durham, North Carolina; and University of Virginia (ECK), Charlottesville, Virginia
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Kennedy C, McEvoy S. Purulent pericarditis. Ir J Med Sci 2008; 178:97-9. [DOI: 10.1007/s11845-008-0119-1] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2007] [Accepted: 01/08/2008] [Indexed: 11/29/2022]
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Abstract
Pericardial effusions may necessitate placement of a catheter into the pericardial space for continuous drainage. If the effusion material is fibrinous or loculated, drainage may slow or cease over time, allowing reaccumulation. Limited data exist to guide the selection of a fibrinolytic agent and the most appropriate dose. We report the case of a 79-year-old woman with malignant pericardial effusion who responded to intrapericardial administration of tenecteplase to facilitate drainage. The patient received three doses of tenecteplase--15 mg, 7.5 mg, and 7.5 mg--over 3 days, resulting in significant drainage. No adverse effects were noted except for a transient episode of hemodynamically stable atrial fibrillation. Use of fibrinolytic agents to facilitate pericardial drainage may offset the need to repeatedly replace the catheter if flow subsides despite continued presence of fluid in the pericardial space.
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Affiliation(s)
- Kelly K Johnson
- Department of Pharmacy, Advocate Lutheran General Hospital, Park Ridge, Illinois, USA.
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Liem NT, Tuan T, Dung LA. Thoracoscopic Pericardiectomy for Purulent Pericarditis: Experience with 21 Cases. J Laparoendosc Adv Surg Tech A 2006; 16:518-21. [PMID: 17004881 DOI: 10.1089/lap.2006.16.518] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
PURPOSE We present our experience in performing thoracoscopic pericardiectomy for purulent pericarditis in 21 children. MATERIALS AND METHODS Pericardiectomy was carried out using one optical trocar and two operating trocars. Pleural insufflation with carbon dioxide was maintained at 2-4 mm Hg. Anterior pericardiectomy was performed from the left phrenic nerve to the right border of the sternum to free the anterior part of the heart, notably the cardiac apex and the original area of the great vessels. Purulent debris was removed prior to detaching the epicardial peel. RESULTS This study included 21 patients. Their mean age was 8 years. The time from onset of the disease to surgery ranged from 4 to 34 days (average, 15.2 days). Operative times ranged from 50 to 180 minutes (average, 100 minutes). There were no intraoperative or postoperative complications. All symptoms of cardiac tamponade disappeared immediately postoperatively. Follow-up ranged from 4 to 15 months and showed normal clinical manifestations, echocardiographs, and chest x-rays in all children. CONCLUSION Thoracoscopic pericardiectomy with removal of a generous amount of the pericardium is feasible and safe for purulent pericarditis.
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Affiliation(s)
- Nguyen Thanh Liem
- Surgical Department, National Hospital of Pediatrics, Hanoi, Vietnam.
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Wagner A, MacGregor JM, Berg J, Sharkey LC, Rush JE. Septic pericarditis in a Yorkshire Terrier. J Vet Emerg Crit Care (San Antonio) 2006. [DOI: 10.1111/j.1476-4431.2006.00175.x] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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Abstract
Bacterial pericarditis occurs by direct infection during trauma, thoracic surgery, or catheter drainage, by spread from an intrathoracic, myocardial, or subdiaphragmatic focus, and by hematogenous dissemination. The frequent causes are Staphylococcus and Streptococcus (rheumatic pancarditis), Haemophilus, and M. tuberculosis. In AIDS pericarditis, the incidence of bacterial infection is much higher than in the general population, with a high proportion of Mycobacterium avium-intracellulare infection. Purulent pericarditis is the most serious manifestation of bacterial pericarditis, characterized by gross pus in the pericardium or microscopically purulent effusion. It is an acute, fulminant illness with fever in virtually all patients. Chest pain is uncommon. Purulent pericarditis is always fatal if untreated. The mortality rate in treated patients is 40%, and death is mostly due to cardiac tamponade, systemic toxicity, cardiac decompensation, and constriction. Tuberculous infection may present as acute pericarditis, cardiac tamponade, silent (often large) relapsing pericardial effusion, effusive-constrictive pericarditis, toxic symptoms with persistent fever, and acute, subacute, or chronic constriction. The mortality in untreated patients approaches 85%. Urgent pericardial drainage, combined with intravenous antibacterial therapy (e.g. vancomycin 1g twice daily, ceftriaxone 1-2g twice daily, and ciprofloxacin 400 mg/day) is mandatory in purulent pericarditis. Irrigation with urokinase or streptokinase, using large catheters, may liquify the purulent exudate, but open surgical drainage is preferable. The initial treatment of tuberculous pericarditis should include isoniazid 300 mg/day, rifampin 600 mg/day, pyrazinamide 15-30 mg/kg/day, and ethambutol 15-25 mg/kg/day. Prednisone 1-2 mg/kg/day is given for 5-7 days and progressively reduced to discontinuation in 6-8 weeks. Drug sensitivity testing is essential. Pericardiectomy is reserved for recurrent effusions or continued elevation of central venous pressure after 4-6 weeks of antituberculous and corticosteroid therapy.
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Affiliation(s)
- Sabine Pankuweit
- Department of Internal Medicine - Cardiology, Philipps University, Marburg, Germany
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Albalá Martínez N, Moneo González A, Waez Tatari B, Argüelles Baquero A, Ferrero Zorita J, Martín Benítez J. Pericarditis neumocócica: presentación de un caso y revisión de la literatura. Med Intensiva 2005. [DOI: 10.1016/s0210-5691(05)74247-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
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Blohm MEG, Schroten H, Heusch A, Christaras A, Micek M, Wintgens J, Mayatepek E, Hoehn T. Acute purulent pericarditis in pneumococcal meningitis. Intensive Care Med 2005; 31:1142. [PMID: 15977005 DOI: 10.1007/s00134-005-2676-3] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/20/2005] [Indexed: 11/25/2022]
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Maisch B, Seferović PM, Ristić AD, Erbel R, Rienmüller R, Adler Y, Tomkowski WZ, Thiene G, Yacoub MH. Guía de Práctica Clínica para el diagnóstico y tratamiento de las enfermedades del pericardio. Versión resumida. Rev Esp Cardiol 2004; 57:1090-114. [PMID: 15544758 DOI: 10.1016/s0300-8932(04)77245-0] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/17/2023]
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Abstract
BACKGROUND/PURPOSE Purulent pericarditis is a rapidly fatal disease if left untreated. This article describes our experience with diagnosis and management of 18 patients seen over a 10-year period. METHODS Eighteen children with purulent pericarditis were treated in our clinics between 1990 and 2000. Ten patients were boys and 8 were girls, and the mean age of all patients was 4 years (range, 8 months to 12 years). RESULTS Most common findings were fever and cardiac tamponade. Staphylococcus aureus was the most common causative agent, and the most common predisposing factor was respiratory tract infection. Chest radiography and echocardiography were the most important methods for diagnosis, and pericardiosynthesis was diagnostic in purulent pericarditis. The treatment methods performed in our patients were subxiphoidal pericardial tube (10 patients), pericardiectomy after subxiphoidal pericardial tube (2 patients), pericardiectomy (3 patients), and pericardiocentesis-intrapericardial thrombolytic treatment (3 patients). Only one patient (5.5%) died who was critically ill at the time of admission. CONCLUSIONS Subxiphoidal tube drainage and pericardiectomy were performed with good results in these cases. Intrapericardial streptokinase and pericardial aspiration method also was thought to be beneficial.
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Affiliation(s)
- Omer Cakir
- Department of Thoracic and Cardiovascular Surgery, in Dicle University, School of Medicine, Diyarbakir, Turkey
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Tutar HE, Yilmaz E, Atalay S, Ucar T, Uysalel A, Kiziltepe U, Gumus H. The changing aetiological spectrum of pericarditis in children. ANNALS OF TROPICAL PAEDIATRICS 2002; 22:251-6. [PMID: 12369490 DOI: 10.1179/027249302125001534] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/31/2022]
Abstract
The aetiologies, clinical features and follow-up data of 62 children with pericarditis admitted to a university hospital during a 6-year period were retrospectively assessed. Uraemic pericarditis was the most frequent and infections the second most frequent cause. In this series, the proportion of children with purulent pericarditis is less than in previous reports from developing countries. Familial Mediterranean fever, neoplasias, acute rheumatic fever and post-pericardiotomy syndrome were other important causes of pericarditis.
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Affiliation(s)
- H Ercan Tutar
- Department of Pediatric Cardiology, Ankara University Medical School, Turkey
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Pericardium. Surgery 2001. [DOI: 10.1007/978-3-642-57282-1_57] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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Hoit BD. Diagnosis and Management of Pericardial Disease. J Intensive Care Med 2000. [DOI: 10.1046/j.1525-1489.2000.00014.x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
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Pawsat DE, Lee JY. Inflammatory disorders of the heart. Pericarditis, myocarditis, and endocarditis. Emerg Med Clin North Am 1998; 16:665-81, ix. [PMID: 9739781 DOI: 10.1016/s0733-8627(05)70024-9] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
The emergency physician frequently sees patients with cardiac complaints. Too often, ischemic heart disease is overwhelmingly considered to the exclusion of other diagnostic possibilities such as inflammatory cardiac disorders. These disorders can cause considerable discomfort, have long-term implications, or lead to more serious cardiac disorders. Emergency physicians must have a practical understanding of the diagnostic evaluation and therapeutic approach to patients with inflammatory cardiac disorders.
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Affiliation(s)
- D E Pawsat
- Michigan State University Emergency Medicine Residency, Ingham Regional Medical Center, Lansing, USA
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