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Al-Kazaz M, Klein AL, Oh JK, Crestanello JA, Cremer PC, Tong MZ, Koprivanac M, Fuster V, El-Hamamsy I, Adams DH, Johnston DR. Pericardial Diseases and Best Practices for Pericardiectomy: JACC State-of-the-Art Review. J Am Coll Cardiol 2024; 84:561-580. [PMID: 39084831 DOI: 10.1016/j.jacc.2024.05.048] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/15/2024] [Revised: 04/09/2024] [Accepted: 05/01/2024] [Indexed: 08/02/2024]
Abstract
Remarkable advances have occurred in the understanding of the pathophysiology of pericardial diseases and the role of multimodality imaging in this field. Medical therapy and surgical options for pericardial diseases have also evolved substantially. Pericardiectomy is indicated for chronic or irreversible constrictive pericarditis, refractory recurrent pericarditis despite optimal medical therapy, or partial agenesis of the pericardium with a complication (eg, herniation). A multidisciplinary evaluation before pericardiectomy is essential for optimal patient outcomes. Overall, given the good outcomes reported, radical pericardiectomy on cardiopulmonary bypass, if feasible, is the preferred approach. Due to patient complexity, as well as the technical aspects of the surgery, pericardiectomy should be performed at high-volume centers that have the required expertise. The current review highlights the essential features of this multidisciplinary approach from diagnosis to recovery in patients undergoing pericardiectomy.
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Affiliation(s)
- Mohamed Al-Kazaz
- Bluhm Cardiovascular Institute, Division of Cardiology, Department of Medicine, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA.
| | - Allan L Klein
- Center for the Diagnosis and Treatment of Pericardial Diseases, Section of Cardiovascular Imaging, Department of Cardiovascular Medicine, Heart, Vascular, and Thoracic Institute, Cleveland Clinic, Cleveland, Ohio, USA
| | - Jae K Oh
- Department of Cardiovascular Medicine, Mayo Clinic, Rochester, Minnesota, USA
| | - Juan A Crestanello
- Department of Cardiovascular Surgery, Mayo Clinic, Rochester, Minnesota, USA
| | - Paul C Cremer
- Bluhm Cardiovascular Institute, Division of Cardiology, Department of Medicine, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA; Bluhm Cardiovascular Institute, Division of Cardiology, Department of Radiology, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA
| | - Michael Z Tong
- Department of Thoracic and Cardiovascular Surgery, Heart, Vascular and Thoracic Institute, Cleveland Clinic, Cleveland, Ohio, USA
| | - Marijan Koprivanac
- Department of Thoracic and Cardiovascular Surgery, Heart, Vascular and Thoracic Institute, Cleveland Clinic, Cleveland, Ohio, USA
| | - Valentin Fuster
- The Mount Sinai Fuster Heart Hospital, Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | - Ismail El-Hamamsy
- Department of Cardiovascular Surgery, Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | - David H Adams
- Department of Cardiovascular Surgery, Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | - Douglas R Johnston
- Bluhm Cardiovascular Institute, Division of Cardiac Surgery, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA
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Koike S, Shiina T, Takasuna K, Kato A, Komatsu K. Extremely Large Fluid Collection in the Superior Aortic Recess Misdiagnosed as Mediastinal Tumors: A Report of Two Cases. Cureus 2024; 16:e66331. [PMID: 39113815 PMCID: PMC11303344 DOI: 10.7759/cureus.66331] [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: 08/06/2024] [Indexed: 08/10/2024] Open
Abstract
The superior aortic recess is one of the superior portions of the transverse sinus which is located around the ascending aorta. The fluid collection of the superior aortic recess is sometimes revealed on chest computed tomography, and it becomes more difficult to differentiate from a cystic tumor or lymphadenopathy when the amount of collected fluid is large or the fluid is extended into another area. We report two cases of fluid collection in the superior aortic recess which was misdiagnosed as a cystic mediastinal tumor that underwent surgical resection. An extremely large amount of fluid collection and cephalad extension led us to this clinical course.
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Affiliation(s)
- Sachie Koike
- Thoracic Surgery, Ina Central Hospital, Ina, JPN
| | | | | | - Akane Kato
- Respiratory Medicine, Ina Central Hospital, Ina, JPN
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3
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Tonko JB, Lambiase PD. Current and novel percutaneous epicardial access techniques for electrophysiological interventions: A comparison of procedural success and safety. J Cardiovasc Electrophysiol 2023; 34:2330-2341. [PMID: 37735956 DOI: 10.1111/jce.16069] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/14/2023] [Revised: 08/22/2023] [Accepted: 09/08/2023] [Indexed: 09/23/2023]
Abstract
Accessing the pericardial space safely and efficiently is an important skill for interventional cardiac electrophysiologist. With the increased recognition of the complexity of the 3-dimensional arrhythmogenic substrate due to advances in imaging and mapping technologies there has been an expansion of epicardial procedures in recent years. Equally, minimally invasive implantation of epicardial pacing, cardiac resynchronization, or defibrillation leads is expanding in specific patients where transvenous systems are contraindicated or their long term sequelae should be ideally avoided. Selective delivery of intrapericardial pharmacological antiarrhythmic therapy is yet another potential indication, albeit still investigational. The expanding indications for percutaneous epicardial procedures is contrasted by the still substantial risk and challenges associated with accessing the pericardial space. Myocardial perforation, coronary artery laceration, and damage to the surrounding organs are all recognized and feared complications. A number of innovative epicardial access techniques have been proposed to overcome the difficulties and risks of traditional dry subxiphoid punctures and may allow for more widespread use of epicardial access in the future. We review 10 different established and novel subxiphoidal epicardial access techniques describing procedural success rates, safety profile and overall experience. The technical aspects as well as access times and costs for extra equipment will be reviewed. Finally, an outlook of reported preclinical techniques awaiting in-human feasibility studies is provided.
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Affiliation(s)
- Johanna B Tonko
- Institute for Cardiovascular Science, University College London, London, UK
| | - Pier D Lambiase
- Institute for Cardiovascular Science, University College London, London, UK
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Adler Y, Ristić AD, Imazio M, Brucato A, Pankuweit S, Burazor I, Seferović PM, Oh JK. Cardiac tamponade. Nat Rev Dis Primers 2023; 9:36. [PMID: 37474539 DOI: 10.1038/s41572-023-00446-1] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 06/05/2023] [Indexed: 07/22/2023]
Abstract
Cardiac tamponade is a medical emergency caused by the progressive accumulation of pericardial fluid (effusion), blood, pus or air in the pericardium, compressing the heart chambers and leading to haemodynamic compromise, circulatory shock, cardiac arrest and death. Pericardial diseases of any aetiology as well as complications of interventional and surgical procedures or chest trauma can cause cardiac tamponade. Tamponade can be precipitated in patients with pericardial effusion by dehydration or exposure to certain medications, particularly vasodilators or intravenous diuretics. Key clinical findings in patients with cardiac tamponade are hypotension, increased jugular venous pressure and distant heart sounds (Beck triad). Dyspnoea can progress to orthopnoea (with no rales on lung auscultation) accompanied by weakness, fatigue, tachycardia and oliguria. In tamponade caused by acute pericarditis, the patient can experience fever and typical chest pain increasing on inspiration and radiating to the trapezius ridge. Generally, cardiac tamponade is a clinical diagnosis that can be confirmed using various imaging modalities, principally echocardiography. Cardiac tamponade is preferably resolved by echocardiography-guided pericardiocentesis. In patients who have recently undergone cardiac surgery and in those with neoplastic infiltration, effusive-constrictive pericarditis, or loculated effusions, fluoroscopic guidance can increase the feasibility and safety of the procedure. Surgical management is indicated in patients with aortic dissection, chest trauma, bleeding or purulent infection that cannot be controlled percutaneously. After pericardiocentesis or pericardiotomy, NSAIDs and colchicine can be considered to prevent recurrence and effusive-constrictive pericarditis.
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Affiliation(s)
- Yehuda Adler
- Sackler Faculty of Medicine, Tel Aviv University, Bnei Brak, Israel.
- College of Law and Business, Ramat Gan, Israel.
| | - Arsen D Ristić
- Department of Cardiology, University Clinical Centre of Serbia, Belgrade, Serbia
- Faculty of Medicine, Belgrade University, Belgrade, Serbia
| | - Massimo Imazio
- Cardiothoracic Department, Cardiology, University Hospital Santa Maria della Misericordia, Azienda Sanitaria Universitaria Friuli Centrale (ASUFC), Udine, Italy
| | - Antonio Brucato
- Department of Biomedical and Clinical Sciences, Fatebenefratelli Hospital, The University of Milan, Milan, Italy
| | - Sabine Pankuweit
- Department of Internal Medicine-Cardiology, Philipps University Marburg, Marburg, Germany
| | - Ivana Burazor
- Faculty of Medicine, Belgrade University, Belgrade, Serbia
- Institute for Cardiovascular Diseases "Dedinje" and Belgrade University, Faculty of Medicine, Belgrade, Serbia
| | - Petar M Seferović
- Department of Cardiology, University Clinical Centre of Serbia, Belgrade, Serbia
- Faculty of Medicine, Belgrade University, Belgrade, Serbia
- Serbian Academy of Sciences and Arts, Belgrade, Serbia
| | - Jae K Oh
- Department of Cardiovascular Medicine, Mayo Clinic, Rochester, MN, USA
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Burg MR, Anderson RD, Patloori SCS, Acosta-Vélez G, Spears D, Ha ACT, Chauhan VS, Bhaskaran AP, Nair K, Cusimano RJ, Nanthakumar K. Re-inventing Larrey's approach for Epicardial Mapping: The Closed Pericardiostomy Technique. Heart Rhythm 2023:S1547-5271(23)02174-4. [PMID: 37088232 DOI: 10.1016/j.hrthm.2023.04.015] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/14/2023] [Revised: 04/14/2023] [Accepted: 04/17/2023] [Indexed: 04/25/2023]
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Wackerly R, Thomas K, Loomis T, Moeller D, Loomis M. Anatomical Correlation for Focused Assessment With Sonography in Trauma. Cureus 2023; 15:e37714. [PMID: 37206498 PMCID: PMC10191455 DOI: 10.7759/cureus.37714] [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: 04/17/2023] [Indexed: 05/21/2023] Open
Abstract
When learning the Focused Assessment with Sonography in Trauma (FAST) exam, anatomical orientation can be difficult, especially in the subxiphoid and upper quadrant views. To facilitate understanding in these areas, a novel in-situ cadaver dissection was used to demonstrate anatomy related to the FAST exam. In situ, because the structures remained in normal positions with adjacent organs, layers, and spaces clearly visible from the point of view of the ultrasound probe. These views were then correlated with what was seen on the ultrasound screen. The right upper quadrant and subxiphoid anatomy were viewed in a mirror to match the ultrasound images, and the left upper quadrant was viewed directly from the examiner's position, also matching the view on the ultrasound screen. The in-situ cadaver dissection was developed as a resource to correlate FAST exam ultrasound images in the upper quadrant and subxiphoid regions with related cadaver anatomy.
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Affiliation(s)
- Rylie Wackerly
- Department of Clinical Anatomy, Sam Houston State University College of Osteopathic Medicine, Conroe, USA
| | - Kathryn Thomas
- Department of Clinical Anatomy, Sam Houston State University College of Osteopathic Medicine, Conroe, USA
| | - Teresa Loomis
- Department of Clinical Anatomy, Sam Houston State University College of Osteopathic Medicine, Conroe, USA
| | - David Moeller
- Department of Clinical Anatomy, Sam Houston State University College of Osteopathic Medicine, Conroe, USA
| | - Mario Loomis
- Department of Clinical Anatomy, Sam Houston State University College of Osteopathic Medicine, Conroe, USA
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