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Weingand N, He C, Grau-Roma L, Adamik KN. Chronic pericarditis and recurrent pericardial effusion of unknown origin in a kitten: a case report. Front Vet Sci 2024; 11:1347083. [PMID: 38952805 PMCID: PMC11216034 DOI: 10.3389/fvets.2024.1347083] [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] [Received: 11/30/2023] [Accepted: 05/27/2024] [Indexed: 07/03/2024] Open
Abstract
A 3-month-old kitten was presented after successful cardiopulmonary resuscitation, including a presumed intracardial injection by its primary care veterinarian. Throughout the subsequent hospitalization in the intensive care unit, the cat exhibited recurrent hemorrhagic pericardial effusions, along with concurrent pleural and abdominal effusions, resulting in multiple clinical deteriorations, necessitating pericardiocentesis and thoracocentesis. Despite more than 3 days of intensive care, the cat experienced another cardiopulmonary arrest with unsuccessful attempts to achieve the return of spontaneous circulation. Necropsy and histopathological findings revealed diffuse chronic-active pericarditis and hemorrhagic pericardial effusion, a condition that has not been documented in the context of cardiopulmonary resuscitation or pericardiocentesis.
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Affiliation(s)
- Nicole Weingand
- Division of Small Animal Emergency and Critical Care, Department of Clinical Veterinary Science, Vetsuisse Faculty, University of Bern, Bern, Switzerland
| | - Chang He
- Institute of Animal Pathology, Vetsuisse Faculty, University of Bern, Bern, Switzerland
| | - Llorenç Grau-Roma
- Institute of Animal Pathology, Vetsuisse Faculty, University of Bern, Bern, Switzerland
| | - Katja-Nicole Adamik
- Division of Small Animal Emergency and Critical Care, Department of Clinical Veterinary Science, Vetsuisse Faculty, University of Bern, Bern, Switzerland
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2
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Cox J, Chatila K, Lick SD. Successful Visceral and Parietal Pericardiectomy for Refractory Effusive-Constrictive Pericarditis: A Challenging Case Report. AMERICAN JOURNAL OF CASE REPORTS 2024; 25:e943979. [PMID: 38835157 PMCID: PMC11163830 DOI: 10.12659/ajcr.943979] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2024] [Revised: 04/18/2024] [Accepted: 04/12/2024] [Indexed: 06/06/2024]
Abstract
BACKGROUND Effusive-constrictive pericarditis (ECP) is an uncommon clinical syndrome characterized by the coexistence of pericardial effusion and constriction involving the visceral pericardium. This differs from constrictive pericarditis, which presents with thickening of the pericardium without effusions. Specific diagnostic criteria of ECP include the failure of right atrial pressure to decrease by 50% or reach a new level below 10 mmHg after normalization of intrapericardial pressure. CASE REPORT We present the case of a 32-year-old obese man with multiple comorbidities who initially presented with flu-like symptoms and pleural effusion with development of constrictive-like symptoms. Despite undergoing numerous pericardiocentesis and appropriate medical management, the patient's condition failed to improve, leading to the likely diagnosis of effusive-constrictive pericarditis. Cultures of pericardial fluid revealed E. -faecium, which required multiple antimicrobial therapy. Despite infection, the exact etiology of ECP remained unknown and likely idiopathic. Common causes of ECP include idiopathic, tuberculosis, cardiac surgery complications, radiation, or neoplasia. Ultimately, the patient underwent a pericardiectomy involving the visceral and parietal pericardium, resulting in hemodynamic stability and resolution of symptoms. CONCLUSIONS This case highlights the challenges in diagnosing and managing ECP, emphasizing the importance of considering surgical intervention in refractory cases. ECP initially presents as a pericardial effusion, often addressed through pericardiocentesis; however, in a small subset of patients, sustained symptoms and altered hemodynamics persist following pericardiocentesis, necessitating further evaluation and management. The success of pericardiectomy in our patient highlights the potential efficacy of surgical intervention in improving outcomes for patients with ECP.
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Affiliation(s)
- Jessica Cox
- School of Medicine, University of Texas Medical Branch, Galveston, TX, USA
| | - Khaled Chatila
- Department of Cardiology, University of Texas Medical Branch, Galveston, TX, USA
| | - Scott D. Lick
- Department of Cardiovascular and Thoracic Surgery, University of Texas Medical Branch, Galveston, TX, USA
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3
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Gillombardo CB, Hoit BD. Constrictive pericarditis in the new millennium. J Cardiol 2024; 83:219-227. [PMID: 37714264 DOI: 10.1016/j.jjcc.2023.09.003] [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: 05/02/2023] [Revised: 09/07/2023] [Accepted: 09/08/2023] [Indexed: 09/17/2023]
Abstract
Constrictive pericarditis (CP) is a complex clinical syndrome in which an inflamed pericardium becomes fibrotic and non-compliant, ultimately reducing cardiac pump performance. Although we have known about CP for centuries, it remains a challenge to diagnose. Recent advances in cardiac imaging, along with an expanding armamentarium of treatment options, have improved the quality and precision of care for patients with CP. This article reviews important historical and contemporary perspectives on the pathophysiology of CP, as well as our approach to diagnosis and management.
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Affiliation(s)
- C Barton Gillombardo
- Harrington Heart and Vascular Institute, University Hospital Cleveland Medical Center, Cleveland, OH, USA
| | - Brian D Hoit
- Harrington Heart and Vascular Institute, University Hospital Cleveland Medical Center, Cleveland, OH, USA; Case Western Reserve University, Cleveland, OH, USA.
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4
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Abouzeid W, Mirza N, Bellafiore P, Kiwan C, Paige A, Suleiman A, Khan A, Miller R. Surviving the Storm: Cardiac Tamponade and Effusive Constrictive Pericarditis Complicated by Pericardial Decompression Syndrome Induced by COVID-19 Infection in the Setting of Newly Diagnosed Acute Myeloid Leukemia (AML). Cureus 2024; 16:e56710. [PMID: 38646402 PMCID: PMC11032651 DOI: 10.7759/cureus.56710] [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: 03/22/2024] [Indexed: 04/23/2024] Open
Abstract
Coronavirus disease 2019 (COVID-19)-induced pericarditis and pericardial myocarditis are common entities; however, the development of pericardial effusion post-COVID-19 infection has only been reported in about 5% of cases. Rapid and acute progression to pericardial tamponade is uncommon, and progression to effusive constrictive pericarditis (ECP) and pericardial decompression syndrome (PDS) is an even rarer phenomenon. We describe these phenomena in this report to raise awareness and aid clinicians in the early diagnosis and management of these conditions. We report a case of a 45-year-old female with a past medical history of recent COVID-19 infection, uncontrolled diabetes mellitus, and hypertension who presented with severe chest pain, which was determined to be acute pericarditis post-COVID-19 infection. The patient developed a large pericardial effusion leading to cardiac tamponade within one day of initial presentation. Urgent pericardiocentesis was performed but was complicated by rapid decompensation of the patient, which has been assumed to be ECP following pericardiocentesis and PDS. Close monitoring of acute pericarditis with pericardial effusion is required in these patients for the early detection of cardiac tamponade, which requires urgent pericardiocentesis. Judicious post-pericardiocentesis follow-up is also required for the early diagnosis of conditions such as ECP and PDS. These cases are generally managed symptomatically, but in cases of severe ECP syndrome, pericardial stripping may be required.
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Affiliation(s)
- Wassim Abouzeid
- Internal Medicine, Saint Michael's Medical Center, Newark, USA
| | - Noreen Mirza
- Internal Medicine, Saint Michael's Medical Center, Newark, USA
| | - Paul Bellafiore
- Internal Medicine, Saint Michael's Medical Center, Newark, USA
| | - Chrystina Kiwan
- Internal Medicine, Saint Michael's Medical Center, Newark, USA
| | - Amy Paige
- Pulmonology and Critical Care, Saint Michael's Medical Center, Newark, USA
| | - Addi Suleiman
- Cardiology, Saint Michael's Medical Center, Newark, USA
| | - Ahsan Khan
- Cardiology, Saint Michael's Medical Center, Newark, USA
| | - Richard Miller
- Pulmonology and Critical Care, Saint Michael's Medical Center, Newark, USA
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5
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Kaur G, Sabatine MS, Schaefer IM, Sun YP, Loscalzo J. Encased in Peril. N Engl J Med 2023; 389:1709-1716. [PMID: 37913509 DOI: 10.1056/nejmcps2306031] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/03/2023]
Affiliation(s)
- Gurleen Kaur
- From the Department of Medicine (G.K., M.S.S., Y.-P.S., J.L.), TIMI Study Group, Division of Cardiovascular Medicine (M.S.S.), and the Department of Pathology (I.-M.S.), Brigham and Women's Hospital, Boston
| | - Marc S Sabatine
- From the Department of Medicine (G.K., M.S.S., Y.-P.S., J.L.), TIMI Study Group, Division of Cardiovascular Medicine (M.S.S.), and the Department of Pathology (I.-M.S.), Brigham and Women's Hospital, Boston
| | - Inga-Marie Schaefer
- From the Department of Medicine (G.K., M.S.S., Y.-P.S., J.L.), TIMI Study Group, Division of Cardiovascular Medicine (M.S.S.), and the Department of Pathology (I.-M.S.), Brigham and Women's Hospital, Boston
| | - Yee-Ping Sun
- From the Department of Medicine (G.K., M.S.S., Y.-P.S., J.L.), TIMI Study Group, Division of Cardiovascular Medicine (M.S.S.), and the Department of Pathology (I.-M.S.), Brigham and Women's Hospital, Boston
| | - Joseph Loscalzo
- From the Department of Medicine (G.K., M.S.S., Y.-P.S., J.L.), TIMI Study Group, Division of Cardiovascular Medicine (M.S.S.), and the Department of Pathology (I.-M.S.), Brigham and Women's Hospital, Boston
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6
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Chokr MO, Pinto Vandoni PM, de Carvalho Neto JN, de Moura LG, Dos Santos Sousa IB, Aiello VD, de Brito FS, Pisani CF, Hardy CA, de Melo SL, Darrieux FCC, Hachul DT, Scanavacca MI. Feasibility of Transatrial Access for Epicardial Ablation: Evaluation of 2 Different Techniques in Swine. JACC Clin Electrophysiol 2023; 9:2315-2328. [PMID: 37676203 DOI: 10.1016/j.jacep.2023.07.015] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2023] [Revised: 07/11/2023] [Accepted: 07/17/2023] [Indexed: 09/08/2023]
Abstract
BACKGROUND The subxiphoid pericardial access is technically difficult and has a considerable rate of complications, thus transatrial access may be an alternative. OBJECTIVES This study sought to assess the feasibility and safety of this strategy regarding periprocedural period and after 1-week follow-up. METHODS The investigators performed epicardial mapping through transatrial puncture in 20 swine. Animals were divided into group A, in which aspiration of the sheath was performed to maintain negative pressure after the withdraw of the catheters, and group B, in which a device (Konar-MF VSD Occluder) was delivered to occlude the right atrial appendage perforation. Bleeding was investigated immediately and 1 week after. RESULTS Access was safe in 19 of 20 animals (95%) with small amount of bleeding (6.4 ± 6 mL). In group A (n = 10), 1 animal presented hemopericardium right after the puncture. In the other 9, epicardial ablation was performed and 60.0 ± 28.0 mL of blood was aspirated without events. After 1 week, fibrin-hemorrhagic pericarditis was identified in 3 animals. In group B (n = 10), reaching the epicardial surface was possible in all animals. An adequate position of the prosthesis was obtained in 90% (9 of 10). One death occurred in the immediate postoperative period, secondary to pneumothorax. After 1 week, postmortem analysis showed absence of pericardial bleeding and a normal-appearing pericardium in the 8 animals with adequate prosthesis position. CONCLUSIONS Transatrial access allows epicardial mapping and ablation. Sheath removal after negative pressure contributes to achieving acute bleeding control but does not prevent its occurrence. The use of the device prevents bleeding and hemorrhagic pericarditis.
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Affiliation(s)
- Muhieddine O Chokr
- Heart Institute (Instituto do Coração), University of Sao Paulo Medical School, Sao Paulo, Brazil.
| | | | | | - Lucas G de Moura
- Heart Institute (Instituto do Coração), University of Sao Paulo Medical School, Sao Paulo, Brazil
| | | | - Vera D Aiello
- Heart Institute (Instituto do Coração), University of Sao Paulo Medical School, Sao Paulo, Brazil
| | - Fabio Sandoli de Brito
- Heart Institute (Instituto do Coração), University of Sao Paulo Medical School, Sao Paulo, Brazil
| | - Cristiano F Pisani
- Heart Institute (Instituto do Coração), University of Sao Paulo Medical School, Sao Paulo, Brazil
| | - Carina A Hardy
- Heart Institute (Instituto do Coração), University of Sao Paulo Medical School, Sao Paulo, Brazil
| | - Sissy L de Melo
- Heart Institute (Instituto do Coração), University of Sao Paulo Medical School, Sao Paulo, Brazil
| | - Francisco C C Darrieux
- Heart Institute (Instituto do Coração), University of Sao Paulo Medical School, Sao Paulo, Brazil
| | - Denise T Hachul
- Heart Institute (Instituto do Coração), University of Sao Paulo Medical School, Sao Paulo, Brazil
| | - Mauricio I Scanavacca
- Heart Institute (Instituto do Coração), University of Sao Paulo Medical School, Sao Paulo, Brazil
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Hiruma T, Murai T, Watanabe M, Nanasato M, Takayama M, Isobe M. Rapid Fatal Progression and Autopsy Findings of Effusive-Constrictive Pericarditis With Hypertrophic Cardiomyopathy. Circ Rep 2023; 5:365-366. [PMID: 37693230 PMCID: PMC10483110 DOI: 10.1253/circrep.cr-23-0061] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/25/2023] [Accepted: 06/26/2023] [Indexed: 09/12/2023] Open
Affiliation(s)
- Takashi Hiruma
- Department of Cardiology, Sakakibara Heart Institute Fuchu Japan
| | - Tatsuya Murai
- Department of Pathology, Sakakibara Heart Institute Fuchu Japan
| | | | - Mamoru Nanasato
- Department of Cardiology, Sakakibara Heart Institute Fuchu Japan
| | | | - Mitsuaki Isobe
- Department of Cardiology, Sakakibara Heart Institute Fuchu Japan
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8
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Isidoro CA, Deniset JF. Pericardial Immune Cells and Their Evolving Role in Cardiovascular Pathophysiology. Can J Cardiol 2023; 39:1078-1089. [PMID: 37270165 DOI: 10.1016/j.cjca.2023.05.017] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2023] [Revised: 05/26/2023] [Accepted: 05/28/2023] [Indexed: 06/05/2023] Open
Abstract
The pericardium plays several homeostatic roles to support and maintain everyday cardiac function. Recent advances in techniques and experimental models have allowed for further exploration into the cellular contents of the pericardium itself. Of particular interest are the various immune cell populations present in the space within the pericardial fluid and fat. In contrast to immune cells of the comparable pleura, peritoneum and heart, pericardial immune cells appear to be distinct in their function and phenotype. Specifically, recent work has suggested these cells play critical roles in an array of pathophysiological conditions including myocardial infarction, pericarditis, and post-cardiac surgery complications. In this review, we spotlight the pericardial immune cells currently identified in mice and humans, the pathophysiological role of these cells, and the clinical significance of the immunocardiology axis in cardiovascular health.
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Affiliation(s)
- Carmina Albertine Isidoro
- Department of Physiology and Pharmacology, University of Calgary, Calgary, Alberta, Canada; Libin Cardiovascular Institute, Cumming School of Medicine, Calgary, Alberta, Canada
| | - Justin F Deniset
- Department of Physiology and Pharmacology, University of Calgary, Calgary, Alberta, Canada; Libin Cardiovascular Institute, Cumming School of Medicine, Calgary, Alberta, Canada; Department of Cardiac Sciences, University of Calgary, Calgary, Alberta, Canada.
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9
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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: 0] [Impact Index Per Article: 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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10
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Tombetti E, Casarin F, Bizzi E, Bezer S, Mascolo R, Pallini G, Gabiati C, Bonaventura A, Trotta L, Pancrazi M, Maestroni S, Brucato A. Relapsing pericarditis: Peripheral blood neutrophilia, lymphopenia and high neutrophil-to-lymphocyte ratio herald acute attacks, high-grade inflammation, multiserosal involvement, and predict multiple recurrences. Int J Rheum Dis 2023; 26:337-343. [PMID: 36537284 DOI: 10.1111/1756-185x.14523] [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: 05/28/2022] [Revised: 11/12/2022] [Accepted: 11/22/2022] [Indexed: 12/24/2022]
Abstract
AIMS To identify peripheral blood cellular correlates of active pericarditis and to verify whether peripheral blood neutrophils, lymphocytes and the neutrophil to-lymphocyte ratio (NLR) are associated with disease phenotype or prognosis. METHODS Observational prospective study on a cohort of 63 patients with idiopathic pericarditis followed for 12 months after each pericarditis recurrence. Two distinct analyses were performed: the "index attack" analysis focused on the first pericarditis episode in each patient, while the "all attacks" analysis included all episodes occurring during the study. RESULTS Absolute and relative neutrophilia and lymphopenia, together with high NLR, were observed during active pericarditis, as compared with disease remission, at both analyses. Neutrophils showed a positive correlation with plasma C-reactive protein levels, while lymphocyte count showed a negative correlation. Relative neutrophil count was higher, and lymphocyte count lower in patients with pleural effusion; a higher NLR and lower absolute lymphocyte count were observed in those with peritoneal involvement. No correlations were found between peripheral blood neutrophil or lymphocyte counts and size of pericardial effusion, or with the presence of myocardial involvement. Peripheral neutrophilia, lymphopenia and NLR during acute attacks predicted the number of recurrences in the following 12 months. CONCLUSIONS Peripheral blood neutrophilia and lymphopenia are typical of acute idiopathic pericarditis. Acute attacks of pericarditis are associated with neutrophilia and lymphopenia, as compared with disease remission. During acute attacks, neutrophilia and lymphopenia reflect the extent of serosal inflammation and could help to customize therapeutic management after remission has been achieved.
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Affiliation(s)
- Enrico Tombetti
- Department of Biomedical and Clinical Sciences, Fatebenefratelli Hospital, Università di Milano, Milan, Italy.,Department of Internal Medicine, ASST Fatebenefratelli-Sacco, Milan, Italy
| | - Francesca Casarin
- Department of Internal Medicine, ASST Fatebenefratelli-Sacco, Milan, Italy
| | - Emanuele Bizzi
- Department of Internal Medicine, ASST Fatebenefratelli-Sacco, Milan, Italy
| | - Sofia Bezer
- Department of Internal Medicine, ASST Fatebenefratelli-Sacco, Milan, Italy
| | - Ruggiero Mascolo
- Department of Internal Medicine, ASST Fatebenefratelli-Sacco, Milan, Italy
| | - Giada Pallini
- Department of Internal Medicine, ASST Fatebenefratelli-Sacco, Milan, Italy
| | - Claudia Gabiati
- Department of Internal Medicine, ASST Fatebenefratelli-Sacco, Milan, Italy
| | - Aldo Bonaventura
- Medicina Generale 1, Medical Center, Ospedale di Circolo e Fondazione Macchi, ASST Sette Laghi, Varese, Italy
| | - Lucia Trotta
- Department of Internal Medicine, ASST Fatebenefratelli-Sacco, Milan, Italy
| | - Massimo Pancrazi
- Department of Internal Medicine, ASST Fatebenefratelli-Sacco, Milan, Italy
| | - Silvia Maestroni
- Department of Internal Medicine, Ospedale Papa Giovanni XXIII, Bergamo, Italy
| | - Antonio Brucato
- Department of Biomedical and Clinical Sciences, Fatebenefratelli Hospital, Università di Milano, Milan, Italy.,Department of Internal Medicine, ASST Fatebenefratelli-Sacco, Milan, Italy
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11
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Curtiaud A, Delmas C, Gantzer J, Zafrani L, Siegemund M, Meziani F, Merdji H. Cardiogenic shock among cancer patients. Front Cardiovasc Med 2022; 9:932400. [PMID: 36072868 PMCID: PMC9441759 DOI: 10.3389/fcvm.2022.932400] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2022] [Accepted: 07/04/2022] [Indexed: 11/13/2022] Open
Abstract
Sophisticated cancer treatments, cardiovascular risk factors, and aging trigger acute cardiovascular diseases in an increasing number of cancer patients. Among acute cardiovascular diseases, cancer treatment, as well as the cancer disease itself, may induce a cardiogenic shock. Although increasing, these cardiogenic shocks are still relatively limited, and their management is a matter of debate in cancer patients. Etiologies that cause cardiogenic shock are slightly different from those of non-cancer patients, and management has some specific features always requiring a multidisciplinary approach. Recent guidelines and extensive data from the scientific literature can provide useful guidance for the management of these critical patients. Even if no etiologic therapy is available, maximal intensive supportive measures can often be justified, as most of these cardiogenic shocks are potentially reversible. In this review, we address the major etiologies that can lead to cardiogenic shock in cancer patients and discuss issues related to its management.
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Affiliation(s)
- Anais Curtiaud
- Université de Strasbourg (UNISTRA), Faculté de Médecine, Hôpitaux Universitaires de Strasbourg, Nouvel Hôpital Civil, Service de Médecine Intensive-Réanimation, Strasbourg, France
| | - Clement Delmas
- Intensive Cardiac Care Unit, Cardiology Department, University Hospital of Rangueil, Toulouse, France
| | - Justine Gantzer
- Department of Medical Oncology, Strasbourg-Europe Cancer Institute (ICANS), Strasbourg, France
| | - Lara Zafrani
- Medical Intensive Care Unit, Saint-Louis Hospital, Assistance Publique des Hôpitaux de Paris, University of Paris, Paris, France
| | - Martin Siegemund
- Intensive Care Unit, Department of Acute Medicine, University Hospital, Basel, Switzerland
- Department of Clinical Research, University of Basel, Basel, Switzerland
| | - Ferhat Meziani
- Université de Strasbourg (UNISTRA), Faculté de Médecine, Hôpitaux Universitaires de Strasbourg, Nouvel Hôpital Civil, Service de Médecine Intensive-Réanimation, Strasbourg, France
- INSERM (French National Institute of Health and Medical Research), UMR 1260, Regenerative Nanomedicine (RNM), FMTS, Strasbourg, France
| | - Hamid Merdji
- Université de Strasbourg (UNISTRA), Faculté de Médecine, Hôpitaux Universitaires de Strasbourg, Nouvel Hôpital Civil, Service de Médecine Intensive-Réanimation, Strasbourg, France
- INSERM (French National Institute of Health and Medical Research), UMR 1260, Regenerative Nanomedicine (RNM), FMTS, Strasbourg, France
- *Correspondence: Hamid Merdji
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12
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Kumar S, Khubber S, Reyaldeen R, Agrawal A, Cremer PC, Imazio M, Kwon DH, Klein AL. Advances in Imaging and Targeted Therapies for Recurrent Pericarditis: A Review. JAMA Cardiol 2022; 7:975-985. [PMID: 35976625 DOI: 10.1001/jamacardio.2022.2584] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
Importance Pericarditis is the most common form of pericardial disease. Recurrence of pericarditis affects 15% to 30% of patients after the initial episode of pericarditis. Up to 50% of patients with the first recurrence have additional recurrences. These patients often progress to have colchicine-resistant and corticosteroid-dependent disease. Rapidly evolving cardiac magnetic resonance imaging techniques and novel targeted therapies have paved the way for imaging-guided therapy for recurrent pericarditis. However, the optimal application of these recent advances remains unclear. Observations A search was conducted using the PubMed and Cochrane databases for English-language studies, management guidelines, meta-analyses, and review articles published until April 2022 on recurrent pericarditis. Following the 2015 European Society of Cardiology guidelines for the diagnosis and management of pericardial diseases, new clinical trials and registry data have emerged that demonstrate the efficacy of interleukin-1 blockers in recurrent pericarditis. In addition, new observational data have come to light supporting the use of cardiac magnetic resonance imaging in the diagnosis, risk stratification, and management of such patients. Conclusions and Relevance Advances in imaging and targeted therapies have led to a paradigm shift in the management of recurrent pericarditis. This narrative review summarizes the established and emerging data on the diagnosis and treatment of recurrent pericarditis with special emphasis on the role of cardiac magnetic resonance imaging and interleukin-1 blockers in the current era of tailored therapy for recurrent pericarditis.
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Affiliation(s)
- Sachin Kumar
- 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
| | - Shameer Khubber
- 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
| | - Reza Reyaldeen
- 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
| | - Ankit Agrawal
- 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
| | - Paul C Cremer
- 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
| | - Massimo Imazio
- Cardiology, Cardiothoracic Department, University Hospital Santa Maria della Misericordia, Udine, Italy
| | - Deborah H Kwon
- 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
| | - 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
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13
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Sohal S, Mathai SV, Lipat K, Kaur A, Visveswaran G, Cohen M, Waxman S, Tiwari N, Vucic E. Multimodality Imaging of Constrictive Pericarditis: Pathophysiology and New Concepts. Curr Cardiol Rep 2022; 24:1439-1453. [PMID: 35917048 PMCID: PMC9344806 DOI: 10.1007/s11886-022-01758-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 07/26/2022] [Indexed: 11/15/2022]
Abstract
Purpose of Review The unique pathophysiological changes of constrictive pericarditis (CP) can now be identified with better imaging modalities, thereby helping in its early diagnosis. Through this review, we outline the pathophysiology of CP and its translation into symptomology and various imaging findings which then are used for both diagnosis and guiding treatment options for CP. Recent Findings Multimodality imaging has provided us with the capability to recognize early stages of the disease and identify patients with a potential for reversibility and can be treated with medical management. Additionally, peri-procedural planning and prediction of post-operative complications has been made possible with the use of advanced imaging techniques. Summary Advanced imaging has the potential to play a greater role in identification of patients with reversible disease process and provide peri-procedural risk stratification, thereby improving outcomes for patients with CP.
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Affiliation(s)
- Sumit Sohal
- Division of Cardiovascular Diseases, Department of Medicine, RWJ-BH Newark Beth Israel Medical Center, 201 Lyons Ave, Newark, NJ, 07112, USA.
| | - Sheetal Vasundara Mathai
- Division of Cardiovascular Diseases, Department of Medicine, Jacobi Medical Center, 1400 Pelham Parkway South, Bronx, NY, 10461, USA
| | - Kevin Lipat
- Division of Cardiovascular Diseases, Department of Medicine, RWJ-BH Newark Beth Israel Medical Center, 201 Lyons Ave, Newark, NJ, 07112, USA
| | - Arpanjeet Kaur
- Department of Medicine, Mount Sinai West, 1000 Tenth Avenue, New York, NY, 10019, USA
| | - Gautam Visveswaran
- Division of Cardiovascular Diseases, Department of Medicine, RWJ-BH Newark Beth Israel Medical Center, 201 Lyons Ave, Newark, NJ, 07112, USA
| | - Marc Cohen
- Division of Cardiovascular Diseases, Department of Medicine, RWJ-BH Newark Beth Israel Medical Center, 201 Lyons Ave, Newark, NJ, 07112, USA
| | - Sergio Waxman
- Division of Cardiovascular Diseases, Department of Medicine, RWJ-BH Newark Beth Israel Medical Center, 201 Lyons Ave, Newark, NJ, 07112, USA
| | - Nidhish Tiwari
- Division of Cardiovascular Diseases, Department of Medicine, Jacobi Medical Center, 1400 Pelham Parkway South, Bronx, NY, 10461, USA
| | - Esad Vucic
- Division of Cardiovascular Diseases, Department of Medicine, RWJ-BH Newark Beth Israel Medical Center, 201 Lyons Ave, Newark, NJ, 07112, USA
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14
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Ng WWS, Tang KB, Man MY, Hui KY, Shum HP. An Unusual Case of Effusive-Constrictive Pericarditis in the Intensive Care Unit. CASE 2022; 6:269-274. [PMID: 36036044 PMCID: PMC9399560 DOI: 10.1016/j.case.2022.04.011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Affiliation(s)
- Wincy Wing-Sze Ng
- Correspondence: Wincy Wing-Sze Ng, MBBS, MRCP (UK), PDipID (HK), FHKCP, FHKAM (Medicine), Department of Intensive Care, Pamela Youde Nethersole Eastern Hospital, 3 Lok Man Road, Chai Wan, Hong Kong Special Administrative Region, China
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15
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Chen JL, Mei DE, Yu CG, Zhao ZY. Pseudomonas aeruginosa-related effusive-constrictive pericarditis diagnosed with echocardiography: A case report. World J Clin Cases 2022; 10:7577-7584. [PMID: 36158001 PMCID: PMC9353922 DOI: 10.12998/wjcc.v10.i21.7577] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/18/2022] [Revised: 04/05/2022] [Accepted: 05/28/2022] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND Effusive-constrictive pericarditis (ECP) is an uncommon pericardial syndrome. Careful echocardiographic examination may provide helpful information not only for diagnosing but also for managing ECP. ECP has various etiologies; however, Pseudomonas aeruginosa (P. aeruginosa) infection has not been reported as a cause to date. Herein, we present a rare case of ECP caused by P. aeruginosa infection, which was followed up using echocardiography.
CASE SUMMARY A 30-year-old man was admitted to our hospital with a 2-mo history of cough, dyspnea, bloating, palpitations, and lower-extremity edema. The patient was initially diagnosed with pericardial effusion by transthoracic echocardiography. Drainage of pericardial effusion was performed to relieve the clinical symptoms. A follow-up echocardiogram showed that the pericardial effusion had decreased; however, the right atrial pressure continued to increase, and signs of constrictive pericarditis were observed upon a more comprehensive inspection. Therefore, the diagnosis of ECP was established based on the comprehensive pre- and post-pericardiocentesis echocardiographic findings. An urgent pericardectomy was subsequently performed, which significantly relieved the patient's clinical symptoms, and the signs of pericardial constriction on echocardiography improved. Pericardial effusion and pericardial culture showed growth of P. aeruginosa.
CONCLUSION ECP induced by P. aeruginosa infection remains a rare disease. The presence of echocardiographic features of constrictive pericarditis after pericardiocentesis therapy is highly indicative of ECP.
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Affiliation(s)
- Jin-Ling Chen
- Department of Echocardiography, Renmin Hospital of Wuhan University, Wuhan 430060, Hubei Province, China
| | - Dan-E Mei
- Department of Echocardiography, Renmin Hospital of Wuhan University, Wuhan 430060, Hubei Province, China
| | - Cai-Gui Yu
- Department of Echocardiography, Renmin Hospital of Wuhan University, Wuhan 430060, Hubei Province, China
| | - Zhi-Yu Zhao
- Department of Echocardiography, Renmin Hospital of Wuhan University, Wuhan 430060, Hubei Province, China
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16
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Cho IJ. Post-pericardiocentesis Constrictive Physiology in Cancer Patients With Pericardial Effusion. Korean Circ J 2022; 52:84-86. [PMID: 34989195 PMCID: PMC8738717 DOI: 10.4070/kcj.2021.0382] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2021] [Accepted: 11/19/2021] [Indexed: 11/11/2022] Open
Affiliation(s)
- In-Jeong Cho
- Division of Cardiology, Department of Internal Medicine, Ewha Womans University Seoul Hospital, Ewha Womans University College of Medicine, Seoul, Korea.
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17
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Park H, Yoon HJ, Lee N, Kim JY, Kim HY, Cho JY, Kim KH, Ahn Y, Jeong MH, Cho JG. Characteristics and Clinical Outcomes of Cancer Patients Who Developed Constrictive Physiology after Pericardiocentesis. Korean Circ J 2021; 52:74-83. [PMID: 34877827 PMCID: PMC8738712 DOI: 10.4070/kcj.2021.0217] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2021] [Revised: 09/29/2021] [Accepted: 10/06/2021] [Indexed: 11/11/2022] Open
Abstract
BACKGROUND AND OBJECTIVES This study aimed to identify the characteristics and clinical outcomes of cancer patients who developed constrictive physiology (CP) after percutaneous pericardiocentesis. METHODS One-hundred thirty-three cancer patients who underwent pericardiocentesis were divided into 2 groups according to follow-up echocardiography (CP vs. non-CP). The clinical history, imaging findings, and laboratory results, and overall survival were compared. RESULTS CP developed in 49 (36.8%) patients after pericardiocentesis. The CP group had a more frequent history of radiation therapy. Pericardial enhancement and malignant masses abutting the pericardium were more frequently observed in the CP group. Fever and ST segment elevation were more frequent in the CP group, with higher C-reactive protein levels (6.6±4.3mg/dL vs. 3.3±2.5mg/dL, p<0.001). Pericardial fluid leukocytes counts were significantly higher, and positive cytology was more frequent in the CP group. In baseline echocardiography before pericardiocentesis, medial e' velocity was significantly higher in the CP group (8.6±2.1cm/s vs. 6.5±2.3cm/s, p<0.001), and respirophasic ventricular septal shift, prominent expiratory hepatic venous flow reversal, pericardial adhesion, and loculated pericardial fluid were also more frequent. The risk of all-cause death was significantly high in the CP group (hazard ratio, 1.53; 95% confidence interval,1.10-2.13; p=0.005). CONCLUSIONS CP frequently develops after pericardiocentesis, and it is associated with poor survival in cancer patients. Several clinical signs, imaging, and laboratory findings suggestive of pericardial inflammation and/or direct malignant pericardial invasion are frequently observed and could be used as predictors of CP development.
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Affiliation(s)
- Hyukjin Park
- Department of Cardiology, Chonnam National University Hwasun Hospital, Hwasun, Korea
| | - Hyun Ju Yoon
- Department of Cardiology, Chonnam National University School/Hospital, Gwangju, Korea.
| | - Nuri Lee
- Department of Cardiology, Chonnam National University School/Hospital, Gwangju, Korea
| | - Jong Yoon Kim
- Department of Cardiology, Chonnam National University School/Hospital, Gwangju, Korea
| | - Hyung Yoon Kim
- Department of Cardiology, Chonnam National University School/Hospital, Gwangju, Korea
| | - Jae Yeong Cho
- Department of Cardiology, Chonnam National University School/Hospital, Gwangju, Korea
| | - Kye Hun Kim
- Department of Cardiology, Chonnam National University School/Hospital, Gwangju, Korea
| | - Youngkeun Ahn
- Department of Cardiology, Chonnam National University School/Hospital, Gwangju, Korea
| | - Myung Ho Jeong
- Department of Cardiology, Chonnam National University School/Hospital, Gwangju, Korea
| | - Jeong Gwan Cho
- Department of Cardiology, Chonnam National University School/Hospital, Gwangju, Korea
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18
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Established and Emerging Techniques for Pericardial Imaging with Cardiac Magnetic Resonance. Curr Cardiol Rep 2021; 23:169. [PMID: 34622359 DOI: 10.1007/s11886-021-01595-z] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 06/14/2021] [Indexed: 12/31/2022]
Abstract
PURPOSE OF REVIEW Pericardial diseases include a wide range of pathologies and their diagnosis can often be challenging. The goal of this review is to describe the established and emerging CMR imaging techniques used in the assessment of common pericardial diseases and explain the role of pericardial characterization in their diagnosis and management. RECENT FINDINGS CMR is indicated in cases of diagnostic uncertainty and for a comprehensive evaluation of the pericardium and its impact on the heart. This includes assessment of pericardial anatomy and associated cardiac hemodynamics, quantification and characterization of an effusion, disease staging, tissue characterization, guiding management, and even prognostication in some diseases of the pericardium. An emerging technique, pericardial characterization, utilizes various sequences to diagnose and stage pericardial inflammation, act as a biomarker in recurrent pericarditis, and guide management in inflammatory pericardial conditions. Beyond imaging, it has ushered in an era of tailored therapy for patients with pericardial diseases. Future directions should aim at exploring the role of tissue characterization in various pericardial diseases.
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19
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Arulselvam V, Al Amer SR, Kalis NN. Acute transient effusive constrictive pericarditis in a child. PROGRESS IN PEDIATRIC CARDIOLOGY 2021. [DOI: 10.1016/j.ppedcard.2021.101411] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
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20
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Abstract
Purpose of Review Pericardial effusion is a challenging pericardial syndrome and a cause of serious concern for physicians and patients due to its potential progression to life-threatening cardiac tamponade. In this review, we summarize the contemporary evidence of the etiology; diagnostic work-up, with particular emphasis on the contribution of multimodality imaging; therapeutic options; and short- and long-term outcomes of these patients. Recent Findings In recent years, an important piece of information has contributed to put together several missing parts of the puzzle of pericardial effusion. The most recent 2015 guidelines of the European Society of Cardiology for the diagnosis and management of pericardial diseases are a valuable aid for a tailored approach to this condition. Actually, current guidelines suggest a 4-step treatment algorithm depending on the presence or absence of hemodynamic impairment; the elevation of inflammatory markers; the presence of a known or first-diagnosed underlying condition, possibly related to pericardial effusion; and finally the duration and size of the effusion. In contrast to earlier perceptions, based on the most recent evidence, it seems that in the subgroup of asymptomatic patients with large (> 2-cm end-diastolic diameter), chronic (> 3 months) C-reactive protein negative, idiopathic (without an apparent cause) pericardial effusion, a conservative approach is the most reasonable option. Summary At present there is an increasing interest in the pericardial syndromes in general and pericardial effusions in specific, which has consistently expanded our knowledge in this “hazy landscape.” Apart from general recommendations applied to all cases, an individualized, etiologically driven treatment is of paramount importance.
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Affiliation(s)
- George Lazaros
- First Cardiology Department, School of Medicine, Hippokration General Hospital, National and Kapodistrian University of Athens, Vas. Sofias 114, 11528 Athens, Greece
| | - Charalambos Vlachopoulos
- First Cardiology Department, School of Medicine, Hippokration General Hospital, National and Kapodistrian University of Athens, Vas. Sofias 114, 11528 Athens, Greece
| | - Emilia Lazarou
- First Cardiology Department, School of Medicine, Hippokration General Hospital, National and Kapodistrian University of Athens, Vas. Sofias 114, 11528 Athens, Greece
| | - Konstantinos Tsioufis
- First Cardiology Department, School of Medicine, Hippokration General Hospital, National and Kapodistrian University of Athens, Vas. Sofias 114, 11528 Athens, Greece
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21
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Adachi K, Hayashi T, Omatsu T, Hirayama A, Higuchi Y. Idiopathic Effusive-Constrictive Pericarditis Presented by Variant Angina. Cureus 2021; 13:e14380. [PMID: 33987048 PMCID: PMC8110287 DOI: 10.7759/cureus.14380] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
An 80-year-old man presented to our hospital complaining of loss of appetite. During the medical examination, he developed variant angina accompanied with heart failure. Oral calcium channel blocker therapy controlled his variant angina, but medical management of heart failure became increasingly difficult due to gradually increasing pericardial effusion, and pericardiocentesis leading to the diagnosis of effusive-constrictive pericarditis (ECP). Here, we report a rare case of idiopathic pericarditis caused variant angina with already having endothelial dysfunction and eventually developed ECP.
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Affiliation(s)
- Kentaro Adachi
- Cardiovascular Medicine, Osaka Police Hospital, Osaka, JPN
| | | | - Takashi Omatsu
- Cardiovascular Medicine, Osaka Police Hospital, Osaka, JPN
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22
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Janus SE, Hoit BD. Effusive-constrictive pericarditis in the spectrum of pericardial compressive syndromes. Heart 2021; 107:heartjnl-2020-316664. [PMID: 33452122 DOI: 10.1136/heartjnl-2020-316664] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/13/2020] [Revised: 12/01/2020] [Accepted: 12/14/2020] [Indexed: 11/03/2022] Open
Abstract
When pericardial fluid accumulates and exceed the reserve volume of the pericardium or when the pericardium becomes scarred and inelastic, one of three pericardial compressive syndromes may ensue, namely, cardiac tamponade (CT), characterised by the accumulation of pericardial fluid under pressure; constrictive pericarditis (CP), the result of scarring and loss of the normal elasticity of the pericardial sac; and effusive-constrictive pericarditis (ECP), characterised by the concurrence of a tense pericardial effusion and constriction of the heart by the visceral pericardium. Although relatively uncommon, prevalence estimates vary widely and depend on the nature of the cohorts studied, the methods used to diagnose ECP and the manner in which ECP is defined. Most cases of ECP are idiopathic, reflecting the frequency of idiopathic pericardial disease in general, and other causes include radiation, malignancy, chemotherapy, infection and postsurgical/iatrogenic pericardial disease. The diagnosis of ECP often becomes apparent when pericardiocentesis fails to decrease the right atrial pressure by 50% or to a level below 10 mm Hg. Important non-invasive diagnostic modalities include echocardiography, cardiac magnetic resonance and, to a lesser extent, cardiac CT. In cases with clear evidence of pericardial inflammation, a trial of an anti-inflammatory regimen is warranted. A complete pericardiectomy should be reserved for refractory symptoms or clinical evidence of chronic CP.
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Affiliation(s)
- Scott E Janus
- Medicine, Case Western Reserve University and University Hospitals of Cleveland, Cleveland, Ohio, USA
| | - Brian D Hoit
- Medicine, Case Western Reserve University and University Hospitals of Cleveland, Cleveland, Ohio, USA
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23
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Lazaros G, Vlachopoulos C, Lazarou E, Tousoulis D, Tsioufis C. Contemporary management of pericardial effusion. Panminerva Med 2021; 63:288-300. [PMID: 33393752 DOI: 10.23736/s0031-0808.20.04197-x] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
Pericardial effusion is a relatively common clinical condition with a variety of clinical manifestations ranging from incidentally discovered asymptomatic cases to life-threatening cardiac tamponade. The etiology encompasses idiopathic cases and forms secondary to different conditions, including autoimmune diseases, malignancies, metabolic disorders, etc. While medical therapy should be offered to patients with elevation of inflammatory markers, in specific forms treatment should be appropriate to the underlying disorder. In cases with hemodynamic compromise pericardial drainage either with pericardiocentesis or pericardial "window" is indicated for therapeutic and diagnostic purposes. In the remainder, factors like comorbidities, size and location of the pericardial effusion will influence the clinical decision making. In asymptomatic or minimally symptomatic chronic large idiopathic pericardial effusions, according to recent evidence, a conservative approach with watchful waiting seems the most reasonable option. The prognosis of pericardial effusions largely depends on the underlying etiologies. Metastatic spread to the pericardium has an ominous prognosis whereas large to moderate effusions have been often associated with known or newly discovered specific underlying causes. Chronic small idiopathic effusions have an excellent prognosis and do not require specific monitoring. Large chronic idiopathic effusions in clinically stable patients require a 3 to 6-month assessment ideally in a specialized unit.
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Affiliation(s)
- George Lazaros
- First Cardiology Clinic, School of Medicine, Hippokration General Hospital, National and Kapodistrian University of Athens, Athens, Greece -
| | - Charalambos Vlachopoulos
- First Cardiology Clinic, School of Medicine, Hippokration General Hospital, National and Kapodistrian University of Athens, Athens, Greece
| | - Emilia Lazarou
- First Cardiology Clinic, School of Medicine, Hippokration General Hospital, National and Kapodistrian University of Athens, Athens, Greece
| | - Dimitris Tousoulis
- First Cardiology Clinic, School of Medicine, Hippokration General Hospital, National and Kapodistrian University of Athens, Athens, Greece
| | - Constantinos Tsioufis
- First Cardiology Clinic, School of Medicine, Hippokration General Hospital, National and Kapodistrian University of Athens, Athens, Greece
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24
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Bonaventura A, Vecchié A, Mauro AG, Brucato AL, Imazio M, Abbate A. An update on the pathophysiology of acute and recurrent pericarditis. Panminerva Med 2020; 63:249-260. [PMID: 33337127 DOI: 10.23736/s0031-0808.20.04205-6] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
Pericarditis is an inflammatory disease of the pericardium. Progress has been done in recent years in the understanding of its pathophysiology. In particular, pre-clinical and clinical studies have contributed to increasing our knowledge on the role of interleukin (IL)-1 and NLRP3 (NACHT, leucine- rich repeat, and pyrin domain- containing protein 3) inflammasome. Based on current evidence, pericarditis should be considered as an inflammatory reaction to various stimuli, including chemical/physical, infectious, or ischemic ones, with a viral infection being a common etiology. Interaction of pathogens or irritants with toll-like receptor (TLRs) and stimulation of IL-1 receptor by IL-1α and IL-1β lead to an increased transcription of pro-inflammatory genes, including those needed for NLRP3 inflammasome assembly. This pathway is confirmed indirectly by the beneficial effect of colchicine (an indirect NLRP3 inflammasome inhibitor) and IL-1 blockers in patients with recurrent pericarditis. More recently, a direct evidence of the NLRP3 inflammasome within the inflamed pericardium has been provided as well. It may, however, occur that selfantigens on the surface of mesothelial cells or microbial peptides may stimulate autoreactive T cells along with B cells producing anti-heart antibodies, although less evidence is available on this. Some uncertainties still remain about the role of neutrophils, neutrophil extracellular traps (NETs), and pericardial interstitial cells in recurrent and constrictive pericarditis. Unraveling these aspects might have a direct impact on the development of novel targeted therapies, especially considering the increasing number of drugs targeting NETs.
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Affiliation(s)
- Aldo Bonaventura
- Virginia Commonwealth University, Pauley Heart Center, Division of Cardiology, Department of Internal Medicine, Richmond, VA, USA - .,First Clinic of Internal Medicine, Department of Internal Medicine, University of Genoa, Genoa, Italy - .,Internal Medicine Unit, Department of Medicine and Surgery, University of Insubria-Ospedale Di Circolo di Varese, ASST Dei Sette Laghi, Varese, Italy -
| | - Alessandra Vecchié
- Virginia Commonwealth University, Pauley Heart Center, Division of Cardiology, Department of Internal Medicine, Richmond, VA, USA.,Internal Medicine Unit, Department of Medicine and Surgery, University of Insubria-Ospedale Di Circolo di Varese, ASST Dei Sette Laghi, Varese, Italy
| | - Adolfo G Mauro
- Virginia Commonwealth University, Pauley Heart Center, Division of Cardiology, Department of Internal Medicine, Richmond, VA, USA
| | - Antonio L Brucato
- Department of Biomedical and Clinical Sciences, Fatebenefratelli Hospital, Università di Milano, Milan, Italy
| | - Massimo Imazio
- University Cardiology, AOU Città della Salute e della Scienza di Torino, Torino, Italy
| | - Antonio Abbate
- Virginia Commonwealth University, Pauley Heart Center, Division of Cardiology, Department of Internal Medicine, Richmond, VA, USA
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25
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Ono Y, Hashimoto T, Sakamoto K, Matsushima S, Higo T, Sonoda H, Kimura Y, Mori M, Shiose A, Tsutsui H. Effusive-constrictive pericarditis secondary to pneumopericardium associated with gastropericardial fistula. ESC Heart Fail 2020; 8:778-781. [PMID: 33300689 PMCID: PMC7835501 DOI: 10.1002/ehf2.13135] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/28/2020] [Revised: 10/30/2020] [Accepted: 11/12/2020] [Indexed: 11/10/2022] Open
Abstract
A 66-year-old man with a history of gastric pull-up reconstruction for oesophageal cancer was hospitalized because of prolonged chest pain. Chest X-ray demonstrated pneumopericardium. Computed tomography revealed ulceration and abscess in the gastric conduit adjacent to the heart, suggesting gastropericardial fistula. As the patient did not show tamponade physiology, he was conservatively treated with antibiotics. The pneumopericardium diminished; however, he developed effusive-constrictive pericarditis with overt heart failure symptoms. Because pericardiocentesis failed to relieve the symptoms, pericardiectomy was performed. Intraoperative exploration revealed remarkably thickened pericardium and epicardium constituting multiple layers with purulent effusion. Epicardiectomy as well as pericardiectomy were required to achieve the effective reduction of central venous pressure. Perforation of the gastric conduit into the pericardial cavity was identified and repaired. Histopathology demonstrated thickened pericardium composed of hyalinized stroma, collagenous bundles, and infiltration of inflammatory cells. Streptococcus anginosus and Candida tropicalis were identified by culture of the resected tissue.
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Affiliation(s)
- Yoshiyasu Ono
- Department of Cardiovascular Medicine, Faculty of Medical Sciences, Kyushu University, 3-1-1 Maidashi, Higashi-ku, Fukuoka, 812-8582, Japan
| | - Toru Hashimoto
- Department of Cardiovascular Medicine, Faculty of Medical Sciences, Kyushu University, 3-1-1 Maidashi, Higashi-ku, Fukuoka, 812-8582, Japan.,Department of Advanced Cardiopulmonary Failure, Faculty of Medical Sciences, Kyushu University, Fukuoka, Japan
| | - Kazuo Sakamoto
- Department of Cardiovascular Medicine, Faculty of Medical Sciences, Kyushu University, 3-1-1 Maidashi, Higashi-ku, Fukuoka, 812-8582, Japan
| | - Shouji Matsushima
- Department of Cardiovascular Medicine, Faculty of Medical Sciences, Kyushu University, 3-1-1 Maidashi, Higashi-ku, Fukuoka, 812-8582, Japan
| | - Taiki Higo
- Department of Cardiovascular Medicine, Faculty of Medical Sciences, Kyushu University, 3-1-1 Maidashi, Higashi-ku, Fukuoka, 812-8582, Japan
| | - Hiromichi Sonoda
- Department of Cardiovascular Surgery, Faculty of Medical Sciences, Kyushu University, Fukuoka, Japan
| | - Yasue Kimura
- Department of Surgery and Science, Faculty of Medical Sciences, Kyushu University, Fukuoka, Japan
| | - Masaki Mori
- Department of Surgery and Science, Faculty of Medical Sciences, Kyushu University, Fukuoka, Japan
| | - Akira Shiose
- Department of Cardiovascular Surgery, Faculty of Medical Sciences, Kyushu University, Fukuoka, Japan
| | - Hiroyuki Tsutsui
- Department of Cardiovascular Medicine, Faculty of Medical Sciences, Kyushu University, 3-1-1 Maidashi, Higashi-ku, Fukuoka, 812-8582, Japan
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26
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Abstract
Effusive-constrictive pericarditis (ECP) is a rare clinical entity resulting from accumulating pericardial fluid within a stiff, non-compliant pericardium. There are a number of etiologies for ECP, which include malignancy, radiation, post-surgical causes, infectious, and collagen disorders. Clinically, ECP often presents as right-sided heart failure, or in advanced cases, cardiac tamponade. Symptoms may persist despite treatment with pericardiocentesis, and may warrant consideration for pericardiectomy for more definitive management. Invasive hemodynamic evaluation with cardiac catheterization remains the gold standard for diagnosis of ECP; however, echocardiography can provide a definitive diagnosis with high sensitivity and specificity. Echocardiographic features suggestive of ECP include ventricular septal motion abnormalities, such as interdependence, accentuated longitudinal motion of the heart, and altered respirophasic ventricular filling. While these features have been well established and can lead to the diagnosis of ECP, they are rarely observed in clinical practice. We present a case of ECP in a 25-year-old active duty male with a history of chest wall myoepithelial carcinoma who clearly demonstrated such echocardiographic findings of ECP.
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Affiliation(s)
- Arjun G Kalra
- Internal Medicine, Brooke Army Medical Center, Fort Sam Houston, USA
| | - Alec J Sharp
- Cardiology, Brooke Army Medical Center, Fort Sam Houston, USA
| | - Laith Dinkha
- Cardiology, Brooke Army Medical Center, Fort Sam Houston, USA
| | - Rosco Gore
- Cardiology, Brooke Army Medical Center, Fort Sam Houston, USA
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Pahwa S, Stephens EH, Dearani JA. High-Risk Reoperative Sternotomy—How We Do It, How We Teach It. World J Pediatr Congenit Heart Surg 2020; 11:459-465. [DOI: 10.1177/2150135120922222] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
With the increasing number of congenital heart disease patients living into adulthood and requiring reoperations, learning a safe and efficient reoperative sternotomy is essential. This article provides insight into the successful reoperative sternotomy, including preoperative evaluation, assessing risk for cardiac injury and preparations to take depending on the level of risk, safeguards taken before and during the sternotomy, and pearls and pitfalls in managing untoward events.
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Affiliation(s)
- Siddharth Pahwa
- Department of Cardiovascular Surgery, Mayo Clinic, Rochester, MN, USA
| | | | - Joseph A. Dearani
- Department of Cardiovascular Surgery, Mayo Clinic, Rochester, MN, USA
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Conti CR. Chronic Effusive Pericarditis and Chronic Constrictive Pericarditis. CARDIOVASCULAR INNOVATIONS AND APPLICATIONS 2020. [DOI: 10.15212/cvia.2019.0020] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
Abstract
Chronic Pericarditis is inflammation that begins gradually, is long lasting and results in fluid accumulation in the pericardial space or thickening of the pericardium. The etiology is unknown but may be cancer, TB or hypothyroidism. Arrhythmias are common and seen in almost half the
patients. The commonest arrhythmia is atrial fibrillation. Symptoms and signs are related to increased right atrial pressure and physical findings include elevated JVP and pericardial knock. Non surgical therapy consists mainly of no salt. Surgery cures about 85% of patients, however 5‐15%
of patients will die. Chronic effusive pericarditis occurs when there is persistent restriction of the visceral pericardium after pericardiocentesis.
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Chetrit M, Xu B, Kwon DH, Ramchand J, Rodriguez RE, Tan CD, Jellis CL, Johnston DR, Renapurkar RD, Cremer PC, Klein AL. Imaging-Guided Therapies for Pericardial Diseases. JACC Cardiovasc Imaging 2020; 13:1422-1437. [DOI: 10.1016/j.jcmg.2019.08.027] [Citation(s) in RCA: 21] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/30/2019] [Revised: 08/01/2019] [Accepted: 08/07/2019] [Indexed: 12/11/2022]
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Acute Transient Effusive-Constrictive Pericarditis. JACC Case Rep 2019; 1:616-621. [PMID: 34316891 PMCID: PMC8289142 DOI: 10.1016/j.jaccas.2019.08.027] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/25/2019] [Revised: 08/09/2019] [Accepted: 08/12/2019] [Indexed: 11/21/2022]
Abstract
A 52-year-old female developed acute idiopathic pericarditis, which was complicated with tamponade. Constrictive physiology persisted after pericardiocentesis, and effusive-constrictive pericarditis (ECP) was diagnosed. Constrictive physiology improved in 10 days with anti-inflammatory therapy. This case was remarkable because it showed that ECP may present in an acute and reversible form. (Level of Difficulty: Beginner.)
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Abstract
PURPOSE OF REVIEW To review the echo-Doppler findings in effusive-constrictive pericarditis (ECP). ECP corresponds to the coexistence of a hemodynamically significant pericardial effusion and markedly reduced compliance of the pericardium, manifested by constrictive physiology post-pericardiocentesis. RECENT FINDINGS We summarize herein the recent observations regarding the prevalence of ECP based on echocardiography as well as the pre- and post-pericardiocentesis echo-Doppler features of ECP. ECP diagnosed by echocardiography was seen in approximately 15% of patients with ECP pre- and post-pericardiocentesis echo-Doppler findings sharing features with both cardiac tamponade and constrictive pericarditis. ECP post-pericardiocentesis is common but its natural history in the current era might be better than previously reported. Further studies and (particularly simultaneous echocardiography-cardiac catheterization) are still critically needed to better understand the underlying hemodynamics of ECP. Moreover, it remains to be determined whether pre- and post-pericardiocentesis echo-Doppler findings can be used to prognosticate or to guide therapy of those undergoing pericardiocentesis.
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Nakao Y, Higaki T, Nakama Y, Morito T, Suenari K, Nishioka K, Masaoka Y, Yoshida H, Shiode N. Primary pericardial abscess caused by Staphylococcus aureus infection without a predisposing condition. J Cardiol Cases 2019; 20:73-76. [PMID: 31497168 DOI: 10.1016/j.jccase.2019.04.004] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/21/2019] [Revised: 03/18/2019] [Accepted: 04/05/2019] [Indexed: 10/26/2022] Open
Abstract
A 75-year-old man presented to the hospital with a low-grade fever and worsening dyspnea. Transthoracic echocardiogram and contrast-enhanced computed tomography revealed a 20 × 20 mm lesion adjacent to the left ventricle with pericardial effusion. We suspected pericardial abscess, but no bacteria were detected even after 6 consecutive blood cultures. Ultimately, we drained 500 mL serosanguinous fluid from the pericardial effusion on the 4th hospital day; a subsequent culture grew methicillin-sensitive Staphylococcus aureus. Although we performed percutaneous and surgical drainage and intravenous administration of antibiotics, he developed constrictive pericarditis, and died due to multi-organ failure on the 21st hospital day. On histological examination, neutrophil infiltration was noted in the thickened pericardium and the myocardium. To our knowledge, a purulent pericarditis complicated pericardial abscess can occur without bacteremia, and early diagnosis and aggressive management are necessary for a good prognosis. <Learning objective: Pericardial abscess (PA) is a rare but serious life-threatening illness. We report the case of a patient with primary PA induced by S. aureus infection without a predisposing condition. A purulent pericarditis complicated PA can occur without bacteremia being detected from sequential blood cultures. Early diagnosis and aggressive management are vital to ensure a good prognosis.>.
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Affiliation(s)
- Yasuhisa Nakao
- Department of Cardiology, Hiroshima City Hiroshima Citizens Hospital, Hiroshima, Japan
| | - Tadanao Higaki
- Department of Cardiology, Hiroshima City Hiroshima Citizens Hospital, Hiroshima, Japan
| | - Yasuharu Nakama
- Department of Cardiology, Hiroshima City Hiroshima Citizens Hospital, Hiroshima, Japan
| | - Toshiaki Morito
- Department of Pathology, Hiroshima City Hiroshima Citizens Hospital, Hiroshima, Japan.,Department of Pathology, NHO Iwakuni Clinical Center, Yamaguchi, Japan
| | - Kazuyoshi Suenari
- Department of Cardiology, Hiroshima City Hiroshima Citizens Hospital, Hiroshima, Japan
| | - Kenji Nishioka
- Department of Cardiology, Hiroshima City Hiroshima Citizens Hospital, Hiroshima, Japan
| | - Yoshiko Masaoka
- Department of Cardiology, Hiroshima City Hiroshima Citizens Hospital, Hiroshima, Japan
| | - Hideo Yoshida
- Department of Cardiovascular Surgery, Hiroshima City Hiroshima Citizens Hospital, Hiroshima, Japan
| | - Nobuo Shiode
- Department of Cardiology, Hiroshima City Hiroshima Citizens Hospital, Hiroshima, Japan
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Chetrit M, Natalie Szpakowski N, Desai MY. Multimodality imaging for the diagnosis and treatment of constrictive pericarditis. Expert Rev Cardiovasc Ther 2019; 17:663-672. [DOI: 10.1080/14779072.2019.1657832] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Affiliation(s)
- Michael Chetrit
- Department of Cardiovascular Medicine, Cleveland Clinic, Heart and Vascular Institute, Cleveland, OH, USA
| | - Natalie Natalie Szpakowski
- Department of Cardiovascular Medicine, Cleveland Clinic, Heart and Vascular Institute, Cleveland, OH, USA
| | - Milind Y. Desai
- Department of Cardiovascular Medicine, Cleveland Clinic, Heart and Vascular Institute, Cleveland, OH, USA
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Chetrit M, Xu B, Verma BR, Klein AL. Multimodality Imaging for the Assessment of Pericardial Diseases. Curr Cardiol Rep 2019; 21:41. [DOI: 10.1007/s11886-019-1115-y] [Citation(s) in RCA: 25] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
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Sinnaeve PR, Adriaenssens T. A contemporary look at pericardiocentesis. Trends Cardiovasc Med 2018; 29:375-383. [PMID: 30482483 DOI: 10.1016/j.tcm.2018.10.016] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/16/2018] [Revised: 10/23/2018] [Accepted: 10/30/2018] [Indexed: 12/19/2022]
Abstract
Percutaneous drainage is the default strategy for evacuating a pericardial effusion. A pericardiocentesis can be necessary or required in a wide variety of clinical settings ranging from urgent tamponade to relieve in iatrogenic hemorrhagic effusions in the electrophysiology or catheterization room, to planned diagnostic procedures in patients with suspected or known malignancy or infections. With the help of several procedural improvements over the past decades, echocardiography and fluoroscopy-guided percutaneous pericardiocentesis has become the standard intervention for evacuating pericardial effusions, as well as an essential tool in the diagnostic work-up of an unexplained pericardial effusion. When performed by skilled physicians assisted by appropriate imaging it is a very safe procedure, and provided that an indwelling catheter is placed, it is also very effective with an acceptably low risk of recurrences. In this review, the indications and standard techniques for pericardiocentesis are discussed, as well as their consequences for patients with iatrogenic and malignant effusions.
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Affiliation(s)
- P R Sinnaeve
- Department of Cardiovascular Medicine, University Hospitals Leuven, Herestraat 49, Leuven 3000, Belgium; Department of Cardiovascular Sciences, University of Leuven, Belgium.
| | - T Adriaenssens
- Department of Cardiovascular Medicine, University Hospitals Leuven, Herestraat 49, Leuven 3000, Belgium; Department of Cardiovascular Sciences, University of Leuven, Belgium
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Bonaventura A, Montecucco F. Inflammation and pericarditis: Are neutrophils actors behind the scenes? J Cell Physiol 2018; 234:5390-5398. [PMID: 30417336 DOI: 10.1002/jcp.27436] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/02/2018] [Accepted: 08/28/2018] [Indexed: 12/11/2022]
Abstract
The morbidity of acute pericarditis is increasing over time impacting on patient quality of life. Recent clinical trials focused especially on clinical aspects, with a modest interest in pathophysiological mechanisms. This narrative review, based on papers in English language obtained via PubMed up to April 2018, aims at focusing on the role of the innate immunity in pericarditis and discussing future potential therapeutic strategies impacting on disease pathophysiology. In developed countries, most cases of pericarditis are referred to as idiopathic, although etiological causes have been described, with autoreactive/lymphocytic, malignant, and infectious ones as the most frequent causes. Apart the known impairment of the adaptive immunity, recently a large body evidence indicated the central role of the innate immune system in the pathogenesis of recurrent pericarditis, starting from similarities with autoinflammatory diseases. Accordingly, the "inflammasome" has been shown to behave as an important player in pericarditis development. Similarly, the beneficial effect of colchicine in recurrent pericarditis confirms that neutrophils are important effectors as colchicine, which can block neutrophil chemotaxis, interferes with neutrophil adhesion and recruitment to injured tissues and abrogate superoxide production. Anyway, the role of the adaptive immune system in pericarditis cannot be reduced to a black or white issue as mechanisms often overlap. Therefore, we believe that more efficient therapeutic strategies have to be investigated by targeting neutrophil-derived mediators (such as metalloproteinases) and disentangling the strict interplay between neutrophils and platelets. In this view, some progress has been done by using the recombinant human interleukin-1 receptor antagonist anakinra.
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Affiliation(s)
- Aldo Bonaventura
- Department of Internal Medicine, First Clinic of Internal Medicine, University of Genoa, Genoa, Italy
| | - Fabrizio Montecucco
- Department of Internal Medicine, First Clinic of Internal Medicine, University of Genoa, Genoa, Italy
- Ospedale Policlinico San Martino, Genoa, Italy
- Centre of Excellence for Biomedical Research (CEBR), University of Genoa, Genoa, Italy
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Alajaji W, Xu B, Sripariwuth A, Menon V, Kumar A, Schleicher M, Isma’eel H, Cremer PC, Bolen MA, Klein AL. Noninvasive Multimodality Imaging for the Diagnosis of Constrictive Pericarditis. Circ Cardiovasc Imaging 2018; 11:e007878. [DOI: 10.1161/circimaging.118.007878] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Affiliation(s)
- Wissam Alajaji
- Department of Cardiovascular Medicine, Summa Health Heart and Vascular Institute, Akron, OH (W.A.)
| | - Bo Xu
- Center for the Diagnosis and Treatment of Pericardial Diseases, Heart and Vascular Institute (B.X., V.M., A.K., P.C.C., A.L.K.), Cleveland Clinic, OH
| | | | - Vivek Menon
- Center for the Diagnosis and Treatment of Pericardial Diseases, Heart and Vascular Institute (B.X., V.M., A.K., P.C.C., A.L.K.), Cleveland Clinic, OH
| | - Arnav Kumar
- Center for the Diagnosis and Treatment of Pericardial Diseases, Heart and Vascular Institute (B.X., V.M., A.K., P.C.C., A.L.K.), Cleveland Clinic, OH
| | - Mary Schleicher
- Cleveland Clinic Alumni Library (M.S.), Cleveland Clinic, OH
| | | | - Paul C. Cremer
- Center for the Diagnosis and Treatment of Pericardial Diseases, Heart and Vascular Institute (B.X., V.M., A.K., P.C.C., A.L.K.), Cleveland Clinic, OH
| | - Michael A. Bolen
- Cardiovascular Section, Imaging Institute (A.S., M.A.B.), Cleveland Clinic, OH
| | - Allan L. Klein
- Center for the Diagnosis and Treatment of Pericardial Diseases, Heart and Vascular Institute (B.X., V.M., A.K., P.C.C., A.L.K.), Cleveland Clinic, OH
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Lekhakul A, Fenstad ER, Assawakawintip C, Pislaru SV, Ayalew AM, Maalouf JF, Nkomo VT, Thaden J, Oh JK, Sinak LJ, Kane GC. Incidence and Management of Hemopericardium: Impact of Changing Trends in Invasive Cardiology. Mayo Clin Proc 2018; 93:1086-1095. [PMID: 30077202 DOI: 10.1016/j.mayocp.2018.01.023] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/10/2017] [Revised: 01/03/2018] [Accepted: 01/08/2018] [Indexed: 10/28/2022]
Abstract
OBJECTIVE As invasive cardiovascular care has become increasingly complex, cardiac perforation leading to hemopericardium is a progressively prevalent complication. We sought to assess the frequency, etiology, and outcomes of hemorrhagic pericardial effusions managed through a nonsurgical echo-guided percutaneous strategy. PATIENTS AND METHODS Over a 10-year period (January 1, 2007, to December 31, 2016), 1097 unique patients required pericardiocentesis for clinically important pericardial effusions. Of these 411 had drainage of hemorrhagic effusions (defined as a pericardial hemoglobin level >50% of serum hemoglobin or frank blood in the setting of cardiac perforation). Clinical characteristics, echocardiographic data, details of the procedure, and outcomes were determined. RESULTS Median patient age was 67 years (interquartile range, 56-76 years), and 60% were men. The procedure was emergent in 83% and elective in 17%. The site of pericardiocentesis was determined by echo-guidance in all: 68% from the left para-apical region, 18% from the left or right parasternal areas, and 14% were subxyphoid. Half (n=215 [52%]) occurred after cardiac perforation with percutaneous interventional procedure (ablation, n=94; device lead implantation, n=65; percutaneous coronary intervention, n=22; other, n=34), whereas 30% followed cardiac or thoracic surgery. Pericardial fluid volume drained was 546±440 mL. In 94% of cases, echo-guided pericardiocentesis was the only treatment of the effusion needed, whereas definitive surgery was required in 25 (6%) cases for persistent bleeding or acute management of the underlying etiology. There was no procedural mortality. Late mortality was better for hemorrhagic effusions compared with a contemporary cohort with nonhemorrhagic effusions. CONCLUSION Echocardiographic guidance allows rapid successful pericardiocentesis in the setting of hemopericardium related to microperforation with interventional procedures, malignancy, or pericarditis, with most not requiring surgical intervention. Surgery should remain the first-line approach for aortic dissection or myocardial rupture.
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Affiliation(s)
- Annop Lekhakul
- Department of Cardiovascular Diseases, Mayo Clinic, Rochester, MN
| | - Eric R Fenstad
- Department of Cardiovascular Diseases, Mayo Clinic, Rochester, MN
| | | | - Sorin V Pislaru
- Department of Cardiovascular Diseases, Mayo Clinic, Rochester, MN
| | - Assefa M Ayalew
- Department of Cardiovascular Diseases, Mayo Clinic, Rochester, MN
| | - Joseph F Maalouf
- Department of Cardiovascular Diseases, Mayo Clinic, Rochester, MN
| | - Vuyisile T Nkomo
- Department of Cardiovascular Diseases, Mayo Clinic, Rochester, MN
| | - Jeremy Thaden
- Department of Cardiovascular Diseases, Mayo Clinic, Rochester, MN
| | - Jae K Oh
- Department of Cardiovascular Diseases, Mayo Clinic, Rochester, MN
| | - Larry J Sinak
- Department of Cardiovascular Diseases, Mayo Clinic, Rochester, MN
| | - Garvan C Kane
- Department of Cardiovascular Diseases, Mayo Clinic, Rochester, MN.
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Miranda WR, Newman DB, Sinak LJ, Espinosa RE, Anavekar NS, Goel K, Oh JK. Pre- and post-pericardiocentesis echo-Doppler features of effusive-constrictive pericarditis compared with cardiac tamponade and constrictive pericarditis. Eur Heart J Cardiovasc Imaging 2018; 20:298-306. [DOI: 10.1093/ehjci/jey081] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/19/2018] [Revised: 05/07/2018] [Accepted: 06/03/2018] [Indexed: 11/12/2022] Open
Affiliation(s)
- William R Miranda
- Department of Cardiovascular Medicine, Mayo Clinic, 200 First St SW, Rochester, MN, USA
| | - Darrell B Newman
- Department of Cardiovascular Medicine, Mayo Clinic, 200 First St SW, Rochester, MN, USA
| | - Lawrence J Sinak
- Department of Cardiovascular Medicine, Mayo Clinic, 200 First St SW, Rochester, MN, USA
| | - Raul E Espinosa
- Department of Cardiovascular Medicine, Mayo Clinic, 200 First St SW, Rochester, MN, USA
| | - Nandan S Anavekar
- Department of Cardiovascular Medicine, Mayo Clinic, 200 First St SW, Rochester, MN, USA
| | - Kashish Goel
- Department of Cardiovascular Medicine, Mayo Clinic, 200 First St SW, Rochester, MN, USA
| | - Jae K Oh
- Department of Cardiovascular Medicine, Mayo Clinic, 200 First St SW, Rochester, MN, USA
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Klein AL, Cremer PC. Ephemeral Effusive Constrictive Pathophysiology. JACC Cardiovasc Imaging 2018; 11:542-545. [DOI: 10.1016/j.jcmg.2017.10.028] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/30/2017] [Revised: 10/09/2017] [Accepted: 10/12/2017] [Indexed: 12/31/2022]
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Xu B, Harb SC, Klein AL. Utility of multimodality cardiac imaging in disorders of the pericardium. Echo Res Pract 2018; 5:ERP-18-0019. [PMID: 29588309 PMCID: PMC5911773 DOI: 10.1530/erp-18-0019] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/19/2018] [Accepted: 03/27/2018] [Indexed: 12/11/2022] Open
Abstract
Disorders of the pericardium represent a diverse range of conditions that traditionally may not have received the same level of attention by cardiologists and physicians, owing partly to a lack of research into advanced diagnostic modalities, and limited, evidence-based treatment options. In recent years, there has been a timely resurgence of interest in pericardial diseases, in particular pericarditis. This is attributable to advances in multi-modality cardiovascular imaging, in particular cardiac magnetic resonance (CMR), which may help guide treatment decisions for patients with pericardial syndromes. Additionally, increased research and understanding of the pathophysiological basis of pericarditis have shed light on the role of inflammation in pericarditis. This knowledge may help identify potential specific treatment targets. This article aims to provide a practical review of the role of multimodality cardiovascular imaging (echocardiography, multidetector cardiac computed tomography (MDCT), CMR) in pericardial conditions, focusing on the strengths and potential limitations of each imaging modality.
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Affiliation(s)
- Bo Xu
- Xu B, Section of Cardiovascular Imaging, Center for the Diagnosis and Treatment of Pericardial Diseases, Heart and Vascular Institute, Cleveland Clinic, Cleveland, OH, USA
- Harb S C, Section of Cardiovascular Imaging, Center for the Diagnosis and Treatment of Pericardial Diseases, Heart and Vascular Institute, Cleveland Clinic, Cleveland, OH, USA
- Klein A L, Section of Cardiovascular Imaging, Center for the Diagnosis and Treatment of Pericardial Diseases, Heart and Vascular Institute, Cleveland Clinic, Cleveland, OH, USA
| | - Serge C Harb
- Xu B, Section of Cardiovascular Imaging, Center for the Diagnosis and Treatment of Pericardial Diseases, Heart and Vascular Institute, Cleveland Clinic, Cleveland, OH, USA
- Harb S C, Section of Cardiovascular Imaging, Center for the Diagnosis and Treatment of Pericardial Diseases, Heart and Vascular Institute, Cleveland Clinic, Cleveland, OH, USA
- Klein A L, Section of Cardiovascular Imaging, Center for the Diagnosis and Treatment of Pericardial Diseases, Heart and Vascular Institute, Cleveland Clinic, Cleveland, OH, USA
| | - Allan L Klein
- Xu B, Section of Cardiovascular Imaging, Center for the Diagnosis and Treatment of Pericardial Diseases, Heart and Vascular Institute, Cleveland Clinic, Cleveland, OH, USA
- Harb S C, Section of Cardiovascular Imaging, Center for the Diagnosis and Treatment of Pericardial Diseases, Heart and Vascular Institute, Cleveland Clinic, Cleveland, OH, USA
- Klein A L, Section of Cardiovascular Imaging, Center for the Diagnosis and Treatment of Pericardial Diseases, Heart and Vascular Institute, Cleveland Clinic, Cleveland, OH, USA
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