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Naicker K, Dalvie S, Said-Hartley Q, Ntsekhe M. Concurrent tuberculous pericarditis and lung adenocarcinoma presenting with cardiac tamponade. SOUTH AFRICAN JOURNAL OF ONCOLOGY 2023. [DOI: 10.4102/sajo.v7i0.255] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023] Open
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Del Portillo-Navarrete JH, Pizano A, Benavides J, Palacio AM, Moreno-Medina K, Cabrales J, Echeverri D. Unveiling the causes of pericardial effusion in a contemporary case series of pericardiocentesis in Latin America. Sci Rep 2022; 12:16010. [PMID: 36163473 PMCID: PMC9512803 DOI: 10.1038/s41598-022-19339-6] [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: 09/19/2021] [Accepted: 08/29/2022] [Indexed: 12/01/2022] Open
Abstract
Pericardial effusions requiring pericardiocentesis have multiple causes that vary among geographical regions and health contexts. This procedure can be performed for diagnostic or therapeutic indications. The purpose of this study was to identify the principal causes of pericardial effusions and indications for pericardiocentesis, exploring differences among groups. This was a retrospective case series of patients who underwent pericardiocentesis for pericardial effusion in a single center in Latin America. Demographic, clinical, echocardiographic, and procedural variables were recorded and analyzed. The primary outcome was to determine the causes of pericardial effusions in these patients and the indication (diagnostic, therapeutic, or both). The results are presented in two groups (inflammatory and noninflammatory) according to the cause of the pericardial effusion. One hundred sixteen patients with pericardial effusion underwent pericardiocentesis. The median age was 58 years (IQR 46.2–70.7), and 50% were male. In the noninflammatory pericardial effusion group, there were 61 cases (53%), among which neoplastic pericardial effusion was the most frequent cause (n = 25, 40.9%). In the inflammatory group, there were 55 cases (47%), and the main cause was postpericardiectomy syndrome after cardiac surgery (n = 31, 56.4%). The principal indication for pericardiocentesis was therapeutic (n = 66, 56.8%). Large pericardial effusion without hemodynamic effect of cardiac tamponade was significantly more frequent in the inflammatory group (p = 0.03). In conclusion, the principal cause of pericardial effusion in patients who underwent pericardiocentesis was postpericardiectomy syndrome after cardiac surgery, followed by neoplastic pericardial effusion. Pericardiocentesis is mainly a therapeutic procedure.
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Affiliation(s)
- Juan Hernando Del Portillo-Navarrete
- Department of Interventional Cardiology, Fundación Cardioinfantil-Instituto de Cardiología, Calle 163A # 13B-60, 110131, Bogotá, Colombia. .,School of Medicine, Universidad el Bosque, Bogotá, Colombia. .,School of Medicine, Universidad del Rosario, Bogotá, Colombia.
| | - Alejandro Pizano
- Department of Interventional Cardiology, Fundación Cardioinfantil-Instituto de Cardiología, Calle 163A # 13B-60, 110131, Bogotá, Colombia
| | | | | | - Karen Moreno-Medina
- Research Department, Fundación Cardioinfantil-Instituto de Cardiología, Bogotá, Colombia
| | - Jaime Cabrales
- Department of Interventional Cardiology, Fundación Cardioinfantil-Instituto de Cardiología, Calle 163A # 13B-60, 110131, Bogotá, Colombia.,School of Medicine, Universidad el Bosque, Bogotá, Colombia.,School of Medicine, Universidad del Rosario, Bogotá, Colombia
| | - Darío Echeverri
- Department of Interventional Cardiology, Fundación Cardioinfantil-Instituto de Cardiología, Calle 163A # 13B-60, 110131, Bogotá, Colombia.,School of Medicine, Universidad el Bosque, Bogotá, Colombia.,School of Medicine, Universidad del Rosario, Bogotá, Colombia
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Cytopathology of pericardial effusions. Herz 2017; 43:543-547. [DOI: 10.1007/s00059-017-4596-8] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/21/2017] [Revised: 06/15/2017] [Accepted: 06/17/2017] [Indexed: 11/27/2022]
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Imazio M, Gaido L, Battaglia A, Gaita F. Contemporary management of pericardial effusion: practical aspects for clinical practice. Postgrad Med 2017; 129:178-186. [PMID: 28135875 DOI: 10.1080/00325481.2017.1285676] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
A pericardial effusion (PE) is a relatively common finding in clinical practice. It may be either isolated or associated with pericarditis with or without an underlying disease. The aetiology is varied and may be either infectious (especially tuberculosis as the most common cause in developing countries) or non-infectious (cancer, systemic inflammatory diseases). The management is essentially guided by the hemodynamic effect (presence or absence of cardiac tamponade), the presence of concomitant pericarditis or underlying disease, and its size and duration. The present paper reviews the current knowledge on the aetiology, classification, diagnosis, management, therapy, and prognosis of PE in clinical practice.
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Affiliation(s)
- Massimo Imazio
- a Department of Medical Sciences , University Cardiology, AOU Città della Salute e della Scienza di Torino, and University of Torino , Torino , Italy
| | - Luca Gaido
- a Department of Medical Sciences , University Cardiology, AOU Città della Salute e della Scienza di Torino, and University of Torino , Torino , Italy
| | - Alberto Battaglia
- a Department of Medical Sciences , University Cardiology, AOU Città della Salute e della Scienza di Torino, and University of Torino , Torino , Italy
| | - Fiorenzo Gaita
- a Department of Medical Sciences , University Cardiology, AOU Città della Salute e della Scienza di Torino, and University of Torino , Torino , Italy
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Surgical Management of Massive Pericardial Effusion and Predictors for Development of Constrictive Pericarditis in a Resource Limited Setting. Adv Med 2016; 2016:8917954. [PMID: 27517082 PMCID: PMC4969508 DOI: 10.1155/2016/8917954] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/22/2016] [Accepted: 06/28/2016] [Indexed: 12/04/2022] Open
Abstract
Background. The diagnosis and treatment of massive pericardial effusion and cardiac tamponade have evolved over the years with a tendency towards a more comprehensive diagnostic workup and less traumatic intervention. Method. We reviewed and analysed the data of 32 consecutive patients who underwent surgery on account of massive pericardial effusion and cardiac tamponade in a semiurban university hospital in Nigeria from February 2010 to February 2016. Results. The majority of patients (34.4%) were between 31 and 40 years. Fourteen patients (43.8%) presented with clinical and echocardiographic feature of cardiac tamponade. The majority of patients (59.4%) presented with haemorrhagic pericardial effusion and the average volume of fluid drained intraoperatively was 846 mL ± 67 mL. Pericardium was thickened in 50% of cases. Subxiphoid pericardiostomy was performed under local anaesthesia in 28 cases. No postoperative recurrence was observed; however 5 patients developed features of constrictive pericarditis. The relationship between pericardial thickness and development of pericardial constriction was statistically significant (p = 0.004). Conclusion. Subxiphoid pericardiostomy is a very effective way of treating massive pericardial effusion. Removing tube after adequate drainage (50 mL/day) and treatment of primary pathology are key to preventing recurrence. There is also a need to follow up patients to detect pericardial constriction especially those with thickened pericardium.
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Imazio M, Lazaros G, Picardi E, Vasileiou P, Orlando F, Carraro M, Tsiachris D, Vlachopoulos C, Georgiopoulos G, Tousoulis D, Belli R, Gaita F. Incidence and prognostic significance of new onset atrial fibrillation/flutter in acute pericarditis. Heart 2015; 101:1463-7. [PMID: 25926597 DOI: 10.1136/heartjnl-2014-307398] [Citation(s) in RCA: 39] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/22/2014] [Accepted: 03/29/2015] [Indexed: 12/14/2022] Open
Abstract
OBJECTIVE Data on the incidence of new onset atrial fibrillation and flutter (AF/f) in patients with acute pericarditis are limited. We sought to determine the incidence and prognostic significance of AF/f in this setting. METHODS Between January 2006 and June 2014, consecutive new cases of acute pericarditis were included in two urban referral centres for pericardial diseases. All new cases of AF/f defined as episodes lasting ≥30 s were recorded. Events considered during follow-up consisted of AF/f and pericarditis recurrence, cardiac tamponade, pericardial constriction and death. RESULTS 822 consecutive new cases of acute pericarditis (mean age 53±15 years, 444 men) were analysed. AF/f was detected in 35 patients (4.3%, mean age 66.5±11.3 years, 18 men). Patients with AF/f were significantly older (p=0.017) and presented more frequently with pericardial effusion (p<0.001). Arrhythmias developed within 24 h of pericarditis onset in 91.4% of cases, lasted >24 h in 25.7% and spontaneously converted in 74.3% of patients. Underlying structural heart disease was present in 17% of AF/f cases. In a 30-month follow-up, patients with history of AF/f at the initial episode had a higher rate of arrhythmia occurrence (34.3% vs 0.9%, p<0.001), mostly (75%) within 3 months. No other differences were detected in additional clinical events including haemorrhagic complications in patients receiving oral anticoagulation. CONCLUSIONS The occurrence of AF/f in acute pericarditis identifies a predisposed population to AF/f with a high recurrence risk (about 35%): in these patients, pericarditis may act as an arrhythmic trigger and oral anticoagulation should be seriously considered according to guidelines.
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Affiliation(s)
- Massimo Imazio
- Cardiology Department, Maria Vittoria Hospital, and Department of Public Health and Pediatrics, University of Torino, Torino, Italy
| | - George Lazaros
- 1st Department of Cardiology, University of Athens Medical School, Hippokration General Hospital, Athens, Greece
| | - Elisa Picardi
- University Division of Cardiology, Department of Medical Sciences, Città della Salute e della Scienza, University of Torino, Torino, Italy
| | - Panagiotis Vasileiou
- 1st Department of Cardiology, University of Athens Medical School, Hippokration General Hospital, Athens, Greece
| | - Fabrizio Orlando
- Cardiology Department, Maria Vittoria Hospital, and Department of Public Health and Pediatrics, University of Torino, Torino, Italy
| | - Mara Carraro
- Cardiology Department, Maria Vittoria Hospital, and Department of Public Health and Pediatrics, University of Torino, Torino, Italy
| | - Dimitris Tsiachris
- 1st Department of Cardiology, University of Athens Medical School, Hippokration General Hospital, Athens, Greece
| | - Charalambos Vlachopoulos
- 1st Department of Cardiology, University of Athens Medical School, Hippokration General Hospital, Athens, Greece
| | - George Georgiopoulos
- 1st Department of Cardiology, University of Athens Medical School, Hippokration General Hospital, Athens, Greece
| | - Dimitrios Tousoulis
- 1st Department of Cardiology, University of Athens Medical School, Hippokration General Hospital, Athens, Greece
| | - Riccardo Belli
- Cardiology Department, Maria Vittoria Hospital, and Department of Public Health and Pediatrics, University of Torino, Torino, Italy
| | - Fiorenzo Gaita
- University Division of Cardiology, Department of Medical Sciences, Città della Salute e della Scienza, University of Torino, Torino, Italy
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Abstract
Pericardial effusion is a common finding in clinical practice either as incidental finding or manifestation of a systemic or cardiac disease. The spectrum of pericardial effusions ranges from mild asymptomatic effusions to cardiac tamponade. The aetiology is varied (infectious, neoplastic, autoimmune, metabolic, and drug-related), being tuberculosis the leading cause of pericardial effusions in developing countries and all over the world, while concurrent HIV infection may have an important promoting role in this setting. Management is guided by the haemodynamic impact, size, presence of inflammation (i.e. pericarditis), associated medical conditions, and the aetiology whenever possible. Pericardiocentesis is mandatory for cardiac tamponade and when a bacterial or neoplastic aetiology is suspected. Pericardial biopsy is generally reserved for cases with recurrent cardiac tamponade or persistence without a defined aetiology, especially when a bacterial or neoplastic aetiology is suspected and cannot be assessed by other conventional and less invasive means. A true isolated effusion may not require a specific treatment if the patient is asymptomatic, but large ones are at risk of progression to cardiac tamponade (up to one third). Pericardiocentesis alone may be curative for large effusions, but recurrences are also common and pericardiectomy or less invasive options (i.e. pericardial window) should be considered with recurrent cardiac tamponade or symptomatic pericardial effusion (either circumferential or loculated). The aim of this paper was to summarize and critically evaluate current knowledge on the management of pericardial effusion.
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Affiliation(s)
- Massimo Imazio
- Department Cardiology, Maria Vittoria Hospital, Via Luigi Cibrario 72, Torino 10141, Italy.
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Abstract
The risk of developing pericarditis is similar in men and women. However, systemic autoimmune diseases are more common in women and may determine an increased risk of recurrences and complications. Specific management issues for women with pericarditis include pregnancy and lactation. Relatively few data have been published on pericardial involvement during pregnancy, and major concerns of clinicians are related to management issues, especially medical treatment. Nowadays, the general outcomes of these pregnancies can be similar to that expected in the general population when carefully followed by dedicated multidisciplinary teams. The aim of this article is to review the management of pericarditis with a focus on gender-specific issues.
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