1
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Hamid N, Aman E, Bae R, Scherer M, Smith TWR, Schwartz J, Rinaldi M, Singh G, Sorajja P. 3D Navigation and Intraprocedural Intracardiac Echocardiography Imaging for Tricuspid Transcatheter Edge-to-Edge Repair. JACC Cardiovasc Imaging 2024; 17:441-447. [PMID: 38569794 DOI: 10.1016/j.jcmg.2024.02.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/12/2023] [Revised: 02/01/2024] [Accepted: 02/02/2024] [Indexed: 04/05/2024]
Affiliation(s)
- Nadira Hamid
- Minneapolis Heart Institute, Minneapolis, Minnesota, USA.
| | - Edris Aman
- University of California Davis Medical Center, Sacramento, California, USA
| | - Richard Bae
- Minneapolis Heart Institute, Minneapolis, Minnesota, USA
| | - Markus Scherer
- Carolinas Medical Center, Charlotte, North Carolina, USA
| | - Thomas W R Smith
- University of California Davis Medical Center, Sacramento, California, USA
| | | | | | - Gagan Singh
- University of California Davis Medical Center, Sacramento, California, USA
| | - Paul Sorajja
- Minneapolis Heart Institute, Minneapolis, Minnesota, USA
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2
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Chaus A, Uretsky BF. Treating cardiac tamponade due to malignant effusion with percutaneous balloon pericardiotomy: Back to the future. Catheter Cardiovasc Interv 2024; 103:682-683. [PMID: 38374786 DOI: 10.1002/ccd.30979] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/05/2024] [Accepted: 02/06/2024] [Indexed: 02/21/2024]
Abstract
Key points
Percutaneous balloon pericardiotomy (PBP) involves creation of large hole in the pericardium with balloon inflation to avoid the need for a surgical “window” for treatment of malignant pericardial effusion.
The procedure can be safely performed effectively with low complication rate and it can be repeated for recurrent pericardial effusion.
The recurrence rate of pericardial effusion was 24.5% with a mean survival of 5.8 months. The subgroup surviving at least 1 month, likely had a longer median survival than the overall group, suggesting its value in a subgroup of patients.
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Affiliation(s)
- Adib Chaus
- Advocate Lutheran General Hospital, Park Ridge, Illinois, USA
| | - Barry F Uretsky
- Central Arkansas Veterans Health System, Little Rock, Arkansas, USA
- Cardiovascular Medicine, University of Arkansas for Medical Sciences, Little Rock, Arkansas, USA
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3
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Ren Y. The clinical value of P-wave terminal force in lead V1 in evaluating pericardial thickness in tuberculous constrictive pericarditis. J Cardiothorac Surg 2024; 19:89. [PMID: 38347560 PMCID: PMC10863288 DOI: 10.1186/s13019-024-02526-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/03/2023] [Accepted: 01/28/2024] [Indexed: 02/15/2024] Open
Abstract
AIM To investigate the relationship between p wave terminal force (Ptfv1) and pericardial thickness in patients with tuberculous constrictive pericarditis. METHODS From January 2018 to October 2022, 95 patients with tuberculous constrictive pericarditis who needed pericarditis dissection in a hospital were collected, and 3 patients who did not meet the criteria were excluded, a total of 92 cases. The absolute value of Ptfv1 in conventional electrocardiogram was tested before surgery, and pericardial thickness was measured by echocardiography and chest CT. Pericardial thickness was measured after pericardial dissection. Pearson correlation analysis was used, R software was used to make scatter plot, and non-parametric square test was used. The correlation of postoperative measurements with echocardiography, chest CT and absolute value of Ptfv1 was analyzed. RESULTS Pearson correlation analysis was conducted with postoperative measurements and echocardiography measurements, postoperative measurements and chest CT measurements, and postoperative measurements and absolute value of Ptfv1. Pearson correlation analysis showed that the correlation coefficients between postoperative measurements and echocardiography, chest CT and Ptfv1 values were statistically significant. Scatter plot and nonparametric Chi-square test showed that postoperative measurements were consistent with absolute values of echocardiography, chest CT and Ptfv1 (p < 0.05). And this study found that the distribution of the value of Ptfv1 ≥ 5 was higher than the value of Ptfv1 < 5 after pericardiectomy (0.95:0.05) in the absolute value of Ptfv1 ≥ 0.04 which measured before pericardiectomy. The hypothesis was statistically significant (p < 0.05). CONCLUSION The absolute value of Ptfv1 in electrocardiogram can be used as an auxiliary diagnostic index to evaluate pericardial thickness in tuberculous constrictive pericarditis.
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Affiliation(s)
- Yanhong Ren
- Affiliated Hangzhou Chest Hospital, Zhejiang University School of Medicine, Hangzhou, China.
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4
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Perez NL, Steenberghe MV, Seebach JD, Meyer P, Lobrinus JA, Huber C, Cikirikcioglu M. Pericardiectomy and Mechanical Mitro-Aortic Valve Replacement in a Young Patient With Erdheim-Chester Disease. Tex Heart Inst J 2024; 51:238201. [PMID: 38321789 DOI: 10.14503/thij-23-8201] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/08/2024]
Abstract
Erdheim-Chester disease is a rare histiocytosis that primarily affects the skeletal system, but cardiovascular manifestations occur in 75% of cases and are associated with a poor prognosis. Given the small number of cases, the evolution and management of the disease are uncertain. Therefore, it is important to report and share Erdheim-Chester cases. This report presents the case of a young patient with constrictive pericarditis and mitral valve regurgitation resulting from Erdheim-Chester disease.
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Affiliation(s)
- Nerea Lopez Perez
- Division of Cardiovascular Surgery, Department of Surgery, University Hospital of Geneva, Geneva, Switzerland
| | - Mathieu van Steenberghe
- Division of Cardiovascular Surgery, Department of Surgery, University Hospital of Geneva, Geneva, Switzerland
| | - Jörg D Seebach
- Division of Immunology and Allergy, Department of Medicine, University Hospitals of Geneva, Geneva, Switzerland
| | - Philippe Meyer
- Division of Cardiology, University Hospital of Geneva, Geneva, Switzerland
| | | | - Christoph Huber
- Division of Cardiovascular Surgery, Department of Surgery, University Hospital of Geneva, Geneva, Switzerland
| | - Mustafa Cikirikcioglu
- Division of Cardiovascular Surgery, Department of Surgery, University Hospital of Geneva, Geneva, Switzerland
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5
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Aoyagi H, Tsujinaga S, Takahashi Y, Naito S, Sato T, Otsuka T, Tamaki Y, Motoi K, Ishizaka S, Chiba Y, Kamiya K, Iwano H, Nagai T, Wakasa S, Anzai T. Multimodal Imaging of Constrictive Pericarditis Induced by Long-term Pergolide Treatment for Parkinson's Disease. Intern Med 2023; 62:3637-3641. [PMID: 37005266 PMCID: PMC10781551 DOI: 10.2169/internalmedicine.1381-22] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/30/2022] [Accepted: 02/12/2023] [Indexed: 04/03/2023] Open
Abstract
We herein report the first case of constrictive pericarditis (CP) induced by long-term pergolide treatment for Parkinson's disease that was assessed using multimodal imaging in a 72-year-old patient with leg edema and dyspnea. The patient was correctly diagnosed with CP using multimodal imaging and successfully treated with pericardiectomy. The treatment history of Parkinson's disease and pathological findings of the removed pericardium suggested that long-term pergolide was the cause of CP. Properly recognizing pergolide as the cause of CP and accurately diagnosing CP using multimodal imaging may contribute to the early detection and treatment of pergolide-induced CP.
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Affiliation(s)
- Hiroyuki Aoyagi
- Department of Cardiovascular Medicine, Faculty of Medicine and Graduate School of Medicine, Hokkaido University, Japan
| | - Shingo Tsujinaga
- Department of Cardiovascular Medicine, Faculty of Medicine and Graduate School of Medicine, Hokkaido University, Japan
- Department of Cardiology, Hokkaido Ohno Memorial Hospital, Japan
| | - Yuki Takahashi
- Department of Cardiovascular Medicine, Faculty of Medicine and Graduate School of Medicine, Hokkaido University, Japan
| | - Seiichiro Naito
- Department of Cardiovascular Medicine, Faculty of Medicine and Graduate School of Medicine, Hokkaido University, Japan
| | - Takuma Sato
- Department of Cardiovascular Medicine, Faculty of Medicine and Graduate School of Medicine, Hokkaido University, Japan
| | - Takuya Otsuka
- Department of Surgical Pathology, Hokkaido University Hospital, Japan
| | - Yoji Tamaki
- Department of Cardiovascular Medicine, Faculty of Medicine and Graduate School of Medicine, Hokkaido University, Japan
| | - Ko Motoi
- Department of Cardiovascular Medicine, Faculty of Medicine and Graduate School of Medicine, Hokkaido University, Japan
| | - Suguru Ishizaka
- Department of Cardiovascular Medicine, Faculty of Medicine and Graduate School of Medicine, Hokkaido University, Japan
| | - Yasuyuki Chiba
- Department of Cardiovascular Medicine, Faculty of Medicine and Graduate School of Medicine, Hokkaido University, Japan
| | - Kiwamu Kamiya
- Department of Cardiovascular Medicine, Faculty of Medicine and Graduate School of Medicine, Hokkaido University, Japan
| | - Hiroyuki Iwano
- Department of Cardiovascular Medicine, Faculty of Medicine and Graduate School of Medicine, Hokkaido University, Japan
- Department of Cardiovascular Medicine, Teine Keijinkai Hospital, Japan
| | - Toshiyuki Nagai
- Department of Cardiovascular Medicine, Faculty of Medicine and Graduate School of Medicine, Hokkaido University, Japan
| | - Satoru Wakasa
- Department of Cardiovascular and Thoracic Surgery, Faculty of Medicine and Graduate School of Medicine, Hokkaido University, Japan
| | - Toshihisa Anzai
- Department of Cardiovascular Medicine, Faculty of Medicine and Graduate School of Medicine, Hokkaido University, Japan
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6
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Haddad RN, Alawadhi Z, Al Soufi M, Kasem M. Improvised bespoke technique for atrial septostomy in the shortage of atrioseptostomy balloon catheters. Cardiol Young 2023; 33:2654-2656. [PMID: 37622316 DOI: 10.1017/s1047951123003049] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 08/26/2023]
Abstract
Atrioseptostomy balloon catheter is an essential item to have on our shelves. However, the recall and shortage in production of the commonly used balloon atrioseptostomy catheters posed an imminent threat to our patients. Herein, we present the case of a newborn with a post-natal diagnosis of simple transposition of great arteries and restrictive atrial communication where repeated static balloon atrial septostomy using a 9 mm x 20 mm Sterling balloon failed to improve his status. We had to improvise per-operatively a new bespoke technique to perform a vital pull-through balloon atrial septostomy. The distal third of a 10 mm x 20 mm semi-compliant Cristal balloon was exteriorised out the tip of a 6-Fr 55 cm Cook Flexor sheath in the left atrium, and both were simultaneously pulled back to the right atrium to create an 8 mm septal defect. The procedure was successful without any complications. The baby was weaned off prostaglandin on day 3 and surgically repaired on day 5 with excellent results.
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Affiliation(s)
- Raymond N Haddad
- M3C-Necker, Hôpital Universitaire Necker-Enfants malades, Assistance Publique-Hôpitaux de Paris (AP-HP), Paris, France
| | - Zainab Alawadhi
- Department of Pediatric Cardiology, Heart Centre of Excellence, Al Jalila Children's Speciality Hospital, Dubai, United Arab Emirates
| | - Mahmoud Al Soufi
- Department of Pediatric Cardiology, Heart Centre of Excellence, Al Jalila Children's Speciality Hospital, Dubai, United Arab Emirates
| | - Mohamed Kasem
- Department of Pediatric Cardiology, Heart Centre of Excellence, Al Jalila Children's Speciality Hospital, Dubai, United Arab Emirates
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7
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Borlaug BA, Schaff HV, Asirvatham SJ, Koepp KE, Mauermann WJ, Rowse PG. Surgical pericardiotomy to treat heart failure with preserved ejection fraction: a first clinical study. Eur Heart J 2023; 44:4719-4721. [PMID: 37740430 PMCID: PMC10659945 DOI: 10.1093/eurheartj/ehad620] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/21/2023] [Revised: 07/19/2023] [Accepted: 09/08/2023] [Indexed: 09/24/2023] Open
Affiliation(s)
- Barry A Borlaug
- Department of Cardiovascular Medicine, Mayo Clinic and Foundation, 200 First Street SW, Rochester, MN 55905, USA
| | - Hartzell V Schaff
- Department of Cardiovascular Surgery, Mayo Clinic, Rochester, MN 55906, USA
| | - Samuel J Asirvatham
- Department of Cardiovascular Medicine, Mayo Clinic and Foundation, 200 First Street SW, Rochester, MN 55905, USA
| | - Katlyn E Koepp
- Department of Cardiovascular Medicine, Mayo Clinic and Foundation, 200 First Street SW, Rochester, MN 55905, USA
| | | | - Phillip G Rowse
- Department of Cardiovascular Surgery, Mayo Clinic, Rochester, MN 55906, USA
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8
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Pajjuru VS, Warren BM, Daoud H, Radaideh Q, Walters RW, Alla VM. Impact of Center Procedural Volume on Mortality and Readmission Rates Following Pericardiectomy in the United States. Am J Cardiol 2023; 205:298-301. [PMID: 37633064 DOI: 10.1016/j.amjcard.2023.08.011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/14/2023] [Revised: 07/29/2023] [Accepted: 08/05/2023] [Indexed: 08/28/2023]
Abstract
Our study aimed to explore the national trends in the rates of perioperative complications, in-hospital mortality, and readmissions after pericardiectomy and the impact of center volume on these outcomes. Using the Nationwide Readmission Database, we identified patients who underwent isolated pericardiectomy from 2010 to 2019. In-hospital mortality and readmission rates were assessed using orthogonal polynomial contrasts, with the linear and nonlinear trends evaluated as needed. Multivariable logistic regression models were constructed to identify the independent predictors of mortality and readmission. All analyses accounted for the Nationwide Readmission Database sampling design and were performed using SAS version 9.4 (SAS Institute Inc. Cary, NC.) with p <0.05 used to indicate statistical significance. A total of 26,169 hospitalizations for pericardiectomy were identified during the study period. The median age was 59 years and 44% were female. In-hospital mortality was 5.2%, and the median length of stay was 7 days. Advanced age, higher co-morbidity index, and lower annual facility pericardiectomy volume were independent predictors of in-hospital mortality. The 30- and 90-day readmission rates after pericardiectomy were 18% and 28%, respectively. Previous cardiac surgery, diagnosis of constrictive pericarditis, and greater co-morbidity score were independent predictors of readmission. In conclusion, isolated pericardiectomy rates have remained mostly constant, with relatively small changes in in-hospital mortality and 30- and 90-day readmission rates over the last decade. Advanced age, lower facility pericardiectomy volume, and higher Elixhauser co-morbidity index are independent predictors of surgical mortality.
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Affiliation(s)
- Venkata S Pajjuru
- Division of Cardiology, Department of Medicine, Creighton University School of Medicine, Omaha, Nebraska.
| | - Blair M Warren
- Division of Cardiology, Department of Medicine, Creighton University School of Medicine, Omaha, Nebraska
| | - Hussein Daoud
- Division of Cardiology, Department of Medicine, Creighton University School of Medicine, Omaha, Nebraska
| | - Qais Radaideh
- Division of Cardiology, Department of Medicine, Creighton University School of Medicine, Omaha, Nebraska
| | - Ryan W Walters
- Department of Clinical Research and Public Health, Creighton University School of Medicine, Omaha, Nebraska
| | - Venkata M Alla
- Division of Cardiology, Department of Medicine, Creighton University School of Medicine, Omaha, Nebraska
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9
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Chen W, Shen Y, Yuan Y, Zheng Q, Zhou Y. Acute cardiac tamponade following thoracoscopic lobectomy: a case report and literatures review. J Cardiothorac Surg 2023; 18:279. [PMID: 37817243 PMCID: PMC10563251 DOI: 10.1186/s13019-023-02374-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/19/2022] [Accepted: 09/29/2023] [Indexed: 10/12/2023] Open
Abstract
Thoracoscopic lobectomy is a common surgical procedure for the treatment of lung cancer. With the continuous development of surgical techniques and medical devices, complications after thoracoscopic lobectomy are less and less, and cardiac tamponade is even rarer. This case is a 62-year-old woman who underwent thoracoscopic left upper lobectomy for a left upper lobe nodule. The patient developed acute cardiac tamponade on postoperative day 2, and symptoms resolved after pericardiocentesis. However, 20 h later, the patient underwent emergency surgery for re-developed acute cardiac tamponade, which was found to be a coronary tear. A review of the literature suggested that cardiac tamponade is more common in left lung surgery than right lung surgery. Pericardiocentesis can resolve initial acute cardiac tamponade, but pericardiotomy may be urgently needed after recurrence.
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Affiliation(s)
- Wei Chen
- Department of Thoracic Surgery, West China School of Public Health and West China Fourth Hospital, Sichuan University, Chengdu, 610044, Sichuan, P.R. China
| | - Yi Shen
- Department of Thoracic Surgery, West China School of Public Health and West China Fourth Hospital, Sichuan University, Chengdu, 610044, Sichuan, P.R. China
| | - Yang Yuan
- Department of Thoracic Surgery, West China School of Public Health and West China Fourth Hospital, Sichuan University, Chengdu, 610044, Sichuan, P.R. China
| | - Qiangqiang Zheng
- Department of Thoracic Surgery, West China School of Public Health and West China Fourth Hospital, Sichuan University, Chengdu, 610044, Sichuan, P.R. China
| | - Yunfeng Zhou
- Department of Thoracic Surgery, West China School of Public Health and West China Fourth Hospital, Sichuan University, Chengdu, 610044, Sichuan, P.R. China.
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10
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Perezgrovas-Olaria R, Chadow D, Lau C, Rahouma M, Soletti GJ, Cancelli G, Harik L, Dimagli A, Rong LQ, Gillinov M, Ad N, DiMaio M, Gelijns AC, Sanna T, Fremes S, Crea F, Girardi L, Gaudino M. Characteristics of Postoperative Atrial Fibrillation and the Effect of Posterior Pericardiotomy. Ann Thorac Surg 2023; 116:615-622. [PMID: 36375495 PMCID: PMC10468100 DOI: 10.1016/j.athoracsur.2022.11.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/06/2022] [Revised: 11/01/2022] [Accepted: 11/05/2022] [Indexed: 11/13/2022]
Abstract
BACKGROUND Postoperative atrial fibrillation (POAF) is a frequent complication of cardiac surgery. However, only a few detailed descriptions of the arrhythmia have been reported. We aim to describe the characteristics, outcomes, and variables associated with POAF and to evaluate how posterior pericardiotomy (PP) affects POAF characteristics. METHODS In this post hoc analysis of the Posterior left pericardiotomy for the prevention of AtriaL fibrillation After Cardiac Surgery (PALACS) trial, we describe POAF characteristics based on continuous in-hospital telemetry data. RESULTS Of 420 patients, 103 (24.5%) developed POAF. Median time to onset was 50.3 hours; 70.9% of events occurred within 3 days. Hemodynamic instability and rapid ventricular response occurred in 8.7% and 51.5% of cases, respectively. Most POAF patients received antiarrhythmics (97.1%), 22.3% electrical cardioversion, and 40.8% systemic anticoagulation. Median POAF duration was 24.0 hours; 70.9% of cases resolved within 36 hours. Median POAF burden was 15.9%. All patients were in sinus rhythm at follow-up. POAF was associated with longer hospitalization (7 vs 6 days; P < .001), but not increased mortality or morbidity. PP reduced POAF incidence (17.7% vs 31.3%; P = .001), especially after postoperative day 2 (time to POAF onset 41.9 vs 57.1 hours; P = .01). Age was associated with POAF. Female sex, coronary artery bypass grafting, beta blockers, and PP were inversely associated. CONCLUSIONS POAF remains frequent after cardiac surgery. Hemodynamic instability is rare, although rapid ventricular response and need for electrical cardioversion are frequent. POAF burden is significant, and the arrhythmias resolve within 30 days. PP reduces POAF especially after postoperative day 2.
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Affiliation(s)
| | - David Chadow
- Department of Cardiothoracic Surgery, Weill Cornell Medicine, New York, New York
| | - Christopher Lau
- Department of Cardiothoracic Surgery, Weill Cornell Medicine, New York, New York
| | - Mohamed Rahouma
- Department of Cardiothoracic Surgery, Weill Cornell Medicine, New York, New York
| | - Giovanni Jr Soletti
- Department of Cardiothoracic Surgery, Weill Cornell Medicine, New York, New York
| | - Gianmarco Cancelli
- Department of Cardiothoracic Surgery, Weill Cornell Medicine, New York, New York
| | - Lamia Harik
- Department of Cardiothoracic Surgery, Weill Cornell Medicine, New York, New York
| | - Arnaldo Dimagli
- Department of Cardiothoracic Surgery, Weill Cornell Medicine, New York, New York
| | - Lisa Q Rong
- Department of Anesthesiology, Weill Cornell Medicine, New York, New York
| | - Marc Gillinov
- Department of Thoracic and Cardiovascular Surgery, Heart and Vascular Institute, Cleveland Clinic, Cleveland, Ohio
| | - Niv Ad
- Division of Cardiothoracic Surgery, University of Maryland School of Medicine, Baltimore, Maryland; Adventist White Oak Medical Center, Silver Spring, Maryland
| | - Michael DiMaio
- Department of Cardiothoracic Surgery, Baylor Scott & White The Heart Hospital, Plano, Texas
| | - Annetine C Gelijns
- Department of Population Health Science and Policy, Icahn School of Medicine at Mount Sinai, New York, New York
| | - Tommaso Sanna
- Department of Cardiovascular Medicine, Fondazione Policlinico Universitario A Gemelli IRCCS, Rome, Italy; Department of Cardiovascular and Pulmonary Sciences, Catholic University of the Sacred Heart, Rome, Italy
| | - Stephen Fremes
- Schulich Heart Centre, Sunnybrook Health Sciences Centre, University of Toronto, Toronto, Canada
| | - Filippo Crea
- Department of Cardiovascular Medicine, Fondazione Policlinico Universitario A Gemelli IRCCS, Rome, Italy; Department of Cardiovascular and Pulmonary Sciences, Catholic University of the Sacred Heart, Rome, Italy
| | - Leonard Girardi
- Department of Cardiothoracic Surgery, Weill Cornell Medicine, New York, New York
| | - Mario Gaudino
- Department of Cardiothoracic Surgery, Weill Cornell Medicine, New York, New York.
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11
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Verma BR, Kumar A, Furqan M, Yesilyaprak A, Agrawal A, Mahalwar G, Majid M, Singh H, Xu B, Klein AL. Post-cardiac injury syndrome after surgical repair of atrial septal defect: Reporting a rare occurrence. Echocardiography 2023; 40:879-883. [PMID: 37392399 DOI: 10.1111/echo.15641] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2023] [Revised: 05/30/2023] [Accepted: 06/14/2023] [Indexed: 07/03/2023] Open
Abstract
A 16-year-old male with past medical history of congenital atrial septal defect surgical repair, presented with recurrent pericarditis secondary to post-cardiotomy injury syndrome (PCIS), After failing medical therapy, he ultimately underwent pericardiectomy for symptom resolution, PCIS is underdiagnosed in children and should be considered in patients with recurrent chest, pain.
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Affiliation(s)
- Beni R Verma
- Center for the Diagnosis and Treatment of Pericardial Diseases, Department of Cardiovascular Medicine, Heart and Vascular Institute, Department of Cardiovascular Medicine, Cleveland Clinic, Cleveland, Ohio, USA
- MetroHealth System, Department of Cardiology, Cleveland, Ohio, USA
| | - Ashwin Kumar
- Center for the Diagnosis and Treatment of Pericardial Diseases, Department of Cardiovascular Medicine, Heart and Vascular Institute, Department of Cardiovascular Medicine, Cleveland Clinic, Cleveland, Ohio, USA
- Department of Internal Medicine, MedStar Georgetown University Hospital, Washington, District of Columbia, USA
| | - Muhammad Furqan
- Center for the Diagnosis and Treatment of Pericardial Diseases, Department of Cardiovascular Medicine, Heart and Vascular Institute, Department of Cardiovascular Medicine, Cleveland Clinic, Cleveland, Ohio, USA
| | - Abdullah Yesilyaprak
- Center for the Diagnosis and Treatment of Pericardial Diseases, Department of Cardiovascular Medicine, Heart and Vascular Institute, Department of Cardiovascular Medicine, Cleveland Clinic, Cleveland, Ohio, USA
- Wayne State University, Department of Internal Medicine, Detroit, Michigan, USA
| | - Ankit Agrawal
- Center for the Diagnosis and Treatment of Pericardial Diseases, Department of Cardiovascular Medicine, Heart and Vascular Institute, Department of Cardiovascular Medicine, Cleveland Clinic, Cleveland, Ohio, USA
| | - Gauranaga Mahalwar
- Center for the Diagnosis and Treatment of Pericardial Diseases, Department of Cardiovascular Medicine, Heart and Vascular Institute, Department of Cardiovascular Medicine, Cleveland Clinic, Cleveland, Ohio, USA
| | - Muhammad Majid
- Center for the Diagnosis and Treatment of Pericardial Diseases, Department of Cardiovascular Medicine, Heart and Vascular Institute, Department of Cardiovascular Medicine, Cleveland Clinic, Cleveland, Ohio, USA
| | - Harjit Singh
- Center for the Diagnosis and Treatment of Pericardial Diseases, Department of Cardiovascular Medicine, Heart and Vascular Institute, Department of Cardiovascular Medicine, Cleveland Clinic, Cleveland, Ohio, USA
| | - Bo Xu
- Center for the Diagnosis and Treatment of Pericardial Diseases, Department of Cardiovascular Medicine, Heart and Vascular Institute, Department of Cardiovascular Medicine, Cleveland Clinic, Cleveland, Ohio, USA
| | - Allan L Klein
- Center for the Diagnosis and Treatment of Pericardial Diseases, Department of Cardiovascular Medicine, Heart and Vascular Institute, Department of Cardiovascular Medicine, Cleveland Clinic, Cleveland, Ohio, USA
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12
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Fremes SE, Soletti GJ, Gaudino M. Posterior pericardiotomy: "omnia cum tempore" (everything in its time). EUROINTERVENTION 2023; 19:e279-e280. [PMID: 37458122 PMCID: PMC10333914 DOI: 10.4244/eij-e-23-00018] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 07/18/2023]
Affiliation(s)
- Stephen E Fremes
- Division of Cardiac Surgery, Schulich Heart Centre, Sunnybrook Health Sciences Centre, University of Toronto, Toronto, ON, Canada
| | - Giovanni Jr Soletti
- Department of Cardiothoracic Surgery, Weill Cornell Medicine, New York, NY, USA
| | - Mario Gaudino
- Department of Cardiothoracic Surgery, Weill Cornell Medicine, New York, NY, USA
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13
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Kirk ME, Merit VT, Moeslund N, Dragsbaek SJ, Hansen JV, Andersen A, Lyhne MD. Impact of sternotomy and pericardiotomy on cardiopulmonary haemodynamics in a large animal model. Exp Physiol 2023; 108:762-771. [PMID: 36892095 PMCID: PMC10988510 DOI: 10.1113/ep090919] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2022] [Accepted: 02/14/2023] [Indexed: 03/10/2023]
Abstract
NEW FINDINGS What is the central question of this study? Invasive cardiovascular instrumentation can occur through closed- or open-chest approaches. To what extent will sternotomy and pericardiotomy affect cardiopulmonary variables? What is the main finding and its importance? Opening of the thorax decreased mean systemic and pulmonary pressures. Left ventricular function improved, but no changes were observed in right ventricular systolic measures. No consensus or recommendation exists regarding instrumentation. Methodological differences risk compromising rigour and reproducibility in preclinical research. ABSTRACT Animal models of cardiovascular disease are often evaluated by invasive instrumentation for phenotyping. As no consensus exists, both open- and closed-chest approaches are used, which might compromise rigour and reproducibility in preclinical research. We aimed to quantify the cardiopulmonary changes induced by sternotomy and pericardiotomy in a large animal model. Seven pigs were anaesthetized, mechanically ventilated and evaluated by right heart catheterization and bi-ventricular pressure-volume loop recordings at baseline and after sternotomy and pericardiotomy. Data were compared by ANOVA or the Friedmann test where appropriate, with post-hoc analyses to control for multiple comparisons. Sternotomy and pericardiotomy caused reductions in mean systemic (-12 ± 11 mmHg, P = 0.027) and pulmonary pressures (-4 ± 3 mmHg, P = 0.006) and airway pressures. Cardiac output decreased non-significantly (-1329 ± 1762 ml/min, P = 0.052). Left ventricular afterload decreased, with an increase in ejection fraction (+9 ± 7%, P = 0.027) and coupling. No changes were observed in right ventricular systolic function or arterial blood gases. In conclusion, open- versus closed-chest approaches to invasive cardiovascular phenotyping cause a systematic difference in key haemodynamic variables. Researchers should adopt the most appropriate approach to ensure rigour and reproducibility in preclinical cardiovascular research.
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Affiliation(s)
- Mathilde Emilie Kirk
- Department of Clinical MedicineAarhus UniversityAarhusDenmark
- Department of CardiologyAarhus University HospitalAarhusDenmark
| | - Victor Tang Merit
- Department of Clinical MedicineAarhus UniversityAarhusDenmark
- Department of CardiologyAarhus University HospitalAarhusDenmark
| | - Niels Moeslund
- Department of Clinical MedicineAarhus UniversityAarhusDenmark
- Department of Cardiac, Lung and Vascular SurgeryAarhus University HospitalAarhusDenmark
| | - Simone Juel Dragsbaek
- Department of Clinical MedicineAarhus UniversityAarhusDenmark
- Department of CardiologyAarhus University HospitalAarhusDenmark
| | - Jacob Valentin Hansen
- Department of Clinical MedicineAarhus UniversityAarhusDenmark
- Department of CardiologyAarhus University HospitalAarhusDenmark
| | - Asger Andersen
- Department of Clinical MedicineAarhus UniversityAarhusDenmark
- Department of CardiologyAarhus University HospitalAarhusDenmark
| | - Mads Dam Lyhne
- Department of Clinical MedicineAarhus UniversityAarhusDenmark
- Department of Anaesthesiology and Intensive CareAarhus University HospitalAarhusDenmark
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Pisani CF, Scanavacca M. Intracardiac Echocardiography Must Be Used in All Patients Who Underwent AF Ablation? Arq Bras Cardiol 2023; 120:e20230290. [PMID: 37341300 PMCID: PMC10263402 DOI: 10.36660/abc.20230290] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/22/2023] Open
Affiliation(s)
- Cristiano F. Pisani
- InCorHCFMUSPSão PauloSPBrasilUnidade Clínica de Arritmia do Instituto do Coração (InCor) do Hospital das Clínicas da FM USP (HC-FMUSP), São Paulo, SP – Brasil
| | - Mauricio Scanavacca
- InCorHCFMUSPSão PauloSPBrasilUnidade Clínica de Arritmia do Instituto do Coração (InCor) do Hospital das Clínicas da FM USP (HC-FMUSP), São Paulo, SP – Brasil
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15
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Kindya B, Lisko J, Inci E, Khatri J, Nicholson W, King S. Left heart catheterization using the single catheter radial approach with the multipurpose catheter: Teaching an old dog new tricks. Clin Cardiol 2022; 45:1123-1127. [PMID: 36445312 PMCID: PMC9707558 DOI: 10.1002/clc.23942] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/23/2022] [Accepted: 10/26/2022] [Indexed: 10/31/2023] Open
Affiliation(s)
- Bryan Kindya
- Department of Medicine, Division of CardiologyEmory University School of MedicineAtlantaGeorgiaUSA
| | - John Lisko
- Department of Medicine, Division of CardiologyEmory University School of MedicineAtlantaGeorgiaUSA
| | - Errol Inci
- Department of Medicine, Division of CardiologyEmory University School of MedicineAtlantaGeorgiaUSA
| | - Jaikirshan Khatri
- Department of Medicine, Division of CardiologyCleveland ClinicClevelandOhioUSA
| | - William Nicholson
- Department of Medicine, Division of CardiologyEmory University School of MedicineAtlantaGeorgiaUSA
| | - Spencer King
- Department of Medicine, Division of CardiologyEmory University School of MedicineAtlantaGeorgiaUSA
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16
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Kikuchi Y, Saijo Y, Narita M, Shibagaki K, Okubo R, Kunioka S, Shirasaka T, Kamiya H. Post-cardiotomy pericardial effusion and postoperative atrial fibrillation risk. Int J Cardiovasc Imaging 2022; 38:1873-1879. [PMID: 37726512 DOI: 10.1007/s10554-022-02560-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/20/2021] [Accepted: 02/07/2022] [Indexed: 11/05/2022]
Abstract
Postoperative atrial fibrillation is a poor prognostic factor associated with increased mortality rates. Patients experiencing significant pericardial effusion develop postoperative atrial fibrillation; however, little is explored about the association between postoperative atrial fibrillation and post-cardiotomy pericardial effusion. This retrospective, single-center study included adult patients who underwent cardiovascular surgery via median sternotomy from January 2016 to December 2019. Patients who underwent routine postoperative computed tomography at 7 ± 3 days after surgery (n = 294) were included. Pericardial effusion was measured at the thickest point. Patients were classified into those with (n = 127) and without (n = 167) postoperative atrial fibrillation. The association of pericardial effusion with other factors was evaluated. A possible confounder-adjusted logistic regression analysis after multiple imputation was performed to obtain odds ratios for postoperative atrial fibrillation using previously published risk factors. Age, intraoperative bleeding volume, and pericardial effusion size were all significantly higher in the group with postoperative atrial fibrillation. Multivariate logistic regression after multiple imputation revealed that age, intraoperative bleeding volume, and postoperative pericardial effusion were significantly associated with postoperative atrial fibrillation. Our findings suggest that post-cardiotomy pericardial effusion is associated with postoperative atrial fibrillation. However, the causality remains unknown, making further studies mandatory.
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Affiliation(s)
- Yuta Kikuchi
- Department of Cardiovascular Surgery, Asahikawa Medical University, 1-1-1 Higashi 2 Jo, Midorigaoka, Asahikawa, Hokkaido, 078-8510, Japan
| | - Yasuaki Saijo
- Department of Public Health and Epidemiology, Department of Social Medicine, Asahikawa Medical University, Asahikawa, Japan
| | - Masahiko Narita
- Department of Cardiovascular Surgery, Asahikawa Medical University, 1-1-1 Higashi 2 Jo, Midorigaoka, Asahikawa, Hokkaido, 078-8510, Japan
| | - Keisuke Shibagaki
- Department of Cardiovascular Surgery, Asahikawa Medical University, 1-1-1 Higashi 2 Jo, Midorigaoka, Asahikawa, Hokkaido, 078-8510, Japan
| | - Ryo Okubo
- Department of Cardiovascular Surgery, Asahikawa Medical University, 1-1-1 Higashi 2 Jo, Midorigaoka, Asahikawa, Hokkaido, 078-8510, Japan
| | - Shingo Kunioka
- Department of Cardiovascular Surgery, Asahikawa Medical University, 1-1-1 Higashi 2 Jo, Midorigaoka, Asahikawa, Hokkaido, 078-8510, Japan
| | - Tomonori Shirasaka
- Department of Cardiovascular Surgery, Asahikawa Medical University, 1-1-1 Higashi 2 Jo, Midorigaoka, Asahikawa, Hokkaido, 078-8510, Japan.
| | - Hiroyuki Kamiya
- Department of Cardiovascular Surgery, Asahikawa Medical University, 1-1-1 Higashi 2 Jo, Midorigaoka, Asahikawa, Hokkaido, 078-8510, Japan
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Iavazzo A, Pinna GB, Romeo MG, Mileo E, Pilato E, Di Tommaso L. A Rare Case of Effusive-Constrictive Pericarditis Caused by Streptococcus agalactiae: Emergency Surgical Treatment. Medicina (B Aires) 2022; 58:medicina58060699. [PMID: 35743962 PMCID: PMC9228528 DOI: 10.3390/medicina58060699] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2022] [Revised: 05/18/2022] [Accepted: 05/19/2022] [Indexed: 11/20/2022] Open
Abstract
A 70-year-old male patient was admitted to the emergency room in cardiac arrest. The patient was resuscitated and then referred to our cardiac surgery department, where he was diagnosed with suspected effusive constrictive pericarditis. A failed trial of TEE-guided pericardiocentesis led to the decision of surgical intervention. Sternotomy was performed and revealed pericardial thickening and very dense adhesions involving the pericardium and both pleurae, suggesting a neoplastic disease. An extensive pericardiectomy and bilateral pleural decortication were performed. After surgery, the patient improved significantly and was discharged from the intensive care unit 24 h later. Pericardial thickening, dense adhesions, the amount and color of pericardial fluid and the aspect of epicardial tissue increased our suspicion of neoplastic disease. Histological samples were sent to be analyzed immediately; a few days later, they were unexpectedly negative for any neoplastic disease but showed a group-B-hemolytic Streptococcus agalactiae infection, which causes pericarditis in extremely rare cases. Postoperatively, the patient, under intravenous antibiotic and anti-inflammatory therapy, remained asymptomatic and was discharged ten days after the surgery. At the three-month follow-up, transthoracic echocardiography showed a normal right and left ventricular function with no pericardial effusion.
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18
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Rusia A, Schott J, Franklin B, Dixon S. Correlation of Peripheral and Central Venous Pressure in Patients Who Underwent Right Heart Catheterization. Am J Cardiol 2022; 167:162-164. [PMID: 35067345 DOI: 10.1016/j.amjcard.2021.12.011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/29/2021] [Accepted: 12/07/2021] [Indexed: 11/18/2022]
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19
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Ryoo J, Huh J, Cho HS, Kim JJ, Kim SC, Lee J. Case report: atrial septostomy as a bridge to lung transplantation in a patient with venovenous extracorporeal membrane oxygenation. Medicine (Baltimore) 2022; 101:e28889. [PMID: 35363206 PMCID: PMC9282069 DOI: 10.1097/md.0000000000028889] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/17/2022] [Accepted: 02/01/2022] [Indexed: 01/04/2023] Open
Abstract
INTRODUCTION Advances in critical care management have led to the recent increase in the use of extracorporeal membrane oxygenation (ECMO) as a bridge to lung transplantation (LT). Patients with respiratory failure requiring venovenous ECMO usually experience progressive right ventricular (RV) failure. Diagnosis and treatment of RV failure during ECMO are essential for improving the prognosis of patients. PATIENT CONCERNS A 28-year-old female patient underwent allogeneic hematopoietic stem cell transplantation (HSCT) from a matched unrelated donor for acute myeloid leukemia presenting with progressive dyspnea. DIAGNOSES Computed tomography revealed multifocal patchy peribronchial and subpleural ground-glass opacities in both lungs, and the patient was clinically diagnosed with cryptogenic organizing pneumonia. INTERVENTIONS AND OUTCOMES Despite intensifying systemic corticosteroid therapy, her symptoms deteriorated, and mechanical ventilation and ECMO were applied. During treatment, her respiratory failure continued to progress, and systemic hypotension developed. An echocardiogram showed evidence of RV failure, and percutaneous atrial septostomy was performed for RV decompression. After a balloon atrial septostomy was performed, RV failure of the patient improved, and LT was successfully performed. LESSONS We report the first case of atrial septostomy as a successful bridge to LT in a HSCT recipient with venovenous ECMO. Atrial septostomy could be an option for management of RV failure during ECMO. Further studies need to be conducted to validate the effect of atrial septostomy in patients with RV failure during ECMO.
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Affiliation(s)
- Jiwon Ryoo
- Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea
| | - Jung Huh
- Department of Internal Medicine, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea
| | - Hee Sun Cho
- Department of Internal Medicine, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea
| | - Jin-Jin Kim
- Division of Cardiology, Department of Internal Medicine, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea
| | - Seok Chan Kim
- Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea
| | - Jongmin Lee
- Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea
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20
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Van der Zande JMJ, Vanhie E, Straver B, Stehmann TA, Van Heerde M, Hol J. [A girl with dyspnea and an enlarged liver]. Ned Tijdschr Geneeskd 2021; 165:D5766. [PMID: 34854607] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/13/2023]
Abstract
BACKGROUND During winter, the influenza and Respiratory Syncytial Virus season, children are often seen in the emergency department with fever and respiratory symptoms. CASE DESCRIPTION We describe the case of a 2-year-old girl with fever, dyspnea and signs of heart failure during physical examination. Echocardiogram showed a large amount of pericardial effusion with signs of cardiac tamponade. Pericardiocentesis showed 200 ml purulent liquid. Surgical drainage was performed. However pericardial effusion recurred. Because constrictive pericarditis was feared, a pericardiectomy was performed after which the patient recovered. Cultures showed Haemophilus influenzae type b and the patient was treated with amoxicillin for 4 weeks in total. CONCLUSION Fever and dyspnea may also be caused by a problem outside the respiratory system. With physical examination a cardiac cause, such as pericarditis, can be detected. An ECG is easily obtained and can help in the differential diagnosis. An echocardiogram can confirm the diagnosis.
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Affiliation(s)
| | - Ellen Vanhie
- Amsterdam UMC, locatie AMC, afd. Kindergeneeskunde
| | - Bart Straver
- Amsterdam UMC, locatie AMC, afd. Kindergeneeskunde
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21
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Iemura J, Yamamoto Y, Kambara A, Fujii K. [Constrictive Pericarditis with Multiple Organ Failure after Coronary Artery Bypass Grafting]. Kyobu Geka 2021; 74:903-907. [PMID: 34601471] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/13/2023]
Abstract
A 67-year-old male patient, who had undergone coronary artery bypass grafting (CABG) 16 years before, developed congestive heart failure 5 years after surgery. Three years later, he developed repeated heart failure, sepsis by methicillin-resistant Staphylococcus aureus (MRSA), renal failure, repeated thrombophlebitis on his right leg and atrial fibrillation. He also suffered from clouding of consciousness and flapping tremor caused by hyperammonemia. The three bypass grafts showed normal flow, but the pericardium was severely thickened. Therefore, pericardiotomy was performed via median sternotomy with additional left thoracotomy without using cardiopulmonary bypass. Although, he developed MRSA mediastinitis after surgery, he recovered after a month of continuous negative pressure wound therapy. His liver function and septic conditions gradually recovered. No recurrence of heart failure has been observed for 8 years since his second surgery.
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Affiliation(s)
- Junzo Iemura
- Department of Cardiovascular Surgery, Okanami General Hospital, Iga, Japan
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22
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Paneer SKM, Christina SR, Adli Azam MR, Balachandran K, Deventhiran P. Complete resolution of constrictive pericarditis after coronary bypass surgery. Med J Malaysia 2021; 76:747-749. [PMID: 34508388] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/13/2023]
Abstract
Classical constrictive pericarditis (CP) is an unusual and rare complication after coronary artery bypass grafting. It can be transient, progressive or fixed form of cardiac constriction. However recently recognized transient variant of constrictive pericarditis can be managed with medical therapy, though other progressive and irreversible forms may require pericardiectomy. We describe a 65-year-old male patient who developed a classical but a very early transient CP, just within two weeks as a result of post cardiac injury syndrome after coronary bypass surgery. The patient had a complete recovery following medical treatment.
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Affiliation(s)
- S K M Paneer
- National Heart Institute, Department of Cardiothoracic Surgery, 50400 Kuala Lumpur, Malaysia.
| | - S R Christina
- National Heart Institute, Department of Cardiothoracic Surgery, 50400 Kuala Lumpur, Malaysia
| | - M R Adli Azam
- National Heart Institute, Department of Cardiothoracic Surgery, 50400 Kuala Lumpur, Malaysia
| | - K Balachandran
- National Heart Institute, Department of Cardiology, 50400 Kuala Lumpur, Malaysia
| | - P Deventhiran
- National Heart Institute, Department of Non-Invasive Cardiac Laboratory, 50400 Kuala Lumpur, Malaysia
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23
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Gandhi K, Reinders JSK, Navsaria PH. Cardiac tamponade following post-pericardiotomy syndrome. S AFR J SURG 2021; 59:130a-130c. [PMID: 34515434] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/13/2023]
Abstract
Subxyphoid pericardial window (SPW) is performed as both a diagnostic and therapeutic intervention in patients presenting with a penetrating cardiac injury (PCI). Post-pericardiotomy syndrome (PPS) with cardiac tamponade has been reported after penetrating cardiac trauma and after transdiaphragmatic pericardial window. We describe the first PPS with acute tamponade, weeks after diagnostic SPW for a PCI.
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Affiliation(s)
- K Gandhi
- Trauma Centre, Department of Surgery, Groote Schuur Hospital, University of Cape Town, South Africa and Surgical Gastroenterology Unit (HPB), Department of Surgery, Faculty of Health Sciences, University of Cape Town, South Africa
| | - J S K Reinders
- Trauma Centre, Department of Surgery, Groote Schuur Hospital, University of Cape Town, South Africa and Trauma Department, Groene Hart Hospital, Gouda, The Netherlands
| | - P H Navsaria
- Trauma Centre, Department of Surgery, Groote Schuur Hospital, University of Cape Town, South Africa
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24
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Gouveia D, Máximo J, Costa N, Moreira S, Abreu A, Pinho P, Casanova J. ECMO POST-CARDIOTOMY, A SINGLE CENTRE EXPERIENCE. Port J Card Thorac Vasc Surg 2021; 28:19-23. [PMID: 33834657] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Received: 04/07/2021] [Indexed: 06/12/2023]
Abstract
OBJECTIVES Our objective was to examine the results of ECMO post cardiotomy in Centro Hospitalar Universitário S. João (CHUSJ). METHODS Between 2011 and 2019, 13 patients were cannulated for refractory cardiogenic shock post-cardiotomy; 8 (61,5%) male and 5 (38,5%) female. Patients under 18 years old were excluded. Data was collected from hospital archives concerning preoperative comorbidities, open-heart surgery procedure, dates of ECMO cannulation and decannulation, postoperative complications, hospital mortality and cause of death. Follow-up was obtained by review of the last outpatient observation. The outcomes investigated were hospital mortality and survival at 12, 36 and 60 months. RESULTS After a median ECMO-VA therapy of 6 days (1-16 days), 7 (53,8%) patients were successfully decannulated; from these 2 succumbed from stroke and septic shock, one is still in intermediate care convalescing steadily and 4 were discharged. Overall 8 (61,5%) patients died. 5 (38,5%) survived, 4 were discharged home and 1 is still in intermediate care. Survival (after discharge) at 12, 36 and 60 months was respectively 25%, 16,7% and 8,3%. Regarding postoperative complications, reoperation for bleeding was necessary in 5 (38.5%), stroke was diagnosed in 2 (15,4%), dialysis in 6 (46,2%), leg ischemia affected 5 (38,5%) and mediastinitis occurred in 1 (7,7%). CONCLUSIONS VA ECMO saves a life in each three patients suffering from refractory cardiogenic shock after cardiac surgery. Despite risks associated with advanced cardiopulmonary support, survivors maintain good health condition.
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Affiliation(s)
- Daniela Gouveia
- Cardiothoracic Surgery Department - Centro Hospitalar Universitário de São João, Portugal
| | - José Máximo
- Cardiothoracic Surgery Department - Centro Hospitalar Universitário de São João, Portugal
| | - Nuno Costa
- Cardiothoracic Surgery Department - Centro Hospitalar Universitário de São João, Portugal
| | - Soraia Moreira
- Cardiothoracic Surgery Department - Centro Hospitalar Universitário de São João, Portugal
| | - Armando Abreu
- Cardiothoracic Surgery Department - Centro Hospitalar Universitário de São João, Portugal
| | - Paulo Pinho
- Cardiothoracic Surgery Department - Centro Hospitalar Universitário de São João, Portugal
| | - Jorge Casanova
- Cardiothoracic Surgery Department - Centro Hospitalar Universitário de São João, Portugal
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25
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Carvalho Guerra N. Post-cardiotomy ECMO: time for hope or time for despair? Port J Card Thorac Vasc Surg 2021; 28:13-14. [PMID: 33834660] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Subscribe] [Scholar Register] [Received: 04/07/2021] [Indexed: 06/12/2023]
Affiliation(s)
- Nuno Carvalho Guerra
- Cardiothoracic Surgery Department, Hospital de Santa Maria, Centro Hospitalar Universitário Lisboa Norte, Portugal
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26
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Lorusso R, Whitman G, Milojevic M, Raffa G, McMullan DM, Boeken U, Haft J, Bermudez C, Shah A, D'Alessandro DA. 2020 EACTS/ELSO/STS/AATS expert consensus on post-cardiotomy extracorporeal life support in adult patients. J Thorac Cardiovasc Surg 2021; 161:1287-1331. [PMID: 33039139 DOI: 10.1016/j.jtcvs.2020.09.045] [Citation(s) in RCA: 17] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/16/2019] [Revised: 04/03/2020] [Accepted: 04/21/2020] [Indexed: 12/26/2022]
Abstract
Post-cardiotomy extracorporeal life support (PC-ECLS) in adult patients has been used only rarely but recent data have shown a remarkable increase in its use, almost certainly due to improved technology, ease of management, growing familiarity with its capability and decreased costs. Trends in worldwide in-hospital survival, however, rather than improving, have shown a decline in some experiences, likely due to increased use in more complex, critically ill patients rather than to suboptimal management. Nevertheless, PC-ECLS is proving to be a valuable resource for temporary cardiocirculatory and respiratory support in patients who would otherwise most likely die. Because a comprehensive review of PC-ECLS might be of use for the practitioner, and possibly improve patient management in this setting, the authors have attempted to create a concise, comprehensive and relevant analysis of all aspects related to PC-ECLS, with a particular emphasis on indications, technique, management, and avoidance of complications, appraisal of new approaches and ethics, education, and training.
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Affiliation(s)
- Roberto Lorusso
- Department of Cardio-Thoracic Surgery, Heart & Vascular Centre, Maastricht University Medical Centre, Cardiovascular Research Institute Maastricht, Maastricht, The Netherlands.
| | - Glenn Whitman
- Cardiovascular Surgery Intensive Care Unit, Johns Hopkins Hospital, Baltimore, Md.
| | - Milan Milojevic
- Department of Anaesthesiology and Critical Care Medicine, Dedinje Cardiovascular Institute, Belgrade, Serbia; Department of Cardiovascular Research, Dedinje Cardiovascular Institute, Belgrade, Serbia; Department of Cardiothoracic Surgery, Erasmus University Medical Center, Rotterdam, The Netherlands
| | - Giuseppe Raffa
- Department for the Treatment and Study of Cardiothoracic Diseases and Cardiothoracic Transplantation, IRCCS-ISMETT (Istituto Mediterraneo per i Trapianti e Terapie ad Alta Specializzazione), Palermo, Italy; Department of Anaesthesia and Intensive Care, IRCCS-ISMETT (Istituto Mediterraneo per i Trapianti e Terapie ad Alta Specializzazione), Palermo, Italy
| | - David M McMullan
- Department of Cardiac Surgery, Seattle Children Hospital, Seattle, Wash
| | - Udo Boeken
- Department of Cardiac Surgery, Heinrich Heine University, Dusseldorf, Germany
| | - Jonathan Haft
- Section of Cardiac Surgery, University of Michigan, Ann Arbor, Mich
| | - Christian Bermudez
- Department of Cardiovascular Surgery, Hospital of the University of Pennsylvania, Philadelphia, Pa
| | - Ashish Shah
- Department of Cardio-Thoracic Surgery, Vanderbilt University Medical Center, Nashville, Tenn
| | - David A D'Alessandro
- Department of Cardio-Thoracic Surgery, Massachusetts General Hospital, Boston, Mass
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27
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McClelland M, McClelland S. Case of a 21-year-old man with persistent lung collapse leading to a pericardectomy linked to vape use. Heart Lung 2020; 50:262-267. [PMID: 33373941 DOI: 10.1016/j.hrtlng.2020.12.012] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/16/2020] [Revised: 12/10/2020] [Accepted: 12/21/2020] [Indexed: 11/19/2022]
Abstract
This case report describes multiple organ failure in a young man with illicit vape use which he did not initially disclose to his health care providers. His symptoms were not readily diagnosed until he experienced lung collapse and significant heart failure. Treatment plan recommendations varied among health care providers leading to increased anxiety for the patient and his family. It was ultimately determined that illicit vape use along with chronic substance abuse contributed to a respiratory virus causing pulmonary collapse. The pulmonary virus migrated to the patient's heart causing severe restrictive pericarditis ultimately requiring a pericardectomy. Assessment, interventions, and follow-up care occurred during the global Corona-19 pandemic of 2020.
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Affiliation(s)
- Molly McClelland
- College of Health Professions, #425, 4001W. McNichols Rd., Detroit, MI 48221, United States.
| | - Steven McClelland
- North Woodward Internal Medicine, NWIMA, Ste. 100, Clawson, MI 48017, United States.
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Kushwaha S, Bogoch II, Mak S, Rogalla P, Detsky AS. In the Absence of Proof. N Engl J Med 2020; 383:1878-1884. [PMID: 33211934 DOI: 10.1056/nejmcps2002083] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Affiliation(s)
- Sameer Kushwaha
- From the Department of Medicine (S.K., I.I.B., S.M., A.S.D.), the Joint Department of Medical Imaging (P.R.), and the Institute for Health Policy, Management, and Evaluation (A.S.D.), University of Toronto, and the Department of Medicine, Mount Sinai Hospital and University Health Network (I.I.B., S.M., A.S.D.), Toronto
| | - Isaac I Bogoch
- From the Department of Medicine (S.K., I.I.B., S.M., A.S.D.), the Joint Department of Medical Imaging (P.R.), and the Institute for Health Policy, Management, and Evaluation (A.S.D.), University of Toronto, and the Department of Medicine, Mount Sinai Hospital and University Health Network (I.I.B., S.M., A.S.D.), Toronto
| | - Susanna Mak
- From the Department of Medicine (S.K., I.I.B., S.M., A.S.D.), the Joint Department of Medical Imaging (P.R.), and the Institute for Health Policy, Management, and Evaluation (A.S.D.), University of Toronto, and the Department of Medicine, Mount Sinai Hospital and University Health Network (I.I.B., S.M., A.S.D.), Toronto
| | - Patrik Rogalla
- From the Department of Medicine (S.K., I.I.B., S.M., A.S.D.), the Joint Department of Medical Imaging (P.R.), and the Institute for Health Policy, Management, and Evaluation (A.S.D.), University of Toronto, and the Department of Medicine, Mount Sinai Hospital and University Health Network (I.I.B., S.M., A.S.D.), Toronto
| | - Allan S Detsky
- From the Department of Medicine (S.K., I.I.B., S.M., A.S.D.), the Joint Department of Medical Imaging (P.R.), and the Institute for Health Policy, Management, and Evaluation (A.S.D.), University of Toronto, and the Department of Medicine, Mount Sinai Hospital and University Health Network (I.I.B., S.M., A.S.D.), Toronto
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Borlaug BA, Reddy YNV. The Role of the Pericardium in Heart Failure: Implications for Pathophysiology and Treatment. JACC Heart Fail 2020; 7:574-585. [PMID: 31248569 DOI: 10.1016/j.jchf.2019.03.021] [Citation(s) in RCA: 86] [Impact Index Per Article: 21.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/21/2018] [Revised: 03/15/2019] [Accepted: 03/19/2019] [Indexed: 01/17/2023]
Abstract
The elastic pericardium exerts a compressive contact force on the surface of the myocardium that becomes more substantial when heart volume increases, as in patients with various forms of heart failure (HF). Pericardial restraint plays an important role in determining hemodynamics and ventricular function in both health and disease. This review discusses the physiology of pericardial restraint in HF and explores the question of whether it can be targeted indirectly through medical interventions or directly through a number of existing and future therapies.
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Affiliation(s)
- Barry A Borlaug
- Department of Cardiovascular Medicine, Mayo Clinic, Rochester, Minnesota.
| | - Yogesh N V Reddy
- Department of Cardiovascular Medicine, Mayo Clinic, Rochester, Minnesota
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Gumireddy SR, Chaliki HP, Cummings KW, Freeman WK. Systemic Lupus Erythematosus Presenting As Constrictive Pericarditis. Circ Cardiovasc Imaging 2020; 13:e010254. [PMID: 32912029 DOI: 10.1161/circimaging.119.010254] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Affiliation(s)
- Srikala R Gumireddy
- Division of Cardiovascular Diseases, Mayo Clinic, Scottsdale, AZ (S.R., H.P.C., W.K.F.)
| | - Hari P Chaliki
- Division of Cardiovascular Diseases, Mayo Clinic, Scottsdale, AZ (S.R., H.P.C., W.K.F.)
| | | | - William K Freeman
- Division of Cardiovascular Diseases, Mayo Clinic, Scottsdale, AZ (S.R., H.P.C., W.K.F.)
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31
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Jaiswal LS, Pandit N, Sah B. Surgical treatment of tuberculous chronic constrictive pericarditis: A retrospective observational study from tertiary hospital of eastern Nepal. Indian J Tuberc 2020; 68:174-178. [PMID: 33845948 DOI: 10.1016/j.ijtb.2020.08.002] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2020] [Revised: 07/13/2020] [Accepted: 08/03/2020] [Indexed: 01/30/2023]
Abstract
BACKGROUND Tuberculosis remains an important cause of chronic constrictive pericarditis (CCP) in developing countries. It is a surgically treatable cause of diastolic heart failure. Without surgery, it is associated with high morbidity and mortality. METHODS We conducted a retrospective observational study of clinical presentations and perioperative outcomes of pericardiectomy in all patients operated from July 2015 to December 2018 for tuberculous CCP. RESULTS A total 14 patients (mean age - 38 ± 13.3 years, 10 male), underwent pericardiectomy via median sternotomy without cardiopulmonary bypass. Eleven patients (79%) had completed treatment for pulmonary tuberculosis, and three (21%) were on anti-tubercular treatment at the time of referral for surgery. Ten patients (71%) had prior hospitalisation for cardiac failure. At the time of surgery, eight patients (57%) were in New York Heart Association (NYHA) class III-IV. The median duration of symptoms before surgical intervention was 15 months (range 11-24 months). Three patients (21%) had associated cardiac cirrhosis. Twelve patients (86%) underwent total pericardiectomy. Two patients (14%) underwent partial pericardiectomy. The mean operative time was 160 ± 33.8 minutes. The mean central venous press pressure before and after surgery were 28 ± 3.9 and 10 ± 2 mmHg respectively. The mean intensive care unit (ICU) and hospital stays were 4 ± 1.5 and 10 ± 2 days respectively. There was one (7%) 30-day mortality. There were two deaths (14%) due to non-cardiac causes at 10 and 16 months respectively. The remaining 11 patients (79%) are doing well (mean follow-up- 23 months), and are in NYHA class I. CONCLUSIONS Tuberculosis is the most common cause of CCP in our region. Pericardiectomy provides definitive treatment to alleviate symptoms resolution and improve survival.
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Affiliation(s)
| | - Narendra Pandit
- Department of Surgery, B P Koirala Institute of Health Sciences (BPKIHS), Nepal
| | - Bijay Sah
- Department of Surgery, B P Koirala Institute of Health Sciences (BPKIHS), Nepal
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32
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Wacker C, Weyand M, Schiffer M, Opgenoorth M. Pericardectomy after pericarditis constrictiva led to onset of transplant kidney function after 98 days of anuric kidney graft: a case report. BMC Nephrol 2020; 21:241. [PMID: 32600269 PMCID: PMC7324971 DOI: 10.1186/s12882-020-01899-2] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2020] [Accepted: 06/18/2020] [Indexed: 12/29/2022] Open
Abstract
BACKGROUND Constrictive pericarditis is easily overlooked and can lead to severe problems in hemodynamics and end-organ perfusion, in our patient leading to 98 days of anuria after living kidney transplantation. This was completely reversible after pericardectomy. CASE PRESENTATION A 43-year-old female caucasian patient received a living kidney donation from her mother. She had developed end-stage renal disease 2 years prior due to nephrotic syndrome linked to graft-versus-host disease after allogenic stem-cell transplantation for aplastic anemia. The graft showed insufficient function already in the early postoperative phase. Dialysis was paused after surgery, but the patient developed hypervolemia with ascites and edema in the lower extremities. Doppler ultrasonography showed scarce perfusion, with intrarenal arterial waveforms without end-diastolic flow. The venous perfusion profiles showed pulsatile retrograde flow. There was no identifiable reason for a primary vascular perfusion problem on ultrasonography or transplant kidney angiography. Kidney transplant biopsy revealed no rejection but extensive acute tubular necrosis. Three weeks after transplantation, the patient developed an acute anuric graft failure caused by severe cardiac decompensation. Echocardiography revealed a previously unnoticed constrictive pericarditis, which could be confirmed in a cardio computed tomography scan. The constrictive pericarditis had not been apparent on previous x-rays, computed tomography scans, or echocardiographies, including those for transplantation evaluation. Conservative management of the constrictive pericarditis was not successful and the graft remained anuric. Eventually, the patient underwent pericardectomy 16 weeks after kidney transplantation. Shortly after surgery, the graft started urine production again, which significantly increased within a few days. The clearance improved and 2 weeks later, the patient was free from dialysis. CONCLUSIONS This case illustrates that special attention should be given to the pericardium during transplant evaluation, especially for patients who previously underwent stem-cell transplantations, chemotherapy or radiation.
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Affiliation(s)
- Caroline Wacker
- Department of Nephrology and Hypertension, University Erlangen-Nürnberg, Ulmenweg 18, 91054, Erlangen, Germany.
| | - Michael Weyand
- Department of Cardiac Surgery, University Erlangen-Nürnberg, Krankenhausstraße 12, 91054, Erlangen, Germany
| | - Mario Schiffer
- Department of Nephrology and Hypertension, University Erlangen-Nürnberg, Ulmenweg 18, 91054, Erlangen, Germany
| | - Mirian Opgenoorth
- Department of Nephrology and Hypertension, University Erlangen-Nürnberg, Ulmenweg 18, 91054, Erlangen, Germany
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33
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Li L, Deng YB, Guo LD, Liu K, Zhang J, Tang QY. Evaluation of Long-Term Impact of Pericardiectomy on Left Atrial Functions in Patients with Constrictive Pericarditis Using Speckle Tracking Echocardiography. Ultrasound Med Biol 2020; 46:1158-1168. [PMID: 32107091 DOI: 10.1016/j.ultrasmedbio.2020.01.020] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/24/2019] [Revised: 01/03/2020] [Accepted: 01/20/2020] [Indexed: 06/10/2023]
Abstract
The aims of this study were to explore the long-term impact of pericardiectomy on left atrial (LA) functions in patients with constrictive pericarditis (CP) using speckle tracking echocardiography (STE) and to correlate post-operative LA functions with clinical status. Echocardiographic examinations were undertaken in 29 patients with CP 1 wk before and 1, 6 and 12 mo after pericardiectomy. STE was performed to obtain LA global longitudinal strain, including strain during the conduit phase (LAScd), strain during the contraction phase (LASct) the sum of the latter and strain during the reservoir phase (LASr). Control patients consisted of 29 age- and sex-matched healthy volunteers. LASct, LAScd and LASr obtained 6 mo after pericardiectomy improved significantly compared with pre-operative values, but were still lower than the values for control patients. Further increases were observed gradually with normalization of LASct 12 mo after pericardiectomy. However, there were still significant differences between LAScd and LASr obtained in control patients and those obtained 12 mo after pericardiectomy. Moreover, the improvements in LAScd, LASct and LASr 12 mo after pericardiectomy correlated well with symptomatic clinical alleviation (p < 0.01). These results indicate that LA strains analyzed with STE might be useful in evaluating the long-term impact of pericardiectomy on LA functions.
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Affiliation(s)
- Li Li
- Department of Medical Ultrasound, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - You-Bin Deng
- Department of Medical Ultrasound, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China.
| | - Ling-Dan Guo
- Department of Medical Ultrasound, Wuhan Center Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Kun Liu
- Department of Medical Ultrasound, Third People's Hospital of Hubei Province, Wuhan, China
| | - Jun Zhang
- Department of Medical Ultrasound, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Qiao-Ying Tang
- Department of Medical Ultrasound, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
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34
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Dall'Ara G, Longhi S, Grotti S, Noera G, Essatari MHM, Bachetti C, Tarantino F, Galvani M. Multimodality Imaging of Purulent Pericarditis: Hints to Speed up Diagnosis and Promote Healing. J Invasive Cardiol 2020; 32:E79-E80. [PMID: 32123150] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/10/2023]
Abstract
Purulent pericarditis is rare and usually associated with pneumonia, bacteremia, immunosuppression, and thoracic surgery. A timely diagnostic pericardiocentesis with dedicated maneuvers to improve the effectiveness of drainage and pericardial fibrinolytic rinsing can improve prognosis and prevent a surgical pericardiectomy. Imaging offers useful clues for a more aggressive approach.
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Affiliation(s)
- Gianni Dall'Ara
- Cardiovascular Department ASL Romagna via Forlanini 34, 47121 Forlì, Italy.
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35
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Taguchi S, Kitamura T, Matsukuma S, Odate T, Ariyoshi T, Hamawaki M, Otsubo C, Kurohama H, Mihara Y. A case of recurrent constrictive pericarditis induced by pericardial substitution with an expanded polytetrafluoroethylene membrane. Gen Thorac Cardiovasc Surg 2020; 68:1479-1482. [PMID: 32008186 DOI: 10.1007/s11748-020-01303-8] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2019] [Accepted: 01/24/2020] [Indexed: 11/30/2022]
Abstract
A 72-year-old man presented with recurrent constrictive pericarditis, which developed 6 months after pericardiectomy, and pericardial substitution with an expanded polytetrafluoroethylene membrane. Re-pericardiectomy was performed. A new thick membranous structure had grown under the expanded polytetrafluoroethylene membrane anterior to the right ventricle, and was firmly adhered to the epicardium. This new structure exhibited collagenous fiber-based fibrotic thickening, and resembled a foreign body reaction. It was surmised that recurrence of constrictive pericarditis may have been induced by the expanded polytetrafluoroethylene membrane. Heart failure resolved after the operation; however, the patient died of respiratory failure on postoperative day 6.
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Affiliation(s)
- Shunsuke Taguchi
- Department of Cardiovascular Surgery and Pathology, National Hospital Organization Nagasaki Medical Center, 2-1001-1 Kubara, Omura, Nagasaki, 856-8562, Japan.
| | - Tessho Kitamura
- Department of Cardiovascular Surgery and Pathology, National Hospital Organization Nagasaki Medical Center, 2-1001-1 Kubara, Omura, Nagasaki, 856-8562, Japan
| | - Seiji Matsukuma
- Department of Cardiovascular Surgery and Pathology, National Hospital Organization Nagasaki Medical Center, 2-1001-1 Kubara, Omura, Nagasaki, 856-8562, Japan
| | - Tomohiro Odate
- Department of Cardiovascular Surgery and Pathology, National Hospital Organization Nagasaki Medical Center, 2-1001-1 Kubara, Omura, Nagasaki, 856-8562, Japan
| | - Tsuneo Ariyoshi
- Department of Cardiovascular Surgery and Pathology, National Hospital Organization Nagasaki Medical Center, 2-1001-1 Kubara, Omura, Nagasaki, 856-8562, Japan
| | - Masayoshi Hamawaki
- Department of Cardiovascular Surgery and Pathology, National Hospital Organization Nagasaki Medical Center, 2-1001-1 Kubara, Omura, Nagasaki, 856-8562, Japan
| | - Chieko Otsubo
- Department of Cardiovascular Surgery and Pathology, National Hospital Organization Nagasaki Medical Center, 2-1001-1 Kubara, Omura, Nagasaki, 856-8562, Japan
| | - Hirokazu Kurohama
- Department of Cardiovascular Surgery and Pathology, National Hospital Organization Nagasaki Medical Center, 2-1001-1 Kubara, Omura, Nagasaki, 856-8562, Japan
| | - Yumi Mihara
- Department of Cardiovascular Surgery and Pathology, National Hospital Organization Nagasaki Medical Center, 2-1001-1 Kubara, Omura, Nagasaki, 856-8562, Japan
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36
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Junqueira N, Ferreira R, Bernardo R, Nobre Â. Combined Pericardiectomy And Beating Heart Coronary Artery Bypass Grafting. Rev Port Cir Cardiotorac Vasc 2020; 27:51. [PMID: 32239828] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Subscribe] [Scholar Register] [Received: 12/18/2019] [Indexed: 06/11/2023]
Affiliation(s)
- Nádia Junqueira
- Cardiothoracic Surgery Department, Santa Maria Hospital, Lisbon, Portugal
| | - Ricardo Ferreira
- Cardiothoracic Surgery Department, Santa Maria Hospital, Lisbon, Portugal
| | - Ricardo Bernardo
- Anesthesiology Department, Santa Maria Hospital, Lisbon, Portugal
| | - Ângelo Nobre
- Cardiothoracic Surgery Department, Santa Maria Hospital, Lisbon, Portugal
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37
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Tan C, Patel HC, Mariani J. An unusual suspect for heart failure. Acute Med 2020; 19:52-55. [PMID: 32226959] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/10/2023]
Abstract
Constrictive pericarditis though an uncommon diagnosis is a potentially reversible form of heart failure (with surgical pericardiectomy) and hence is imperative to diagnose. Diagnosis is dependent on a high index of clinical suspicion and further testing with appropriate cardiac investigations including cardiac imaging with invasive cardiac catheterisation as the gold standard.
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Affiliation(s)
- C Tan
- Department of Cardiology, The Alfred Hospital, Australia
| | - H C Patel
- Department of Cardiology, The Alfred Hospital, Australia
| | - J Mariani
- Department of Cardiology, The Alfred Hospital, Australia
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38
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Itagaki H, Yamamoto T, Uto K, Hiroi A, Onizuka H, Arashi H, Shibahashi E, Isomura S, Oda H, Yamashita T, Nagashima Y. Recurrent pericardial effusion with pericardial amyloid deposition: a case report and literature review. Cardiovasc Pathol 2019; 46:107191. [PMID: 31927216 DOI: 10.1016/j.carpath.2019.107191] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/20/2019] [Revised: 11/25/2019] [Accepted: 11/28/2019] [Indexed: 11/19/2022] Open
Abstract
Pericardial amyloidosis is a rare cause of pericardial effusion. Here, we report a case of recurrent pericardial effusion because of pericardial amyloid deposition. The patient was a man in his 40s admitted for pulmonary embolism. During hospitalization, arterial fibrillation and cardiac tamponade were observed, and an initial pericardial puncture was performed. Thereafter, pericardial puncture was repeated nine times over the next two years. Cytological examination of the pericardial effusion suggested malignant mesothelioma. Afterward, pericardial fenestration and partial resection were performed. Intraoperatively, a thickened pericardium and hemorrhagic pericardial effusion were noted. Histologically, the surface of the pericardium was covered by an eosinophilic amorphous material. Congo red and DYLON stains, electron microscopy, and immunohistochemical findings revealed localized amyloidosis composed of an immunoglobulin lambda light chain. Although the patient did not receive further treatment for 5 years postoperatively, his renal and cardiac functions remained within normal limits. Based on these findings, the patient was diagnosed with localized amyloidosis. So far, hemorrhagic pericardial effusion has been reported in few cases with systemic amyloidosis. Because localized immunoglobulin light-chain-derived (AL) amyloidosis may progress to systemic disease (although it is a very rare occurrence), long-term follow-up is necessary to detect recurrence or progression to a systemic form.
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Affiliation(s)
- Hiroko Itagaki
- Department of Surgical Pathology, Tokyo Women's Medical University, Tokyo, Japan; Department of Pathology, Tokyo Women's Medical University, Tokyo, Japan.
| | - Tomoko Yamamoto
- Department of Surgical Pathology, Tokyo Women's Medical University, Tokyo, Japan; Department of Pathology, Tokyo Women's Medical University, Tokyo, Japan
| | - Kenta Uto
- Department of Pathology, Tokyo Women's Medical University, Tokyo, Japan; Department of Cardiology, Tokyo Women's Medical University, Tokyo, Japan
| | - Atsuko Hiroi
- Department of Surgical Pathology, Tokyo Women's Medical University, Tokyo, Japan; Department of Pathology, Tokyo Women's Medical University, Tokyo, Japan
| | - Hiromi Onizuka
- Department of Surgical Pathology, Tokyo Women's Medical University, Tokyo, Japan
| | - Hiroyuki Arashi
- Department of Cardiology, Tokyo Women's Medical University, Tokyo, Japan
| | - Eiji Shibahashi
- Department of Cardiology, Tokyo Women's Medical University, Tokyo, Japan
| | - Shogo Isomura
- Department of Cardiovascular Surgery, Tokyo Women's Medical University, Tokyo, Japan
| | - Hideaki Oda
- Department of Pathology, Tokyo Women's Medical University, Tokyo, Japan
| | - Taro Yamashita
- Diagnostic Unit for Amyloidosis, Department of Neurology, Kumamoto University Hospital, Kumamoto, Japan
| | - Yoji Nagashima
- Department of Surgical Pathology, Tokyo Women's Medical University, Tokyo, Japan
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39
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Ogasawara T, Saito Y, Minakawa M, Fukuda I. [Re-operation for Recurrent Constrictive Pericarditis with Multiple Organ Dysfunction]. Kyobu Geka 2019; 72:427-431. [PMID: 31268015] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/09/2023]
Abstract
The patient was a 64-year-old man with recurrent constrictive pericarditis which developed 12 years after the initial pericardiectomy. He had bilateral heart failure with severe left ventricular diastolic dysfunction, massive ascites, renal failure, and coagulopathy. Computed tomography showed a heavily calcified pericardium around the right atrium, the phrenic side of the right ventricle, and the left ventricle. He underwent pericardiectomy via median sternal re-entry. The calcified pericardium was safely decorticated with an ultrasonic surgical knife. The pericardium around the left ventricular side was safely decorticated under cardiopulmonary bypass and use of a heart positioner. Although permanent hemodialysis was necessary after the operation, he has been well for 6 years since the operation.
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Affiliation(s)
- Takashi Ogasawara
- Department of Thoracic and Cardiovascular Surgery, Hirosaki University, Hirosaki, Japan
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40
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Ogura H, Kimata R, Mitta S, Umeda E, Ishida N, Shimabukuro K, Nakashima T, Kanamori H, Kawasaki M, Doi K. Neovascularization in pericarditis: a possible etiology of hemopericardium. Gen Thorac Cardiovasc Surg 2019; 68:392-395. [PMID: 30968260 DOI: 10.1007/s11748-019-01124-4] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/06/2019] [Accepted: 04/02/2019] [Indexed: 12/01/2022]
Abstract
Hemorrhagic pericardial effusion is life-threatening and mostly occurs during pericarditis; however, its underlying mechanism is unclear. We report a case of pericardial hematoma with obvious hemorrhage. A 56-year-old man without prior chest trauma presenting with exertional dyspnea and abdominal fullness was treated for idiopathic pericarditis. The echocardiogram showed a thickened pericardium with effusion. Imaging showed extravasation and neovascularization. Following ineffective pharmacotherapy, we performed pericardiectomy. The site of bleeding was undetectable. Because parietal pericardiectomy with hematoma evacuation did not improve diastolic function, we removed the epicardium. During the follow-up period, the patient remained almost asymptomatic. We identified neovascularization as the potential source of idiopathic pericardial hemorrhage.
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Affiliation(s)
- Hiroki Ogura
- Department of General and Cardiothoracic Surgery, Graduate School of Medicine, Gifu University, 1-1 Yanagido, Gifu, Gifu, 501-1194, Japan.
| | - Ryutaro Kimata
- Department of General and Cardiothoracic Surgery, Graduate School of Medicine, Gifu University, 1-1 Yanagido, Gifu, Gifu, 501-1194, Japan
| | - Shohei Mitta
- Department of General and Cardiothoracic Surgery, Graduate School of Medicine, Gifu University, 1-1 Yanagido, Gifu, Gifu, 501-1194, Japan
| | - Etsuji Umeda
- Department of General and Cardiothoracic Surgery, Graduate School of Medicine, Gifu University, 1-1 Yanagido, Gifu, Gifu, 501-1194, Japan
| | - Narihiro Ishida
- Department of General and Cardiothoracic Surgery, Graduate School of Medicine, Gifu University, 1-1 Yanagido, Gifu, Gifu, 501-1194, Japan
| | - Katsuya Shimabukuro
- Department of General and Cardiothoracic Surgery, Graduate School of Medicine, Gifu University, 1-1 Yanagido, Gifu, Gifu, 501-1194, Japan
| | - Takashi Nakashima
- Department of Cardiology, Graduate School of Medicine, Gifu University, Gifu, Gifu, 501-1194, Japan
| | - Hiromitsu Kanamori
- Department of Cardiology, Graduate School of Medicine, Gifu University, Gifu, Gifu, 501-1194, Japan
| | - Masanori Kawasaki
- Department of Cardiology, Graduate School of Medicine, Gifu University, Gifu, Gifu, 501-1194, Japan
| | - Kiyoshi Doi
- Department of General and Cardiothoracic Surgery, Graduate School of Medicine, Gifu University, 1-1 Yanagido, Gifu, Gifu, 501-1194, Japan
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41
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Kalińczuk Ł, Markiewicz MG, Rzeszutko M, Pastuszek-Tyc M, Kuśmierczyk M, Demkow M. Additive value of a novel 384-row CT insight into the actual pathomechanism of a constrictive pericarditis and its effective surgical treatment guided by the pre-procedural detailed imaging. J Cardiovasc Comput Tomogr 2018; 14:e97-e98. [PMID: 30509775 DOI: 10.1016/j.jcct.2018.11.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/11/2018] [Revised: 11/05/2018] [Accepted: 11/11/2018] [Indexed: 11/18/2022]
Affiliation(s)
- Łukasz Kalińczuk
- Institute of Cardiology, Alpejska 42 St., 04-628, Warsaw-Anin, Poland.
| | - Michał G Markiewicz
- Medical University of Warsaw, Żwirki i Wigury 61 St., 02-091, Warsaw, Poland
| | - Marzena Rzeszutko
- Medical University of Warsaw, Żwirki i Wigury 61 St., 02-091, Warsaw, Poland
| | | | | | - Marcin Demkow
- Institute of Cardiology, Alpejska 42 St., 04-628, Warsaw-Anin, Poland
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42
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Tong X, Harada H, Yamada H, Kimura F, Kuriyama N. [Pericardial Hematoma Mimicking Pericardial Tumor;Report of a Case]. Kyobu Geka 2018; 71:1104-1107. [PMID: 30587751] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/09/2023]
Abstract
A case was diagnosed as pericardial tumor preoperatively, which was found to be pericardial hematoma and localized constrictive pericarditis intraoperatively. A pericardial hematoma resection and a pericardiectomy were performed.
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Affiliation(s)
- Xiaoning Tong
- Department of Cardiovascular Surgery, Kushiro Memorial Hospital, Kushiro, Japan
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Ichikawa S, Murakami F, Ogiwara H. [Primary Malignant Pericardial Mesothelioma;Report of a Case]. Kyobu Geka 2018; 71:135-137. [PMID: 29483467] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/08/2023]
Abstract
A 69-year-old male was referred to our hospital after being diagnosed as having pericarditis with pericardial effusion. The symptoms of tamponade disappeared after the effusion was drained;although the cause of pericarditis remained unidentified. About 4 months later, the tamponade symptoms recurred due to the thickened nodular pericardium. Partial pericardiectomy was performed, however the patient died on the 52nd day after surgery. Immunohistological examination with calretinin led to the diagnosis of primary malignant pericardial mesothelioma, which was an extremely rare pathology. Because the hyaluronic acid content of the effusion has been reported as a diagnostic aid for malignant mesothelioma, routine examination of the hyaluronic acid content for pericarditis with pericardial effusion may be necessary for early diagnosis and to improve prognosis.
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Affiliation(s)
- Seiji Ichikawa
- Department of Thoracic and Cardiovascular Surgery, Meijo Hospital, Nagoya, Japan
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Abstract
BACKGROUND Tuberculous pericarditis can impair the heart's function and cause death; long term, it can cause the membrane to fibrose and constrict causing heart failure. In addition to antituberculous chemotherapy, treatments include corticosteroids, drainage, and surgery. OBJECTIVES To assess the effects of treatments for tuberculous pericarditis. SEARCH METHODS We searched the Cochrane Infectious Diseases Group Specialized Register (27 March 2017); the Cochrane Central Register of Controlled Trials (CENTRAL), published in the Cochrane Library (2017, Issue 2); MEDLINE (1966 to 27 March 2017); Embase (1974 to 27 March 2017); and LILACS (1982 to 27 March 2017). In addition we searched the metaRegister of Controlled Trials (mRCT) and the World Health Organization (WHO) International Clinical Trials Registry Platform (ICTRP) search portal using 'tuberculosis' and 'pericard*' as search terms on 27 March 2017. We searched ClinicalTrials.gov and contacted researchers in the field of tuberculous pericarditis. This is a new version of the original 2002 review. SELECTION CRITERIA We included randomized controlled trials (RCTs) and quasi-RCTs. DATA COLLECTION AND ANALYSIS Two review authors independently screened search outputs, evaluated study eligibility, assessed risk of bias, and extracted data; and we resolved any discrepancies by discussion and consensus. One trial assessed the effects of both corticosteroid and Mycobacterium indicus pranii treatment in a two-by-two factorial design; we excluded data from the group that received both interventions. We conducted fixed-effect meta-analysis and assessed the certainty of the evidence using the GRADE approach. MAIN RESULTS Seven trials met the inclusion criteria; all were from sub-Saharan Africa and included 1959 participants, with 1051/1959 (54%) HIV-positive. All trials evaluated corticosteroids and one each evaluated colchicine, M. indicus pranii immunotherapy, and open surgical drainage. Four trials (1841 participants) were at low risk of bias, and three trials (118 participants) were at high risk of bias.In people who are not infected with HIV, corticosteroids may reduce deaths from all causes (risk ratio (RR) 0.80, 95% confidence interval (CI) 0.59 to 1.09; 660 participants, 4 trials, low certainty evidence) and the need for repeat pericardiocentesis (RR 0.85, 95% CI 0.70 to 1.04; 492 participants, 2 trials, low certainty evidence). Corticosteroids probably reduce deaths from pericarditis (RR 0.39, 95% CI 0.19 to 0.80; 660 participants, 4 trials, moderate certainty evidence). However, we do not know whether or not corticosteroids have an effect on constriction or cancer among HIV-negative people (very low certainty evidence).In people living with HIV, only 19.9% (203/1959) were on antiretroviral drugs. Corticosteroids may reduce constriction (RR 0.55, 0.26 to 1.16; 575 participants, 3 trials, low certainty evidence). It is uncertain whether corticosteroids have an effect on all-cause death or cancer (very low certainty evidence); and may have little or no effect on repeat pericardiocentesis (RR 1.02, 0.89 to 1.18; 517 participants, 2 trials, low certainty evidence).For colchicine among people living with HIV, we found one small trial (33 participants) which had insufficient data to make any conclusions about any effects on death or constrictive pericarditis.Irrespective of HIV status, due to very low certainty evidence from one trial, it is uncertain whether adding M. indicus pranii immunotherapy to antituberculous drugs has an effect on any outcome.Open surgical drainage for effusion may reduce repeat pericardiocentesis In HIV-negative people (RR 0.23, 95% CI 0.07 to 0.76; 122 participants, 1 trial, low certainty evidence) but may make little or no difference to other outcomes. We did not find an eligible trial that assessed the effects of open surgical drainage in people living with HIV.The review authors found no eligible trials that examined the length of antituberculous treatment needed nor the effects of other adjunctive treatments for tuberculous pericarditis. AUTHORS' CONCLUSIONS For HIV-negative patients, corticosteroids may reduce death. For HIV-positive patients not on antiretroviral drugs, corticosteroids may reduce constriction. For HIV-positive patients with good antiretroviral drug viral suppression, clinicians may consider the results from HIV-negative patients more relevant.Further research may help evaluate percutaneous drainage of the pericardium under local anaesthesia, the timing of pericardiectomy in tuberculous constrictive pericarditis, and new antibiotic regimens.
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Affiliation(s)
- Charles S Wiysonge
- South African Medical Research CouncilCochrane South AfricaFrancie van Zijl Drive, Parow ValleyCape TownWestern CapeSouth Africa7505
- Stellenbosch UniversityCentre for Evidence‐based Health Care, Faculty of Medicine and Health SciencesCape TownSouth Africa
| | - Mpiko Ntsekhe
- Groote Schuur HospitalDivision of CardiologyObservatory 7925Cape TownSouth Africa
| | - Lehana Thabane
- McMaster UniversityDepartment of Clinical Epidemiology and Biostatistics50 Charlton Ave ERoom H325, St. Joseph's HealthcareHamiltonONCanadaL8N 4A6
| | - Jimmy Volmink
- Stellenbosch UniversityCentre for Evidence‐based Health Care, Faculty of Medicine and Health SciencesCape TownSouth Africa
| | - Dumisani Majombozi
- Stellenbosch UniversityCentre for Evidence‐based Health Care, Faculty of Medicine and Health SciencesCape TownSouth Africa
| | - Freedom Gumedze
- University of Cape TownDepartment of Statistical SciencesCape TownSouth Africa
| | - Shaheen Pandie
- University of Cape TownDepartment of MedicineCape TownSouth Africa
| | - Bongani M Mayosi
- University of Cape TownDepartment of MedicineCape TownSouth Africa
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Hashiyama N, Nemoto H, Kato A, Hashimoto M, Mo M, Masuda M. [Effectiveness of the Waffle Procedure for Constrictive Pericarditis]. Kyobu Geka 2017; 70:765-769. [PMID: 28790244] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/07/2023]
Abstract
A 66-year-old woman was referred to our hospital with dyspnea. Right-sided congestive pleural effusion of an unknown etiology was detected and she was diagnosed with constrictive pericarditis. Pericardiectomy was performed via median sternotomy under extracorporeal circulation because severe adhesion was observed. However, hemodynamics did not improve after pericardial resection because of thickend epicardium in front of the right ventricle. Hence, the waffle procedure was additionally performed on the anterior surface of the right ventricle after coming-off the extracorporeal circulation. Although significant cardiac dilatation was achieved, hemodynamics did not change markedly. The symptoms gradually alleviated postoperatively and cardiac catheterization performed 3 weeks later revealed marked improvement in hemodynamics. Although improvement in hemodynamics takes time, the waffle procedure appears to be effective.
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Affiliation(s)
- Naoki Hashiyama
- Department of Cardiovascular Surgery, Yokohama Minami Kyousai Hospital, Yokohama, Japan
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Braga A, Oliveira A, Domingues K, Andrade MJ, Abecacis M, Neves JP. Diagnostic Challenges in Chronic Constrictive Pericarditis. Rev Port Cir Cardiotorac Vasc 2017; 24:160. [PMID: 29701391] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Received: 07/18/2017] [Indexed: 06/08/2023]
Abstract
INTRODUCTION Chronic constrictive pericarditis (CCP) is a disease that has multiple possible causes and is associated with variable clinical findings, depending on its severity. It develops insidiously, and in many cases, particularly in developed countries, no antecedent diagnosis can be found. These cases are termed idiopathic. Tuberculosis is the leading cause of constrictive pericarditis in developing nations but represents only a small minority in developed countries. METHODS Here the authors describe two different case reports where tuberculosis was the probable cause of CCP. RESULTS A 21-year-old man born in Cape Verde living in Europe for 4 years and a 24-year-old man born in Guiné Bissau were both admitted due to intense precordial pain and syncope after exertion. Interestingly both had fatigability, dyspnea, chest discomfort and palpitations on exertion, as well as progressive involuntary weight loss and decubitus cough. On physical examination they had tachycardia, jaundice, cachexia, elevated jugular venous pressure, hepatomegaly and ascites. Both electrocardiograms showed prominent P waves and chest X-ray showed bilateral pulmonary interstitial infiltrates and enlargement of the right cavities. Analytically, elevated bilirubin, leukopenia and thrombocytopenia was also found in both. Echocardiography revealed findings, in both cases, compatible with CCP including less common signs as annulus reversus and annulus paradoxus. Thoraco-abdomino-pelvic CT from both patients revealed chronic liver disease with congestion, pleural effusion, pericardial calcifications, ascites and massive mediastinal and abdominal adenopathies. Blood cultures and IGRA test were negative. However, given the presumptive diagnosis of tuberculosis (TB), anti-TB therapy was started. Despite the diagnosis of "end-stage" CCP with very high operative risk multidisciplinary team decided after informed consent, to perform total anterior pericardiectomy, that occurred without complications. Pericardial and mediastinal biopsies, pericardial/pleural fluid cultures/ immune-phenotyping were inconclusive. Anti- tuberculosis therapy was maintained. After surgery, the patients had a remarkable clinical improvement (NYHA I) that persisted in 6- month follow-up. CONCLUSION These two case reports illustrate that despite the markedly elevated operative risk of pericardiectomy in "end-stage" forms of disease after patients informed consent must be a considered option. The other point to consider is that, despite rare, tuberculosis still is a possible diagnosis to consider in CCP in Portugal.
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Papageorgiou K, Schmithausen J, Kahr P, Ruschitzka F, Maisano F, Benussi S, Müggler SA. [Not Available]. Praxis (Bern 1994) 2017; 106:617-628. [PMID: 28609246 DOI: 10.1024/1661-8157/a002720] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/07/2023]
Abstract
Zusammenfassung. Die konstriktive Perikarditis stellt als seltene und gefürchtete Komplikation einer akuten Perikarditis eine schwere und ungewöhnliche Form einer diastolischen Herzinsuffizienz dar bei primär erhaltener systolischer Pumpfunktion. Häufigste Ursache ist die virale/idiopathische Perikarditis, gefolgt von spezifischen Ursachen (postoperativ nach herzchirurgischer Operation, postaktinisch nach mediastinaler Radiotherapie und weitere Ursachen). Durch das steife, unelastische Perikard ist die diastolische Füllung des Herzens eingeschränkt, was zum klinischen Bild einer Rechtsherzinsuffizienz führt und sich mit erhöhten Füllungsdrücken und spezifischen respiratorischen Phänomenen in der klinischen und apparativ-technischen Untersuchung manifestiert (Kussmaul-Zeichen, Pulsus paradoxus, vermehrte interventrikuläre Interdependenz, Annulus reversus, Quadratwurzelzeichen). Differenzialdiagnostisch müssen die restriktive Kardiomyopathie, die schwere Trikuspidalinsuffizienz und die Perikardtamponade ausgeschlossen werden. Die Therapie der Wahl ist zumeist eine chirurgische Perikardektomie, in Einzelfällen kann auch eine spezifische Therapie oder eine medikamentös-antiinflammatorische Therapie erfolgen. Obwohl die konstriktive Perikarditis unbehandelt eine schlechte Prognose hat, ist die Erkrankung potenziell kurativ therapierbar. Die Prognose ist vor allem von der Ursache der konstriktiven Perikarditis abhängig.
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Affiliation(s)
| | - Julia Schmithausen
- 1 Universitäres Herzzentrum, Klinik für Kardiologie, Universitätsspital Zürich
| | - Peter Kahr
- 1 Universitäres Herzzentrum, Klinik für Kardiologie, Universitätsspital Zürich
| | - Frank Ruschitzka
- 1 Universitäres Herzzentrum, Klinik für Kardiologie, Universitätsspital Zürich
| | - Francesco Maisano
- 2 Universitäres Herzzentrum, Klinik für Herz- und Gefässchirurgie, Universitätsspital Zürich
| | - Stefano Benussi
- 2 Universitäres Herzzentrum, Klinik für Herz- und Gefässchirurgie, Universitätsspital Zürich
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Sreter KB, Degoricija V, Trbušić M. Pneumopericardium and colo-pericardial fistula. QJM 2017; 110:237-238. [PMID: 28082381 DOI: 10.1093/qjmed/hcx015] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/16/2016] [Indexed: 11/13/2022] Open
Affiliation(s)
- K B Sreter
- From the Department of Clinical Immunology, Pulmonology and Rheumatology, University Hospital Centre "Sestre Milosrdnice", Zagreb, Croatia
| | - V Degoricija
- University of Zagreb School of Medicine, Zagreb, Croatia
- Department of Internal Medicine, University Hospital Centre "Sestre Milosrdnice", Zagreb, Croatia
| | - M Trbušić
- University of Zagreb School of Medicine, Zagreb, Croatia
- Department of Cardiology, University Hospital Centre "Sestre Milosrdnice", Zagreb, Croatia
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Jung IY, Song YG, Choi JY, Kim MH, Jeong WY, Oh DH, Kim YC, Song JE, Kim EJ, Lee JU, Jeong SJ, Ku NS, Kim JM. Predictive factors for unfavorable outcomes of tuberculous pericarditis in human immunodeficiency virus-uninfected patients in an intermediate tuberculosis burden country. BMC Infect Dis 2016; 16:719. [PMID: 27899066 PMCID: PMC5129391 DOI: 10.1186/s12879-016-2062-5] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/16/2016] [Accepted: 11/23/2016] [Indexed: 12/13/2022] Open
Abstract
BACKGROUND In areas where Mycobacterium tuberculosis is endemic, tuberculosis is known to be the most common cause of pericarditis. However, the difficulty in diagnosis may lead to late complications such as constrictive pericarditis and increased mortality. Therefore, identification of patients at a high risk for poor prognosis, and prompt initiation of treatment are important in the outcome of TB pericarditis. The aim of this study is to identify the predictive factors for unfavorable outcomes of TB pericarditis in HIV-uninfected persons in an intermediate tuberculosis burden country. METHODS A retrospective review of 87 cases of TB pericarditis diagnosed at a tertiary referral hospital in South Korea was performed. Clinical characteristics, treatment outcomes, complications during treatment, duration of treatment, and medication history were reviewed. Unfavorable outcome was defined as constrictive pericarditis identified on echocardiography performed 3 to 6 months after initial diagnosis of TB pericarditis, cardiac tamponade requiring emergency pericardiocentesis, or death. Predictive factors for unfavorable outcomes were identified. RESULTS Of the 87 patients, 44 (50.6%) had unfavorable outcomes; cardiac tamponade (n = 36), constrictive pericarditis (n = 18), and mortality (n = 4). 14 patients experienced both cardiac tamponade and constrictive pericarditis. During a 1 year out-patient clinic follow up, 4 patients required repeat pericardiocentesis and pericardiectomy was performed in 0 patients. In the multivariate analysis, patients with large amounts of pericardial effusion (P = .003), those with hypoalbuminemia (P = .011), and those without cardiovascular disease (P = .011) were found to have a higher risk of unfavorable outcomes. CONCLUSION HIV-uninfected patients with TB pericarditis are at a higher risk for unfavorable outcomes when presenting with low serum albumin, with large pericardial effusions, and without cardiovascular disease.
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Affiliation(s)
- In Young Jung
- Department of Internal Medicine and AIDS Research Institute, Yonsei University College of Medicine, 50-1 Yonsei-ro, Seodaemun-gu, 120-752, Seoul, Republic of Korea
| | - Young Goo Song
- Department of Internal Medicine and AIDS Research Institute, Yonsei University College of Medicine, 50-1 Yonsei-ro, Seodaemun-gu, 120-752, Seoul, Republic of Korea
| | - Jun Yong Choi
- Department of Internal Medicine and AIDS Research Institute, Yonsei University College of Medicine, 50-1 Yonsei-ro, Seodaemun-gu, 120-752, Seoul, Republic of Korea
| | - Moo Hyun Kim
- Department of Internal Medicine and AIDS Research Institute, Yonsei University College of Medicine, 50-1 Yonsei-ro, Seodaemun-gu, 120-752, Seoul, Republic of Korea
| | - Woo Yong Jeong
- Department of Internal Medicine and AIDS Research Institute, Yonsei University College of Medicine, 50-1 Yonsei-ro, Seodaemun-gu, 120-752, Seoul, Republic of Korea
| | - Dong Hyun Oh
- Department of Internal Medicine and AIDS Research Institute, Yonsei University College of Medicine, 50-1 Yonsei-ro, Seodaemun-gu, 120-752, Seoul, Republic of Korea
| | - Yong Chan Kim
- Department of Internal Medicine and AIDS Research Institute, Yonsei University College of Medicine, 50-1 Yonsei-ro, Seodaemun-gu, 120-752, Seoul, Republic of Korea
| | - Je Eun Song
- Department of Internal Medicine and AIDS Research Institute, Yonsei University College of Medicine, 50-1 Yonsei-ro, Seodaemun-gu, 120-752, Seoul, Republic of Korea
| | - Eun Jin Kim
- Department of Internal Medicine and AIDS Research Institute, Yonsei University College of Medicine, 50-1 Yonsei-ro, Seodaemun-gu, 120-752, Seoul, Republic of Korea
| | - Ji Un Lee
- Department of Internal Medicine and AIDS Research Institute, Yonsei University College of Medicine, 50-1 Yonsei-ro, Seodaemun-gu, 120-752, Seoul, Republic of Korea
| | - Su Jin Jeong
- Department of Internal Medicine and AIDS Research Institute, Yonsei University College of Medicine, 50-1 Yonsei-ro, Seodaemun-gu, 120-752, Seoul, Republic of Korea.
| | - Nam Su Ku
- Department of Internal Medicine and AIDS Research Institute, Yonsei University College of Medicine, 50-1 Yonsei-ro, Seodaemun-gu, 120-752, Seoul, Republic of Korea
| | - June Myung Kim
- Department of Internal Medicine and AIDS Research Institute, Yonsei University College of Medicine, 50-1 Yonsei-ro, Seodaemun-gu, 120-752, Seoul, Republic of Korea
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Granel B, Gaudy C, Serratrice J, Ene N, Mesana T, Bonnet JL, Lepidi H, Disdier P, Piana L, Weiller PJ. Severe Lower Limbs Lymphedema Following Breast Carcinoma Treatment Revealing Radiation-Induced Constrictive Pericarditis. Angiology 2016; 56:119-21. [PMID: 15678267 DOI: 10.1177/000331970505600118] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
In patients treated for breast carcinoma, unilateral lymphedema of the upper limb is usual. However, to the authors’ knowledge, lower limb lymphedema has never been reported as a complication of breast carcinoma therapy. They report here the first case of a radiation-induced constrictive pericarditis revealed by severe lower limbs lymphedema. A 60-year-old woman was treated for left breast carcinoma with quadrantectomy, axillary lymphadenectomy, and combined radio chemotherapy (60 grays). Three and a half years later she suffered from a diffuse and increasing lower limbs lymphedema, which became huge and disabling. Radiation-induced constrictive pericarditis was evidenced by right cardiac cavities catheterization. A dramatic improvement was rapidly obtained after pericardectomy. Histopathologic analysis of the pericardium did not reveal neoplastic cells. Radiation-induced constrictive pericarditis is usually responsible for lower limbs edema, but lymphedema is exceptional. This case highlights the need to search for a constrictive pericarditis also in the case of lower limbs lymphedema, particularly in a patient treated with mediastinal radiotherapy or combined radio chemotherapy.
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Affiliation(s)
- B Granel
- Service de Médecine Interne, CHU Timone, Marseille, France
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