Abstract
Background
Leftatrial appendageclosure is an alternative to systemic anticoagulation for stroke prevention in appropriate atrial fibrillation patients,however, it is not without complications. Most complications arise during the procedure and in the following days, however they can also be extended over time and therefore, we must be alert.
Case summary
We present the clinical case of a 68-year-old man admitted to our hospital three weeks after being discharged due to a percutaneous closure of the left appendage complicated with a pericardial tamponade resolved mediated pericadiocentesis with pericarditis clinic with persistent severe pericardial effusion. After a week without being able to remove the drainage tube, he required pericardiotomy due to superinfection with adequate subsequent evolution. In the following weeks he presented a recurrent left pleural effusion that required several evacuating thoracocentesis. After last thoracocentesis, he presented a cardiac perforation showing the catheter lodged in the pulmonary artery in the chest Computed Tomography, so he was again submitted to cardiac surgery for catheter extraction. Finally after stabilization, the patient could be discharged and after 6 months of follow-up he is stable and without new complications.
Discussion
Post-cardiac injury syndromes is a group of inflammatory pericardial syndromes including post-myocardial infarction pericarditis, post-pericardiotomy syndrome and post-traumatic pericarditis iatrogenic or not, that’s include pericarditis after invasive cardiac interventions. It is presumed that these syndromes have an autoimmune pathogenesis triggered by an initial damage and after a latent period of a few weeks are revealed.
Our patient evidence of pericardial effusion with elevated CRP several weeks after a cardiac injury due to perforated during a percutaneous closure of the left appendage complicated with a pericardial tamponade resolved mediated pericadiocentesis. The persistent effusion motivated he imposibility of removed pericadiocentesis tube, and it superinfecction required an urgent pericardiotomy. After pericardial window, the effusion continued into the left pleural.
The perforation of cardiac cavities after an evacuatorythoracocentesis is a described but unusual complication that requires surgical removal.
Our patient survived a pericardiocentesis, several evacuatorythoracocentesis and two cardiac surgeries, all after a percutaneous closure of the left appendage.
Conclusion
Any invasive procedure presents a risk of iatrogenic complication, especially in elderly patients with comorbidities. We must be alert and start a treatment as soon as possible to solve the problem.
Abstract P1340 Figure. Chest-CT_EECHO2019
Pericardial window used in the diagnosis of cardiac injury
