"BLEEDING MY HEART OUT": WARFARIN-RELATED HEMOPERICARDIUM REQUIRING REPEAT PERICARDIAL WINDOW

Background: Patients with recurrent pericardial effusion and pericardial tamponade are usually treated in thoracic surgery clinics by VATS (video-assisted thoracoscopic surgery) or open pericardial window operation. The diagnostic importance of pathological evaluation of the pericardial fluid and tissue in the same patients has been reported in few studies. We reviewed pathological examination of the pericardial tissue and fluid specimens and the effect on the clinical treatment in our clinic, and compared the results with the literature. Methods: We retrospectively analyzed 174 patients who underwent pericardial window operation due to pericardial tamponade or recurrent pericardial effusion. For all patients both the results of the pericardial fluid and pericardial biopsy specimen were evaluated. Clinicopathological factors were analyzed by using descriptive analysis. Results: Median age was 61 (range, 20-94 years). The most common benign diagnosis was chronic inflammation (94 patients) by pericardial biopsy. History of malignancy was present in 28 patients (16.1%) and the most common disease was lung cancer (14 patients). A total of 24 patients (13.8%) could be diagnosed as having malignancy by pericardial fluid or pericardial biopsy examination. The malignancy was recognized for 12 patients who had a history of cancer; 9 of 12 with pericardial biopsy, 7 diagnosed by pericardial fluid. Twelve of 156 patients were recognized as having underlying malignancy by pericardial biopsy (n = 9) or fluid examination (n = 10), without known malignancy previously. Conclusion: Recurrent pericardial effusion/pericardial tamponade are entities frequently diagnosed, and surgical interventions may be needed either for diagnosis and/or treatment, but specific etiology can rarely be obtained in spite of pathological examination of either pericardial tissue or fluid. For increasing the probability of a specific diagnosis both the pericardial fluid and the pericardial tissues have to be sent for pathologic examination.

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Pericardial effusion and cardiac tamponade requiring pericardial window in an otherwise healthy 30-year-old patient with COVID-19: a case report

Journal of Medical Case Reports ◽

10.1186/s13256-020-02467-w ◽

2020 ◽

Vol 14 (1) ◽

Author(s):

Christina Walker ◽

Vincent Peyko ◽

Charles Farrell ◽

Jeanine Awad-Spirtos ◽

Matthew Adamo ◽

...

Keyword(s):

Case Report ◽

Pericardial Effusion ◽

Cardiac Tamponade ◽

Case Reports ◽

Healthy Woman ◽

Signs And Symptoms ◽

Rare Presentation ◽

Pericardial Window ◽

Acute Pericarditis ◽

Novel Coronavirus

Abstract Background This case report demonstrates pericardial effusion, acute pericarditis, and cardiac tamponade in an otherwise healthy woman who had a positive test result for coronavirus disease 2019. Few case reports have been documented on patients with this presentation, and it is important to share novel presentations of the disease as they are discovered. Case presentation A Caucasian patient with coronavirus disease 2019 returned to the emergency department of our hospital 2 days after her initial visit with worsening chest pain and shortness of breath. Imaging revealed new pericardial effusion since the previous visit. The patient became hypotensive, was taken for pericardial window for cardiac tamponade with a drain placed, and was treated for acute pericarditis. Conclusion Much is still unknown about the implications of coronavirus disease 2019. With the novel coronavirus disease 2019 pandemic, research is still in process, and we are slowly learning about new signs and symptoms of the disease. This case report documents a lesser-known presentation of a patient with coronavirus disease 2019 and will help to further understanding of a rare presentation.

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Video-thoracoscopic pericardial window in the diagnosis and treatment of pericardial effusions

The American Journal of Cardiology ◽

10.1016/s0002-9149(98)00225-2 ◽

1998 ◽

Vol 82 (1) ◽

pp. 124-A9 ◽

Cited By ~ 15

Author(s):

Patrick Nataf ◽

P. Cacoub ◽

Mary Regan ◽

F. Baron ◽

Richard Dorent ◽

...

Keyword(s):

Diagnosis And Treatment ◽

Pericardial Window ◽

Pericardial Effusions

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Anesthesia for pericardial window in a pregnant patient with cardiac tamponade and mediastinal mass

Canadian Journal of Anesthesia/Journal canadien d anesthésie ◽

10.1007/bf03019378 ◽

2003 ◽

Vol 50 (8) ◽

pp. 815-818 ◽

Cited By ~ 16

Author(s):

J. Anne Webster ◽

D. Dean Self

Keyword(s):

Cardiac Tamponade ◽

Mediastinal Mass ◽

Pregnant Patient ◽

Pericardial Window

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Subxiphoid pericardial window in the diagnosis of penetrating cardiac trauma

The Annals of Thoracic Surgery ◽

10.1016/0003-4975(94)90473-1 ◽

1994 ◽

Vol 58 (4) ◽

pp. 1139-1141 ◽

Cited By ~ 32

Author(s):

Rafael Andrade-Alegre ◽

Luis Mon

Keyword(s):

Pericardial Window ◽

Cardiac Trauma ◽

Penetrating Cardiac Trauma ◽

Subxiphoid Pericardial Window

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Video-assisted transportal pericardial window

Catheterization and Cardiovascular Diagnosis ◽

10.1002/ccd.1810330318 ◽

1994 ◽

Vol 33 (3) ◽

pp. 277-280 ◽

Cited By ~ 1

Author(s):

Michael B. Selig ◽

Nercy Jafari ◽

Earl Sipes

Keyword(s):

Pericardial Window ◽

Video Assisted

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Video-Assisted Pericardial Fenestration for Effusions after Cardiac Surgery

Asian Cardiovascular and Thoracic Annals ◽

10.1177/0218492309348505 ◽

2009 ◽

Vol 17 (5) ◽

pp. 480-482 ◽

Cited By ~ 5

Author(s):

Georgios P Georghiou ◽

Eyal Porat ◽

Avi Fuks ◽

Bernardo A Vidne ◽

Milton Saute

Keyword(s):

Cardiac Surgery ◽

Pericardial Effusion ◽

Surgical Techniques ◽

Lung Ventilation ◽

Pericardial Window ◽

Invasive Approach ◽

Video Assisted ◽

Institutional Experience ◽

Pericardial Fenestration ◽

Thoracoscopic Technique

Delayed-onset pericardial effusion following cardiac surgery can give rise to significant morbidity due to its presentation as well as management by traditional surgical techniques. An institutional experience of a video-assisted thoracoscopic technique to create a pericardial window, with the advantages of a minimally invasive approach combined with excellent visualization in such patients, was reviewed. A retrospective analysis was conducted on all patients undergoing video-assisted thoracoscopic for delayed pericardial effusion after cardiac surgery from January 2001 to January 2006 at our center. Seven patients with echocardiographically diagnosed delayed tamponade underwent video-assisted thoracoscopy; 5 were receiving anticoagulants after valve replacement, and 2 had undergone heart transplantation. Pericardial windows were created under general anesthesia and single-lung ventilation using 2 to 3 trocars. Mean operative time was 45 min. There were no complications of the thoracoscopic technique. Video-assisted thoracoscopic creation of a pericardial window is safe and effective treatment for loculated pericardial effusions secondary to cardiac surgery.

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