TO DRAIN OR NOT TO DRAIN: A THERAPEUTIC CONUNDRUM IN A PATIENT WITH PERICARDIAL TAMPONADE AND EISENMENGER SYNDROME

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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Acute Aortic Intramural Hematoma Presenting with Painless Recurrent Syncope

The Heart Surgery Forum ◽

10.1532/hsf98.20121014 ◽

2012 ◽

Vol 15 (5) ◽

pp. 286

Author(s):

Jan Droste ◽

Heidar Zafarani Zadeh ◽

Mohammed Arif ◽

Ian Craig ◽

A K Thakur

Keyword(s):

Aortic Wall ◽

Surgical Intervention ◽

Intramural Hematoma ◽

Pericardial Tamponade ◽

Transthoracic Echocardiogram ◽

Type A Aortic Dissection ◽

Severe Hypotension ◽

Patient’S History ◽

Aortic Intramural Hematoma ◽

Venous Pulse

A patient presented with recurrent syncope due to transient severe hypotension. The patient's history, physical examination, and initial baseline investigation did not suggest a cardiovascular cause. After fluid resuscitation, a raised jugular venous pulse was noted. Bedside transthoracic echocardiogram showed a pericardial effusion and a proximally dilated aorta. Computed tomography of the thorax confirmed these findings and also demonstrated an intramural hematoma of the proximal aortic wall.The patient was transferred to a cardiothoracic center, where he was at first treated medically. He then developed sudden cardiogenic shock due to pericardial tamponade and was successfully operated on.It is important to recognize an acute intramural hematoma of the proximal aortic wall as a cardiothoracic emergency. This condition can present atypically, but nevertheless warrants urgent surgical intervention, equal to type A aortic dissection. Echocardiography can help in making the diagnosis.

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The Use of Posterior Pericardiotomy Technique to Prevent Postoperative Pericardial Effusion in Cardiac Surgery

The Heart Surgery Forum ◽

10.1532/hsf98.20111128 ◽

2012 ◽

Vol 15 (2) ◽

pp. 84 ◽

Cited By ~ 4

Author(s):

Canturk Cakalagaoglu ◽

Cengiz Koksal ◽

Ayse Baysal ◽

Gokhan Alici ◽

Birol Ozkan ◽

...

Keyword(s):

Cardiac Surgery ◽

Heart Surgery ◽

Artery Bypass ◽

Pericardial Tamponade ◽

Anxiety Level ◽

Control Group ◽

Echocardiographic Study ◽

Number Of Patients ◽

Hospital Stays

Aim: The goal was to determine the effectiveness of the posterior pericardiotomy technique in preventing the development of early and late pericardial effusions (PEs) and to determine the role of anxiety level for the detection of late pericardial tamponade (PT).Materials and Methods: We divided 100 patients randomly into 2 groups, the posterior pericardiotomy group (n = 50) and the control group (n = 50). All patients undergoing coronary artery bypass grafting surgery (CABG), valvular heart surgery, or combined valvular and CABG surgeries were included. The posterior pericardiotomy technique was performed in the first group of 50 patients. Evaluations completed preoperatively, postoperatively on day 1, before discharge, and on postoperative days 5 and 30 included electrocardiographic study, chest radiography, echocardiographic study, and evaluation of the patient's anxiety level. Postoperative causes of morbidity and durations of intensive care unit and hospital stays were recorded.Results: The 2 groups were not significantly different with respect to demographic and operative data (P > .05). Echocardiography evaluations revealed no significant differences between the groups preoperatively; however, before discharge the control group had a significantly higher number of patients with moderate, large, and very large PEs compared with the pericardiotomy group (P < .01). There were 6 cases of late PT in the control group, whereas there were none in the pericardiotomy group (P < .05). Before discharge and on postoperative day 15, the patients in the pericardiotomy group showed significant improvement in anxiety levels (P = .03 and .004, respectively). No differences in postoperative complications were observed between the 2 groups.Conclusion: Pericardiotomy is a simple, safe, and effective method for reducing the incidence of PE and late PT after cardiac surgery. It also has the potential to provide a better quality of life.

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Faculty Opinions recommendation of Improved survival among patients with Eisenmenger syndrome receiving advanced therapy for pulmonary arterial hypertension.

Faculty Opinions – Post-Publication Peer Review of the Biomedical Literature ◽

10.3410/f.2182959.2966059 ◽

2010 ◽

Author(s):

Larry Latson ◽

Athar Qureshi

Keyword(s):

Pulmonary Arterial Hypertension ◽

Arterial Hypertension ◽

Eisenmenger Syndrome ◽

Advanced Therapy ◽

Pulmonary Arterial

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Paradoxical intraoperative embolism in a patient with Eisenmenger syndrome undergoing hip arthroplasty

Revista Española de Anestesiología y Reanimación (English Edition) ◽

10.1016/j.redare.2019.03.011 ◽

2019 ◽

Vol 66 (8) ◽

pp. 439-442

Author(s):

J.L. Tomé Roca ◽

R. López Martín ◽

Y. Baca Morilla ◽

C. de la Linde Valverde

Keyword(s):

Hip Arthroplasty ◽

Eisenmenger Syndrome

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Heart and lung transplantation in pulmonary arterial hypertension related to congenital heart disease: an unusual indication

Journal of Congenital Cardiology ◽

10.1186/s40949-020-00047-7 ◽

2020 ◽

Vol 4 (S1) ◽

Author(s):

Rosaria Barracano ◽

Heba Nashat ◽

Andrew Constantine ◽

Konstantinos Dimopoulos

Keyword(s):

Pulmonary Hypertension ◽

Pulmonary Arterial Hypertension ◽

Arterial Hypertension ◽

Lung Transplantation ◽

Atrial Septal Defect ◽

Septal Defect ◽

Pulmonary Vascular Disease ◽

Eisenmenger Syndrome ◽

Pulmonary Arterial ◽

Recurrent Haemoptysis

Abstract Background Eisenmenger syndrome is a multisystem disorder, characterised by a significant cardiac defect, severe pulmonary hypertension and long-standing cyanosis. Despite the availability of pulmonary hypertension therapies and improved supportive care in specialist centres, Eisenmenger patients are still faced with significant morbidity and mortality. Case presentation We describe the case of a 44-year-old woman with Eisenmenger syndrome secondary to a large secundum atrial septal defect. Her pulmonary vascular disease was treated with pulmonary vasodilators, but she experienced a progressive decline in exercise tolerance, increasing atrial arrhythmias, resulting in referral for transplantation. Her condition was complicated by significant recurrent haemoptysis in the context of extremely dilated pulmonary arteries and in-situ thrombosis, which prompted successful heart and lung transplantation. She made a slow recovery but remains well 3 years post-transplant. Conclusions Patients with Eisenmenger syndrome secondary to a pre-tricuspid lesion, such as an atrial septal defect have a natural history that differs to patients with post-tricuspid shunts; the disease tends to present later in life but is more aggressive, prompting early and aggressive medical intervention with pulmonary arterial hypertension therapies. This case illustrates that severe recurrent haemoptysis can be an indication for expediting transplantation in Eisenmenger syndrome patients.

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A Rare Case of Adult Aortopulmonary Window Combined with Anomalous Origin of the Right Pulmonary Artery from the Aorta Leading to Eisenmenger Syndrome

Journal of International Medical Research ◽

10.1177/0300060520984656 ◽

2021 ◽

Vol 49 (1) ◽

pp. 030006052098465

Author(s):

Mingyue Cui ◽

Binfeng Xia ◽

Heru Wang ◽

Haihui Liu ◽

Xia Yin

Keyword(s):

Pulmonary Artery ◽

Rare Case ◽

Congenital Heart ◽

Respiratory Tract Infections ◽

Anomalous Origin ◽

Aortopulmonary Window ◽

Eisenmenger Syndrome ◽

Right Pulmonary Artery ◽

The Right ◽

Tract Infections

Aortopulmonary window is a rare congenital heart disease that can increase pulmonary vascular resistance, exacerbate left-to-right shunt and lead to heart failure and respiratory tract infections. Most patients die during childhood. We report a 53-year-old male patient with a large aortopulmonary window combined with anomalous origin of the right pulmonary artery from the aorta, with Eisenmenger syndrome and without surgery.

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Acute pericardial tamponade: The initial manifestation of systemic lupus erythematosus with Graves’ hyperthyroidism

Lupus ◽

10.1177/09612033211004729 ◽

2021 ◽

pp. 096120332110047

Author(s):

Muming Yu ◽

Yulei Gao ◽

Heng Jin ◽

Songtao Shou

Keyword(s):

Myocardial Infarction ◽

Systemic Lupus Erythematosus ◽

Female Patient ◽

Lupus Erythematosus ◽

Pericardial Tamponade ◽

Medical Emergency ◽

Systemic Lupus ◽

Initial Manifestation ◽

Life Threatening ◽

Obstructive Shock

Acute pericardial tamponade, which can cause obstructive shock, is a serious life-threatening medical emergency that can be readily reversed by timely identification and appropriate intervention. Acute pericardial tamponade can occur for a number of reasons, including idiopathic, malignancy, uremia, iatrogenic, post-myocardial infarction, infection, collagen vascular, hypothyroidism, and others. Systemic lupus erythematosus (SLE) and hyperthyroidism associated with pericardial tamponade are rarely reported. Here, we report the case of a 20-year-old female patient was final diagnosed of SLE with Graves’ hyperthyroidism.

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