Pericardiocentesis in children: 20-year experience at a tertiary children’s hospital

2021 ◽  
pp. 1-6
Author(s):  
Christopher Herron ◽  
Thomas J. Forbes ◽  
Daisuke Kobayashi
Keyword(s):  
Pericardial Effusion ◽  
Adverse Events ◽  
Pericardial Fluid ◽  
Anesthesia Induction ◽  
Life Saving ◽  
Common Etiology ◽  
Procedural Success ◽  
Catheterisation Laboratory ◽  
Excessive Accumulation

Abstract Background: Pericardiocentesis is the invasive percutaneous procedure for acute and chronic excessive accumulation of pericardial fluid. There is a paucity of data on the effectiveness and safety of pericardiocentesis in children. Objectives: To evaluate the effectiveness and safety of pericardiocentesis and factors associated with acute procedural failure and adverse events. Methods: This was a single-centered retrospective study to describe all the children aged ≤20 years who underwent pericardiocentesis. Data on demographics, etiologies of pericardial effusion, and repeat intervention at follow-up were collected. Results: A total of 127 patients underwent 153 pericardiocentesis. The median age was 6.5 years (1 day–20 years) with weight of 17 kg (0.5–125). Most common etiology was post-pericardiotomy syndrome (n = 56, 44%), followed by infectious (12%), malignant (10%), and iatrogenic (9%). Pericardiocentesis was performed more commonly in the catheterisation laboratory (n = 86, 59%). Concurrent pericardial drain placement was performed in 67 patients (53%). Acute procedural success was 92% (141/153). Repeat intervention was performed in 33 patients (22%). The incidence of adverse events was 4.6% (7/153): hemopericardium requiring emergent surgery (n = 2); hemopericardium with hypotension (n = 2); seizure with anesthesia induction (n = 1); and right ventricle puncture with needle (n = 2). Pericardiocentesis at the bedside had a higher rate of acute procedural failure than that in the catheterisation lab (17 versus 1%, p < 0.01). No identifiable risk factors were associated with adverse events. Conclusions: Pericardiocentesis was life-saving in children with its high effectiveness and safety even in urgent situations. Although initial pericardiocentesis was effective, one of five patients required re-intervention for recurrent pericardial effusion.

scholarly journals Alteplase for Massive Pulmonary Embolism after Complicated Pericardiocentesis

2019 ◽  
Author(s):  
Ricardo Cleto Marinho ◽  
José Luis Martins ◽  
Susana Costa ◽  
Rui Baptista ◽  
Lino Gonçalves ◽  
...  
Keyword(s):  
Pulmonary Embolism ◽  
High Risk ◽  
Pericardial Effusion ◽  
Thrombolytic Therapy ◽  
Cardiac Tamponade ◽  
Massive Pulmonary Embolism ◽  
Extensive Study ◽  
Life Saving ◽  
Obstructive Shock

Background: The occurrence of a high-risk pulmonary embolism (PE) within 48 hours of a complicated pericardiocentesis to remove a haemorrhagic pericardial effusion, is an uncommon clinical challenge. Case summary: The authors report the case of a 75-year-old woman who presented with signs of imminent cardiac tamponade due to recurring idiopathic pericardial effusion. The patient underwent pericardiocentesis that was complicated by the loss of 1.5 litres of blood. Within 48 hours, the patient had collapsed with clear signs of obstructive shock. This was a life-threating situation so alteplase was administered after cardiac tamponade and hypertensive pneumothorax had been excluded. CT chest angiography later confirmed bilateral PE. The patient achieved haemodynamic stability less than an hour after receiving the alteplase. However, due to the high risk of bleeding, the medical team suspended the thrombolysis protocol and switched to unfractionated heparin within the hour. The cause of the PE was not identified despite extensive study, but after 1 year of follow-up the patient remained asymptomatic. Discussion: Despite the presence of a contraindication, the use of thrombolytic therapy in obstructive shock after exclusion of hypertensive pneumothorax can be life-saving, and low-dose thrombolytic therapy may be a valid option in such cases.

scholarly journals The long-term efficacy and safety of combining ablation and left atrial appendage closure: A systematic review and meta-analysis

2021 ◽  
Author(s):  
Feng Li ◽  
Jin-Yu Sun ◽  
Li-Da Wu ◽  
Jian-feng Hao ◽  
Ru-Xing Wang
Keyword(s):  
Pericardial Effusion ◽  
Adverse Events ◽  
Meta Analysis ◽  
Efficacy And Safety ◽  
Bleeding Events ◽  
Combined Procedure ◽  
Term Efficacy ◽  
Device Embolization

Backgroud The long-term outcomes of this combined procedure remain elusive. This meta-analysis aimed to assess the long-term efficacy and safety of combined procedure. Methods PubMed, Embase, Cochrane Library, and Web of Science were systematically searched from the establishment of databases to 1 January 2021. Studies on the long-term (defined as a mean follow-up of approximately 12 months or longer) efficacy and safety outcomes of combined ablation and LAAC were included for meta-analysis. Results A total of 16 studies comprising 1,428 patients were included in the meta-analysis. The pooled long term freedom rate from atrial arrhythmia was 0.66 (95% confidence interval [CI], 0.59-0.71), long-term successful rate sealing of LAAC was 1.00 (95% CI, 1.00-1.00), and ischemic stroke/transient ischemic attack/systemic embolism during follow-up was 0.01 (95% CI, 0.00-0.02). Meanwhile, the rates of peri-procedural adverse events included phrenic nerve palsy, intracoronary air embolus, device embolization, peri-procedural death of 0.00 (95% CI, 0.00-0.00), procedure-related bleeding events of 0.03 (95% CI, 0.02-0.04), and pericardial effusion requiring or not requiring intervention of 0.00 (95% CI, 0.00-0.01). Moreover, the rates of long-term adverse events rate included device dislocation, intracranial bleeding, and pericardial effusion requiring or not requiring intervention, and all-cause mortality of 0.00 (95% CI, 0.00-0.00), device embolization of 0.01 (95% CI, 0.00-0.01), and other bleeding events of 0.01 (95% CI, 0.00-0.03). Conclusion This meta-analysis suggests that the strategy of combined atrial ablation and LAAC is effective and safe during long-term follow-up

An Unusual Presentation of Tuberculous Pericardial Effusion

2009 ◽  
Vol 1 (3) ◽  
pp. 71-72
Author(s):  
Shaheen LNU ◽  
Rajyashri Sharma ◽  
Parvez Anjum ◽  
Pathak Jayshree
Keyword(s):  
Pericardial Effusion ◽  
Cardiac Tamponade ◽  
Pericardial Fluid ◽  
Accurate Diagnosis ◽  
Unusual Presentation ◽  
Severe Bleeding ◽  
Acute Pericarditis ◽  
Prompt Treatment ◽  
Antitubercular Treatment ◽  
Life Saving

ABSTRACT Tuberculosis accounts for upto 4% of acute pericarditis and 7% cases of cardiac tamponade. 19% of women with tuberculosis can present with menorrhagia. Prompt treatment can be life saving but requires accurate diagnosis. We report a case of 25-year-old women who presented with severe bleeding per vaginum for four days. She was in shock. Echocardiography showed moderate pericardial effusion with features of cardiac tamponade. ADA was positive in aspirated pericardial fluid. The patient responded well to antitubercular treatment.

PP443 Effectiveness And Safety Of Transcatheter Therapy Interventions Devices For Treatment Of Tricuspid Regurgitation

2020 ◽  
Vol 36 (S1) ◽  
pp. 35-36
Author(s):  
Esther Elena Garcia_Carpintero ◽  
Jordi Gol Freixa ◽  
Luis María Sánchez Gómez
Keyword(s):  
Quality Of Life ◽  
Heart Failure ◽  
Adverse Events ◽  
Mortality Rates ◽  
Transcatheter Therapy ◽  
Procedural Success ◽  
Therapy Interventions ◽  
The Right

IntroductionTricuspid regurgitation (TR) is defined as incompetence of the tricuspid valve (TV), which produces the movement of blood flow from the right ventricle (RV) to the right atrium during systole. Pathological TR is functional in nearly 80–90 percent of cases, secondary to volume and/or pressure overload in the RV. Surgical intervention of TR is associated with mortality rates of 10 percent. Transcatheter therapy interventions (TTI) can be an alternative for severe TR. The aim of this study is to assess effectiveness and safety of TTI.MethodsA systematic review was carried out. The scientific literature search was performed in major medical databases. Studies analyzing the efficacy and safety of the devices were included. Outcomes related with mortality rates, TR volume reduction, echocardiographic findings and adverse events were analyzed. The methodological quality of the studies was analyzed with the Canadian Institute of Health Economics Quality Appraisal Checklist.ResultsNine studies comprising 557 patients were included (two first-in-human studies, one retrospective, five single arm prospective studies and one international registry). The studies were small with short follow up. The outcome of procedural success ranged from 80 to 100 percent. Mortality rates at 30 days were lower than 5 percent. Improvements in reduction of TR, European System for Cardiac Operative Risk Evaluation (EuroSCORE), heart failure symptoms or quality of life scores were observed in all studies.ConclusionsTTI for moderate-severe TR show significant reduction of annulus dimension, improvements in heart failure symptoms and quality of life, which are maintained in mid-term follow up. TTI present lower rates of major serious adverse events. No differences were observed between different TTI devices in terms of procedural success, mortality or safety. Randomized studies comparing TTI with optimal medical therapy are needed to confirm the preliminary clinical impact in patients with severe TR, and define aspects such as patient selection, risk factors associated with procedural success or mortality rates.

scholarly journals Outcome of significant pericardial effusion of infectious etiology in children: An observational retrospective cohort study

2021 ◽  
Author(s):  
Dinesh Kumar ◽  
Dheeraj Deo Bhatt ◽  
Ankit Verma ◽  
Ayub Ansari ◽  
Vijay Grover
Keyword(s):  
Pericardial Effusion ◽  
Tertiary Care ◽  
Treatment Protocol ◽  
Current Treatment ◽  
Pericardial Fluid ◽  
Care Hospital ◽  
Northern India ◽  
Pericardial Diseases ◽  
Infectious Etiology

Abstract Background: Information on outcome of paediatric pericardial diseases from India is limited. Aim: To study the outcome of significant pericardial effusion of infectious etiology in children.Setting and Design: Retrospective analysis of significant pericardial effusion of infectious aetiology in children admitted to a tertiary care hospital of northern India during the last 10 yearsResults: Of the 74 patients, 71.6% (53/74) had tuberculosis, most being “probable” tubercular effusion. Pyogenic cases (17/74) usually had a pleura-pulmonary focus. Pericardial fluid adenosine deaminase and CT chest were useful diagnostic aids in tubercular effusions. Pericardiocentesis and surgery were done in 72.9 % (54/74) and 12.1% (9/74) respectively. On median follow up of 18 months, death or chronic constrictive pericarditis was seen in 2 patients each, both had tubercular effusions. Conclusions: Tuberculosis is still the commonest infectious cause of pericardial effusion in children from this part of the world. Current treatment protocol has improved the outcome of this once deadly disease.

scholarly journals Outcomes evaluated in controlled clinical trials on the management of COVID-19: A methodological systematic review

2020 ◽  
Author(s):  
Alexander G. Mathioudakis ◽  
Markus Fally ◽  
Rola Hashad ◽  
Ahmed Kouta ◽  
Ali Sina Hadi ◽  
...  
Keyword(s):  
Systematic Review ◽  
Adverse Events ◽  
Outcome Measurement ◽  
Treatment Success ◽  
Community Setting ◽  
Significant Heterogeneity ◽  
Measurement Instruments ◽  
Life Saving

AbstractIt is crucial that randomized controlled trials (RCTs) on the management of coronavirus disease 2019 (COVID-19) evaluate the outcomes that are critical to patients and clinicians, to facilitate relevance, interpretability, and comparability.This methodological systematic review describes the outcomes evaluated in 415 RCTs on the management of COVID-19, that were registered with ClinicalTrials.gov, by 5/5/2020.Significant heterogeneity was observed in the selection of outcomes and the instruments used to measure them. Mortality, adverse events and treatment success or failure are only evaluated in 64.4%, 48.4% and 43% of the included studies, respectively, while other outcomes are selected less often. Studies focusing on more severe presentations (hospitalized patients or requiring intensive care) most frequently evaluate mortality and adverse events, while hospital admission and viral detection/load are most frequently assessed in the community setting. Outcome measurement instruments are poorly reported and heterogeneous. In general, simple instruments that can control for important sources of bias are favoured. Follow-up does not exceed one month in 64.3% of these earlier trials, and long-term COVID-19 burden is rarely assessed.The methodological issues identified could delay the introduction of potentially life-saving treatments in clinical practice. Our findings demonstrate the need for consensus in the design of RCTs.Take home message@ERSpublications: This systematic review describes the heterogeneity in outcomes evaluated in 415 RCTs on COVID-19 management and the instruments used to measure them. Our findings reveal a need for consensus in the design of future RCTs.

Non hemorrhagic pericardial effusion from ibrutinib İn a patient without comorbidities

2022 ◽  
pp. 107815522110738
Author(s):  
Burcu Aslan Candır ◽  
Tuğçe Nur Yiğenoğlu ◽  
Merih Kızıl Çakar ◽  
Mehmet Sinan Dal ◽  
Fevzi Altuntaş
Keyword(s):  
Pericardial Effusion ◽  
Adverse Events ◽  
Cardiac Arrhythmias ◽  
Pericardial Tamponade ◽  
Lymphocytic Leukemia ◽  
Shortness Of Breath ◽  
Probability Scale ◽  
Serious Adverse Events ◽  
Flow Cytometric

Introduction The most common kind of leukemia in adults is chronic lymphocytic leukemia (CLL). CLL is treated with ibrutinib. During the course of ibrutinib therapy, bleeding and cardiac arrhythmias may occur. Non-hemorrhagic adverse events are extremely infrequent in individuals using ibrutinib. Case report A 64 year-old man was diagnosed with CLL in June 2016. He was treated with 6 courses of FCR, he stayed in remission for 3 years and then relapsed. He achieved partial remission after two months of therapy with ibrutinib. The patient was admitted to the hospital with fever and shortness of breath. Pericardial tamponade and effusion was diagnosed during his evaluation. Management & outcome Non-hemorrhagic exudative effusion was drained by pericardiocentesis and a pericardial catheter was inserted to drain pericardial effusion. In all pleural and pericardial effusion samples, pathological and flow cytometric examination revealed no atypical malignant cells for malignancy, including CLL. Infections, both bacterial and viral, were also undetectable in the samples, as were rheumatological markers of collagen vascular disease. Ibrutinib therapy was discontinued. The pericardial effusion and tamponade were linked to ibrutinib treatment after evaluating the adverse drug reaction probability scale with a total score of 6. Colchicine was administered to reduce the pericardial effusion. The catheter was removed; pericardial effusion did not reoccur during follow up visits. Discussion Serious adverse events of ibrutinib are seen when treating CLL patients. This group of individuals should be closely monitored for potentially serious complications such as pericardial effusion and cardiac tamponade.

The Diagnostic Value of Pericardial Fluid and Pericardial Biopsy: Single Center Experiences

2016 ◽  
Vol 19 (1) ◽  
pp. 023 ◽  
Author(s):  
Mehmet Yildirim ◽  
Recep Ustaalioglu ◽  
Murat Erkan ◽  
Bala Basak Oven Ustaalioglu ◽  
Hatice Demirbag ◽  
...  
Keyword(s):  
Pericardial Effusion ◽  
Thoracoscopic Surgery ◽  
Pericardial Tamponade ◽  
Pericardial Fluid ◽  
Pathological Examination ◽  
Common Disease ◽  
Pericardial Window ◽  
Surgical Interventions ◽  
History Of ◽  
Recurrent Pericardial Effusion

<strong>Background:</strong> 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. <br /><strong>Methods:</strong> 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. <br /><strong>Results:</strong> 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. <br /><strong>Conclusion:</strong> 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.

Hybrid Endovascular Repair of Thoracoabdominal Aorta: Early Results

2014 ◽  
Vol 17 (3) ◽  
pp. 146
Author(s):  
Osman Tansel Darcin ◽  
Mehmet Kalender ◽  
Ayse Gul Kunt ◽  
Okay Guven Karaca ◽  
Ata Niyazi Ecevit ◽  
...  
Keyword(s):  
Endovascular Repair ◽  
Therapeutic Option ◽  
Complete Recovery ◽  
Aortic Aneurysms ◽  
Thoracoabdominal Aorta ◽  
Mortality And Morbidity ◽  
Early Results ◽  
The Mean ◽  
Procedural Success

<p><b>Background:</b> Thoracoabdominal aortic aneurysms (TAAA) present a significant clinical challenge, as they are complex and require invasive surgery. In an attempt to prevent considerably high mortality and morbidity in open repair, hybrid endovascular repair has been developed by many authors. In this study, we evaluated the early-term results obtained from this procedure.</p><p><b>Methods:</b> From November 2010 to February 2013, we performed thoracoabdominal hybrid aortic repair in 18 patients. The mean age was 68 years (12 men, 6 women). All of the patients had significant comorbidities. Follow-up computed tomography (CT) scans were performed at 1 week, 3 months, 6 months, and annually thereafter.</p><p><b>Results:</b> All patients were operated on in a staged procedure and stent graft deployment was achieved. Procedural success was achieved in all cases. All patients were discharged with complete recovery. No endoleaks weres detected in further CT examination.</p><p><b>Conclusion:</b> Our results suggests that hybrid debranching and endovascular repair of extensive thoracoabdominal aneurysms represents a suitable therapeutic option to reduce the morbidity and mortality of TAAA repair, particularly in those typically considered at high risk for standard repair.</p>

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