scholarly journals Surgical Management of Massive Pericardial Effusion and Predictors for Development of Constrictive Pericarditis in a Resource Limited Setting

2016 ◽  
Vol 2016 ◽  
pp. 1-5 ◽  
Author(s):  
Emeka B. Kesieme ◽  
Peter O. Okokhere ◽  
Christopher Ojemiega Iruolagbe ◽  
Angela Odike ◽  
Clifford Owobu ◽  
...  
Keyword(s):  
Pericardial Effusion ◽  
Cardiac Tamponade ◽  
Constrictive Pericarditis ◽  
Postoperative Recurrence ◽  
University Hospital ◽  
Average Volume ◽  
Resource Limited ◽  
The Relationship ◽  
Limited Setting

Background. The diagnosis and treatment of massive pericardial effusion and cardiac tamponade have evolved over the years with a tendency towards a more comprehensive diagnostic workup and less traumatic intervention.Method. We reviewed and analysed the data of 32 consecutive patients who underwent surgery on account of massive pericardial effusion and cardiac tamponade in a semiurban university hospital in Nigeria from February 2010 to February 2016.Results. The majority of patients (34.4%) were between 31 and 40 years. Fourteen patients (43.8%) presented with clinical and echocardiographic feature of cardiac tamponade. The majority of patients (59.4%) presented with haemorrhagic pericardial effusion and the average volume of fluid drained intraoperatively was 846 mL  ± 67 mL. Pericardium was thickened in 50% of cases. Subxiphoid pericardiostomy was performed under local anaesthesia in 28 cases. No postoperative recurrence was observed; however 5 patients developed features of constrictive pericarditis. The relationship between pericardial thickness and development of pericardial constriction was statistically significant (p=0.004).Conclusion. Subxiphoid pericardiostomy is a very effective way of treating massive pericardial effusion. Removing tube after adequate drainage (50 mL/day) and treatment of primary pathology are key to preventing recurrence. There is also a need to follow up patients to detect pericardial constriction especially those with thickened pericardium.

scholarly journals US Database Study of Clinical Burden and Unmet Need in Recurrent Pericarditis

2021 ◽  
Author(s):  
Allan Klein ◽  
Paul Cremer ◽  
Apostolos Kontzias ◽  
Muhammad Furqan ◽  
Ryan Tubman ◽  
...  
Keyword(s):  
Pericardial Effusion ◽  
Cardiac Tamponade ◽  
Treatment Response ◽  
Constrictive Pericarditis ◽  
Unmet Need ◽  
Recurrent Pericarditis ◽  
Pericardial Window ◽  
Clinical Burden ◽  
Large Pericardial Effusion ◽  
Multiple Recurrences

Background Patients with recurrent pericarditis (RP) may develop complications, multiple recurrences, or inadequate treatment response. This study aimed to characterize disease burden and unmet needs in RP. Methods and Results This retrospective US database analysis included newly diagnosed patients with RP with ≥24 months of continuous history following their first pericarditis episode. RP was defined as ≥2 pericarditis episodes ≥28 days apart. Some patients had ≥2 recurrences, while others had a single recurrence with a serious complication, ie, constrictive pericarditis, cardiac tamponade, or a large pericardial effusion with pericardiocentesis/pericardial window. Among these patients with multiple recurrences and/or complications, some had features relating to treatment history, including long‐term corticosteroid use (corticosteroids started within 30 days of flare, continuing ≥90 consecutive days) or inadequate treatment response (pericarditis recurring despite corticosteroids and/or colchicine, or other drugs [excluding NSAIDs] within 30 days of flare, or prior pericardiectomy). Patients (N=2096) had hypertension (60%), cardiomegaly (9%), congestive heart failure (17%), atrial fibrillation (16%), autoimmune diseases (18%), diabetes mellitus (21%), renal disease (20%), anxiety (21%), and depression (14%). Complications included pericardial effusion (50%), cardiac tamponade (9%), and constrictive pericarditis (4%). Pharmacotherapy included colchicine (51%), NSAIDs (40%), and corticosteroids (30%), often in combination. This study estimates 37 000 US patients with RP; incidence was 6.0/100 000/year (95% CI, 5.6‒6.3), and prevalence was 11.2/100 000 (95% CI, 10.6‒11.7). Conclusions Patients with RP may have multiple recurrences and/or complications, often because of inadequate treatment response and persistent underlying disease. Corticosteroid use is frequent despite known side‐effect risks, potentially exacerbated by prevalent comorbidities. Substantial clinical burden and lack of effective treatments underscore the high unmet need.

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 Clinical Prognosis of Pericardial Effusion in COVID 19

2021 ◽  
Author(s):  
İbrahim Saraç ◽  
Gökhan Tonkaz ◽  
Emrah Aksakal ◽  
Faruk Aydınyılmaz ◽  
Kaan Alişar ◽  
...  
Keyword(s):  
Intensive Care ◽  
Mortality Rate ◽  
Pericardial Effusion ◽  
Hospital Mortality ◽  
Elevated Serum ◽  
Clinical Prognosis ◽  
Pneumonia Severity ◽  
Polymerase Chain ◽  
The Relationship

Abstract Purpose In our study, we investigated the relationship between pneumonia severity and pericardial effusion, predisposing factors and the effect of pericardial effusion on clinical prognosis and mortality in COVID-19 patients. Methods A total of 3794 patients who were diagnosed with COVID- 19 by polymerase chain reaction (PCR), were hospitalized between March 21 and November 30, 2020 were included in the study. For each of the 3794 patients, the initial chest CT images, pericardial efusion (PE), pleural efusion and pneumonia severity were evaluated. Results The mean age of patients with PE was higher and it was more common in males. Patients with PE had more comorbid diseases and significantly elevated serum cardiac and inflammatory biomarkers. In addition, the need for intensive care and mortality rates were higher in these patients. While the in-hospital mortality rate was 56.9% in patients with PE and AC involvement above 50%, in-hospital mortality rate was 34.4% in patients with AC involvement above 50% and without PE (p < 0.001). Conclusions In patients presenting with severe AC involvement on CT or being followed up with COVID-19 pneumonia, PE often accompanies the deterioration in the laboratories and clinics of the patients. The clinical prognosis in patients presenting with PE was quite poor, and the frequency of intensive care admissions and mortality were significantly higher. In conclusion, in our study, PE emerged as an important finding in the follow-up and management of patients with COVID-19 and reflects the clinical prognosis.

Purulent Pericarditis Due to Paronychia in a 16-Month-Old Child: A Nail-Biting Story

2018 ◽  
Vol 11 (4) ◽  
pp. NP125-NP128
Author(s):  
Neha Bansal ◽  
Henry L. Walters ◽  
Daisuke Kobayashi
Keyword(s):  
Infectious Disease ◽  
Staphylococcus Aureus ◽  
Cardiac Tamponade ◽  
Constrictive Pericarditis ◽  
Median Sternotomy ◽  
Purulent Pericarditis ◽  
Surgical Interventions ◽  
Nail Biting ◽  
Significant Mortality

Purulent pericarditis is a rare infectious disease with significant mortality, even in the modern antibiotic era. The presenting signs can often be subtle and patients can deteriorate rapidly with cardiac tamponade. We report a previously healthy 16-month-old female who developed purulent pericarditis associated with paronychia and sepsis caused by methicillin-sensitive Staphylococcus aureus. In addition to antibiotic treatment, she required emergent pericardiocentesis for cardiac tamponade, followed by two surgical interventions including full median sternotomy incision and partial pericardiectomy. At 4-month follow-up, she did well with no evidence of constrictive pericarditis on echocardiogram.

scholarly journals 502 Secondary cardiac lymphoma complicated with tamponade

2020 ◽  
Vol 21 (Supplement_1) ◽  
Author(s):  
P H Lee
Keyword(s):  
Pericardial Effusion ◽  
Malignant Lymphoma ◽  
Cardiac Tamponade ◽  
Complete Resolution ◽  
Sinus Tachycardia ◽  
Left Ventricular ◽  
Pulmonary Congestion ◽  
Shortness Of Breath ◽  
Pericardial Mass

Abstract Introduction A 72-year-old lady presented with one-week history of palpitation and shortness of breath. She had pyrexia of unknown origin for 4 weeks associated with weight loss. Initial clinical examination revealed sinus tachycardia of 110 beats/min and saturations of 96% on 2L/min oxygen. Neck exam revealed a 2 x 3 cm firm mass at left supraclavicular fossa. Electrocardiogram showed sinus tachycardia at 106 beats/min. There was fixed T wave inversions over anterolateral chest leads and inferior limb leads. Chest radiograph showed enlarged cardiac silhouette and evidence of pulmonary congestion Procedure Transthoracic echocardiogram revealed a moderate pericardial effusion with an 8 x 4 cm pericardial mass compressing at the right atrioventricular groove (Figure B & C). Respiratory variation of Doppler mitral and tricuspid inflow velocities suggested cardiac tamponade (Figure A). Inferior vena cava was engorged with impaired inspiratory collapse. Left ventricular size and function were otherwise normal. Urgent pericardiocentesis was performed which yielded 1 litre of light blood stained fluid. Her had subjective improvement of symptoms. There was also resolution of sinus tachycardia and pulmonary congestion. PET/CT scan showed multiple enlarged hypermetabolic lymph nodes in multiple regions above and below the diaphragm, worrisome for malignant lymphoma. Cytological assessment of pericardial fluid showed scattered large lymphoid cells which are immunoreactive to B cell marker CD 20 (Figure E & F). Bone marrow exam showed normal marrow. First cycle of R-CEOP and intrathecal methotrexate was given. Follow-up echocardiogram in one week after chemotherapy showed complete resolution of pericardial effusion. Prior pericardial mass also showed marked reduction in size (Figure D). No tamponade physiology was present. She tolerated the chemotherapy well with complete resolution of palpitation and shortness of breath. She was discharged from hospital with outpatient follow up and continuation of chemotherapy course. Discussion Cardiac tumors are rare and secondary tumors remain the most common etiology. Most of these metastatic tumors arise from solid organs such as lung, breast, kidney, melanoma as well as lymphoma. Echocardiography is a valuable tool both in diagnosis and assessment of hemodynamic significance of cardiac masses. It also aids in diagnosis of associated condition such as pericardial effusion. In this case, the cardiac tamponade is both contributed by mechanical compression of cardiac mass coupled with moderate pericardial effusion. Successful pericardiocentesis achieved temporary normalization of tamponade physiology and aided in early histological diagnosis of malignant lymphoma with pericardial metastasis. Timely initiation of intensive systemic chemotherapy was the key to rapid tumor size reduction, complete resolution of tamponade physiology and control of recurrent pericardial effusion. Abstract 502 Figure. Echo & histology

scholarly journals Mediastinal Pseudocyst and Cardiac Tamponade Due to Massive Pericardial Effusion in Pediatric Chronic Calcific Pancreatitis

2016 ◽  
Vol 06 (03) ◽  
pp. 194-198 ◽  
Author(s):  
Suprit Basu ◽  
Mala Bhatacharya ◽  
Bidyut Debnath ◽  
Sandip Sen ◽  
Anish Chatterjee ◽  
...  
Keyword(s):  
Pericardial Effusion ◽  
Cardiac Tamponade ◽  
Pancreatic Enzyme ◽  
Recurrent Abdominal Pain ◽  
Chronic Calcific Pancreatitis ◽  
Contrast Enhanced ◽  
History Of ◽  
Posterior Mediastinal ◽  
Enhanced Computed Tomography

AbstractA 7-year-old male patient with a history of recurrent abdominal pain over 1 year presented with cardiac tamponade due to massive pericardial effusion, which was percutaneously drained. Contrast-enhanced computed tomography revealed a large posterior mediastinal cyst and calcified, heterogeneous pancreatic parenchyma. Elevated amylase and lipase levels of the cyst fluid confirmed the diagnosis of pancreatic pseudocyst, which was treated with an octreotide infusion and Roux-en-Y cystojejunostomy. The child was discharged on pancreatic enzyme supplement and was asymptomatic on follow-up.

scholarly journals A case report: delayed right ventricular pericardial fistula and aneurysm following penetrating traumatic injury—a controversial aetiology

2020 ◽  
Vol 4 (4) ◽  
pp. 1-5
Author(s):  
Martina Steinmaurer ◽  
Blanche Cupido ◽  
Matthew Hannington ◽  
Rodgers Manganyi
Keyword(s):  
Pericardial Effusion ◽  
Right Ventricular ◽  
Cardiac Tamponade ◽  
Traumatic Injury ◽  
Clinical Signs ◽  
The Body ◽  
Delayed Presentation ◽  
True Aneurysm ◽  
History Of

Abstract Background Right ventricular aneurysms (RVAs) are rare. We present a case with a combined RVA and right ventricular pericardial fistula resulting in a pericardial effusion and cardiac tamponade. The RVA was detected 47 days after the patient suffered a gunshot wound. This report adds to the body of scarce literature on RVA aetiology, diagnoses, and treatment. Case summary A 30-year-old male patient presented with worsening respiratory distress over a 7-day period with clinical signs of cardiac tamponade following a history of a gunshot (with associated liver laceration, pulmonary embolism, right nephrectomy, and sepsis) 47 days prior. Transthoracic echocardiography showed a large circumferential pericardial effusion and an RVA. The patient was emergently taken for surgical repair of the RVA. Discussion Our case presents a delayed presentation of a gunshot heart and an aetiology with indications of and against a true aneurysm. It brings attention to possible complications of penetrating precordial injuries, with the need for consideration and possible evaluation at follow-up. The literature on the operative excision of RVA is reviewed and various aetiological factors and consequences are discussed.

scholarly journals Assessment of short-term outcome with TiO2 mesh in laparoscopic repair of large paraesophageal hiatal hernias

BMC Surgery ◽  
2019 ◽  
Vol 19 (1) ◽  
Author(s):  
Islam Khaled ◽  
Pablo Priego ◽  
Mohammed Faisal ◽  
Marta Cuadrado ◽  
Francisca García-Moreno ◽  
...  
Keyword(s):  
Hiatal Hernia ◽  
Laparoscopic Repair ◽  
Postoperative Recurrence ◽  
University Hospital ◽  
Suture Repair ◽  
Short Term ◽  
Recurrence Rates ◽  
Term Outcome ◽  
Clinical Recurrence

Abstract Background Laparoscopic large para-oesophageal hiatal hernia (LPHH) repair using mesh reinforcement significantly reduces postoperative recurrence rates compared to conventional suture repair, especially within short follow-up times. However, the ideal strategy for repairing LPHH remains disputable because no clear guidelines are given regarding indications, mesh type, shape or position. The aim of this study was to survey our short-term results of LPHH management with a biosynthetic monofilament polypropylene mesh coated with titanium dioxide to enhance biocompatibility (TiO2Mesh™). Methods A retrospective study was performed at Ramon y Cajal University Hospital, Spain from December 2014 to October 2018. Data were collected on 27 consecutive patients with extensive hiatal hernia defects greater than 5 cm for which a laparoscopic repair was performed by primary suture and additional reinforcement with a TiO2Mesh™. Study outcomes were investigated, including clinical and radiological recurrences, dysphagia and mesh-related drawbacks. Results Twenty-seven patients were included in our analysis; 10 patients were male, and 17 were female. The mean age was 73 years (range, 63–79 years). All operations were performed laparoscopically. The median postoperative hospital stay was 3 days. After a mean follow-up of 18 months (range, 8-29 months), only 3 patients developed clinical recurrence of reflux symptoms (11%), and 2 had radiological recurrences (7%). No mesh-related complications occurred. Conclusions TiO2Mesh™ was found to be safe for laparoscopic repair of LPHH with a fairly low recurrence rate in this short-term study. Long-term studies conducted over a period of years with large sample sizes will be essential for confirming whether this mesh is suitable as a standard method of care with few drawbacks.

scholarly journals Preoperative AICS (lung) abnormalities predict postoperative recurrence in patients undergoing curative resection for non-small cell lung cancer

2020 ◽  
Author(s):  
Masahiko Higashiyama ◽  
Ryohei Miyazaki ◽  
Hiroshi Yamamoto ◽  
Takashi Anayama ◽  
Shinya Kikuchi ◽  
...  
Keyword(s):  
Lung Cancer ◽  
Multivariate Analysis ◽  
Curative Resection ◽  
Postoperative Recurrence ◽  
Small Cell ◽  
Clinicopathological Factors ◽  
Small Cell Lung ◽  
Lung Abnormalities ◽  
The Relationship

Abstract [Background] AminoIndexTM Cancer Screening (AICS (lung)) was developed as a screening test for lung cancer using a multivariate analysis of plasma-free amino acid (PFAA) profiles. According to the developed index composed of PFAA, the probability of lung cancer was categorized into AICS (lung) ranks A, B, and C in order of increasing risk. The aim of the present study was to investigate the relationship between the preoperative AICS (lung) rank and surgical outcomes in patients who underwent curative resection for non-small cell lung cancer (NSCLC).[Methods] Preoperative blood samples were collected from 297 patients who underwent curative resection for NSCLC between 2006 and 2015. PFAA concentrations were measured. The relationship between the preoperative AICS (lung) rank and clinicopathological factors was examined. The effects of the preoperative AICS (lung) rank on postoperative outcomes were also analyzed.[Results] The AICS (lung) rank was A in 93 patients (31.3%), B in 82 (27.6%), and C in 122 (41.1%). The AICS (lung) rank did not correlate with any clinicopathological factors, except for age. Based on follow-up data (median follow-up period of 6 years), postoperative recurrence was observed in 22 rank A patients (23.7%), 15 rank B (18.3%) and 49 rank C (40.2%). In the univariate analysis, preoperative AICS (lung) rank C was a worse factor of recurrence-free survival (p=0.0002). The multivariate analysis identified preoperative AICS (lung) rank C (HR: 2.17, p=0.0005) as a significant predictor of postoperative recurrence, particularly in patients with early-stage disease or adenocarcinoma. [Conclusion] Preoperative AICS (lung) abnormalities are a high-risk predictor of postoperative recurrence in NSCLC patients undergoing curative resection.

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