scholarly journals Anterior parasternal approach for creation of a pericardial window

2015 ◽  
Vol 97 (5) ◽  
pp. 375-378 ◽  
Author(s):  
E Altman ◽  
O Rutsky ◽  
A Shturman ◽  
Y Yampolsky ◽  
S Atar
Keyword(s):  
Pericardial Effusion ◽  
Symptomatic Improvement ◽  
Obese Patients ◽  
Pericardial Window ◽  
Optimal Method ◽  
Large Pericardial Effusion ◽  
Novel Approach ◽  
Underlying Malignancy ◽  
Discharged Patients ◽  
The Mean

Introduction The optimal method for creation of a pericardial window (PW) is still controversial and it remains a surgical challenge, mainly in obese patients. The aim of this study was to evaluate the efficacy and safety of a novel approach that has not been described previously, for creation of a PW in patients with symptomatic, chronic, large pericardial effusion. Methods We retrospectively analysed the records of 30 patients (14 men, 16 women) who underwent a PW procedure between 2001 and 2011. The mean age was 63 years (standard deviation [SD]: 17 years, median: 60 years, range: 27–90 years) and the mean body mass index was 34kg/m 2 (SD: 2kg/m 2 ). The operation was performed through a curvilinear parasternal approach, 6–8cm in length, followed by a mini-thoracotomy between ribs 4 and 5. Discharged patients were followed up clinically. Results The mean operative time was 73 minutes (SD: 21 minutes) and a median of 658ml (range: 300–1,500ml) of fluid was evacuated. The main aetiologies were idiopathic in 17 patients (57%) and malignant in 9 (30%). Seven patients (23%) died in hospital owing to underlying malignancy. Postoperative complications included mild renal failure (20%), respiratory failure (20%), pneumonia (13%), atrial fibrillation (10%) and atelectasis (6%). There were no wound infections. The median length of stay following the procedure was 8 days. In a median follow-up period of 3.8 years, 16 patients with non-malignant effusion were free of recurrence of pericardial effusion. Conclusions The anterior parasternal approach for creation of a PW is simple, safe and efficacious, and results in long-term symptomatic improvement, specifically in patients with non-malignant effusions. This approach may be more appealing in obese patients.

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 Capnocytophaga Induced Acute Necrotizing and Exudative Pericarditis with Abscess Formation

2018 ◽  
Vol 2018 ◽  
pp. 1-3
Author(s):  
Alexa Bello ◽  
Alejandro Castaneda ◽  
Abhay Vakil ◽  
Joseph Varon ◽  
Salim Surani
Keyword(s):  
Pulmonary Embolism ◽  
Pericardial Effusion ◽  
Broad Spectrum ◽  
Developed Countries ◽  
Abscess Formation ◽  
Pericardial Window ◽  
Acute Pericarditis ◽  
Large Pericardial Effusion ◽  
Acute Necrotizing ◽  
Pericardial Abscess

We present the case of a 55-year-old gentleman, with bilateral pulmonary embolism and a large pericardial effusion that lead to a pericardial window with evacuation of creamy pus. Gram stains were negative, with culture growing Capnocytophaga. Pathology revealed acute necrotizing and exudative changes, including frank abscess formation. In developed countries, pericardial abscess and acute pericarditis are uncommon due to availability of broad-spectrum antibiotics. Pericardial abscess due to Capnocytophaga is even more uncommon.

scholarly journals Subacute idiopathic pericarditis with a large pericardial effusion in a young adult seven months post COVID-19 (SARS-Cov-2) infection

2021 ◽  
Vol 10 (1) ◽  
pp. 340-342
Author(s):  
Ashan T Hatharasinghe ◽  
Andrey E Manov
Keyword(s):  
Pericardial Effusion ◽  
Time Frame ◽  
Young Female ◽  
Past Medical History ◽  
Active Infection ◽  
Pericardial Window ◽  
Large Pericardial Effusion ◽  
The World ◽  
History Of ◽  
Short Time

The number of COVID-19 (SARS-Cov-2) cases has risen substantially throughout the world, and consequently we are finding there are several extrapulmonary manifestations associated with this disease. Viral pericarditis and pericardial effusion have been reported several times in COVID-19 patients, however the majority of these cases occurred during active infection or within a relatively short time frame afterwards. The following case is a young female with only a past medical history of COVID-19 pneumonia, seven months prior, presenting with abdominal pain and progressively worsening dyspnea. She was subsequently found to have a large pericardial effusion without tamponade, but requiring a pericardial window. Gross pathology showed fibrinous pericarditis. It is suspected her symptoms and pericardial effusion resulted from a subacute idiopathic pericarditis likely as post-viral complication of COVID-19.

scholarly journals SAT-484 Presyncope as Initial Presentation of Massive Pericardial Effusion with Tamponade in a Patient with Primary Hypothyroidism

2020 ◽  
Vol 4 (Supplement_1) ◽  
Author(s):  
Susan Garcia ◽  
Su Lei Tin
Keyword(s):  
Pericardial Effusion ◽  
Cardiac Tamponade ◽  
Cardiovascular Complications ◽  
Left Ventricular ◽  
Primary Hypothyroidism ◽  
Initial Presentation ◽  
Polymorphonuclear Cells ◽  
Normal Range ◽  
Pericardial Window ◽  
Large Pericardial Effusion

Abstract Presyncope as initial presentation of massive pericardial effusion with tamponade in a patient with primary hypothyroidism Background: Hypothyroidism is an endocrinologic disorder that affects multiple systems ranging from cardiovascular, central nervous system, musculoskeletal, etc. One of the possible cardiovascular complications of hypothyroidism is pericardial effusion which is only rarely associated with tamponade. In this case report we have a 49 years old woman who presented with impending pericardial tamponade secondary to chronic primary hypothyroidism. Clinical case: A 49 years old woman with history of hypothyroidism presented to the hospital on account of headache, dizziness with presyncope episode, generalized weakness and shortness of breath for 7 days, physical exam showed normal vital signs, distant heart sounds, laboratory tests showed TSH:29.5 uIU/mL (normal range 0.270- 0.4200 uIU/mL), fT4: <0.1ng/dL (normal range 0.9–1.8 ng/dL), fT3: 1.68 pg/mL (normal range 1.80–4.60 pg/mL. Electrocardiogram showed low voltage QRS, chest CT showed large pericardial effusion with findings suggestive of right heart failure, Echocardiogram showed left ventricular dysfunction and large pericardial effusion. The patient was taken to the operating room for emergent pericardial window creation with pericardiectomy and was admitted to the Cardiac Care Unit for management of tamponade status post pericardial window. Levothyroxine 150 mcg, Liothyronine 25 mcg and Hydrocortisone 50 mg were started, the steroid was discontinued after adrenal insufficiency was ruled out. The pericardial drain was removed after 8 days and repeated tests showed TSH: 13.1 uIU/mL, fT3: 3.37 pg/mL, fT4: 0.5 ng/dL, studies of pericardial fluid only showed polymorphonuclear cells. The patient’s symptoms resolved and she was discharged on Levothyroxine 150 mcg and Liothyronine 25 mcg. During follow up visits the thyroid function tests were normal, Liothyronine was discontinued and a repeated Echocardiogram showed normal systolic function. Conclusions: Pericardial effusion can be found in 3–30% of patients with hypothyroidism but only in very rare cases (less than 3%) is associated with cardiac tamponade and occurs when there is a severe underlying condition like myxedema coma or prolonged untreated hypothyroidism (1). It is important not to miss that dizziness and presyncope in a patient with hypothyroidism may be a manifestation of cardiac tamponade. Once the diagnosis of hypothyroidism is made it is imperative to start treatment early as untreated hypothyroidism can cause severe cardiovascular complications but even when such are present, they can be reversible with thyroid replacement therapy. Reference: (1) Kahaly, G. and Dillmann, W. (2005). Thyroid Hormone Action in the Heart. Available at: https://academic.oup.com/edrv/article/26/5/704/2355198 [Accessed July 12 2019].

Abstract 17341: A 19-Year-Old Female with Recurrent Chylopericardium

Circulation ◽  
2014 ◽  
Vol 130 (suppl_2) ◽  
Author(s):  
Cheng-Han Chen ◽  
Angela Kleiber ◽  
Christine Megerdichian ◽  
Gregg C Fonarow ◽  
Arnold S Baas
Keyword(s):  
Pericardial Effusion ◽  
Thoracic Duct ◽  
Correct Diagnosis ◽  
Pericardial Fluid ◽  
Shortness Of Breath ◽  
Pericardial Window ◽  
Percutaneous Embolization ◽  
Fluid Analysis ◽  
Large Pericardial Effusion ◽  
Work Up

A 19-year-old female initially presented to an outside hospital with worsening shortness of breath over the course of hours. Echocardiogram revealed a large pericardial effusion with tamponade physiology. An urgent pericardiocentesis followed by a pericardial window yielded 600cc of cloudy fluid, and work-up for infectious, auto-immune, and malignant etiologies was unrevealing. She was discharged home, but over the next four weeks developed a repeat pericardial effusion requiring another pericardiocentesis yielding 750cc of cloudy fluid. She then presented to our hospital two weeks later with progressive shortness of breath. Echocardiogram revealed a large pericardial effusion with evidence of early tamponade physiology. Our differential diagnosis for her recurrent pericardial effusions remained broad, with infectious and malignant etiologies at the top of consideration. Computed tomography of the chest demonstrated the pericardial effusion and mild mediastinal adenopathy. She underwent another pericardial window with removal of 600cc of milky fluid, and fluid analysis was notable for a markedly elevated triglyceride level consistent with a diagnosis of chylopericardium. Work-up for malignancy as an etiology for recurrent chylopericardium was negative. A percutaneous lymphangiogram was then performed, which revealed a significant leak in the superior aspect of the thoracic duct into the pericardial space. Percutaneous embolization of the thoracic duct was performed using detachable coils along with embolic glue, resulting in resolution of the leak. She has since remained asymptomatic, and follow-up echocardiogram was without recurrence of any pericardial effusion. This case of idiopathic recurrent chylopericardium as the cause for pericardial effusion represents a rare manifestation of a relatively common cardiac condition. It illustrates the importance of routine pericardial fluid analysis for triglycerides, as this led to her correct diagnosis of chylopericardium. The use of percutaneous thoracic duct embolization has only recently been reported as a novel approach for treatment of chylous leak, and may emerge as a useful alternative to surgery for recurrent chylopericardium.

scholarly journals P5: SYSTEMIC MASTOCYTOSIS PRESENTING AS CARDIAC TAMPONADE WITH CD25+ PERICARDIAL MAST CELLS

2016 ◽  
Vol 64 (3) ◽  
pp. 819.1-819
Author(s):  
VK Sukrithan ◽  
JN Salamon ◽  
G Berulava ◽  
NE Sibinga ◽  
AK Verma
Keyword(s):  
Bone Marrow ◽  
Lymph Node ◽  
Mast Cells ◽  
Pericardial Effusion ◽  
Systemic Mastocytosis ◽  
Maculopapular Rash ◽  
Epinephrine Infusion ◽  
Pericardial Window ◽  
Bone Marrow Biopsies ◽  
Large Pericardial Effusion

Purpose of StudyCase.Methods UsedDescriptive.Summary of ResultsA 59 year old man with a history of lymphadenopathy, presented with shortness of breath and pleuritic chest pain since three days. A hyperpigmented maculopapular rash with urticaria was present along with multiple syncopal episodes and chronic diarrhea. CT scan of the abdomen in 2006 revealed lymphadenopathy, hepatosplenomegaly, and osteosclerosis. Inguinal and cervical lymph node biopsies in 2006 and 2012, and two bone marrow biopsies in 2012 were negative for malignancy. In 2009, he was diagnosed with non-ischemic cardiomyopathy with an ejection fraction of 40%. Peripheral blood, lymph node, and bone marrow flow cytometry were also unrevealing. On admission, the eosinophil count on admission was 500/µL. Echocardiography showed a large pericardial effusion with impaired right ventricular filling and significant respiratory variation in transmitral flow velocity. A pericardial window was placed, with drainage of approximately 1 liter of exudative fluid. During the surgery, the patient suffered sudden hypotension requiring epinephrine infusion. Tryptase levels drawn were 115 and 154 ng/ml. Pericardial tissue showed scattered c-Kit+ and CD25+ mast cells and blood PCR showed D816V mutation in the c-KIT gene. Re-stained stomach biopsy specimens from 2006 showed two clusters of c-Kit+ and CD25+ mast cells. A bone marrow biopsy showed aggregates of c-Kit+, tryptase+, CD25+ mast cells consistent with Systemic Mastocytosis. The transient hypotension was likely due to distributive shock from mast cell degranulation. Hyperactive mast cells may have served as mediators of the inflammatory response, contributing to production of the pericardial effusion leading to tamponade.ConclusionsSM with tamponade.Abstract P5 Figure 1

scholarly journals Pericardial Effusion due to Primary Malignant Pericardial Mesothelioma: A Common Finding but an Uncommon Cause

2016 ◽  
Vol 2016 ◽  
pp. 1-3 ◽  
Author(s):  
Valery Istomin ◽  
David S. Blondheim ◽  
Simcha R. Meisel ◽  
Aaron Frimerman ◽  
Moshe Lapidot ◽  
...  
Keyword(s):  
Pericardial Effusion ◽  
Empirical Therapy ◽  
Common Finding ◽  
Pericardial Window ◽  
Large Pericardial Effusion ◽  
Pericardial Mesothelioma ◽  
Uncommon Disease ◽  
Chest X Ray ◽  
The Common ◽  
Infectious Etiology

This case report describes a 37-year-old female who was admitted to our Emergency Department because of shortness of breath. On physical examination, she had dyspnea and tachycardia and blood pressure was 80/50 mmHg with a pulsus paradoxus of 22 mmHg. Neck veins were distended, heart sounds were distant, and dullness was found on both lung bases. Her chest X-ray revealed bilateral pleural effusion and cardiomegaly. On both computed tomography and echocardiography the heart was of normal size and a large pericardial effusion was noted. The echocardiogram showed signs of impending tamponade, so the patient underwent an emergent pericardiocentesis. No infectious etiology was found and she was assumed to have viral pericarditis and was treated accordingly. However, when the pericardial effusion recurred and empirical therapy for tuberculosis failed, a pericardial window was performed. A typical staining pattern for mesothelioma was found on her pericardial biopsy specimen. Since no other mesodermal tissue was affected, a diagnosis of primary malignant pericardial mesothelioma was made. Chemotherapy was not effective and she passed away a year after the diagnosis was made. This case highlights the difficulties in diagnosing this uncommon disease in patients that present with the common finding of pericardial effusion.

Cardiac tamponade in a patient with stage IV lung adenocarcinoma treated with pembrolizumab

Immunotherapy ◽  
2019 ◽  
Vol 11 (18) ◽  
pp. 1533-1540 ◽  
Author(s):  
Abdul Moiz Khan ◽  
Ayesha Munir ◽  
Vimala Thalody ◽  
Mohamed Khalid Munshi ◽  
Syed Mehdi
Keyword(s):  
Pericardial Effusion ◽  
Lung Adenocarcinoma ◽  
Cardiac Tamponade ◽  
Stage Iv ◽  
High Dose ◽  
Shortness Of Breath ◽  
Pericardial Window ◽  
Large Pericardial Effusion ◽  
Immune Mediated ◽  
Dose Prednisone

Immunotherapy drugs are associated with a multitude of immune-related adverse events. We describe a case of cardiac tamponade in a patient with stage IV lung adenocarcinoma, with almost 100% expression of PDL-1, treated with pembrolizumab. The patient is a 62-year-old male who developed worsening shortness of breath after five cycles of pembrolizumab. He was diagnosed with large pericardial effusion on computed tomography chest. Echocardiogram confirmed tamponade physiology. He was treated with discontinuation of pembrolizumab and urgent pericardial window followed by high dose prednisone with tapering. The patient responded very well to the treatment. We have comprehensively reviewed cases of pericardial effusion secondary to either immune mediated mechanisms or pseudoprogression.

scholarly journals Early Cardiac Tamponade in a Patient with Postsurgical Hypothyroidism

2015 ◽  
Vol 2015 ◽  
pp. 1-5
Author(s):  
Archana Sinha ◽  
Sri Lakshmi Hyndavi Yeruva ◽  
Rajan Kumar ◽  
Bryan H. Curry
Keyword(s):  
Pericardial Effusion ◽  
Cardiac Tamponade ◽  
Replacement Therapy ◽  
Mental Status ◽  
African American Woman ◽  
American Woman ◽  
Close Monitoring ◽  
Pericardial Window ◽  
Large Pericardial Effusion ◽  
Thyroxine Replacement

Pericardial effusion is a common cardiac manifestation of hypothyroidism, but effusion resulting in cardiac tamponade is extremely rare. We present a case of a 56-year-old African American woman with slurred speech and altered mental status that was initially suspected to have stroke. Her chest X-ray revealed cardiomegaly and subsequent echocardiogram showed a large pericardial effusion with echocardiographic evidence of cardiac tamponade. Clinically, patient did not have pulsus paradoxus or hypotension. Further questioning revealed a history of total surgical thyroidectomy and noncompliance with thyroid replacement therapy. Pericardiocentesis was performed promptly and thyroxine replacement therapy was started. Thereafter, her mental status improved significantly. The management of pericardial effusion associated with hypothyroidism varies depending on size of effusion and hemodynamic stability of the patient. The management strategy ranges from conservative management with close monitoring and thyroxine replacement to pericardiocentesis or creation of a pericardial window.

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