Efficacy of Short-Term Oral Prednisolone Treatment in the Management of Pericardial Effusion Following Pediatric Cardiac Surgery

A standard treatment for pericardial effusion without cardiac tamponade after pediatric cardiac surgery has not been established. We evaluated the efficacy of short-term oral prednisolone administration, which is the initial treatment for postoperative pericardial effusion without cardiac tamponade at our institution. Between October 2008 and March 2020, 1429 pediatric cardiac surgeries were performed at our institution. 91 patients required postoperative treatment for pericardial effusion. 81 were treated with short-term oral prednisolone. Pericardial effusion was evaluated using serial echocardiography during diastole. Pericardial drainage was performed for patients with circumferential pericardial effusion with a maximum diameter of ≥ 10 mm or signs of cardiac tamponade. Short-term oral prednisolone treatment was administered to patients with circumferential pericardial effusion with a maximum diameter of < 10 mm or localized pericardial effusion with a maximum diameter of ≥ 5 mm. Patients with localized pericardial effusion with a maximum diameter of < 5 mm were observed. Prednisolone (2 mg/kg/day) was administered orally for 3 days, added as needed. Short-term oral prednisolone treatment was effective in 71 cases and 90% of patients were regarded as responders. The remaining patients were deemed non-responders who required pericardial drainage. Overall, 55 responders were deemed early responders whose pericardial effusion disappeared within 3 days. There were no cases of deaths, infections, or recurrence of pericardial effusion. The amount of drainage fluid on the day of surgery was higher in the non-responders. In conclusion, short-term oral prednisolone treatment is effective and safe for treating pericardial effusion without cardiac tamponade after pediatric cardiac surgery.

The Efficacy and Safety of Postoperative Tranexamic Acid, Hemocoagulase Agkistrodon, and their Combination in Patients Undergoing Heart Valve Replacement With Cardiopulmonary Bypass

Background Excessive bleeding is a major complication in patients undergoing cardiac surgery. We aimed to compare the efficacy and safety of postoperative tranexamic acid (TXA), hemocoagulase agkistrodon and their combination in patients undergoing heart valve replacement surgery with cardiopulmonary bypass (CPB). Methods This was a retrospective study. The enrolled patients were intravenously injected with TXA at a dose of 1.0 g during the intraoperative period. After surgery, the patients were assigned to four groups: the control group (Group C), the TXA group (Group T), the hemocoagulase agkistrodon group (Group H) and the combination group (Group TH). The primary efficacy outcomes were the total blood loss (TBL) from the time of the operation to postoperative Day 2, postoperative blood loss within 2 days, and transfusion of red blood cells and plasma from the operation to postoperative Day 3. The primary safety endpoint was the incidence of thromboembolic events. Results A total of 252 patients were recruited. There were no statistically significant differences in terms of the TBL, postoperative blood loss, volumes of red blood cells or plasma transfusion among the four groups. However, an increased total pericardial drainage volume and longer length of stay in the ICU were found in Group H compared with in Group T. In addition, increased volumes of total pericardial drainage were found in Group TH compared with Groups C and T. A similar result was also found in the number of days of pericardial drainage. Regarding safety outcomes, fibrinogen levels on postoperative Days 1 and 2 in Groups H and TH were significantly lower than those in Groups C and T, while the frequencies of human fibrinogen transfusion in Groups H and TH were higher, with the highest frequency in Group H. The transfusions of human fibrinogen among Groups C, T, H and TH were 1.45%, 2.78%, 64.71%, and 28.72%, respectively. No significant differences were found in the postoperative incidences of thromboembolic events and acute kidney injuries among all groups. Conclusions Bleeding events after cardiac valve replacement surgery with CPB were not improved by postoperative administration of TXA, hemocoagulase agkistrodon or their combination. Hemocoagulase agkistrodon is related to hypofibrinogenemia and increased transfusions of human fibrinogen.

Purulent pericarditis, an unusual cause of cardiac arrest

Purulent pericarditis is a rare infection of the pericardial space defined by the presence of gross pus or microscopic purulence. Here, we present a case of Streptococcus anginosus purulent pericarditis, leading to obstructive and septic shock. After prompt pericardial drainage, the patient experienced rapid improvement in symptoms. However, due to the presence of a loculated effusion and concern for development of constrictive pericarditis, a pericardial window was performed. Although purulent pericarditis is often fatal, this case illustrates the reduced morbidity following prompt recognition and drainage.

A case of peritoneal-pericardial leak in a 19-year-old patient on peritoneal dialysis

We report a case of a peritoneal-pericardial leak in peritoneal dialysis.A 19-year-old patient, with no history of heart disease, with unkown chronic kidney disease, treated with continuous ambulatory peritoneal dialysis (CAPD) for 10 months. complained of chest pain and tachycardia, revealing pericardial effusion of great abundance. Pericardial drainage was necessary. The fluid analysis was a transudate with glucose levels 5 times higher than glucose plasma levels. A peritoneal scintigraphy was performed and showed a distribution of the radio-tracer in the peritoneal cavity without any image of a leak. With clinical and especillay biological arguments, the patient was diagnosed with a peritoneal-pericardial leak.After pericardial drainage and temporary switch to hemodialysis, automated peritoneal dialysis was resumed with progressive increase in volumes, without recurrence of the leak after a 6 months follow-up.

Rescue Pericardial Drainage and Return Connected to ECMO for Aortic Rupture into the Pericardial Sac with Acute Type A Aortic Dissection

We present the first documented case of emergent pericardial drainage and return (PD-R) under extracorporeal membrane oxygenation (ECMO) for the management of aortic rupture into the pericardial sac caused by acute type A aortic dissection (AADA). An 83-year-old woman collapsed during an elective coronary intervention. ECMO was eventually required. Acute accumulation of pericardial effusion with aortic dissection was revealed by echocardiography. Percutaneous pericardial drainage was performed using a drainage line connected to the venous line of the ECMO system to maintain blood flow and blood pressure. After stabilization of the patient’s hemodynamics, immediate aortic repair was successfully performed and the patient was discharged with no neurological deficit. In cases of massive amounts of pericardial drainage and persistent hemorrhagic shock due to aortic rupture with AADA, PD-R connected to ECMO is useful while waiting for aortic repair.

Emergency pericardial drainage without aortic repair for type A intramural haematoma complicated by cardiac tamponade

From April 2011 to March 2020, 87 patients with type A intramural haematoma and acute aortic dissection with thrombosed false lumen of the ascending aorta were treated at Kitasato University Hospital. The initial watch-and-wait strategy without emergency aortic repair was taken in 52 cases in which the maximum aortic diameter was ≤50 mm, pain score on arrival at our hospital was ≤3/10 on the numerical rating scale and there was no ulcer-like projection (ULP) in the ascending aorta. Eleven patients who fulfilled the criteria but developed cardiac tamponade underwent emergency pericardial drainage without aortic repair. Among these 11 patients, 3 patients developed an aortic event during the hospitalization; 1 patient developed enlargement of the ULP 18 days later but refused surgery, another patient developed rupture of the dissected brachiocephalic artery 4 days later and underwent emergency repair of the ascending aorta and the brachiocephalic artery and the other patient developed a new ULP in the ascending aorta 14 days later and underwent aortic repair. All 11 patients were discharged home. During follow-up (3.0 ± 2.4 years), 1 patient developed a recurrent type A acute aortic dissection and underwent emergency aortic repair 29 months later. There was no aorta-related death.

Management of neoplastic pericarditis – overview of 156 patients

Introduction Neoplastic pericarditis may develop in any type of cancer, but it is found more frequently in lung cancer, breast cancer and lymphoma. Methods We studied 156 consecutive oncological patients presented with pericardial fluid between 2010 and 2015. Among them, 80 patients were stable, with no indication for pericardial drainage or biopsy, and 76 patients needed surgery to evacuate the pericardium and obtain biopsy. Results Echocardiography and computed tomography were essential in evaluating the topography of the pericardial fluid and the haemodynamic effect, and these investigations helped us choose the appropriate surgical procedure. We performed pericardiocentesis, subxiphoid pericardial drainage, left paraxifoidian pericardial drainage, pericardio-pleural window through intercostal video-assisted thoracic surgery (VATS) or through classical thoracic surgery. Twenty-three patients (14.7%) were admitted and treated for cardiac tamponade. The rate of recurrence after pericardial drainage was 3.89%. The immediate survival at 48 h was 97.3%. Conclusion Long-term survival in patients with malignancy and drained pericardial effusion is influenced mainly by the type of underlying malignant disease. We observed a better survival in patients without cardiac tamponade. Immediate survival depends on the pericardial shock complication – postoperative low cardiac output syndrome (LCOS) or pericardial decompression syndrome (PDS). The indication for pericardial drainage depends on the quantity of pericardial fluid, presence of tamponade, associated pleural effusion and need for biopsy, offering the maximum possible benefit and safety for the patient.

Abstract 17352: Seasonal Trends of Acute Idiopathic Pericardial Effusion Requiring Pericardial Drainage

Background: The seasonal trends of idiopathic pericardial effusion (PEff) are not known. Small PEff is usually asymptomatic but moderate to large PEff may lead to cardiac tamponade necessitating pericardial drainage procedures. Seasonal variations of PEff can help identify the association with viral infections that follow a seasonal pattern. Therefore, we sought to characterize the seasonal trends of moderate to large PEff. Methods: We retrospectively identified pericardial effusion patients from January 2015 to December 2019. Moderate to large PEff was defined as PEff requiring either pericardiocentesis or pericardial window. Patients with minimal to small PEff, autoimmune diseases (systemic lupus erythematosus, rheumatoid arthritis, systemic sclerosis), cardiac surgeries/invasive procedures, hemopericardium, chronic pericarditis, malignancy, and metastasis were excluded. Data was acquired from electronic medical records and frequencies, means, percentages, and chi-square test statistics were calculated. Results: Of the 472 patients with PEff, 63% (n=296) were males and 37% (n=176) females. The median age was 61 years. Pericardiocentesis was performed in 65% of patients and 35% had pericardial window. All seasons had similar incidence of PEff (winter 27%, spring 25%, summer 24%, fall 23%, [X 2 =1.81, p=0.612]). The incidence also remained same across all the quarters of the year (Q1 25%, Q2 25%, Q3 26%, Q4 24%, [X2=0.119, p=0.990). The incidence of pericardiocentesis and pericardial window in winter (27% vs 27.5), Spring (22% vs 31%), summer (26% vs 20%), fall (25% vs 20%) showed no difference (X2=6.40, p=0.094). Conclusion: The incidence of moderate to large acute idiopathic pericardial effusion is consistent across all seasons and quarters. Similarly, no significant seasonality was associated with pericardiocentesis and pericardial window procedures.