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Yeşiltaş MA, Kavala AA, Turkyilmaz S, Kuserli Y, Türkyilmaz G, Toz H, Özen C. Surgical treatment of constrictive pericarditis at a single center: 10 years of experience. Acta Chir Belg 2024; 124:107-113. [PMID: 37232347 DOI: 10.1080/00015458.2023.2216377] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/28/2022] [Accepted: 05/16/2023] [Indexed: 05/27/2023]
Abstract
BACKGROUND Constrictive pericarditis (CP) is a pericardial disease characterized by the pericardium becoming calcified or fibrotic as a result of chronic inflammation, which impairs diastolic filling by compressing the cardiac chambers. Pericardiectomy is a promising surgical option for treating CP. In this study, we reviewed over 10 years of preoperative, perioperative, and short-term postoperative follow-ups of patients who underwent pericardiectomy for constrictive pericarditis at our clinic. METHODS Between January 2012 and May 2022, 44 patients were diagnosed with constrictive pericarditis. Twenty-six patients underwent pericardiectomy for CP. Median sternotomy is the surgical approach of choice because it provides easy access for complete pericardiectomy. RESULTS The patient median age was 56 (min: 32, max: 71), and 22 out of 26 patients (84.6%) were male. Twenty-one patients (80.8%) complained of dyspnea, which was the most common reason for admission. Twenty-four patients (92.3%) were scheduled for elective surgery. Cardiopulmonary bypass (CPB) was used during the procedure in six patients (23%). The duration of intensive care stay was two days (min: 1, max: 11), and the total hospitalization was six days (min: 4, max: 21). No in-hospital mortality was observed. CONCLUSION The median sternotomy approach provides a critical advantage in terms of performing a complete pericardiectomy. Although CP is a chronic condition, early diagnosis and planning of pericardiectomy before irreversible deterioration of cardiac function leads to a notable reduction in mortality and morbidity.
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Affiliation(s)
- Mehmet Ali Yeşiltaş
- Department of Cardiovascular Surgery, Bakirkoy Dr. Sadi Konuk Training and Research Hospital, Istanbul, Turkey
| | - Ali Aycan Kavala
- Department of Cardiovascular Surgery, Bakirkoy Dr. Sadi Konuk Training and Research Hospital, Istanbul, Turkey
| | - Saygin Turkyilmaz
- Department of Cardiovascular Surgery, Bakirkoy Dr. Sadi Konuk Training and Research Hospital, Istanbul, Turkey
| | - Yusuf Kuserli
- Department of Cardiovascular Surgery, Bakirkoy Dr. Sadi Konuk Training and Research Hospital, Istanbul, Turkey
| | - Gülsüm Türkyilmaz
- Department of Cardiovascular Surgery, Bakirkoy Dr. Sadi Konuk Training and Research Hospital, Istanbul, Turkey
| | - Hasan Toz
- Department of Cardiovascular Surgery, Bakirkoy Dr. Sadi Konuk Training and Research Hospital, Istanbul, Turkey
| | - Can Özen
- Department of Cardiovascular Surgery, Bakirkoy Dr. Sadi Konuk Training and Research Hospital, Istanbul, Turkey
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Ceriani E, Vittorio B, Samuele P, Rizzi G, Torzillo D. Look at the moon not (only) at the fingers. Intern Emerg Med 2024; 19:139-144. [PMID: 37486572 DOI: 10.1007/s11739-023-03367-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/29/2023] [Accepted: 07/03/2023] [Indexed: 07/25/2023]
Affiliation(s)
- Elisa Ceriani
- Department of Internal Medicine, Ospedale Luigi Sacco, Via GB Grassi 74, 20157, Milano, Italy.
| | - Borroni Vittorio
- Department of Internal Medicine, Ospedale Luigi Sacco, Via GB Grassi 74, 20157, Milano, Italy
| | - Pentiricci Samuele
- Cardiovascular Department, Cardiosurgery Unit, Ospedali Riuniti Di Bergamo, Bergamo, Italy
| | - Giulia Rizzi
- Department of Internal Medicine, Ospedale Luigi Sacco, Via GB Grassi 74, 20157, Milano, Italy
| | - Daniela Torzillo
- Department of Internal Medicine, Ospedale Luigi Sacco, Via GB Grassi 74, 20157, Milano, Italy
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Bain E, Guglin M. A case report of constrictive pericarditis following COVID-19 vaccination. Eur Heart J Case Rep 2023; 7:ytad540. [PMID: 38025132 PMCID: PMC10656752 DOI: 10.1093/ehjcr/ytad540] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2023] [Revised: 10/17/2023] [Accepted: 11/03/2023] [Indexed: 12/01/2023]
Abstract
Background COVID-19 infection and the COVID-19 vaccines have been associated with rare cases of pericarditis. We present a case of constrictive pericarditis (CP) following the vaccine. Case summary A 19-year-old healthy male started having progressive abdominal pain, emesis, dyspnoea, and pleuritic chest pain 2 weeks after the second dose of Pfizer vaccine. Computed tomography angiography chest revealed bilateral pleural effusions and pericardial thickening with effusion. Cardiac catheterization showed ventricular interdependence. Cardiac magnetic resonance (CMR) showed septal bounce and left ventricular tethering suggestive of CP. A total pericardiectomy was performed with significant symptom improvement. Pathology showed chronic fibrosis without amyloid, iron deposits, or opportunistic infections. Patient had Epstein-Barr Virus (EBV) viraemia 825 IU/mL and histoplasmosis complement-fixation positive with negative serum and urine antigen. Hypercoagulable panel and infectious workup were otherwise negative. The patient had resolution of cardiac symptoms at 3 months of follow-up. Discussion The patient developed progressive symptoms within 2 weeks of his second Pfizer vaccine. Echocardiogram and CMR had classic signs of CP, and pericardial pathology confirmed fibrotic pericardium. The patient had no prior surgery, thoracic radiation, or bacterial infection. Epstein-Barr Virus viraemia was thought to be reactionary, and histoplasmosis complement likely represented chronic exposure. The timing of symptoms and negative multidisciplinary workup raises the suspicion for COVID vaccine-induced CP. The COVID vaccines benefits far exceed the risks, but complications still can occur. Practitioners should have a high index of suspicion to allow prompt diagnosis of CP.
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Affiliation(s)
- Eric Bain
- Department of Internal Medicine, Indiana University School of Medicine, 635 Barnhill Drive, Van Nuys Medical Science Building 116, Indianapolis, IN 46202, USA
| | - Maya Guglin
- Krannert Institute of Cardiology, Indiana University School of Medicine, Indianapolis, IN, USA
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Restelli D, Carerj ML, Bella GD, Zito C, Poleggi C, D’Angelo T, Donato R, Ascenti G, Blandino A, Micari A, Mazziotti S, Minutoli F, Baldari S, Carerj S. Constrictive Pericarditis: An Update on Noninvasive Multimodal Diagnosis. J Cardiovasc Echogr 2023; 33:161-170. [PMID: 38486689 PMCID: PMC10936705 DOI: 10.4103/jcecho.jcecho_61_23] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2023] [Revised: 10/28/2023] [Accepted: 10/29/2023] [Indexed: 03/17/2024] Open
Abstract
Constrictive pericarditis (CP) is a rare condition that can affect the pericardium after every pericardial disease process and has been described even after SARS-CoV-2 infection or vaccine. In CP, the affected pericardium, usually the inner layer, is noncompliant, constraining the heart to a fixed maximum volume and impairing the diastolic function. This leads to several clinical features, that, however, can be pleomorphic. In its difficult diagnostic workup, noninvasive multimodal imaging plays a central role, providing important morphological and functional data, like the enhanced ventricular interdependence and the dissociation between intrathoracic and intracardiac pressures. An early and proper diagnosis is crucial to set an appropriate therapy, changing the prognosis of patients affected by CP. In this review, we cover in detail the main elements of each imaging technique, after a reminder of pathophysiology useful for understanding the diagnostic findings.
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Affiliation(s)
- Davide Restelli
- Department of Clinical and Experimental Medicine, Cardiology Unit, University of Messina, Messina, Italy
| | - Maria Ludovica Carerj
- Department of Biomedical and Dental Sciences and Morpho-Functional Imaging (BIOMORF), Diagnostic and Interventional Radiology Unit, University of Messina, Messina, Italy
| | - Gianluca Di Bella
- Department of Clinical and Experimental Medicine, Cardiology Unit, University of Messina, Messina, Italy
| | - Concetta Zito
- Department of Clinical and Experimental Medicine, Cardiology Unit, University of Messina, Messina, Italy
| | - Cristina Poleggi
- Department of Clinical and Experimental Medicine, Cardiology Unit, University of Messina, Messina, Italy
| | - Tommaso D’Angelo
- Department of Biomedical and Dental Sciences and Morpho-Functional Imaging (BIOMORF), Diagnostic and Interventional Radiology Unit, University of Messina, Messina, Italy
| | - Rocco Donato
- Department of Biomedical and Dental Sciences and Morpho-Functional Imaging (BIOMORF), Diagnostic and Interventional Radiology Unit, University of Messina, Messina, Italy
| | - Giorgio Ascenti
- Department of Biomedical and Dental Sciences and Morpho-Functional Imaging (BIOMORF), Diagnostic and Interventional Radiology Unit, University of Messina, Messina, Italy
| | - Alfredo Blandino
- Department of Biomedical and Dental Sciences and Morpho-Functional Imaging (BIOMORF), Diagnostic and Interventional Radiology Unit, University of Messina, Messina, Italy
| | - Antonio Micari
- Department of Clinical and Experimental Medicine, Cardiology Unit, University of Messina, Messina, Italy
| | - Silvio Mazziotti
- Department of Biomedical and Dental Sciences and Morpho-Functional Imaging (BIOMORF), Diagnostic and Interventional Radiology Unit, University of Messina, Messina, Italy
| | - Fabio Minutoli
- Department of Biomedical and Dental Sciences and Morpho-Functional Imaging (BIOMORF), Nuclear Medicine Unit, University of Messina, Messina, Italy
| | - Sergio Baldari
- Department of Biomedical and Dental Sciences and Morpho-Functional Imaging (BIOMORF), Nuclear Medicine Unit, University of Messina, Messina, Italy
| | - Scipione Carerj
- Department of Clinical and Experimental Medicine, Cardiology Unit, University of Messina, Messina, Italy
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Hajsadeghi S, Gholizadeh Mesgarha M, Saberi Shahrbabaki E, Pishgahi M, Ebadi Fard Azar A, Pour Mohammad A. Constrictive pericarditis following inactivated virus COVID-19 vaccine: a case report with review of the literature. Radiol Case Rep 2022; 17:3774-3778. [PMID: 35950151 PMCID: PMC9355495 DOI: 10.1016/j.radcr.2022.07.021] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2022] [Revised: 07/01/2022] [Accepted: 07/05/2022] [Indexed: 11/26/2022] Open
Abstract
Cardiac adverse effects of the COVID-19 vaccine are very rare, myocarditis and pericarditis are the most common amid them, and constrictive pericarditis (CP) is reported to be restricted to a few cases following mRNA COVID-19 vaccines. We report a case of a 72-year-old male patient who developed symptoms of right-sided heart failure, which started after 8 days of receiving the third dose of inactivated virus COVID-19 vaccine and his diagnostic tests comprising transthoracic echocardiography, chest CT scan, cardiac magnetic resonance were in favor of CP. Ultimately, invasive cardiac catheterization confirmed the diagnosis of CP. Due to the lack of satisfactory response to corticosteroid therapy, pericardiectomy was performed, which gave rise to symptom relief progressively and substantially. Considering the temporal course of the patient's symptoms and exclusion of other possible etiologies based on the patient's medical history and diagnostic evaluation, immunization with the COVID-19 vaccine was recognized as a culprit for developing CP. Despite being a scarce phenomenon, the COVID-19 vaccine could have a tendency to provoke pericardial inflammation in so far as causing CP. Hence, physicians should have a high index of suspicion in these circumstances and accelerate the diagnostic investigation.
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Misumi I, Ogata A, Fukuda K, Sato K, Nagano M, Usuku H, Tsujita K. Constrictive pericarditis following mRNA COVID-19 vaccination in a patient with systemic sclerosis. J Cardiol Cases 2022; 26:97-100. [PMID: 35401886 PMCID: PMC8977375 DOI: 10.1016/j.jccase.2022.03.014] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2021] [Revised: 02/16/2022] [Accepted: 03/14/2022] [Indexed: 11/28/2022] Open
Affiliation(s)
- Ikuo Misumi
- Department of Cardiology, Kumamoto City Hospital, Kumamoto City, Kumamoto, Japan
- Corresponding author at: Department of Cardiology, Kumamoto City Hospital, 4-1-60, Higashi-machi, Higashi-ku, Kumamoto City, Kumamoto 862-8505, Japan.
| | - Aki Ogata
- Department of Dermatology, Kumamoto City Hospital, Kumamoto City, Kumamoto, Japan
| | - Koichiro Fukuda
- Department of Respiratory Medicine, Kumamoto City Hospital, Kumamoto City, Kumamoto, Japan
| | - Koji Sato
- Department of Cardiology, Kumamoto City Hospital, Kumamoto City, Kumamoto, Japan
| | - Miwa Nagano
- Department of Cardiology, Kumamoto City Hospital, Kumamoto City, Kumamoto, Japan
| | - Hiroki Usuku
- Department of Cardiovascular Medicine, Kumamoto University School of Medicine, Kumamoto, Japan
| | - Kenichi Tsujita
- Department of Cardiovascular Medicine, Kumamoto University School of Medicine, Kumamoto, Japan
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Coronavirus-vaccine-stemirna-therapeutics/tongji-university. REACTIONS WEEKLY 2022. [PMCID: PMC8913206 DOI: 10.1007/s40278-022-11368-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
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