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Il'Giovine ZJ, Gage A, Higgins A. Cardiac Tamponade and Pericardiocentesis: Recognition, Standard Techniques, and Modern Advancements. Cardiol Clin 2024; 42:159-164. [PMID: 38631787 DOI: 10.1016/j.ccl.2024.02.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 04/19/2024]
Abstract
Pericardiocentesis is an important diagnostic and therapeutic procedure. In the setting of cardiac tamponade, pericardiocentesis can rapidly improve hemodynamics, and in cases of diagnostic uncertainty, pericardiocentesis allows for fluid analysis to aid in diagnosis. In contemporary practice, the widespread availability of ultrasonography has made echocardiographic guidance the standard of care. Additional tools such as micropuncture technique, live ultrasonographic guidance, and adjunctive tools including fluoroscopy continue to advance and enhance procedural efficiency and safety. When performed by experienced operators, pericardiocentesis is a safe, effective, and potentially life-saving procedure.
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Affiliation(s)
- Zachary J Il'Giovine
- Department of Cardiovascular Medicine, Heart, Vascular, and Thoracic Institute, Cleveland Clinic Foundation, 9500 Euclid Avenue, Cleveland, OH 44106
| | - Ann Gage
- Centennial Heart, Tristar Centennial Medical Center, 2300 Patterson Street, Nashville, TN 37203
| | - Andrew Higgins
- Department of Cardiovascular Medicine, Heart, Vascular, and Thoracic Institute, Cleveland Clinic Foundation, 9500 Euclid Avenue, Cleveland, OH 44106.
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Sasi S, Kolleri J, Ben Abid F, Thapur M, Nair AP, Al-Maslamani M. Unveiling rare and severe complications of respiratory viruses: A diverse case series of influenza A, influenza B, and Covid-19. Qatar Med J 2024; 2024:16. [PMID: 38680400 PMCID: PMC11046109 DOI: 10.5339/qmj.2024.qitc.16] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/01/2024] [Accepted: 01/21/2024] [Indexed: 05/01/2024] Open
Affiliation(s)
- Sreethish Sasi
- Infectious Diseases Division, Department of Internal Medicine, Communicable Diseases Center, Hamad Medical Corporation, Doha, Qatar
| | - Jouhar Kolleri
- Department of Clinical Imaging, Hamad Medical Corporation, Doha, Qatar
| | - Fatma Ben Abid
- Infectious Diseases Division, Department of Internal Medicine, Communicable Diseases Center, Hamad Medical Corporation, Doha, Qatar
| | - Maliha Thapur
- Infectious Diseases Division, Department of Internal Medicine, Communicable Diseases Center, Hamad Medical Corporation, Doha, Qatar
| | - Arun P Nair
- Infectious Diseases Division, Department of Internal Medicine, Communicable Diseases Center, Hamad Medical Corporation, Doha, Qatar
| | - Muna Al-Maslamani
- Infectious Diseases Division, Department of Internal Medicine, Communicable Diseases Center, Hamad Medical Corporation, Doha, Qatar
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Mori S, Bertamino M, Guerisoli L, Stratoti S, Canale C, Spallarossa P, Porto I, Ameri P. Pericardial effusion in oncological patients: current knowledge and principles of management. Cardiooncology 2024; 10:8. [PMID: 38365812 PMCID: PMC10870633 DOI: 10.1186/s40959-024-00207-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/02/2024] [Accepted: 02/05/2024] [Indexed: 02/18/2024]
Abstract
BACKGROUND This article provides an up-to-date overview of pericardial effusion in oncological practice and a guidance on its management. Furthermore, it addresses the question of when malignancy should be suspected in case of newly diagnosed pericardial effusion. MAIN BODY Cancer-related pericardial effusion is commonly the result of localization of lung and breast cancer, melanoma, or lymphoma to the pericardium via direct invasion, lymphatic dissemination, or hematogenous spread. Several cancer therapies may also cause pericardial effusion, most often during or shortly after administration. Pericardial effusion following radiation therapy may instead develop after years. Other diseases, such as infections, and, rarely, primary tumors of the pericardium complete the spectrum of the possible etiologies of pericardial effusion in oncological patients. The diagnosis of cancer-related pericardial effusion is usually incidental, but cancer accounts for approximately one third of all cardiac tamponades. Drainage, which is mainly attained by pericardiocentesis, is needed when cancer or cancer treatment-related pericardial effusion leads to hemodynamic impairment. Placement of a pericardial catheter for 2-5 days is advised after pericardial fluid removal. In contrast, even a large pericardial effusion should be conservatively managed when the patient is stable, although the best frequency and timing of monitoring by echocardiography in this context are yet to be established. Pericardial effusion secondary to immune checkpoint inhibitors typically responds to corticosteroid therapy. Pericardiocentesis may also be considered to confirm the presence of neoplastic cells in the pericardial fluid, but the yield of cytological examination is low. In case of newly found pericardial effusion in individuals without active cancer and/or recent cancer treatment, a history of malignancy, unremitting or recurrent course, large effusion or presentation with cardiac tamponade, incomplete response to empirical therapy with nonsteroidal anti-inflammatory, and hemorrhagic fluid at pericardiocentesis suggest a neoplastic etiology.
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Affiliation(s)
- S Mori
- Department of Internal Medicine, University of Genova, Genova, Italy
| | - M Bertamino
- Department of Internal Medicine, University of Genova, Genova, Italy
| | - L Guerisoli
- Department of Internal Medicine, University of Genova, Genova, Italy
| | - S Stratoti
- Department of Internal Medicine, University of Genova, Genova, Italy
| | - C Canale
- IRCCS Ospedale Policlinico San Martino, Genova, Italy
| | - P Spallarossa
- IRCCS Ospedale Policlinico San Martino, Genova, Italy
| | - I Porto
- Department of Internal Medicine, University of Genova, Genova, Italy
- IRCCS Ospedale Policlinico San Martino, Genova, Italy
| | - P Ameri
- Department of Internal Medicine, University of Genova, Genova, Italy.
- IRCCS Ospedale Policlinico San Martino, Genova, Italy.
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Shakeri A, Memary E. Erector spinae plane block as an anesthesia technique for an emergent thoracotomy; a case report. BMC Anesthesiol 2024; 24:57. [PMID: 38331721 PMCID: PMC10851452 DOI: 10.1186/s12871-024-02431-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2023] [Accepted: 01/26/2024] [Indexed: 02/10/2024] Open
Abstract
BACKGROUND The erector spinae plane block (ESPB) is a novel regional block technique for pain management following thoracic surgeries. However, there are minimal cases in which the technique was used as the main anesthesia technique during surgery. CASE PRESENTATION Here, we report the successful use of ESBP for applying anesthesia in a case during an emergent thoracotomy for performing pericardiotomy and loculated tamponade evacuation. CONCLUSIONS Using ESPB with a higher concentration of local anesthetics, in this case, prepared appropriate anesthesia for performing an emergent thoracotomy while avoiding multiple needle insertions and the risk of further hemodynamic instability.
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Affiliation(s)
- Alireza Shakeri
- Anesthesiology Department, Imam Hosein Hospital, Shahid Beheshti University of Medical Sciences, Tehran, Iran
- Anesthesiology Research Center, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Elham Memary
- Anesthesiology Department, Imam Hosein Hospital, Shahid Beheshti University of Medical Sciences, Tehran, Iran.
- Anesthesiology Research Center, Shahid Beheshti University of Medical Sciences, Tehran, Iran.
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Tyagi M, Reddy NG, Sahoo NK. Fibrin-Glue-Assisted Surgery for Idiopathic Macular Holes. Semin Ophthalmol 2024; 39:172-175. [PMID: 37864463 DOI: 10.1080/08820538.2023.2271047] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/20/2023] [Accepted: 09/25/2023] [Indexed: 10/22/2023]
Abstract
METHODS This pilot clinical trial included 10 eyes of 10 patients with idiopathic MH, where PPV along with ILMP was done. Fibrin glue was used as a tamponade, and no postoperative positioning was given to any patient. The primary outcome measure was successful anatomical closure of the MH. The secondary outcome measures were postoperative improvement in best-corrected visual acuity (BCVA) and any complications of the procedure. RESULTS The median age of patients was 62.5 years. Eight eyes were pseudophakic and two were phakic. The mean basal diameter of the MH was 1193 microns. The mean minimal linear diameter was 652 microns. Successful anatomic closure of MH was achieved in eight cases. The median BCVA improved from a Snellen equivalent of 20/100 preoperatively to 20/60 at 1 month postoperatively. The median follow-up period was 4 months. CONCLUSION The findings of this study suggest that the use of fibrin glue can be useful in patients where postoperative positioning is difficult.
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Affiliation(s)
- Mudit Tyagi
- Smt. Kanuri Santhamma Center for Vitreo Retinal Diseases, L V Prasad Eye Institute, Hyderabad, Telangana, India
| | - Nikitha Gurram Reddy
- Smt. Kanuri Santhamma Center for Vitreo Retinal Diseases, L V Prasad Eye Institute, Hyderabad, Telangana, India
| | - Niroj Kumar Sahoo
- Dept. of Vitreo Retinal Diseases, L V Prasad Eye Institute, Vijayawada, Andhra Pradesh, India
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Ravikumar DB, Sivasubramanian BP, Singla A, Venu R, Shekar SP. Shorter antitubercular therapy for extrapulmonary tuberculosis - a case report. BMC Infect Dis 2024; 24:86. [PMID: 38225554 PMCID: PMC10788989 DOI: 10.1186/s12879-023-08941-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/21/2023] [Accepted: 12/20/2023] [Indexed: 01/17/2024] Open
Abstract
INTRODUCTION Extrapulmonary tuberculosis (EPTB) adds to India's significant economic burden, with pericardial effusion being a potentially fatal complication. This case report highlights the need for early diagnosis and the feasibility of shorter-duration treatment for EPTB in developing countries. PRESENTATION This case report describes a 19-year-old male from Southeast Asia who had a history of bronchiectasis involving the left lower lobe and the right middle lobe, which was cystic in nature, as well as multiple episodes of non-tuberculous pneumonia. Currently, he presented with fever, hypotension, tachycardia, and acute kidney injury. Echocardiogram showed left ventricular dysfunction with a left ventricular ejection fraction (LVEF) of 45% and moderate pericardial effusion. Early signs of cardiac tamponade were noted, specifically the absence of respiratory variation in the right ventricle and left ventricle collapse. Emergent pericardiocentesis was performed, and hemorrhagic pericardial fluid was aspirated. Fluid analysis revealed high levels of LDH (5000 U/L), polymorphonuclear leukocytosis, and acid-fast bacilli that were visualized on microscopy, which led to the diagnosis of pericardial tuberculosis. A CT of the abdomen showed hepatosplenomegaly and polyserositis. Empirically, antitubercular therapy consisting of isoniazid, rifampin, pyrazinamide, and ethambutol was administered for 2 months and isoniazid along with rifampicin was given for the next 4 months. Serial echocardiograms in the following months showed an improvement in LVEF (55%) and decreased effusion. However, during this treatment period, due to frequent episodes of pneumonia, the evaluation of immunodeficiency disorders was performed and revealed low levels of IgG (4.741 g/L), IgA (0.238 g/L), and IgM (0.098 g/L). He was diagnosed with common variable immunodeficiency disease and received intravenous immunoglobulin therapy. CONCLUSION This report emphasizes the timely identification of cardiac tamponade and the effective management of EPTB through a shorter-than-recommended course of antitubercular therapy, resulting in the alleviation of symptoms and better overall health outcomes.
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Affiliation(s)
| | | | - Ankur Singla
- Internal Medicine, Dayanand Medical College & Hospital, Ludhiana, Punjab, 141001, India
| | - Rakshaya Venu
- Internal Medicine, Saveetha Medical College and Hospital, Chennai, Tamilnadu, India.
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Nair R, Zuo J, Shiloh AL. The Importance of Serial POCUS Exams - Dual Pathologies in Play. POCUS J 2023; 8:124-125. [PMID: 38099166 PMCID: PMC10721285 DOI: 10.24908/pocus.v8i2.16595] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/17/2023]
Abstract
Serial point of care ultrasound (POCUS) exams are essential to assess acute pericardial effusions which can rapidly evolve into cardiac tamponade. A typical presentation includes dyspnea, tachycardia, and chest pain. Importantly, serial cardiac exams in such high-risk patients can detect other concurrent pathologies. We present an unusual case of a patient who initially presented with an acute circumferential pericardial effusion and upon serial POCUS exams developed an unexpected Takotsubo cardiomyopathy in the setting of cardiac tamponade.
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Affiliation(s)
- Rahul Nair
- Division of Critical Care Medicine, Department of Medicine, Montefiore Medical Center/Albert Einstein College of MedicineBronx, NYUSA
| | | | - Ariel L Shiloh
- Division of Critical Care Medicine, Department of Medicine, Montefiore Medical Center/Albert Einstein College of MedicineBronx, NYUSA
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Malik MI, Jae JC, Sefein OSS, Zamper RPC, Nagpal AD. Radical mediastinal lipectomy for tamponade-like cardiac physiology. J Cardiothorac Surg 2023; 18:338. [PMID: 37990270 PMCID: PMC10664668 DOI: 10.1186/s13019-023-02421-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/21/2023] [Accepted: 11/03/2023] [Indexed: 11/23/2023] Open
Abstract
BACKGROUND Re-opening the chest is an unwanted and potentially morbid complication after open heart surgery, most commonly required for refractory bleeding or tamponade. In this report, we present a unique case of a postoperative coronary artery bypass patient, demonstrating clinical features of cardiac tamponade of the right atrium and ventricle with inconclusive findings on imaging. CASE PRESENTATION A 62 year-old male presented to hospital with exertional angina and a coronary angiogram found severe three-vessel coronary artery disease with preserved left ventricular function. He underwent an uncomplicated triple coronary artery bypass surgery. Over the following hours in the cardiac intensive care unit, the patient had a climbing serum lactate level and increasing vasopressor requirements. On investigations, there was evidence of compression of the right heart. The patient was taken back to the operating room where very little clot or bleeding was identified, rather there was significant amounts of mediastinal fat surrounding the heart which was subsequently resected with wide margins. The patient had complete resolution of their symptoms and an uncomplicated postoperative course thereafter. CONCLUSIONS To our knowledge, this case is the first reported occurrence of cardiac constriction from excessive mediastinal fat after open heart surgery. Identifying patients at high-risk for excessive pericardial fat, as well as considering alternative modalities of imaging appear to be the main stay in diagnosis at this point. Current treatment is a mediastinal lipectomy with wide margins, avoiding injury to surrounding structures such as the phrenic nerve and innominate vein. Future study might consider the value of prophylactic mediastinal lipectomy at time of surgery, and methods to improve detection with current and future imaging modalities.
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Affiliation(s)
- Mohsyn Imran Malik
- Division of Cardiac Surgery, London Health Science Centre/Western University, Suite B6-104, 339 Windermere Rd, London, ON, N6A 5A5, Canada
| | - James Changhyun Jae
- Department of Anesthesia and Perioperative Medicine, London Health Sciences Centre/Western University, London, ON, Canada
- Critical Care Western, London Health Sciences Centre/Western University, London, ON, Canada
| | - Osama Sedky Shehata Sefein
- Department of Anesthesia and Perioperative Medicine, London Health Sciences Centre/Western University, London, ON, Canada
- Critical Care Western, London Health Sciences Centre/Western University, London, ON, Canada
| | - Raffael Pereira Cezar Zamper
- Department of Anesthesia and Perioperative Medicine, London Health Sciences Centre/Western University, London, ON, Canada
| | - A Dave Nagpal
- Division of Cardiac Surgery, London Health Science Centre/Western University, Suite B6-104, 339 Windermere Rd, London, ON, N6A 5A5, Canada.
- Critical Care Western, London Health Sciences Centre/Western University, London, ON, Canada.
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Kalaba F, Qarmout M, Lakshaman H, Ahmed A, Manam R, Shah DP. A serious complication of high-power short-duration radiofrequency atrial fibrillation ablation associated with genetic hypodysfibrinogenemia. HeartRhythm Case Rep 2023; 9:800-801. [PMID: 38023675 PMCID: PMC10667113 DOI: 10.1016/j.hrcr.2023.08.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2023] Open
Affiliation(s)
- Frank Kalaba
- The Zena and Michael A. Wiener Cardiovascular Institute, Icahn School of Medicine at Mount Sinai, New York, New York
| | - Mohammed Qarmout
- Internal Medicine Residency Program, Providence Hospital/Michigan State University College of Human Medicine, Southfield, Michigan
| | - Harini Lakshaman
- Division of Cardiovascular Diseases, Providence Hospital/Michigan State University College of Human Medicine, Southfield, Michigan
| | - Ammar Ahmed
- Division of Cardiovascular Diseases, Providence Hospital/Michigan State University College of Human Medicine, Southfield, Michigan
| | - Rajendra Manam
- Division of Hematology and Oncology, Providence Hospital/Michigan State University College of Human Medicine, Southfield, Michigan
| | - Dipak P. Shah
- Division of Cardiovascular Diseases, Providence Hospital/Michigan State University College of Human Medicine, Southfield, Michigan
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Patel K, Hsu KY, Lou K, Soni K, Lee YJ, Mulvey CK, Baik AH. Osimertinib-induced biventricular cardiomyopathy with abnormal cardiac MRI findings: a case report. Cardiooncology 2023; 9:38. [PMID: 37908018 PMCID: PMC10617075 DOI: 10.1186/s40959-023-00190-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/28/2023] [Accepted: 10/20/2023] [Indexed: 11/02/2023]
Abstract
BACKGROUND Osimertinib is a third-generation epidermal growth factor receptor (EGFR) inhibitor that is currently the first-line treatment for metastatic EGFR-mutated non-small-cell lung cancer (NSCLC) due to its favorable efficacy and tolerability profile compared to previous generations of EGFR inhibitors. However, it can cause uncommon, yet serious, cardiovascular adverse effects. CASE PRESENTATION We present the case of a 63-year-old man with EGFR-mutated NSCLC treated with osimertinib who developed new-onset non-ischemic cardiomyopathy with biventricular dysfunction and heart failure in the context of an enlarging pericardial effusion. For the first time, we demonstrate cardiac MR imaging findings associated with osimertinib-associated cardiomyopathy, including focal late gadolinium enhancement and myocardial edema. The patient's biventricular function normalized after initiation of goal-directed medical therapy for heart failure and holding osimertinib. The patient was subsequently started on afatinib, a second-generation epidermal growth factor receptor-tyrosine kinase inhibitor (EGFR-TKI), without recurrence of cardiomyopathy. CONCLUSIONS This case highlights the need to better understand osimertinib-induced cardiotoxicity and strategies to optimize oncologic care in patients who develop severe cardiac toxicities from cancer therapy. It further underlines the importance of specialized multidisciplinary care of cancer patients who develop cardiotoxicities to optimize their oncologic outcomes.
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Affiliation(s)
- Karishma Patel
- Department of Medicine, University of California, San Francisco, CA, USA
| | - Kristie Y Hsu
- Department of Medicine, University of California, San Francisco, CA, USA
| | - Kevin Lou
- Department of Medicine, University of California, San Francisco, CA, USA
| | - Krishan Soni
- Department of Medicine, University of California, San Francisco, CA, USA
- Division of Cardiology, University of California, San Francisco, CA, USA
| | - Yoo Jin Lee
- Department of Radiology, University of California, San Francisco, CA, USA
| | - Claire K Mulvey
- Department of Medicine, University of California, San Francisco, CA, USA
- Division of Oncology, University of California, San Francisco, CA, USA
| | - Alan H Baik
- Department of Medicine, University of California, San Francisco, CA, USA.
- Division of Cardiology, University of California, San Francisco, CA, USA.
- Department of Medicine, Division of Cardiology, Section of Cardio-Oncology and Immunology, University of California, San Francisco, CA, USA.
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Basyal B, Ullah W, Derk CT. Pericardial effusions and cardiac tamponade in hospitalized systemic sclerosis patients: analysis of the national inpatient sample. BMC Rheumatol 2023; 7:34. [PMID: 37759292 PMCID: PMC10537065 DOI: 10.1186/s41927-023-00360-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/24/2023] [Accepted: 09/19/2023] [Indexed: 09/29/2023] Open
Abstract
INTRODUCTION Clinically significant pericardial effusions and cardiac tamponade in systemic sclerosis (SSc) patients is uncommon and the factors that contribute to progression of pericardial involvement in SSc patients have not been well established. METHODS A review of the national inpatient sample database was performed looking SSc related hospitalizations between 2002 and 2019. Data was collected on patients with pericardial effusions and cardiac tamponade and analyzed to identify and describe patient characteristics and comorbidities. RESULTS Out of a total of 523,410 SSc hospitalizations, with an overall inpatient mortality rate of 4.7% (24,764 patients), pericardial effusion was identified in 3.1% of all hospitalizations (16,141 patients) out of which 0.2% (838 patients) had a diagnosis of cardiac tamponade. Patients with pericardial effusion were significantly more likely to have pulmonary circulatory disease (p = < 0.0001), congestive heart failure (p = < 0.0001) end stage renal disease (p = < 0.0001), diabetes (p = 0.015), and hypothyroidism (p = 0.025). Patients with cardiac tamponade were significantly more likely to have a history of coronary artery bypass graft surgery (p = 0.001) or atrial fibrillation (p = < 0.0001). Hospitalized patients with cardiac tamponade had a significantly increased mortality rate of 17.7% compared to 8.8% in patients with pericardial effusions without a tamponade physiology, with an odds ratio of 2.3 (1.97-2.86), p = < 0.0001. CONCLUSION Pericardial effusion and tamponade are associated with increased morbidity and mortality in SSc patients. Further studies are required to explore the role of patient comorbidities and characteristics in development into pericardial effusions or tamponade.
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Affiliation(s)
- Bikash Basyal
- Department of Medicine, Jefferson Abington Hospital, Abington, PA, USA
| | - Waqas Ullah
- Division of Cardiology, Thomas Jefferson University Hospital, Philadelphia, PA, USA
| | - Chris T Derk
- Division of Rheumatology, University of Pennsylvania, 5th Floor White Bldg 3400 Spruce Street, Philadelphia, PA, 19104, USA.
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Vemu SM, Farii HA, Bird JE, Lin PP, Lewis VO, Patel SS. The Use of Photodynamic Bone Stabilization to Tamponade Bleeding in a Pathologic Humeral Shaft Fracture: A Case Report. J Orthop Case Rep 2023; 13:137-143. [PMID: 37753123 PMCID: PMC10519327 DOI: 10.13107/jocr.2023.v13.i09.3906] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2023] [Revised: 07/16/2023] [Indexed: 09/28/2023] Open
Abstract
Introduction Hypervascular tumors such as renal and thyroid carcinoma have a significant risk of intraoperative bleeding. To help mitigate bleeding, interventional preoperative embolization is traditionally used; however, it is success is highly variable. This is the first case report to discuss using expandable balloon implants with a minimally invasive approach to achieve fracture fixation and tamponade acute intraoperative bleeding. Case Report A 48-year-old male with clear-cell renal cell carcinoma presented with a left humeral shaft pathologic fracture. The patient was scheduled to undergo open biopsy, curettage of tumor, and fracture fixation with an intramedullary device. Intraoperatively, during open biopsy and curettage, brisk bleeding was encountered, which ceased after inserting an intramedullary photodynamic bone stabilization implant (IlluminOss). The implant's balloon expanded to the diameter of the humerus allowing for tamponade, fracture stability, and a minimally invasive approach. Conclusion We present a possible intraoperative option for achieving control of bleeding in pathologic long bone fractures by deploying a photodynamic stabilization device. The method described can have applications in specific patients and obviate the need for pre-operative embolization for highly vascular tumors due to the implant's ability to create tamponade within the bone.
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Affiliation(s)
- Sree M Vemu
- Department of Orthopedic Surgery, Houston Methodist, 6445 Main St #2500, Houston, Texas 77030, United States
| | - Humaid Al Farii
- Department of Orthopedic Surgery, University of Texas MD Anderson Cancer Center, P.O. Box 301402, Unit 1448 Houston, Texas 77230-1402, United States
| | - Justin E Bird
- Department of Orthopedic Surgery, University of Texas MD Anderson Cancer Center, P.O. Box 301402, Unit 1448 Houston, Texas 77230-1402, United States
| | - Patrick P Lin
- Department of Orthopedic Surgery, University of Texas MD Anderson Cancer Center, P.O. Box 301402, Unit 1448 Houston, Texas 77230-1402, United States
| | - Valerae O Lewis
- Department of Orthopedic Surgery, University of Texas MD Anderson Cancer Center, P.O. Box 301402, Unit 1448 Houston, Texas 77230-1402, United States
| | - Shalin S Patel
- Department of Orthopedic Surgery, University of Texas MD Anderson Cancer Center, P.O. Box 301402, Unit 1448 Houston, Texas 77230-1402, United States
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Koumallos N, Aggeli C, Milas T, Tsioufis K. Late erosion of Amplatzer Septal Occluder device 9 years after the implantation: a case report. Interdiscip Cardiovasc Thorac Surg 2023; 37:ivad132. [PMID: 37589663 PMCID: PMC10481768 DOI: 10.1093/icvts/ivad132] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/20/2023] [Accepted: 08/16/2023] [Indexed: 08/18/2023]
Abstract
Cardiac erosion is a rare but life-threatening complication after the interventional closure of an atrial septal defect. We present the case of a patient who developed cardiac erosion 9 years after the placement of an Amplatzer Septal Occluder. The patient presented to our hospital with symptoms of tamponade. Surgical exploration revealed a tear in the roof of the left atrium. To our knowledge, this is one of the most delayed presentations reported. In these cases, diagnosis is difficult and a level of clinical suspicion is demanded.
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Affiliation(s)
- Nikolaos Koumallos
- Department of Cardiac Surgery, Hippokration General Hospital, Athens, Greece
| | - Costantina Aggeli
- Cardiology Department, Hippokration General Hospital, Athens, Greece
| | - Theodoros Milas
- Department of Cardiac Surgery, Hippokration General Hospital, Athens, Greece
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14
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Ya'Qoub L, Butera B, Sorek C, Lemor A, Alqarqaz M, Villablanca P. Computed Tomography-Guided Pericardiocentesis for a Loculated Pericardial Effusion With Tamponade. Cardiovasc Revasc Med 2023; 53S:S326-S328. [PMID: 36089456 DOI: 10.1016/j.carrev.2022.08.030] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/11/2022] [Revised: 08/20/2022] [Accepted: 08/23/2022] [Indexed: 11/03/2022]
Affiliation(s)
- Lina Ya'Qoub
- Division of Interventional Cardiology, Henry Ford Hospital, Detroit, MI, United States of America.
| | - Brian Butera
- Division of Interventional Cardiology, Henry Ford Hospital, Detroit, MI, United States of America
| | - Claire Sorek
- Department of Radiology, Henry Ford Hospital, Detroit, MI, United States of America
| | - Alejandro Lemor
- Division of Interventional Cardiology, Henry Ford Hospital, Detroit, MI, United States of America
| | - Mohammad Alqarqaz
- Division of Interventional Cardiology, Henry Ford Hospital, Detroit, MI, United States of America
| | - Pedro Villablanca
- Division of Structural Heart Disease, Henry Ford Hospital, Detroit, MI, United States of America
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15
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Yao Y, Yan H, Qu J, Dong C, Liang J, Yin H, Ren C, Jin E, Zhao M. Vitrectomy with sulfur hexafluoride versus air tamponade for idiopathic macular hole: a retrospective study. BMC Ophthalmol 2023; 23:331. [PMID: 37474921 PMCID: PMC10357688 DOI: 10.1186/s12886-023-03049-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/10/2023] [Accepted: 06/17/2023] [Indexed: 07/22/2023] Open
Abstract
BACKGROUND To evaluate the effect of room air and sulfur hexafluoride (SF6) gas in idiopathic macular hole(MH)surgery. METHODS Retrospective, interventional, and comparative study. 238 eyes with the idiopathic macular hole that underwent pars plana vitrectomy, internal limiting membrane peeling, fluid-air exchange, and 20% SF6 (SF6 group:125 eyes) or room air tamponade (air group: 113 eyes) were reviewed. The primary outcome measure was the closure rate of primary surgery. RESULTS The baseline characteristics of the SF6 group and air group were comparable except for the hole size (479.90 ± 204.48 vs. 429.38 ± 174.63 μm, P = 0.043). The anatomical closure rate was 92.8% (116 / 125) with the SF6 group and 76.1% (86 / 113) with the air group (P < 0.001). A cut-off value of MH size to predict primary anatomical closure was 520 μm, which is based on the lower limit of 95% confidential interval of the MH size among the unclosed patients in the air group. There was no significant difference in anatomical closure rates between SF6 and air group (98.7% vs. 91.9%, P = 0.051) for MH ≤ 520 μm, whereas a significantly lower anatomical closure rate was shown in the air group than SF6 group (46.2% vs. 84.0%, P < 0.001) for MH > 520 μm. CONCLUSION SF6 exhibited more effectiveness than air to achieve a good anatomical outcome for its longer tamponade when MH > 520 μm.
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Affiliation(s)
- Yuou Yao
- Department of Ophthalmology, Peking University People's Hospital, Xizhimen South Street 11, Xi Cheng District, Beijing, 100044, China
- Eye Diseases and Optometry Institute, Beijing, China
- Beijing Key Laboratory of Diagnosis and Therapy of Retinal and Choroid Diseases, Beijing, China
- College of Optometry, Peking University Health Science Center, Beijing, China
| | - Huichao Yan
- Department of Ophthalmology, Peking University People's Hospital, Xizhimen South Street 11, Xi Cheng District, Beijing, 100044, China
- Eye Diseases and Optometry Institute, Beijing, China
- Beijing Key Laboratory of Diagnosis and Therapy of Retinal and Choroid Diseases, Beijing, China
- College of Optometry, Peking University Health Science Center, Beijing, China
| | - Jinfeng Qu
- Department of Ophthalmology, Peking University People's Hospital, Xizhimen South Street 11, Xi Cheng District, Beijing, 100044, China.
- Eye Diseases and Optometry Institute, Beijing, China.
- Beijing Key Laboratory of Diagnosis and Therapy of Retinal and Choroid Diseases, Beijing, China.
- College of Optometry, Peking University Health Science Center, Beijing, China.
| | - Chongya Dong
- Department of Biostatistics, Peking University Clinical Research Institute, Beijing, China
| | - Jianhong Liang
- Department of Ophthalmology, Peking University People's Hospital, Xizhimen South Street 11, Xi Cheng District, Beijing, 100044, China
- Eye Diseases and Optometry Institute, Beijing, China
- Beijing Key Laboratory of Diagnosis and Therapy of Retinal and Choroid Diseases, Beijing, China
- College of Optometry, Peking University Health Science Center, Beijing, China
| | - Hong Yin
- Department of Ophthalmology, Peking University People's Hospital, Xizhimen South Street 11, Xi Cheng District, Beijing, 100044, China
- Eye Diseases and Optometry Institute, Beijing, China
- Beijing Key Laboratory of Diagnosis and Therapy of Retinal and Choroid Diseases, Beijing, China
- College of Optometry, Peking University Health Science Center, Beijing, China
| | - Chi Ren
- Department of Ophthalmology, Peking University People's Hospital, Xizhimen South Street 11, Xi Cheng District, Beijing, 100044, China
- Eye Diseases and Optometry Institute, Beijing, China
- Beijing Key Laboratory of Diagnosis and Therapy of Retinal and Choroid Diseases, Beijing, China
- College of Optometry, Peking University Health Science Center, Beijing, China
| | - Enzhong Jin
- Department of Ophthalmology, Peking University People's Hospital, Xizhimen South Street 11, Xi Cheng District, Beijing, 100044, China
- Eye Diseases and Optometry Institute, Beijing, China
- Beijing Key Laboratory of Diagnosis and Therapy of Retinal and Choroid Diseases, Beijing, China
- College of Optometry, Peking University Health Science Center, Beijing, China
| | - Mingwei Zhao
- Department of Ophthalmology, Peking University People's Hospital, Xizhimen South Street 11, Xi Cheng District, Beijing, 100044, China.
- Eye Diseases and Optometry Institute, Beijing, China.
- Beijing Key Laboratory of Diagnosis and Therapy of Retinal and Choroid Diseases, Beijing, China.
- College of Optometry, Peking University Health Science Center, Beijing, China.
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16
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Nelson DM, Brennan AP, Burns AT, MacIsaac AI. Pericardial decompression syndrome with acute right ventricular failure: a case series. Eur Heart J Case Rep 2023; 7:ytad275. [PMID: 37408529 PMCID: PMC10319428 DOI: 10.1093/ehjcr/ytad275] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2022] [Revised: 10/05/2022] [Accepted: 06/20/2023] [Indexed: 07/07/2023]
Abstract
Background Pericardial decompression syndrome (PDS) is an uncommon complication of pericardial drainage of large pericardial effusions and cardiac tamponade characterized by paradoxical haemodynamic instability following drainage. Pericardial decompression syndrome may occur immediately, or in the days following pericardial decompression, and presents with signs and symptoms suggestive of uni-/biventricular failure or acute pulmonary oedema. Case summary This series describes two cases of this syndrome which demonstrates acute right ventricular failure as a mechanism of PDS and provides insights into the echocardiographic findings and clinical course of this poorly understood syndrome. Case 1 describes a patient who underwent pericardiocentesis, whilst Case 2 describes a patient who underwent surgical pericardiostomy. In both patients, acute right ventricular failure was observed following the release of tamponade and is favoured to be the cause of haemodynamic instability. Discussion Pericardial decompression syndrome is a poorly understood, likely underreported complication of pericardial drainage for cardiac tamponade associated with high morbidity and mortality. Whilst a number of hypotheses exist as to the aetiology of PDS, this case series supports haemodynamic compromise being secondary to left ventricular compression following acute right ventricular dilatation.
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Affiliation(s)
- Dean M Nelson
- Department of Cardiology, St Vincent's Hospital Melbourne, 41 Victoria Parade, 3065, Fitzroy, Victoria, Australia
| | - Anthony P Brennan
- Department of Cardiology, St Vincent's Hospital Melbourne, 41 Victoria Parade, 3065, Fitzroy, Victoria, Australia
| | - Andrew T Burns
- Department of Cardiology, St Vincent's Hospital Melbourne, 41 Victoria Parade, 3065, Fitzroy, Victoria, Australia
| | - Andrew I MacIsaac
- Department of Cardiology, St Vincent's Hospital Melbourne, 41 Victoria Parade, 3065, Fitzroy, Victoria, Australia
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Treviño-Herrera AB, Gonzalez-Cortes JH, Gonzalez-Cantu JE, Garza-Chavarria JA, Martinez-Pacheco VA, Bilgic A. Suprachoroidal silicone oil as an intraoperative complication during Pars Plana Vitrectomy: A case report. Int J Surg Case Rep 2023; 108:108441. [PMID: 37393679 PMCID: PMC10382846 DOI: 10.1016/j.ijscr.2023.108441] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/28/2023] [Revised: 06/13/2023] [Accepted: 06/27/2023] [Indexed: 07/04/2023] Open
Abstract
INTRODUCTION AND IMPORTANCE Complications related to silicone oil tamponade are frequent. There are reports of events related to silicone oil (SO) injection during Pars Plana Vitrectomy (PPV). This case presents the unexpected injection of SO in the suprachoroidal space. The proper management of this complication along with the preventive measures are discussed. CASE PRESENTATION A 38-year-old male presented with a one-week history of decreased vision in his right eye (OD). His visual acuity was hand motion (HM). A late-onset retinal detachment recurrence with proliferative vitreoretinopathy (PVR) in his OD was diagnosed. Cataract surgery and PPV were scheduled. During PPV, a choroidal detachment (CD) secondary to the suprachoroidal injection of silicone oil (SO) was noted. Suprachoroidal SO was identified timely and was managed with external drainage through a posterior sclerotomy. CLINICAL DISCUSSION Suprachoroidal silicone oil injection is a potential complication during PPV. For the management of this complication, the drainage of the silicone oil from the suprachoroidal space through a posterior sclerotomy may be considered as an option. This complication may be avoided by periodically checking the correct position of the infusion cannula during the PPV, by injecting the SO into the vitreous cavity under direct visualization and by using automated injection systems. CONCLUSION Suprachoroidal silicone oil injection is an intraoperative complication that might be avoided by cross-checking the correct position of the infusion cannula and by injecting SO under direct visualization.
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Affiliation(s)
- Alan Baltazar Treviño-Herrera
- Department of Ophthalmology, University Hospital and Faculty of Medicine, Autonomous University of Nuevo León (UANL), Monterrey 64460, Mexico
| | - Jesus Hernan Gonzalez-Cortes
- Department of Ophthalmology, University Hospital and Faculty of Medicine, Autonomous University of Nuevo León (UANL), Monterrey 64460, Mexico; Department of Retina and Vitreous, Especialistas en Retina Medica y Quirurgica ERVOS, ISSSTE Constitucion, UNAM, Monterrey, Nuevo Leon, Mexico.
| | - Jesus Emiliano Gonzalez-Cantu
- Department of Ophthalmology, University Hospital and Faculty of Medicine, Autonomous University of Nuevo León (UANL), Monterrey 64460, Mexico
| | - Javier Alan Garza-Chavarria
- Department of Retina and Vitreous, Especialistas en Retina Medica y Quirurgica ERVOS, ISSSTE Constitucion, UNAM, Monterrey, Nuevo Leon, Mexico
| | | | - Alper Bilgic
- Department of Retina and Vitreous, Especialistas en Retina Medica y Quirurgica ERVOS, ISSSTE Constitucion, UNAM, Monterrey, Nuevo Leon, Mexico
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18
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Yoon JH, Kim JH, Kim CG, Kim JW. Incidence of early complications requiring treatment plan changes after vitreoretinal surgery: a single-center study in South Korea. BMC Ophthalmol 2023; 23:282. [PMID: 37332012 DOI: 10.1186/s12886-023-03030-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2023] [Accepted: 06/09/2023] [Indexed: 06/20/2023] Open
Abstract
BACKGROUND Information regarding incidence of treatment plan changes may be useful when discussing postoperative treatment plans for patients. Moreover, it may help establish a standardized postoperative treatment plan. This study aimed to evaluate the incidence of early complications requiring treatment plan changes in patients following vitreoretinal surgery and investigate its risk factors. METHODS This single-center retrospective study included 465 patients who had undergone vitreoretinal surgery. The reasons, incidence, and timing of treatment plan changes within 14 days of surgery were identified. Potential factors associated with the changes, such as patient demographics, surgeon's experience, diagnoses, and type of surgery were also analyzed. RESULTS The treatment plan was changed in 76 patients (16.3%) at a mean of 4.0 ± 3.2 days after vitreoretinal surgery. The reasons for the plan changes were increased intraocular pressure (IIOP) in 66(86.8%), intraocular inflammation in 2(2.6%), corneal edema in 3(3.9%), leakage from the sclerotomy wound in 3(3.9%) patients, and combined IIOP and intraocular inflammation in 2(2.6%). The date of discharge was postponed because of treatment plan changes in 17 patients (22.4%). The incidence of plan changes was higher in patients who underwent gas or oil tamponade (P < 0.001) and those who underwent surgery performed by less experienced surgeons (P = 0.034). CONCLUSIONS Treatment plan was changed in 16.3% of patients after vitreoretinal surgery. The risk of treatment plan changes was associated with the surgeon's experience in vitreoretinal surgery and the type of surgery. These results should be considered when establishing standardized care plans for patients who require vitreoretinal surgery.
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Affiliation(s)
- Ji Hyun Yoon
- Department of Ophthalmology, Kim's Eye Hospital, #156 Youngdeungpo-dong 4ga, Youngdeungpo-gu, Seoul, 150-034, South Korea
| | - Jae Hui Kim
- Department of Ophthalmology, Kim's Eye Hospital, #156 Youngdeungpo-dong 4ga, Youngdeungpo-gu, Seoul, 150-034, South Korea.
| | - Chul Gu Kim
- Department of Ophthalmology, Kim's Eye Hospital, #156 Youngdeungpo-dong 4ga, Youngdeungpo-gu, Seoul, 150-034, South Korea
| | - Jong Woo Kim
- Department of Ophthalmology, Kim's Eye Hospital, #156 Youngdeungpo-dong 4ga, Youngdeungpo-gu, Seoul, 150-034, South Korea
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Almulhim S, Almakhaita G, Al-Osail EM. Marked hemopneumopericardium in a patient with rectal cancer with distant metastasis: a case report. J Med Case Rep 2023; 17:225. [PMID: 37264442 DOI: 10.1186/s13256-023-03935-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/21/2022] [Accepted: 04/17/2023] [Indexed: 06/03/2023] Open
Abstract
INTRODUCTION Hemopneumopericardium defines a condition of combined pathology of weakened, dense blood content (hemopericardium) and air (pneumopericardium) in the pericardial cavity with an air fluid level. It is a rare disease, with only one such case reported in the literature. In this case report, we assessed a patient rectal cancer in addition to hemopneumopericardium, dyspnea, and chest pain. CLINICAL CASE REPORT A 47-year-old Arab woman previously diagnosed with rectal cancer metastasized to bones, lymph nodes, and lungs post-Hartmann procedure reported to the emergency department complaining of worsening dyspnea for 2 weeks, more significantly in the supine position. A productive cough with yellowish sputum characterized this; however, there was no pertinent family or psychological history. Examination of the respiratory system revealed dullness on the left side associated with decreased breath sound. The chest radiograph also revealed marked hydro-pneumopericardium. Spiral computed tomography angiography of pulmonary arteries demonstrated pericardial effusion with the air fluid level at pericardial space, implying hydro-pneumopericardium. CLINICAL CONCLUSION A successful pericardiocentesis was performed, in which 180 cc of blood-filled pericardial fluid was drained, suggesting the presence of hemopneumopericardium. Hemopneumopericardium has multiple etiologies, yet critical intervention is restricted in patients with cardiac tamponade. Hence, pericardiocentesis could be a definitive treatment.
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Affiliation(s)
- Sager Almulhim
- Imam Abdulrahman Bin Faisal Hospital-National Guard, Dammam, Saudi Arabia
| | - Ghada Almakhaita
- Imam Abdulrahman Bin Faisal Hospital-National Guard, Dammam, Saudi Arabia
| | - Emad M Al-Osail
- Department of General Surgery, College of Medicine, Imam Abdulrahman Bin Faisal University, Dammam, Saudi Arabia.
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20
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Mete M, Parolini B, Maggio E, Airaghi G, De Santis N, Guerriero M, Pertile G. Use of Heavy Silicon Oil as Intraocular Tamponade for Inferior Retinal Detachment Complicated by Proliferative Vitreoretinopathy: A Multicentric Experience. Ophthalmologica 2023; 246:209-218. [PMID: 37245503 DOI: 10.1159/000531141] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2023] [Accepted: 05/12/2023] [Indexed: 05/30/2023]
Abstract
INTRODUCTION This is a multicentric study on the use of heavy silicon oil (HSO) as an intraocular tamponade for inferior retinal detachment (RD) complicated by proliferative vitreoretinopathy (PVR). METHODS 139 eyes treated for RD with PVR were included in the study. 10 (7.2%) were affected by primary RD with inferior PVR, while 129 (92.8%) were affected by recurrent RD with inferior PVR. 102 eyes (73.9%) had received a silicon oil (SO) tamponade in a previous intervention prior to receiving HSO. Mean follow-up was 36.5 (standard deviation = 32.3) months. RESULTS The median interval between HSO injection and removal was 4 months (interquartile range: 3). At the time of HSO removal, the retina was attached in 120 eyes (87.6%), whereas in 17 eyes (12.4%), it had re-detached while the HSO was in situ. 32 eyes (23.2%) showed recurrent RD. A subsequent RD relapse was observed in 14.2% of cases with no RD at the time of HSO removal, and in 88.2% if an RD was present at the time of HSO removal. Advancing age showed a positive association with retinal attachment at the end of follow-up, while the risk of RD relapse at the end of the follow-up showed a significant negative association with HSO tamponade duration and with the use of SO rather than air or gas as post-HSO tamponade materials. Mean best corrected visual acuity was 1.1 logarithm of minimum angle of resolution at all follow-up time points. 56 cases (40.3%) needed treatment for elevated intraocular pressure (IOP), with which no clinically relevant variables were associated during follow-up. CONCLUSION HSO represents a safe and effective tamponade in cases of inferior RD with PVR. The presence of RD at the time of HSO removal is a negative prognostic factor for the development of a subsequent RD relapse. According to our findings, in cases of RD at the time of HSO removal, a short-term tamponade should definitely be avoided, in favor of SO. Special attention must be paid to the risk of IOP elevation, and patients should be closely monitored.
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Affiliation(s)
- Maurizio Mete
- Department of Ophthalmology, IRRCS Sacro Cuore-Don Calabria Hospital, Negrar di Valpolicella, Verona, Italy
| | | | - Emilia Maggio
- Department of Ophthalmology, IRRCS Sacro Cuore-Don Calabria Hospital, Negrar di Valpolicella, Verona, Italy
| | - Giulia Airaghi
- Department of Ophthalmology, ASST Valle Olona, Varese, Italy
| | - Nicoletta De Santis
- Clinic Research Unit, URC, IRRCS Sacro Cuore-Don Calabria Hospital, Negrar di Valpolicella, Verona, Italy
| | - Massimo Guerriero
- Clinic Research Unit, URC, IRRCS Sacro Cuore-Don Calabria Hospital, Negrar di Valpolicella, Verona, Italy
| | - Grazia Pertile
- Department of Ophthalmology, IRRCS Sacro Cuore-Don Calabria Hospital, Negrar di Valpolicella, Verona, Italy
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Probasco B, Melnychuk V, Hong A, Gabra A, Lieberman S. A Case of Granulomatosis with Polyangiitis Masquerading as Community Acquired Pneumonia. J Community Hosp Intern Med Perspect 2023; 13:103-107. [PMID: 37877061 PMCID: PMC10593167 DOI: 10.55729/2000-9666.1191] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/25/2022] [Revised: 03/10/2023] [Accepted: 03/16/2023] [Indexed: 10/26/2023] Open
Abstract
Granulomatosis with polyangiitis (GPA) has a multitude of presentations, including appearing as a refractory community-acquired pneumonia (CAP) or an isolated localized pulmonary disease. This case describes a patient suspected to have a CAP before further workup and lung biopsy revealed his diagnosis of GPA. This case report demonstrates GPA's diverse presentations, critical complications such as diffuse alveolar hemorrhage (DAH) and cardiac tamponade, and nuanced management options.
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Affiliation(s)
- Brianna Probasco
- Department of Internal Medicine, HCA Florida Northwest Hospital,
USA
| | | | - Angelina Hong
- Department of Internal Medicine, HCA Florida Northwest Hospital,
USA
| | - Abanoub Gabra
- Department of Pathology, HCA Florida Northwest Hospital,
USA
| | - Scott Lieberman
- Department of Pulmonology and Critical Care, HCA Florida Northwest Hospital,
USA
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Heriot WJ, Metha AB, He Z, Lim JK, Hoang A, Nishimura T, Okada M, Bui BV. Optimizing Retinal Thermofusion in Retinal Detachment Repair: Achieving Instant Adhesion without Air Tamponade. Ophthalmol Sci 2022; 2:100179. [PMID: 36531586 PMCID: PMC9754973 DOI: 10.1016/j.xops.2022.100179] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/27/2022] [Revised: 05/25/2022] [Accepted: 06/06/2022] [Indexed: 06/17/2023]
Abstract
PURPOSE Rhegmatogenous retinal detachment repair by intraoperative sealing of the tear without a tamponade agent should enable faster restoration of vision and resumption of normal activities. It avoids the need for further surgery in the case of silicone oil endotamponade. This study evaluated the retinal thermofusion (RTF) retinopexy method of subretinal space dehydration before photocoagulation to create an instantaneous intraoperative retina reattachment in a preclinical model. DESIGN Preclinical study. PARTICIPANTS Twenty Dutch Belt, pigmented rabbits that underwent RTF repair after experimental retinal detachment. METHODS This ex vivo model quantified adhesion force between the retina and underlying retinal pigment epithelium and choroid after treatment of 1 retinal edge using postmortem porcine or human retina (6 × 12 mm). We compared (1) control, (2) laser photocoagulation alone, (3) dehydration alone, and (4) dehydration followed by photocoagulation (RTF). Optimized parameters for RTF were then applied in the in vivo rabbit model of retinal detachment. Animals were followed up for 14 days. MAIN OUTCOME MEASURES For this ex vivo model, we measured adhesion force and related this to tissue temperature. For the in vivo study, we assessed retinal attachment using funduscopy and histologic analysis. RESULTS The ex vivo model showed that RTF repair produced significantly higher adhesion force than photocoagulation alone independent of dehydration method: warm (60° C) high airflow (50-70 ml/minute) or using laser wavelengths targeting water absorption peaks (1470 or 1940 nm) with coaxial low airflow (10-20 ml/minute). The latter approach produced a smaller footprint of dehydration. Application of RTF (1940-nm laser with coaxial airflow) in an in vivo retinal detachment model in rabbit eyes resulted in immediate retinal adhesion, achieving forces similar to those in the ex vivo experiments. Retinal thermofusion repair resulted in stable reattachment of the retina over the 2-week follow-up period. CONCLUSIONS We showed that a short preliminary dehydrating laser treatment of a retinal tear margin before traditional laser photocoagulation creates an immediate intraoperative waterproof retinopexy adhesion independent of tamponade and a wound-healing response. This approach potentially will allow rapid postoperative recovery regardless of the tear location and improved vision.
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Affiliation(s)
- Wilson J. Heriot
- Retinology Institute, Glen Iris, Australia
- Centre for Eye Research Australia, East Melbourne, Australia
- Department of Optometry and Vision Sciences, University of Melbourne, Parkville, Australia
| | - Andrew B. Metha
- Department of Optometry and Vision Sciences, University of Melbourne, Parkville, Australia
| | - Zheng He
- Department of Optometry and Vision Sciences, University of Melbourne, Parkville, Australia
| | - Jeremiah K.H. Lim
- Department of Optometry and Vision Sciences, University of Melbourne, Parkville, Australia
- Caring Futures Institute, Flinders University, Bedford Park, Australia
| | - Anh Hoang
- Centre for Eye Research Australia, East Melbourne, Australia
- Department of Optometry and Vision Sciences, University of Melbourne, Parkville, Australia
| | - Tomoharu Nishimura
- Department of Optometry and Vision Sciences, University of Melbourne, Parkville, Australia
- Department of Ophthalmology, Dokkyo Medical University Saitama Medical Center, Saitama, Japan
| | - Mali Okada
- Centre for Eye Research Australia, East Melbourne, Australia
| | - Bang V. Bui
- Department of Optometry and Vision Sciences, University of Melbourne, Parkville, Australia
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Easton A, Joret M, Xian S, Ternouth I. Pericardial effusion and tamponade in the context of herpes zoster: a novel occurrence. Eur Heart J Case Rep 2022; 7:ytac459. [PMID: 36600801 PMCID: PMC9800266 DOI: 10.1093/ehjcr/ytac459] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2022] [Revised: 05/06/2022] [Accepted: 11/23/2022] [Indexed: 11/30/2022]
Abstract
Background Pericarditis and pericardial effusion are relatively common hospital presentations, which rarely result in cardiac tamponade. The aetiology is often undetermined and presumed idiopathic or viral. This article reviews varicella zoster virus (VZV)-associated pericardial effusion and peri/myopericarditis and constitutes the first report of VZV-associated cardiac tamponade in the adult population. Case summary We report the case of a 59-year-old woman who presented to hospital with pleuritic chest pain, haemodynamic instability, and a recent herpes zoster rash in the left T1 distribution. Computed tomography revealed a large pericardial effusion, and echocardiography showed features of cardiac tamponade. The patient was treated with pericardial drainage. Aspirate analysis revealed abundant polynuclear cells and histocytes with no organism. Polymerase chain reaction did not determine a cause. Discussion There are 13 reported cases of VZV-associated peri/myopericarditis in adults in the literature published in the English language. Of these, only three patients had a pericardial effusion. Aetiological diagnosis of an effusion is challenging and rarely made on virological grounds but rather on clinical features. Varicella zoster virus-associated pericardial effusion should be considered in patients presenting with haemodynamic instability and a dermatomal rash affecting the C3-C5 and T1-T4 distributions.
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Affiliation(s)
| | - Maximilian Joret
- Department of General Surgery, Taranaki Base Hospital, David Street, Westown, New Plymouth 4310, New Zealand
| | - Susan Xian
- Department of General Medicine, Taranaki Base Hospital, David Street, Westown, New Plymouth 4310, New Zealand
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Hoch VC, Abdel-Hamid M, Liu J, Hall AE, Theyyunni N, Fung CM. ED point-of-care ultrasonography is associated with earlier drainage of pericardial effusion: A retrospective cohort study. Am J Emerg Med 2022; 60:156-163. [PMID: 35986978 PMCID: PMC9937040 DOI: 10.1016/j.ajem.2022.08.008] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2022] [Revised: 07/30/2022] [Accepted: 08/01/2022] [Indexed: 01/11/2023] Open
Abstract
OBJECTIVES To determine the association between emergency department point-of-care cardiac ultrasonography (POCUS) utilization and time to pericardial effusion drainage during an 8-year period when the emergency ultrasound program was established at our institution. METHODS We performed a single-center retrospective cohort study in patients undergoing pericardiocentesis or other procedure for evacuation of pericardial effusion. Data was collected using both direct queries to the electronic health record database and two-examiner chart review. The primary outcome was time to intervention for pericardial effusion drainage. Multivariable Cox regression, with and without inverse probability weighting for likelihood to receive POCUS, was used to determine the association between POCUS and time to intervention. Secondary outcomes included 28-day mortality. RESULTS 257 patient encounters were included with 137 receiving POCUS and 120 who did not. The proportion of patients receiving POCUS increased from 18.5% to 69.5% during the early to late periods of the study. POCUS was associated with an earlier median time to intervention of 21.6 h (95% CI 17.2, 24.2) compared to 34.6 h (27.0, 50.5) in the No POCUS group. After adjustment for patient demographics, anticoagulation, time of presentation and hemodynamic instability, POCUS was associated with earlier intervention (HR 2.08 [95% CI 1.56, 2.77]). POCUS use was not associated with a difference in 28-day mortality, which was evaluated as a secondary outcome. However, diagnosis of pericardial effusion by the ED physician using any means (POCUS or other imaging) was associated with decreased 28-day mortality (9.7% vs. 26.0%, -16.3% for POCUS [95% CI -29.1, -3.5]). CONCLUSION POCUS was associated with an earlier time to intervention for pericardial effusions after adjustment for multiple confounding factors. Failure to diagnose pericardial effusion in the ED using any diagnostic testing including POCUS, was associated with increased 28-day mortality.
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Affiliation(s)
- Victoria C Hoch
- Department of Emergency Medicine, Brigham and Women's Hospital, Boston, MA, USA
| | - Mostafa Abdel-Hamid
- Department of Emergency Medicine, University of Michigan, Ann Arbor, MI, USA
| | - Jia Liu
- Department of Emergency Medicine, University of Michigan, Ann Arbor, MI, USA
| | - Ashley E Hall
- Department of Emergency Medicine, University of Michigan, Ann Arbor, MI, USA
| | - Nik Theyyunni
- Department of Emergency Medicine, University of Michigan, Ann Arbor, MI, USA
| | - Christopher M Fung
- Department of Emergency Medicine, University of Michigan, Ann Arbor, MI, USA.
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25
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Zarkesh MR, Haghjoo M. Neonatal cardiac tamponade, a life-threatening complication secondary to peripherally inserted central catheter: a case report. J Med Case Rep 2022; 16:305. [PMID: 35902974 PMCID: PMC9335958 DOI: 10.1186/s13256-022-03506-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2021] [Accepted: 06/26/2022] [Indexed: 11/30/2022] Open
Abstract
Background Although the use of a peripherally inserted central catheter (PICC) has many advantages for the treatment of neonates, catheter malposition may result in serious complications that could be life-threatening. We report the case of a 10-day-old neonate with cardiac tamponade secondary to a PICC line who was successfully treated by pericardiocentesis. Case presentation An Iranian (Asian) preterm male neonate was born by Cesarean section with a birth weight of 1190 g and a first-minute Apgar score of 7. Based on an increased respiratory distress syndrome (RDS) score from 4 to 7, resuscitation measures and intubation were performed at the neonatal intensive care unit (NICU). On day 3 after birth, a PICC line was inserted for parenteral therapy. A chest X-ray confirmed that the tip of the PICC line was in the appropriate position. Mechanical ventilation was discontinued 72 h post-NICU admission because of the improved respiratory condition. On the day 10 post-NICU admission, he suddenly developed hypotonia, apnea, hypoxia, hypotension, and bradycardia. Resuscitation and ventilation support were immediately started, and inotropic drugs were also given. Emergency echocardiography showed a severe pericardial effusion with tamponade. The PICC line was removed, and urgent pericardiocentesis was carried out. The respiratory situation gradually improved, the O2 saturation increased to 95%, and vital signs remained stable. Conclusions Dramatic improvement of the neonate's clinical responses after pericardial drainage and PICC removal were suggestive of PICC displacement, pericardial perforation, and cardiac tamponade. Supplementary Information The online version contains supplementary material available at 10.1186/s13256-022-03506-4.
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Affiliation(s)
- Mohammad Reza Zarkesh
- Maternal, Fetal, and Neonatal Research Center, Family Health Institute, Tehran University of Medical Sciences, Sarv Ave., North Nejatolahi Street, Tehran, 1598718311, Iran. .,Department of Neonatology, Yas Women Hospital, Tehran University of Medical Sciences, Tehran, Iran.
| | - Mokaram Haghjoo
- Department of Neonatology, Yas Women Hospital, Tehran University of Medical Sciences, Tehran, Iran
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26
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Waddingham PH, Elliott J, Bates A, Bilham J, Muthumala A, Honarbakhsh S, Ullah W, Hunter RJ, Lambiase PD, Lane RE, Chow AWC. Iatrogenic cardiac perforation due to pacemaker and defibrillator leads: a contemporary multicentre experience. Europace 2022; 24:1824-1833. [PMID: 35894862 DOI: 10.1093/europace/euac105] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2022] [Indexed: 11/14/2022] Open
Abstract
AIMS To determine the incidence, clinical features, management, and outcomes of pacemaker (PM) and implantable cardioverter-defibrillator (ICD) lead cardiac perforation. Cardiac perforations due to PM and ICD leads are rare but serious complications. Clinical features vary widely and may cause diagnostic delay. Management strategies are non-guideline based due to paucity of data. METHODS AND RESULTS A multicentre retrospective series including 3 UK cardiac tertiary centres from 2016 to 2020. Patient, device, and lead characteristics were obtained including 6-month outcomes. Seventy cases of perforation were identified from 10 631 procedures; perforation rate was 0.50% for local implants. Thirty-nine (56%) patients were female, mean ( ± standard deviation) age 74 ( ± 13.8) years. Left ventricular ejection fraction 51 ( ± 13.2) %. Median time to diagnosis was 9 (range: 0-989) days. Computed tomography (CT) diagnosed perforation with 97% sensitivity. Lead parameter abnormalities were present in 86% (whole cohort) and 98.6% for perforations diagnosed >24 h. Chest pain was the commonest symptom, present in 46%. The management strategy was percutaneous in 98.6% with complete procedural success in 98.6%. Pericardial effusion with tamponade was present in 17% and was associated with significantly increased mortality and major complications. Anticoagulation status was associated with tamponade by multivariate analysis (odds ratio 21.7, 95% confidence interval: 1.7-275.5, P = 0.018). CONCLUSIONS Perforation was rare (0.50%) and managed successfully by a percutaneous strategy with good outcomes. Tamponade was associated with increased mortality and major complications. Anticoagulation status was an independent predictor of tamponade. Case complexity is highly variable and requires skilled operators with a multi-disciplinary approach to achieve good outcomes.
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Affiliation(s)
- Peter H Waddingham
- Barts Heart Centre, St Bartholomew's Hospital, Barts Health NHS Trust, West Smithfield, London, EC1A 7BE, UK.,William Harvey Research Institute, Barts & The London School of Medicine & Dentistry, Queen Mary University of London, Charterhouse Square, London, EC1M 6BQ, UK
| | - James Elliott
- Barts Heart Centre, St Bartholomew's Hospital, Barts Health NHS Trust, West Smithfield, London, EC1A 7BE, UK
| | - Alexander Bates
- Department of Cardiology, University Hospital Southampton NHS Foundation Trust, Southampton, UK
| | - James Bilham
- Harefield Hospital, Royal Brompton, and Harefield NHS Trust, London, UK
| | - Amal Muthumala
- Barts Heart Centre, St Bartholomew's Hospital, Barts Health NHS Trust, West Smithfield, London, EC1A 7BE, UK
| | - Shohreh Honarbakhsh
- Barts Heart Centre, St Bartholomew's Hospital, Barts Health NHS Trust, West Smithfield, London, EC1A 7BE, UK.,William Harvey Research Institute, Barts & The London School of Medicine & Dentistry, Queen Mary University of London, Charterhouse Square, London, EC1M 6BQ, UK
| | - Waqas Ullah
- Department of Cardiology, University Hospital Southampton NHS Foundation Trust, Southampton, UK
| | - Ross J Hunter
- Barts Heart Centre, St Bartholomew's Hospital, Barts Health NHS Trust, West Smithfield, London, EC1A 7BE, UK.,William Harvey Research Institute, Barts & The London School of Medicine & Dentistry, Queen Mary University of London, Charterhouse Square, London, EC1M 6BQ, UK
| | - Pier D Lambiase
- Barts Heart Centre, St Bartholomew's Hospital, Barts Health NHS Trust, West Smithfield, London, EC1A 7BE, UK.,Institute of Cardiovascular Science, University College London, London, UK
| | - Rebecca E Lane
- Harefield Hospital, Royal Brompton, and Harefield NHS Trust, London, UK
| | - Anthony W C Chow
- Barts Heart Centre, St Bartholomew's Hospital, Barts Health NHS Trust, West Smithfield, London, EC1A 7BE, UK.,William Harvey Research Institute, Barts & The London School of Medicine & Dentistry, Queen Mary University of London, Charterhouse Square, London, EC1M 6BQ, UK
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27
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AlAttab N, Wani T, Alomar K, Alfozan A. Bullet embolism: a rare cause of acute ischaemia. Interact Cardiovasc Thorac Surg 2022; 34:1186-1187. [PMID: 35088832 PMCID: PMC9714595 DOI: 10.1093/icvts/ivac006] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2021] [Revised: 11/21/2021] [Accepted: 01/12/2022] [Indexed: 10/07/2023] Open
Abstract
Embolization of a bullet or shrapnel from the heart (left ventricle) to the peripheral arterial circulation is practically unknown. We present a 38-year-old man with no comorbidities who was referred to our centre with a bullet injury to the left side of his chest. The patient complained of mild pain and numbness in his right lower limb. A trauma series was advised. A contrast angiogram of the peripheral lower limbs showed a bullet in the right popliteal artery with no flow in the tibial arteries. A bullet was removed from the distal popliteal artery at its bifurcation with a long thrombus proximal to it. Removal of the foreign body is the widely accepted management, especially when it leads to symptoms like ischaemia or signs of infection, as was the situation in our case.
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Affiliation(s)
- Nashwan AlAttab
- Department of vascular surgery, King Fahad Medical City, Riyadh, Saudi Arabia
| | - Tariq Wani
- Department of vascular surgery, King Fahad Medical City, Riyadh, Saudi Arabia
| | - Khalid Alomar
- Department of vascular surgery, King Fahad Medical City, Riyadh, Saudi Arabia
| | - Abdullah Alfozan
- Department of vascular surgery, King Fahad Medical City, Riyadh, Saudi Arabia
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28
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Savvoulidis P, Mechery A, Lawton E, Ludman PF, Sharma H, Thompson S, Khalil A, Kalogeropoulos A, Khan S, Nadir AM, Doshi SN. Comparison of left ventricular with right ventricular rapid pacing on tamponade during TAVI. Int J Cardiol 2022; 360:46-52. [PMID: 35597495 DOI: 10.1016/j.ijcard.2022.05.035] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/17/2022] [Revised: 04/28/2022] [Accepted: 05/16/2022] [Indexed: 11/05/2022]
Abstract
BACKGROUND Small studies have suggested left ventricular (LV) rapid pacing has similar safety and efficacy to conventional right ventricular (RV) rapid pacing in transcatheter aortic valve implantation (TAVI). However, there are limited data on the comparative rates of tamponade. The study compared the rate of cardiac tamponade between LV and RV-pacing during TAVI. METHODS Between 2008 and 2021, 1226 consecutive patients undergoing transfemoral or transaxillary TAVI were included. 470(38.3%) patients had TAVI deployment with RV-pacing and 756(61.7%) with LV-pacing. The primary outcome was the frequency and cause of cardiac tamponade. Secondary outcomes included efficacy, procedure duration and crossover rates. RESULTS There was a trend to less tamponade with LV-pacing, which did not reach statistical significance [11(2.3%) vs 11(1.5%);P = 0.27]. There was no significant difference in the frequency of tamponade due to annular tear [4(0.9%) vs 9(1.2%);P = 0.59] or LV free-wall perforation [1(0.2%) vs 2(0.3%);P = 0.86]. The frequency of tamponade due to RV perforation was significantly lower in the LV-pacing group [0 vs 6(2.3%);P < 0.005)]. Two patients with tamponade due to RV perforation required emergency sternotomy of whom one died. Deployment success was similar (99% vs 99.6%;P=NS). Procedure duration was shorter with LV-pacing (70 vs 80 mins;P < 0.005). Crossover to RV-pacing was low (0.9%). There were no embolizations caused by loss-of-capture in either group. CONCLUSIONS LV-pacing appears equally efficacious and is associated with a lower risk of tamponade due to RV perforation caused by the temporary pacing wire. LV-pacing was not associated with an increased risk of tamponade due to LV free-wall perforation.
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Affiliation(s)
- Panagiotis Savvoulidis
- Department of Cardiology, Queen Elizabeth University Hospital, Mindelsohn Way, Edgbaston, Birmingham B15 2WB, UK
| | - Anthony Mechery
- Department of Cardiology, Queen Elizabeth University Hospital, Mindelsohn Way, Edgbaston, Birmingham B15 2WB, UK
| | - Ewa Lawton
- Department of Cardiology, Queen Elizabeth University Hospital, Mindelsohn Way, Edgbaston, Birmingham B15 2WB, UK
| | - Peter F Ludman
- Department of Cardiology, Queen Elizabeth University Hospital, Mindelsohn Way, Edgbaston, Birmingham B15 2WB, UK; Institute for Cardiovascular Sciences, College of Medical & Dental Sciences, University of Birmingham, Edgbaston, Birmingham B15 2TT, UK
| | - Harish Sharma
- Department of Cardiology, Queen Elizabeth University Hospital, Mindelsohn Way, Edgbaston, Birmingham B15 2WB, UK; Institute for Cardiovascular Sciences, College of Medical & Dental Sciences, University of Birmingham, Edgbaston, Birmingham B15 2TT, UK
| | - Sophie Thompson
- Department of Cardiology, Queen Elizabeth University Hospital, Mindelsohn Way, Edgbaston, Birmingham B15 2WB, UK
| | - Arsalan Khalil
- Department of Cardiology, Queen Elizabeth University Hospital, Mindelsohn Way, Edgbaston, Birmingham B15 2WB, UK
| | | | - Sohail Khan
- Department of Cardiology, Queen Elizabeth University Hospital, Mindelsohn Way, Edgbaston, Birmingham B15 2WB, UK; Institute for Cardiovascular Sciences, College of Medical & Dental Sciences, University of Birmingham, Edgbaston, Birmingham B15 2TT, UK
| | - Adnan M Nadir
- Department of Cardiology, Queen Elizabeth University Hospital, Mindelsohn Way, Edgbaston, Birmingham B15 2WB, UK; Institute for Cardiovascular Sciences, College of Medical & Dental Sciences, University of Birmingham, Edgbaston, Birmingham B15 2TT, UK
| | - Sagar N Doshi
- Department of Cardiology, Queen Elizabeth University Hospital, Mindelsohn Way, Edgbaston, Birmingham B15 2WB, UK; Institute for Cardiovascular Sciences, College of Medical & Dental Sciences, University of Birmingham, Edgbaston, Birmingham B15 2TT, UK..
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29
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Lee KH, Chung YR, Yeo S, Lee K. Is gas/air tamponade essential for eyes with small peripheral retinal breaks without detachment during vitrectomy? BMC Ophthalmol 2022; 22:186. [PMID: 35459110 PMCID: PMC9027820 DOI: 10.1186/s12886-022-02401-2] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2022] [Accepted: 04/11/2022] [Indexed: 12/03/2022] Open
Abstract
Background To investigate the safety of vitrectomy with laser photocoagulation in eyes with small peripheral retinal breaks without air or gas tamponade. Methods Among patients who underwent vitrectomy for various retinal disorders, those with small peripheral retinal breaks treated by laser photocoagulation without air or gas tamponade were included in this study. Their medical records were assessed retrospectively, and we investigated the characteristics of small peripheral retinal breaks and the incidence of postoperative retinal detachment (RD). Results Thirty-one eyes of 31 patients who presented with small peripheral retinal breaks requiring endolaser photocoagulation during vitrectomy were included in this analysis. There were two cases of iatrogenic retinal breaks that occurred during vitrectomy, while others were preexisting lesions, including retinal tears, atrophic retinal holes, and retinal holes with lattice degeneration. There were no cases of RD during the follow-up period of at least 6 months. Conclusions Adequate laser treatment without gas or air tamponade may be sufficient during vitrectomy in cases with small peripheral retinal breaks without concurrent RD, along with complete removal of vitreoretinal traction. Supplementary Information The online version contains supplementary material available at 10.1186/s12886-022-02401-2.
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Affiliation(s)
- Kyung Ho Lee
- Department of Ophthalmology, Ajou University School of Medicine, 164 World Cup-ro, Yeongtong-gu, Suwon, 16499, South Korea
| | - Yoo-Ri Chung
- Department of Ophthalmology, Ajou University School of Medicine, 164 World Cup-ro, Yeongtong-gu, Suwon, 16499, South Korea
| | - Suji Yeo
- Department of Ophthalmology, Ajou University School of Medicine, 164 World Cup-ro, Yeongtong-gu, Suwon, 16499, South Korea
| | - Kihwang Lee
- Department of Ophthalmology, Ajou University School of Medicine, 164 World Cup-ro, Yeongtong-gu, Suwon, 16499, South Korea.
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30
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Abstract
In rheumatoid arthritis, pericarditis is commonly asymptomatic, but rarely, it progresses to a morbid complication, like cardiac tamponade or restrictive pericarditis. Current studies have indicated that conventional drugs have limited ability to reverse these lethal conditions. To date, invasive surgical measures remain the only definitive therapy for patients who are unresponsive to drugs. Recently, anti-tumor necrosis factor-α and anti-interleukin-1 antibody-based drugs have shown limited success. Consequently, given the importance of pericarditis, we need new treatment methods. Here, we describe a patient with rheumatoid arthritis and effusive pericarditis, which progressed to life-threatening cardiac tamponade. The patient responded very well to rituximab. Thus, rituximab represents a potential new therapy for this rarely treated complication of rheumatoid arthritis.
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Affiliation(s)
- Ali Taylan
- Department of Rheumatology, Saglik Bilimleri University, Tepecik Teaching and Research Hospital, Izmir, Rheumatology Section, Yenisehir, Turkey.
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31
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Hauser RG, Gornick CC, Abdelhadi RH, Tang CY, Kapphahn-Bergs M, Casey SA, Okeson BK, Steele EA, Sengupta JD. Leadless Pacemaker Perforations: Clinical Consequences and Related Device and User Problems. J Cardiovasc Electrophysiol 2021; 33:154-159. [PMID: 34953099 PMCID: PMC9305184 DOI: 10.1111/jce.15343] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/24/2021] [Revised: 11/15/2021] [Accepted: 11/30/2021] [Indexed: 11/27/2022]
Abstract
Background Cardiac perforation during leadless pacemaker implantation is more likely to require intervention than perforation by a transvenous lead. This study reports the consequences of Micra pacemaker perforations and related device and operator use problems based on information the manufacturer has submitted to the Food and Drug Administration (FDA). Methods FDA's Manufacturer and User Facility Device Experience (MAUDE) database was searched for Micra perforations. Data extracted included deaths, major adverse clinical events (MACEs), and device and/or operator use problems. Results Between 2016 and July 2021, 563 perforations were reported within 30 days of implant and resulted in 150 deaths (27%), 499 cardiac tamponades (89%), 64 pericardial effusions (11%), and 146 patients (26%) required emergency surgery. Half of perforations were associated with 139 (25%) device problems, 78 (14%) operator use problems, and 62 (11%) combined device and operator use problems. Inadequate electrical measurements or difficult positioning were the most frequent device problems (n = 129); non‐septal implants and perforation of other structures were the most frequent operator use problems (n = 69); a combined operator use and device problem resulted in 62 delivery system perforations. No device or operator use problem was identified for 282 perforations (50%), but they were associated with 78 deaths, 245 tamponades, and 57 emergency surgeries. Conclusion The Micra perforations reported in MAUDE are often associated with death and major complications requiring emergency intervention. Device and use problems account for at least half of perforations. Studies are needed to identify who is at risk for a perforation and how MACE can be avoided or mitigated.
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Affiliation(s)
- Robert G Hauser
- Heart Rhythm Science Center, Minneapolis Heart Institute Foundation, 920 East 28th Street, Minneapolis, MN, USA
| | - Charles C Gornick
- Heart Rhythm Science Center, Minneapolis Heart Institute Foundation, 920 East 28th Street, Minneapolis, MN, USA
| | - Raed H Abdelhadi
- Heart Rhythm Science Center, Minneapolis Heart Institute Foundation, 920 East 28th Street, Minneapolis, MN, USA
| | - Chuen Y Tang
- Heart Rhythm Science Center, Minneapolis Heart Institute Foundation, 920 East 28th Street, Minneapolis, MN, USA
| | - Melanie Kapphahn-Bergs
- Heart Rhythm Science Center, Minneapolis Heart Institute Foundation, 920 East 28th Street, Minneapolis, MN, USA
| | - Susan A Casey
- Heart Rhythm Science Center, Minneapolis Heart Institute Foundation, 920 East 28th Street, Minneapolis, MN, USA
| | - Brynn K Okeson
- Heart Rhythm Science Center, Minneapolis Heart Institute Foundation, 920 East 28th Street, Minneapolis, MN, USA
| | - Elizabeth A Steele
- Heart Rhythm Science Center, Minneapolis Heart Institute Foundation, 920 East 28th Street, Minneapolis, MN, USA
| | - Jay D Sengupta
- Heart Rhythm Science Center, Minneapolis Heart Institute Foundation, 920 East 28th Street, Minneapolis, MN, USA
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32
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Siller RA, Skubic JJ, Almeda JL, Villarreal JF, Kaplan AE. Candida pericarditis presenting with cardiac tamponade and multiple organ failure after combined damage control thoracotomy and laparotomy with splenectomy in a trauma patient: Case report and review of literature. Trauma Case Rep 2021; 37:100564. [PMID: 34917734 PMCID: PMC8669452 DOI: 10.1016/j.tcr.2021.100564] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/03/2021] [Indexed: 12/04/2022] Open
Abstract
Candida pericarditis is a rare condition which has previously been described after cardiothoracic surgery and immunosuppressive states (Geisler et al., 1981; Eng et al., 1981; Kraus et al., 1988; Kaufman et al., 1988; Tang et al., 2009; Glower et al., 1990; Carrel et al., 1991; Rabinovici et al., 1997; Canver et al., 1998; Farjah et al., 2005; Gronemeyer et al., 1982 [1-11]). We describe the case of a 19-year-old male blunt trauma patient, who survived a damage control thoracotomy and laparotomy with splenectomy, who later developed a loculated Candida pericardial effusion, complicated with cardiac tamponade and multiple organ failure, and required antifungals and surgical reintervention with thoracotomy for drainage. A literature search of the reported cases demonstrates that Candida pericarditis is indeed a rare but fatal condition if not identified and treated appropriately. This article discusses the difficulties we encountered while recognizing the disorder in our patient and proposes a guideline to adequately treat the condition in an effective and timely manner. Candida pericarditis poses a special challenge for the physician since its correct diagnosis and management requires a multidisciplinary approach.
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Affiliation(s)
- R A Siller
- University of Texas at Rio Grande Valley - General Surgery Residency at Doctors Hospital at Renaissance, 5321 S, McColl Road, Edinburg, TX 78569, United States of America
| | - J J Skubic
- DHR Health Surgery Institute, Department of Trauma and Critical Care, 1100 E. Dove Ave, Suite 201, McAllen, TX 78504, United States of America
| | - J L Almeda
- DHR Health Transplant Institute, Hepatobiliary, Pancreas and Organ Transplantation Center, 5540 Raphael Drive, Edinburg, TX 78539, United States of America
| | - J F Villarreal
- DHR Health Heart Institute, 224 Lindberg Ave, McAllen, TX 78501, United States of America
| | - A E Kaplan
- Pulmonary Sleep Center of the Rio Grande Valley, 5300 N, McColl Rd, McAllen, TX 78504, United States of America
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33
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Fujimoto T, Yanishi K, Zen K, Matoba S. A very rare complication of subacute pericarditis: a case report of spontaneous coronary artery rupture. Eur Heart J Case Rep 2021; 5:ytab484. [PMID: 34909575 PMCID: PMC8665675 DOI: 10.1093/ehjcr/ytab484] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2021] [Revised: 08/03/2021] [Accepted: 11/24/2021] [Indexed: 01/01/2023]
Abstract
BACKGROUND Spontaneous coronary artery rupture (SCAR) is an extremely rare and highly lethal disease. CASE SUMMARY A 74-year-old man who had undergone respiratory surgery (robot-assisted thoracoscopic surgery) presented with exertional dyspnoea since postoperative day (POD) 6. Echocardiography and contrast-enhanced computed tomography showed diffuse pericardial effusion, and a 12-lead electrocardiogram showed widespread concave ST-segment elevation. The diagnosis of acute pericarditis was made based on the absence of significant elevation of cardiac enzymes and the presence of elevated C-reactive peptide levels. The patient was started on anti-inflammatory medication, including steroids; however, on POD 11, the patient developed a sudden cardiopulmonary arrest due to cardiac tamponade. Extracorporeal cardiopulmonary resuscitation was performed, and an emergency coronary angiography showed contrast extravasation from the left anterior descending artery to the epicardium. He was diagnosed with SCAR and underwent transcatheter arterial embolization (TAE) and pericardial drainage. DISCUSSION In this case, SCAR occurred during the course of acute pericarditis. We speculated that the cause of SCAR was more affected with pericarditis than injury by the respiratory surgery. The clinical course of acute pericarditis generally has a good prognosis, but the rare occurrence of fatal complications should be considered, suggesting the need for careful follow-up. In addition, TAE was a less invasive and feasible treatment for SCAR.
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Affiliation(s)
- Tomotaka Fujimoto
- Department of Cardiovascular Medicine, Kyoto Prefectural University of Medicine, Kajii-cho 465, Kawaramachi-Hirokoji, Kamigyo-ku, Kyoto 602-8566, Japan
| | - Kenji Yanishi
- Department of Cardiovascular Medicine, Kyoto Prefectural University of Medicine, Kajii-cho 465, Kawaramachi-Hirokoji, Kamigyo-ku, Kyoto 602-8566, Japan
| | - Kan Zen
- Department of Cardiovascular Medicine, Kyoto Prefectural University of Medicine, Kajii-cho 465, Kawaramachi-Hirokoji, Kamigyo-ku, Kyoto 602-8566, Japan
| | - Satoaki Matoba
- Department of Cardiovascular Medicine, Kyoto Prefectural University of Medicine, Kajii-cho 465, Kawaramachi-Hirokoji, Kamigyo-ku, Kyoto 602-8566, Japan
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Gopal K, Ahamed H, Jose R, Varma PK. Cardiac tamponade as a presentation of COVID-19 after cardiac surgery. Indian J Thorac Cardiovasc Surg 2021; 38:191-194. [PMID: 34840443 PMCID: PMC8608559 DOI: 10.1007/s12055-021-01270-6] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2021] [Revised: 09/08/2021] [Accepted: 09/09/2021] [Indexed: 12/24/2022] Open
Abstract
We present two patients who turned positive for coronavirus disease 2019 (COVID-19) after elective cardiac surgery, developing postoperative pericardial effusion with tamponade. One of the patients who presented with tamponade had no other symptoms of COVID-19 infection. COVID-19 can rarely present with cardiac manifestations including pericardial effusion and tamponade. In the post cardiac surgery setting, this effect of the virus may be accentuated. Hence, a high index of suspicion and prompt management are the keys for a successful outcome.
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Affiliation(s)
- Kirun Gopal
- Department of Cardiovascular and Thoracic Surgery, Amrita Institute of Medical Sciences, Amrita Vishwa Vidyapeetham (Amrita University), Kochi, Kerala India
| | - Hisham Ahamed
- Department of Cardiology, Amrita Institute of Medical Sciences, Amrita Vishwa Vidyapeetham (Amrita University), Kochi, Kerala India
| | - Rajesh Jose
- Department of Cardiovascular and Thoracic Surgery, Amrita Institute of Medical Sciences, Amrita Vishwa Vidyapeetham (Amrita University), Kochi, Kerala India
| | - Praveen Kerala Varma
- Department of Cardiovascular and Thoracic Surgery, Amrita Institute of Medical Sciences, Amrita Vishwa Vidyapeetham (Amrita University), Kochi, Kerala India
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Ellenbroek DFJ, van Kessel L, Compagner W, Brouwer T, Bouwman RA, van Straten BAHM, Otterspoor LC, De Bie AJR. Diagnostic performance of echocardiography to predict cardiac tamponade after cardiac surgery. Eur J Cardiothorac Surg 2021; 62:6430389. [PMID: 34791128 PMCID: PMC9257667 DOI: 10.1093/ejcts/ezab468] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/30/2021] [Revised: 08/14/2021] [Accepted: 09/23/2021] [Indexed: 11/29/2022] Open
Affiliation(s)
- Dennis F J Ellenbroek
- Department of Intensive Care, Radboud University Medical Center, Nijmegen, Netherlands
| | - Luc van Kessel
- Department of Intensive Care, Catharina Hospital, Michelangelolaan 2, Eindhoven, Netherlands
| | - Wilma Compagner
- Department of Intensive Care, Catharina Hospital, Michelangelolaan 2, Eindhoven, Netherlands
| | - Tim Brouwer
- Department of Intensive Care, Catharina Hospital, Michelangelolaan 2, Eindhoven, Netherlands
| | - R Arthur Bouwman
- Department of Anesthesiology, Catharina Hospital, Eindhoven, Netherlands
| | | | - Luuk C Otterspoor
- Department of Cardiology, Catharina Hospital, Eindhoven, Netherlands
| | - Ashley J R De Bie
- Department of Intensive Care, Radboud University Medical Center, Nijmegen, Netherlands.,Department of Intensive Care, Catharina Hospital, Michelangelolaan 2, Eindhoven, Netherlands
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Gevaert SA, Halvorsen S, Sinnaeve PR, Sambola A, Gulati G, Lancellotti P, Van Der Meer P, Lyon AR, Farmakis D, Lee G, Boriani G, Wechalekar A, Okines A, Asteggiano R. Evaluation and management of cancer patients presenting with acute cardiovascular disease: a Consensus Document of the Acute CardioVascular Care (ACVC) association and the ESC council of Cardio-Oncology-Part 1: acute coronary syndromes and acute pericardial diseases. Eur Heart J Acute Cardiovasc Care 2021; 10:947-959. [PMID: 34453829 DOI: 10.1093/ehjacc/zuab056] [Citation(s) in RCA: 31] [Impact Index Per Article: 10.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/17/2021] [Revised: 06/22/2021] [Accepted: 06/30/2021] [Indexed: 12/24/2022]
Abstract
Advances in treatment, common cardiovascular (CV) risk factors and the ageing of the population have led to an increasing number of cancer patients presenting with acute CV diseases. These events may be related to the cancer itself or the cancer treatment. Acute cardiac care specialists must be aware of these acute CV complications and be able to manage them. This may require an individualized and multidisciplinary approach. We summarize the most common acute CV complications of cytotoxic, targeted, and immune-based therapies. This is followed by a proposal for a multidisciplinary approach where acute cardiologists work close together with the treating oncologists, haematologists, and radiation specialists, especially in situations where immediate therapeutic decisions are needed. In this first part, we further focus on the management of acute coronary syndromes and acute pericardial diseases in patients with cancer.
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Affiliation(s)
- Sofie A Gevaert
- Department of Cardiology, Ghent University Hospital, C Heymanslaan 10, 9000 Gent, Belgium
| | - Sigrun Halvorsen
- Department of Cardiology, Oslo University Hospital Ulleval and University of Oslo, Kirkeveien 166, 0450 Oslo, Norway
| | - Peter R Sinnaeve
- Department of Cardiology, University Hospital Leuven, Herestraat 49, 3000 Leuven, Belgium
| | - Antonia Sambola
- Department of Cardiology, University Hospital Vall d'Hebron, Universitat Autonòma, CIBER-CV, Passeig de la Vall d'Hebron 119, 08035 Barcelona, Spain
| | - Geeta Gulati
- Department of Cardiology, Oslo University Hospital Ulleval and University of Oslo, Kirkeveien 166, 0450 Oslo, Norway
| | - Patrizio Lancellotti
- University of Liège Hospital, GIGA Cardiovascular Science and Department of Cardiology, CHU Sart Tilman, Avenue del'Hôpital 1, 4000 Liège, Belgium
| | - Peter Van Der Meer
- Department of Cardiology, University of Groningen University Medical Center Groningen and University of Groningen, Hanzeplein 1, 9713 GZ Groningen, The Netherlands
| | - Alexander R Lyon
- Cardio-Oncology Clinic at Royal Brompton Hospital and Imperial College, Sydney street, SW3 6NP London, UK
| | - Dimitrios Farmakis
- University of Cyprus Medical School, Agio Nikolaou street 93, 2408 Nicosia, Cyprus
| | - Geraldine Lee
- Florence Nightingale Faculty of Nursing, Midwifery and Palliative Care, King's College, Strand, WC2R 2LS London, UK
| | - Giuseppe Boriani
- Cardiology Division, Department of Biomedical, Metabolic and Neural Sciences, University of Modena and Reggio Emilia and Policlinico Di Modena, Via Giuseppe Campi 287, 41125 Modena, Italy
| | - Ashutosh Wechalekar
- Department of Haematology, University College London/University College London Hospitals, Huntley street 72, WC1E 6DD London, UK
| | - Alicia Okines
- Department of Medicine, The Royal Marsden NHS Foundation Trust, Fulham road 203, SW3 6JJ London, UK
| | - Riccardo Asteggiano
- Insubria University, Via Ravasi 2, 21100 Varese, Italy.,LARC (Laboratorio Analisi e Ricerca Clinica), Via Mombarcaro 80, 10136 Turin, Italy
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Bashir J, Lee AJ, Philippon F, Mondesert B, Krahn AD, Sadek MM, Exner D, Pak M, Legare JF, Karim S, Fedoruk L, Peng D, Cusimano RJ, Parkash R, Tyers GFO, Andrade J. Predictors of perforation during lead extraction: Results of the Canadian Lead ExtrAction Risk (CLEAR) study. Heart Rhythm 2021:S1547-5271(21)02310-9. [PMID: 34695576 DOI: 10.1016/j.hrthm.2021.10.019] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/17/2021] [Revised: 10/18/2021] [Accepted: 10/19/2021] [Indexed: 01/27/2023]
Abstract
BACKGROUND Transvenous lead extraction can have serious adverse events, such as cardiac or vascular perforation. Risk factors have not been well characterized. OBJECTIVE The purpose of this study was to identify factors associated with perforation and death, and to characterize lead extraction in a large contemporary population. METHODS We performed a retrospective multicenter study examining patients undergoing lead extraction at 8 Canadian institutions from 1996 through 2016. Demographic and clinical data were used to identify variables associated with perforation and mortality using logistic regression modeling. RESULTS A total of 2325 consecutive patients (age 61.9 ±16.5 years) underwent extraction of 4527 leads. Perforation rate was 2.7% (63/2325) and 30-day mortality was 1.6% (38/2325), with mortality of 0.4% due to perforation (10/2325). Variables associated with perforation included no previous cardiac surgery (odds ratio [OR] 3.33; 95% confidence interval [CI] 1.54-7.19; P = .002), female sex (OR 3.27; 95% CI 1.91-5.60; P <.001); left ventricular ejection fraction ≥40% (OR 2.81; 95% CI 1.28-6.14; P = .010); lead age >8 years (OR 2.64; 95% CI 1.52-4.60; P <.001); ≥2 leads extracted (OR 2.49; 95% CI 1.23-5.04; P = .011); and diabetes (OR 2.12; 95% CI 1.16-3.86; P = .014). Variables associated with death included infection as indication for extraction (OR 3.85; 95% CI 1.38-10.73; P = .010); anemia (OR 3.14; 95% CI 1.38-6.61; P = .003), and patient age (OR 1.04; 95% CI 1.01-1.07; P = .012). CONCLUSION Risk factors associated with perforation in lead extraction include no history of cardiac surgery, female sex, preserved left ventricular ejection fraction, lead age >8 years, ≥2 leads extracted, and diabetes.
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Terry NLJ, Manapragada PP, Aziz MU, Singh SP. Review of pericardial disease on computed tomography. J Med Imaging Radiat Sci 2021; 52:S65-S77. [PMID: 34588141 DOI: 10.1016/j.jmir.2021.09.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2021] [Revised: 08/23/2021] [Accepted: 09/10/2021] [Indexed: 10/20/2022]
Abstract
Echocardiography has long been the mainstay in the evaluation of cardiac and pericardial disease. As computed tomography (CT) has advanced, it has become a valuable partner in the imaging of the pericardium. The advantages of CT include a larger field of view, multiplanar reconstruction and increased discrimination between various soft tissues and fluids. CT is less operator dependent and can more easily, and reproducibly, image areas of the pericardium for which echocardiography has poor windows such as the right pericardium. The introduction of EKG gating has decreased cardiac motion artifact and can allow functional evaluation although echocardiography remains the primary source of real-time imaging of cardiac and valve motion. It is essential for the skilled cardiac imager to understand the strengths and weaknesses of CT and its role in the definition and assessment of pericardial disease.
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Affiliation(s)
- Nina L J Terry
- University of Alabama at Birmingham, Department of Radiology, Birmingham, AL, USA.
| | - Padma P Manapragada
- University of Alabama at Birmingham, Department of Radiology, Birmingham, AL, USA
| | - Muhammad Usman Aziz
- University of Alabama at Birmingham, Department of Radiology, Birmingham, AL, USA
| | - Satinder P Singh
- University of Alabama at Birmingham, Department of Radiology, Birmingham, AL, USA
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Elkammash A, Abdel-Hay MA, Kanaan S, Alsinan M, Taha Y, Fadul M, Degheidy N. A Life-Threatening Presentation of Primary Small Cell Colorectal Non-Hodgkin Lymphoma as Cardiac Tamponade and Its Challenging Management. Eur J Case Rep Intern Med 2021; 8:002753. [PMID: 34527621 DOI: 10.12890/2021_002753] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2021] [Accepted: 07/12/2021] [Indexed: 11/05/2022] Open
Abstract
Colorectal non-Hodgkin lymphoma (NHL) is quite aggressive and rare, only constituting less than 1% of all cases of colorectal cancer. The pericardium is an extremely rare first site of metastasis. Cardiac tamponade can be a life-threatening initial presentation. We report a 55-year-old female who presented with severe shortness of breath, intermittent abdominal pain and altered bowel habits. She had low blood pressure with congested neck veins. Her echocardiogram showed pericardial and cardiac infiltration with tumour mass; a large pericardial effusion with signs of cardiac tamponade. There was no safe window for percutaneous drainage, and the patient was not physically fit for surgical drainage. A multidisciplinary approach was used to diagnose and manage the case involving a cardiologist, gastroenterologist, pathologist, radiologist and oncologist. CT scans of the whole body showed a large rectosigmoid mass infiltrating the uterus and adnexa. Flexible sigmoidoscopy showed a large bleeding mass at the rectosigmoid junction. The biopsy confirmed small cell NHL. Three cycles of chemotherapy were urgently commenced over a period of 5 weeks (1 cycle of CVP; 2 cycles of CHOP). The patient showed significant symptomatic improvement. A 5-week follow-up echocardiogram showed significant shrinkage of the pericardial tumour and only a small rim of pericardial effusion. The effusion did not recollect in her follow-up echocardiograms. A year later, she was referred to the palliative care team due to the further spreading of her lymphoma. In conclusion, colorectal small cell NHL may initially present as cardiac tamponade. Urgent initiation of chemotherapy can be a treatment option whenever a drainage procedure is unsafe. LEARNING POINTS Colorectal small cell NHL is a quite rare malignancy that may present initially with pericardial metastasis.Cardiac tamponade secondary to colorectal NHL is a life-threatening presentation. It can be managed by timely chemotherapy alone whenever the usual drainage procedures are not safe.A multidisciplinary approach is a cornerstone in the management of unstable lymphoma patients. It helps the rapid diagnosis and initiation of appropriate chemotherapy.
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Affiliation(s)
- Amr Elkammash
- Department of General Internal Medicine, University Hospitals Dorset, The Royal Bournemouth Hospital, Bournemouth, UK
| | | | - Saleh Kanaan
- Department of General Internal Medicine, University Hospitals Dorset, The Royal Bournemouth Hospital, Bournemouth, UK
| | - Mustafa Alsinan
- Department of General Internal Medicine, University Hospitals Dorset, The Royal Bournemouth Hospital, Bournemouth, UK
| | - Yosra Taha
- Department of General Internal Medicine, University Hospitals Dorset, The Royal Bournemouth Hospital, Bournemouth, UK
| | - Mohammed Fadul
- Department of General Internal Medicine, University Hospitals Dorset, The Royal Bournemouth Hospital, Bournemouth, UK
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Brun M, Brun S, Pearson D, Wullschleger M. The way to a man's heart is through his stomach: a case of myocardial infarction mimic and pseudo- tamponade in a polytrauma patient. Scand J Trauma Resusc Emerg Med 2021; 29:106. [PMID: 34332603 PMCID: PMC8325207 DOI: 10.1186/s13049-021-00911-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2021] [Accepted: 07/02/2021] [Indexed: 12/05/2022] Open
Abstract
Background There exists a therapeutic conflict between haemorrhage control and prevention of thromboembolic events following polytrauma and complications are not uncommon. Such opposing therapies can result in unexpected pathophysiology and there is a real risk of misdiagnosis resulting in harm. This case presents a previously unreported complication of prevention and management of thromboembolism- STEMI (ST elevation myocardial infarction) and tamponade mimic secondary to retroperitoneal haematoma. Case presentation We present a 50-year-old male polytrauma patient who following treatment for presumed pulmonary embolus demonstrated classical clinical findings of myocardial infarction and pericardial tamponade secondary to a retroperitoneal haematoma. This is an event not previously reported in the literature. The risk of adverse outcome by management along the standard lines of STEMI (ST elevation myocardial infarction) was averted through awareness for alternative aetiology via a multi-team approach which resulted in percutaneous drainage of the haematoma and complete resolution of symptoms. Conclusions This manuscript highlights the therapeutic conflict between haemorrhage control and prevention of thromboembolic events in critically injured, the importance of high index of suspicion in this patient cohort and the benefits of multidisciplinary decision making in the complex patient through a not previously published pathophysiologic phenomenon.
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Affiliation(s)
- Mathew Brun
- Adult Intensive Care, Unit Gold Coast University Hospital, 1 Hospital Blvd, Southport, Queensland, 4215, Australia.
| | - Shane Brun
- Medical Education Unit Gold Coast University Hospital, 1 Hospital Blvd, Southport, Queensland, 4215, Australia
| | - David Pearson
- Adult Intensive Care, Unit Gold Coast University Hospital, 1 Hospital Blvd, Southport, Queensland, 4215, Australia
| | - Martin Wullschleger
- Trauma Service Royal Brisbane and Women's Hospital, Herston, Queensland, 4029, Australia
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Baragé A, Harouna Idrissa S, Mahoungou-Mackonia N, Arous S, Bennouna G, Azzouzi L, Habbal R. Cardiac tamponade: Better prognosis in association with pulmonary embolism: Case report. Ann Med Surg (Lond) 2021; 66:102410. [PMID: 34094528 PMCID: PMC8166641 DOI: 10.1016/j.amsu.2021.102410] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2021] [Revised: 05/15/2021] [Accepted: 05/16/2021] [Indexed: 11/19/2022] Open
Abstract
The tamponade leads to an increase in intrapericardial pressure, which impairs the diastolic filling of the ventricles and reduces ejection. However, the association with pulmonary arterial hypertension, which in turn leads to an intracardiac hyper-pressure, constitutes a compensatory mechanism. We report the case of a 23 year old patient followed for anemia due to martial deficiency for 2 years, who consulted us with right heart failure evolving for 5 months, a hemoptoic cough and chest tightness. The entire workup revealed a pericardial and pleural tamponade of tuberculous origin associated with a pulmonary embolism evaluated at 15% according to the Qanadli score. After stabilization of her hemodynamic state, the patient was put on anti-bacillary and anticoagulant treatment with a good improvement of her cardiopulmonary state. She was discharged after 1 month (satisfactory check-up), regularly followed up in outpatient clinic with check-up of hemostasis and cardiac echography every 2 weeks. She was declared cured of her tuberculosis after 6 months of treatment. There was no recurrence after two years of follow-up. The combination of tamponade and pulmonary hypertension is synergistic in that it improves the patient's prognosis.
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Affiliation(s)
- A. Baragé
- Department of Cardiology, IBN ROCHD University Hospital, Casablanca, B.P, 5696, Casablanca, Morocco
- Corresponding author. Department of Cardiology, IBN ROCHD University Hospital, Casablanca, Morocco.
| | - S. Harouna Idrissa
- Department of Cardiology, IBN ROCHD University Hospital, Casablanca, B.P, 5696, Casablanca, Morocco
| | - N. Mahoungou-Mackonia
- Department of Cardiology, IBN ROCHD University Hospital, Casablanca, B.P, 5696, Casablanca, Morocco
| | - S. Arous
- Faculty of Medicine and Pharmacy, Hassan II University of Casablanca, B.P, 5696, Casablanca, Morocco
- Department of Cardiology, IBN ROCHD University Hospital, Casablanca, B.P, 5696, Casablanca, Morocco
| | - G. Bennouna
- Faculty of Medicine and Pharmacy, Hassan II University of Casablanca, B.P, 5696, Casablanca, Morocco
- Department of Cardiology, IBN ROCHD University Hospital, Casablanca, B.P, 5696, Casablanca, Morocco
| | - L. Azzouzi
- Faculty of Medicine and Pharmacy, Hassan II University of Casablanca, B.P, 5696, Casablanca, Morocco
- Department of Cardiology, IBN ROCHD University Hospital, Casablanca, B.P, 5696, Casablanca, Morocco
| | - R. Habbal
- Faculty of Medicine and Pharmacy, Hassan II University of Casablanca, B.P, 5696, Casablanca, Morocco
- Department of Cardiology, IBN ROCHD University Hospital, Casablanca, B.P, 5696, Casablanca, Morocco
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Denroche K, Fox PR, Prittie J, Crecraft C. Septic pericarditis caused by a migrating grass awn in a cat. J Vet Cardiol 2021; 36:14-19. [PMID: 34038860 DOI: 10.1016/j.jvc.2021.04.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2021] [Revised: 04/11/2021] [Accepted: 04/15/2021] [Indexed: 10/21/2022]
Abstract
Septic pericarditis and cardiac tamponade associated with migrating grass awn foreign bodies is reported rarely in companion animals. We report such a case in a previously healthy, 9-year-old, neutered female, indoor-outdoor, domestic long-hair cat who presented for acute tachypnea. Large volume pericardial effusion and pericardial tamponade was identified by thoracic-focused assessment with sonography. Following removal of 108 mL of purulent pericardial effusion by pericardiocentesis, the cat improved. Cytologic examination of pericardial fluid demonstrated septic, suppurative inflammation, Pasteurella sp. was cultured from pericardial effusion, and antibiotics were administered. Subsequent echocardiographic examination revealed large volume pericardial effusion, pericardial thickening, and a linear foreign body within the pericardial space. Whole-body computed tomography confirmed pericardial thickening, pericardial, and pleural effusion. A 16-mm long grass awn was identified within the pericardial space during thoracic exploratory surgery performed through a median sternotomy. Successful foreign body removal and subtotal pericardiectomy was accomplished. Histopathology of pericardial tissue disclosed chronic pericarditis with lymphoplasmacytic-to-pyogranulomatous inflammation, and transmural presence of grass awn foreign body. The cat responded to supportive therapy and was discharged 4 days postoperatively. When examined 3 weeks later, the cat appeared healthy with normal appetite. The cat remained healthy as of this writing, 487 days following surgery. To the author's knowledge, this is the first report in the cat of septic pericarditis and cardiac tamponade resulting from a migrating grass awn foreign body.
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Affiliation(s)
- K Denroche
- The Animal Medical Center, Department of Emergency and Critical Care, 510 East 62nd Street, New York, NY, 10065, USA
| | - P R Fox
- The Animal Medical Center, Department of Cardiology, 510 East 62nd Street, New York, NY, 10065, USA.
| | - J Prittie
- The Animal Medical Center, Department of Emergency and Critical Care, 510 East 62nd Street, New York, NY, 10065, USA
| | - C Crecraft
- The Animal Medical Center, Department of Emergency and Critical Care, 510 East 62nd Street, New York, NY, 10065, USA
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Al-Kaf FA, Al Garni TA, Al-Harbi N, Sandokji H, Samargandy S. Cardiac Tamponade, Sever Hypothyroidism and Acute Respiratory Distress Syndrome (ARDS) with COVID-19 Infection. J Saudi Heart Assoc 2021; 33:71-76. [PMID: 33936940 PMCID: PMC8084305 DOI: 10.37616/2212-5043.1235] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/19/2020] [Revised: 12/31/2020] [Accepted: 01/19/2021] [Indexed: 11/29/2022] Open
Abstract
A 21-years-old with Down syndrome presented with respiratory distress. Initial investigations revealed a cardiac tamponade. On further evaluation, he had positive coronavirus disease-2019 (COVID-19), severe chest infection and severe hypothyroidism. He responded well to urgent pericardiocentesis, levothyroxine, hydrocortisone and tocilizumab.
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Affiliation(s)
- Fahmi A Al-Kaf
- Adult Cardiology Department, Prince Sultan Cardiac Center, Riyadh, Kingdom of Saudi Arabia
| | - Turki A Al Garni
- Adult Cardiology Department, Prince Sultan Cardiac Center, Riyadh, Kingdom of Saudi Arabia
| | - Nahes Al-Harbi
- Adult Cardiology Department, Prince Sultan Cardiac Center, Riyadh, Kingdom of Saudi Arabia
| | - Hassan Sandokji
- Adult Cardiology Department, Prince Sultan Cardiac Center, Riyadh, Kingdom of Saudi Arabia
| | - Sondos Samargandy
- Adult Cardiology Department, Prince Sultan Cardiac Center, Riyadh, Kingdom of Saudi Arabia
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Muensterer NR, Werner E, Muensterer OJ. Successful Foley catheter tamponade of an epigastric vessel trocar injury in a toddler - A case report. Int J Surg Case Rep 2021; 81:105779. [PMID: 33752031 PMCID: PMC7985414 DOI: 10.1016/j.ijscr.2021.105779] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2021] [Revised: 03/12/2021] [Accepted: 03/12/2021] [Indexed: 11/28/2022] Open
Abstract
Epigastric vessel injury is a well recognized complication during laparoscopic trocar placement. Precautionary measures to prevent trocar induced injuries should be implemented to lower the incidence of this complication. If this complication is encountered, tamponade by Foley catheter placement is an effective measure to provide hemostasis. Hemorrhage control using a Foley catheter is feasible even in small children and toddlers.
Introduction and importance Injuries to the inferior epigastric vessels during laparoscopic surgery are rare but reported. They can lead to significant morbidity. We report the successful tamponade of a bleeding epigastric vessel during laparoscopic inguinal hernia repair in a child using a Foley catheter. A Foley catheter has not been routinely used in pediatric surgery for this indication so far. Case presentation A 32-month-old boy underwent laparoscopic left inguinal hernia repair. During insertion of a 2 mm trocar, the left inferior epigastric vessels were lacerated, leading to a brisk bleed into the abdominal wall and into the abdomen through the trocar site during the procedure. When the hemorrhage was noted, the trocar was removed. The trocar tract was slightly dilated using a blunt forceps and a 12 F Foley catheter was introduced into the abdomen. The balloon was insufflated with 10 ml of water and the catheter was retracted towards the abdominal wall, tamponading the bleed. The inguinal hernia repair was completed, and after desufflating the catheter at the end of the procedure, the hemorrhage had stopped. Clinical discussion Postoperatively, the hemoglobin had dropped by 1.5 g/dl to 9.3 g/dl. The patient was observed and then discharged on the same day. Besides an additional 2 mm scar in the right lower quadrant, he had no further sequellae or adverse effects. Conclusion Hemorrhage resulting from trocar injury of the inferior epigastric vessels during laparoscopy can be controlled by Foley catheter insertion and tamponade in children. Pediatric surgeons should be aware of this useful maneuver to manage this complication.
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Affiliation(s)
- Nadine R Muensterer
- Department of Pediatric Surgery, Dr. von Hauner Children's Hospital, Ludwig-Maximilians-University Munich, Munich, Germany.
| | - Evgenij Werner
- Department of Pediatric Surgery, University Medical Center, Johannes Gutenberg University Mainz, Mainz, Germany
| | - Oliver J Muensterer
- Department of Pediatric Surgery, Dr. von Hauner Children's Hospital, Ludwig-Maximilians-University Munich, Munich, Germany; Department of Pediatric Surgery, University Medical Center, Johannes Gutenberg University Mainz, Mainz, Germany
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Hauser RG, Gornick CC, Abdelhadi RH, Tang CY, Casey SA, Sengupta JD. Major adverse clinical events associated with implantation of a leadless intracardiac pacemaker. Heart Rhythm 2021; 18:1132-1139. [PMID: 33713856 DOI: 10.1016/j.hrthm.2021.03.015] [Citation(s) in RCA: 34] [Impact Index Per Article: 11.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/25/2021] [Revised: 03/06/2021] [Accepted: 03/09/2021] [Indexed: 11/26/2022]
Abstract
BACKGROUND Leadless intracardiac pacemakers were developed to avoid the complications of transvenous pacing systems. The Medtronic Micra™ transcatheter pacemaker is one such system. We found an unexpected number of major adverse clinical events (MACE) in the Food and Drug Administration's Manufacturers and User Facility Device Experience (MAUDE) database associated with Micra implantation. OBJECTIVE The purpose of this study was to describe these MACE and compare them to implant procedure MACE in MAUDE for Medtronic CapSureFix™ active-fixation transvenous pacing leads. METHODS During January 2021, we queried the MAUDE database for reports of MACE for Micra pacemakers and CapSureFix leads using the simple search terms "death," "tamponade," and "perforation." Reports from 2016-2020 were included. RESULTS The search identified 363 MACE for Micra and 960 MACE for CapSureFix leads, including 96 Micra deaths (26.4%) vs 23 CapSureFix deaths (2.4%) (P <.001); 287 Micra tamponades (79.1%) vs 225 tamponades for CapSureFix (23.4%) (P <.001); and 99 rescue thoracotomies for Micra (27.3%) vs 50 rescue thoracotomies for CapSureFix (5.2%) (P <.001). More Micra patients required cardiopulmonary resuscitation (21.8% vs 1.1%) and suffered hypotension or shock (22.0% vs 5.8%) than CapSureFix recipients (P <.001). Micra patients were more likely to survive a myocardial perforation or tear if they had surgical repair (P = .014). CONCLUSION Micra leadless pacemaker implantation may be complicated by myocardial and vascular perforations and tears that result in cardiac tamponade and death. We estimate the incidence is low (<1%). Rescue surgery to repair perforations may be lifesaving. MACE are significantly less for implantation of CapSureFix transvenous ventricular pacing leads.
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Affiliation(s)
- Robert G Hauser
- Minneapolis Heart Institute Foundation, Minneapolis, Minnesota.
| | | | | | - Chuen Y Tang
- Minneapolis Heart Institute Foundation, Minneapolis, Minnesota
| | - Susan A Casey
- Minneapolis Heart Institute Foundation, Minneapolis, Minnesota
| | - Jay D Sengupta
- Minneapolis Heart Institute Foundation, Minneapolis, Minnesota
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Shergill S, Davies J, Cairns N. Effusive-constrictive cholesterol pericarditis: a case report. Eur Heart J Case Rep 2021; 5:ytaa496. [PMID: 33554027 PMCID: PMC7850630 DOI: 10.1093/ehjcr/ytaa496] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/09/2020] [Revised: 07/21/2020] [Accepted: 11/18/2020] [Indexed: 11/26/2022]
Abstract
Background Cholesterol pericarditis (CP) remains a rare pericardial disease characterized by chronic pericardial effusions with high cholesterol concentrations with or without the formation of cholesterol crystals. Effusions are often large and can cause ventricular compression and subsequent pericardial adhesion formation. CP can be idiopathic but has associations with rheumatoid arthritis (RA), tuberculosis and hypothyroidism. Case summary We present a case of a 72-year-old male with a background of seropositive RA with a finding of an incidental pericardial effusion on computed tomography thorax abdomen and pelvis. Transthoracic echocardiogram demonstrated a large effusion with echocardiographic features of tamponade. On review, he was breathless with a raised venous pressure, bilateral ankle oedema, and pulsus paradoxus was present. Pericardial drainage was performed with fluid analysis demonstrating a cholesterol concentration of 8.3 mmol/L and numerous cholesterol crystal formation. Interval imaging demonstrated recurrence of the effusion with pericardial thickening and progressive constriction. He remained asymptomatic and underwent a successful pericardial window. At present, he is under close clinical outpatient surveillance with symptoms guiding a future pericardiectomy if warranted. Discussion CP can present as an emergent situation with signs and symptoms of acute heart failure with prompt pericardiocentesis required in cases of clinical tamponade. However, the disease course is often one of chronicity with relapsing large effusions that tend to recur following drainage, with the development of pericardial constriction necessitating pericardiectomy for definitive management.
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Affiliation(s)
- Simran Shergill
- Cardiology Department, South Warwickshire NHS Foundation Trust, Lakin Road, Warwick CV34 5BW, UK
| | - James Davies
- Cardiology Department, South Warwickshire NHS Foundation Trust, Lakin Road, Warwick CV34 5BW, UK
| | - Naomi Cairns
- Cardiology Department, South Warwickshire NHS Foundation Trust, Lakin Road, Warwick CV34 5BW, UK
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Stremmel C, Scherer C, Lüsebrink E, Kupka D, Schmid T, Stocker T, Kellnar A, Kleeberger J, Sinner MF, Petzold T, Mehilli J, Braun D, Orban M, Hausleiter J, Massberg S, Orban M. Treatment of acute cardiac tamponade: A retrospective analysis of classical intermittent versus continuous pericardial drainage. Int J Cardiol Heart Vasc 2021; 32:100722. [PMID: 33644296 PMCID: PMC7887384 DOI: 10.1016/j.ijcha.2021.100722] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2020] [Revised: 01/08/2021] [Accepted: 01/13/2021] [Indexed: 01/06/2023]
Abstract
Acute cardiac tamponade is a highly relevant complication in modern cardiology. Continuous pericardial drainage is safe and does not increase total drainage volume. Continuous drainage associates with lower rates of open-heart surgical interventions. Continuous drainage associates with reduced re-tamponades and mortality on day 5.
Background Acute cardiac tamponade is a life-threatening pathology in modern cardiology as catheter-based interventions become increasingly relevant. Pericardiocentesis is usually the primary treatment of choice. However, protocols for handling of draining pigtail catheters are very variable due to limit data and require further investigation. Methods We retrospectively analyzed 52 patients with acute cardiac tamponade requiring immediate pericardiocentesis from January 2017 to August 2020. Patients were treated with a classical approach of intermittent manual aspiration or continuous pericardial drainage using a redon drainage system. Results Mean age of patients was 74 years in both groups. Most common causes for cardiac tamponade were percutaneous coronary interventions in about 50% and transaortic valve implantations in 25% of all cases. 28 patients were treated with classic intermittent drainage from 2017 to 2020. 24 patients were treated with continuous drainage from December 2018–2020. Compared to classical intermittent drainage treatment, continuous drainage was associated with a lower rate of a surgical intervention or cardiac re-tamponade and a lower mortality at 5 days (HR 0.2, 95% CI 0.1–0.9, log-rank p = 0.03). Despite a longer total drainage time under continuous suction, drainage volumes were comparable in both groups. Conclusion Acute cardiac tamponade can be efficiently treated by pericardiocentesis with subsequent continuous negative pressure drainage via a pigtail catheter. Our retrospective analysis shows a significantly lower mortality, a decreased rate of interventions and lower rates of cardiac re-tamponade without any relevant side effects when compared to classical intermittent manual drainage. These findings require further investigations in larger, randomized trials.
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Affiliation(s)
- Christopher Stremmel
- Medizinische Klinik und Poliklinik I, Klinikum der Universität München, Munich, Germany
- DZHK (German Centre for Cardiovascular Research), partner site Munich Heart Alliance, Klinikum der Universität München, Munich, Germany
| | - Clemens Scherer
- Medizinische Klinik und Poliklinik I, Klinikum der Universität München, Munich, Germany
- DZHK (German Centre for Cardiovascular Research), partner site Munich Heart Alliance, Klinikum der Universität München, Munich, Germany
| | - Enzo Lüsebrink
- Medizinische Klinik und Poliklinik I, Klinikum der Universität München, Munich, Germany
- DZHK (German Centre for Cardiovascular Research), partner site Munich Heart Alliance, Klinikum der Universität München, Munich, Germany
| | - Danny Kupka
- Medizinische Klinik und Poliklinik I, Klinikum der Universität München, Munich, Germany
- DZHK (German Centre for Cardiovascular Research), partner site Munich Heart Alliance, Klinikum der Universität München, Munich, Germany
| | - Teresa Schmid
- Medizinische Klinik und Poliklinik I, Klinikum der Universität München, Munich, Germany
- DZHK (German Centre for Cardiovascular Research), partner site Munich Heart Alliance, Klinikum der Universität München, Munich, Germany
| | - Thomas Stocker
- Medizinische Klinik und Poliklinik I, Klinikum der Universität München, Munich, Germany
- DZHK (German Centre for Cardiovascular Research), partner site Munich Heart Alliance, Klinikum der Universität München, Munich, Germany
| | - Antonia Kellnar
- Medizinische Klinik und Poliklinik I, Klinikum der Universität München, Munich, Germany
- DZHK (German Centre for Cardiovascular Research), partner site Munich Heart Alliance, Klinikum der Universität München, Munich, Germany
| | - Jan Kleeberger
- Medizinische Klinik und Poliklinik I, Klinikum der Universität München, Munich, Germany
- DZHK (German Centre for Cardiovascular Research), partner site Munich Heart Alliance, Klinikum der Universität München, Munich, Germany
| | - Moritz F. Sinner
- Medizinische Klinik und Poliklinik I, Klinikum der Universität München, Munich, Germany
- DZHK (German Centre for Cardiovascular Research), partner site Munich Heart Alliance, Klinikum der Universität München, Munich, Germany
| | - Tobias Petzold
- Medizinische Klinik und Poliklinik I, Klinikum der Universität München, Munich, Germany
- DZHK (German Centre for Cardiovascular Research), partner site Munich Heart Alliance, Klinikum der Universität München, Munich, Germany
| | - Julinda Mehilli
- DZHK (German Centre for Cardiovascular Research), partner site Munich Heart Alliance, Klinikum der Universität München, Munich, Germany
- Medizinische Klinik I, Krankenhaus Landshut-Achdorf, Landshut, Germany
| | - Daniel Braun
- Medizinische Klinik und Poliklinik I, Klinikum der Universität München, Munich, Germany
- DZHK (German Centre for Cardiovascular Research), partner site Munich Heart Alliance, Klinikum der Universität München, Munich, Germany
| | - Mathias Orban
- Medizinische Klinik und Poliklinik I, Klinikum der Universität München, Munich, Germany
- DZHK (German Centre for Cardiovascular Research), partner site Munich Heart Alliance, Klinikum der Universität München, Munich, Germany
| | - Jörg Hausleiter
- Medizinische Klinik und Poliklinik I, Klinikum der Universität München, Munich, Germany
- DZHK (German Centre for Cardiovascular Research), partner site Munich Heart Alliance, Klinikum der Universität München, Munich, Germany
| | - Steffen Massberg
- Medizinische Klinik und Poliklinik I, Klinikum der Universität München, Munich, Germany
- DZHK (German Centre for Cardiovascular Research), partner site Munich Heart Alliance, Klinikum der Universität München, Munich, Germany
| | - Martin Orban
- Medizinische Klinik und Poliklinik I, Klinikum der Universität München, Munich, Germany
- DZHK (German Centre for Cardiovascular Research), partner site Munich Heart Alliance, Klinikum der Universität München, Munich, Germany
- Corresponding author at: Intensive Care Unit, Medizinische Klinik und Poliklinik I, Klinikum der Universität München, Marchioninistraße 15, 81377 Munich, Germany.
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Wong SW, Ng JKX, Chia YW. Tuberculous pericarditis with tamponade diagnosed concomitantly with COVID-19: a case report. Eur Heart J Case Rep 2021; 5:ytaa491. [PMID: 33644650 PMCID: PMC7898573 DOI: 10.1093/ehjcr/ytaa491] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/09/2020] [Revised: 09/01/2020] [Accepted: 11/13/2020] [Indexed: 12/15/2022]
Abstract
Background Tuberculous pericarditis is a rare manifestation of tuberculosis infection. COVID-19 pandemic poses a challenge in detecting uncommon diseases. Case summary A 47-year-old man was admitted with symptoms of COVID-19 infection. Rapid progression of cardiomegaly on radiograph with clinical deterioration were suggestive of pericardial tamponade. Urgent pericardiocentesis revealed haemoserous fluid, elevated adenosine deaminase, and positive tuberculous (TB) polymerase chain reaction (PCR). He was started on anti-TB therapy and Remdesivir with marked improvement of symptoms. Repeat echocardiogram and CT thorax showed resolution of pericardial fluid, and the patient remained well on discharge. Discussion This case highlights the difficulty in detecting a concomitant rare but important disease. The development of massive pericardial tamponade acutely is not pathognomonic for COVID-19, and a careful diagnostic process involving multi-modality imaging occurred to arrive at a diagnosis of tuberculosis.
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Affiliation(s)
- Shiun Woei Wong
- Department of Cardiology, Tan Tock Seng Hospital, 11, Jalan Tan Tock Seng, 308433 Singapore
| | - Jessica Ke Xuan Ng
- Department of Cardiology, Tan Tock Seng Hospital, 11, Jalan Tan Tock Seng, 308433 Singapore
| | - Yew Woon Chia
- Department of Cardiology, Tan Tock Seng Hospital, 11, Jalan Tan Tock Seng, 308433 Singapore
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Abstract
Ventricular septal rupture and hemopericardium are rare postinfarction complications. Contrast[HYPHEN]enhanced echocardiography can help identify pericardial effusion etiologies. Transcaval percutaneous ventricular assist device implantation is a viable strategy.
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Affiliation(s)
- Samuel D Maidman
- Division of Cardiology, Emory University School of Medicine, Atlanta, Georgia
| | - Logan M Eberly
- Division of Cardiology, Emory University School of Medicine, Atlanta, Georgia
| | - Adam B Greenbaum
- Division of Cardiology, Emory University School of Medicine, Atlanta, Georgia
| | - Robert A Guyton
- Division of Cardiothoracic Surgery, Emory University School of Medicine, Atlanta, Georgia
| | - Bryan J Wells
- Division of Cardiology, Emory University School of Medicine, Atlanta, Georgia
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50
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Duanmu Y, Choi DS, Tracy S, Harris OM, Schleifer JI, Dadabhoy FZ, Wu JC, Platz E. Development and validation of a novel prediction score for cardiac tamponade in emergency department patients with pericardial effusion. Eur Heart J Acute Cardiovasc Care 2020; 10:542-549. [PMID: 33823539 PMCID: PMC8245142 DOI: 10.1093/ehjacc/zuaa023] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/01/2020] [Revised: 09/10/2020] [Accepted: 09/11/2020] [Indexed: 12/23/2022]
Abstract
Aims Determining which patients with pericardial effusion require urgent intervention can be challenging. We sought to develop a novel, simple risk prediction score for patients with pericardial effusion. Methods and results Adult patients admitted through the emergency department (ED) with pericardial effusion were retrospectively evaluated. The overall cohort was divided into a derivation and validation cohort for the generation and validation of a novel risk score using logistic regression. The primary outcome was a pericardial drainage procedure or death attributed to cardiac tamponade within 24 h of ED arrival. Among 195 eligible patients, 102 (52%) experienced the primary outcome. Four variables were selected for the novel score: systolic blood pressure < 100 mmHg (1.5 points), effusion diameter [1–2 cm (0 points), 2–3 cm (1.5 points), >3 cm (2 points)], right ventricular diastolic collapse (2 points), and mitral inflow velocity variation > 25% (1 point). The need for pericardial drainage within 24 h was stratified as low (<2 points), intermediate (2–4 points), or high (≥4 points), which corresponded to risks of 8.1% [95% confidence interval (CI) 3.0–16.8%], 63.8% [95% CI 50.1–76.0%], and 93.7% [95% CI 84.5–98.2%]. The area under the curve of the simplified score was 0.94 for the derivation and 0.91 for the validation cohort. Conclusion Among ED patients with pericardial effusion, a four-variable prediction score consisting of systolic blood pressure, effusion diameter, right ventricular collapse, and mitral inflow velocity variation can accurately predict the need for urgent pericardial drainage. Prospective validation of this novel score is warranted.
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Affiliation(s)
- Youyou Duanmu
- Department of Emergency Medicine, Stanford University School of Medicine, 900 Welch Road Suite 350, Palo Alto, CA 94304, USA
| | - Daniel S Choi
- Department of Emergency Medicine, Brigham and Women's Hospital, 75 Francis Street, Boston, MA 02115, USA
| | - Sam Tracy
- Genentech, Inc., South San Francisco, CA 94080, USA
| | - Owen M Harris
- Department of Emergency Medicine, Brigham and Women's Hospital, 75 Francis Street, Boston, MA 02115, USA.,Department of Emergency Medicine, North Shore Medical Center, 3 Dove Avenue, Salem, MA 01970, USA
| | - Jessica I Schleifer
- Department of Anesthesia and Intensive Care Medicine, University Hospital Bonn, Venusberg-Campus 1, Bonn 53127, Germany
| | - Farah Z Dadabhoy
- Department of Emergency Medicine, Brigham and Women's Hospital, 75 Francis Street, Boston, MA 02115, USA
| | - Justina C Wu
- Department of Medicine, Cardiovascular Division, Brigham and Women's Hospital, 75 Francis Street, Boston, MA 02115, USA
| | - Elke Platz
- Department of Medicine, Cardiovascular Division, Brigham and Women's Hospital, 75 Francis Street, Boston, MA 02115, USA
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