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Cureus Jun 2021Pericardial disease is a common manifestation of malignancy. Gynecologic malignancies such as ovarian cancer rarely present with cardiac involvement. Cardiac tamponade...
Pericardial disease is a common manifestation of malignancy. Gynecologic malignancies such as ovarian cancer rarely present with cardiac involvement. Cardiac tamponade may be the initial presentation of malignancy in as many as half of pericardial disease cases. We report the case of a 60-year-old female with known ovarian adenocarcinoma, who achieved initial success with tumor debulking and adjuvant chemotherapy but was lost to follow-up. She presented again three years later with new-onset dyspnea and described a syncopal episode. A chest radiograph showed an enlarged cardiac silhouette and bilateral pleural effusions. Transthoracic echocardiography revealed a large pericardial effusion with diastolic collapse of the right atrium and ventricle, consistent with tamponade physiology. Subxiphoid pericardiocentesis and pigtail drain were placed under fluoroscopy with resolution of symptoms and no recurrence. Neoplastic etiology was confirmed by immunocytochemistry on cell block positive for PAX-8. As an adjunct or alternative to cytologic evaluation, diffusion-weighted magnetic resonance imaging and calculation of the apparent diffusion coefficient can be used to differentiate between malignant and benign effusions. Malignant pericardial effusion in ovarian cancer is a treatable oncologic emergency where timely diagnosis and management may facilitate palliation and prolong life.
PubMed: 34113528
DOI: 10.7759/cureus.15464 -
European Heart Journal. Case Reports May 2021Effusive-constrictive pericarditis (ECP) is a rare syndrome involving pericardial effusion and concomitant constrictive pericarditis. The hallmark is a persistently...
BACKGROUND
Effusive-constrictive pericarditis (ECP) is a rare syndrome involving pericardial effusion and concomitant constrictive pericarditis. The hallmark is a persistently elevated right atrial pressure of >10 mmHg or reduction of less than 50% from baseline despite pericardiocentesis. Aetiologies include radiation, infection, malignancy, and autoimmune disease.
CASE SUMMARY
A 71-year-old man with a history of atrial fibrillation, obesity, hypertension, obstructive sleep apnoea, managed with continuous positive airway pressure presented with acute pericarditis complicated by pericardial effusion leading to cardiac tamponade. He was diagnosed with ECP after pericardiocentesis and was managed surgically with a pericardial window.
DISCUSSION
Early detected cases of ECP can be managed by medical therapy. Therapeutic interventions include pericardiocentesis, balloon pericardiostomy, and pericardiectomy. This report describes a case of new-onset congestive heart failure secondary to ECP.
PubMed: 34109293
DOI: 10.1093/ehjcr/ytab174 -
Animals : An Open Access Journal From... May 2021Pericardial effusion presents clinicians with a challenge when diagnosing the underlying cause and performing a prognosis. Different techniques have been suggested for...
Pericardial effusion presents clinicians with a challenge when diagnosing the underlying cause and performing a prognosis. Different techniques have been suggested for canine thoracoscopic pericardiectomy with the creation of variable pericardial window size. The aim of this study was to statistically compare the surgical time and achieved window size of the paraxiphoid transdiaphragmatic and monolateral intercostal approaches. The paraxifoid and monolateral intercostal approaches showed a mean surgical time of 55 ± 20.08 (SD) minutes and 13.94 ± 4.61 (SD) minutes, and a mean pericardial window diameter of 4.23 ± 0.80 (SD) cm and 3.31 ± 0.43 (SD) cm, respectively. A significant correlation was observed between the dogs' bodyweight and window size (r = 0.48; = 0.04) for both surgical approaches, and between the dogs' bodyweight and surgical time (r = 0.72; = 0.0016) for monolateral intercostal approach. All treated dogs showed no clinical signs of recurrent cardiac tamponade during the follow-up. Our results provided useful information to help surgeons make the definitive choice of the surgical technique to treat the pericardial effusion.
PubMed: 34069765
DOI: 10.3390/ani11051438 -
Anatolian Journal of Cardiology May 2021
Topics: Cardiac Tamponade; Carotenoids; Heart Ventricles; Humans; Oxygenases; Pericardial Effusion; Pericardial Window Techniques
PubMed: 33960313
DOI: 10.14744/AnatolJCardiol.2020.37863 -
The American Journal of Case Reports Apr 2021BACKGROUND Pericardio-peritoneal windows are surgically created to treat symptomatic pericardial effusion, usually of oncological origin, to alleviate cardiac...
BACKGROUND Pericardio-peritoneal windows are surgically created to treat symptomatic pericardial effusion, usually of oncological origin, to alleviate cardiac tamponade-like symptoms. Common complications include infection, failure to drain the fluid correctly, and arrythmias. There are few published cases of intra-abdominal complications due to these interventions. This report discusses pericardial diaphragmatic incarcerated hernia, which is one such complication. CASE REPORT We report the case of an 84-year-old woman with advanced non-small cell lung carcinoma, who recently underwent surgery to create a pericardio-peritoneal window to treat a chronic malignant pericardial effusion. The patient presented in our Emergency Department because of abdominal pain with absence of flatus and stool for more than 4 days. Computed tomography scanning confirmed a proximal small-bowel obstruction due to incarcerated small bowel into the pericardial window. Reduction of the hernia was performed laparoscopically. After a bowel viability assessment by indocyanine green angiography, the pericardial window was covered by a noncovered macroporous mesh to avoid recurrence and to allow continuous pericardial fluid drainage. CONCLUSIONS In case of abdominal pain after the creation of a pericardio-peritoneal window, we suggest the prompt use of computed tomography after initial examination. Indeed, although rare, a pericardial diaphragmatic hernia is possible and requires surgical exploration if there is a risk of bowel strangulation. The operation can be done laparoscopically, and the hernia repair should involve the placement of a nonabsorbable and noncovered macroporous mesh. This should prevent hernia recurrence, while also allowing adequate drainage of the pericardial effusion.
Topics: Aged, 80 and over; Cardiac Tamponade; Female; Humans; Neoplasm Recurrence, Local; Pericardial Effusion; Pericardial Window Techniques; Peritoneum
PubMed: 33850094
DOI: 10.12659/AJCR.930441 -
Brazilian Journal of Cardiovascular... Aug 2021The presence of mild to moderate pericardial effusion after cardiac surgery is common and oral medical therapy is usually able to treat it. Larger effusions are less...
INTRODUCTION
The presence of mild to moderate pericardial effusion after cardiac surgery is common and oral medical therapy is usually able to treat it. Larger effusions are less frequent and surgical intervention is usually necessary. However, there are some rare cases of large effusions that are recurrent even after intervention and become challenging to treat.
METHODS
We describe the case of a patient submitted to coronary artery bypass grafting (CABG) without any intraoperative complications, who was regularly discharged from the hospital. She was referred to our emergency department twice after surgery with large pericardial effusion that was drained. Even after those two interventions and with adequate oral medication, the large effusion recurred.
RESULTS
During follow-up, the patient had her symptoms resolved, with no need for further hospital admission. Her echocardiograms after the last intervention showed no pericardial effusion. The present surgical technique demonstrated to be easy to perform, thus it should be considered as a treatment option for these rare cases of large and repetitive effusions, which do not respond to the traditional methods.
CONCLUSIONS
In challenging cases of recurrent and large pericardial effusions, the pericardial-peritoneal window is an alternative surgical technique that brings clinical improvement and diminishes the risk of cardiac tamponade.
Topics: Cardiac Surgical Procedures; Cardiac Tamponade; Female; Humans; Pericardial Effusion; Pericardial Window Techniques; Pericardiectomy
PubMed: 33656833
DOI: 10.21470/1678-9741-2020-0355 -
Brazilian Journal of Cardiovascular... Dec 2020A case of a 49-year-old patient, male, victim of stab wound, developing belatedly cardiac tamponade and hemodynamic stability was reported. The patient underwent a...
A case of a 49-year-old patient, male, victim of stab wound, developing belatedly cardiac tamponade and hemodynamic stability was reported. The patient underwent a pericardial window with drainage of pericardial effusion of blackened aspect; however, without visualization of the cardiac lesion, enlargement of the incision by median sternotomy was opted for. A hematoma was spotted at the left ventricle with epicardial lesion and a patch of pericardium was made with 3-0 polypropylene. The patient developed acute pulmonary edema and atrial fibrillation, which improved after the intensive care unit clinical management, with hospital discharge in the 7th postoperative day.
Topics: Cardiac Tamponade; Humans; Male; Middle Aged; Pericardial Effusion; Sternotomy; Wounds, Penetrating; Wounds, Stab
PubMed: 33306330
DOI: 10.21470/1678-9741-2019-0130 -
BMJ Case Reports Nov 2020A 37-year-old woman presented to her local district general hospital with a cough, pleuritic chest pain and intermittent cyanosis. Eight months prior, she underwent a...
A 37-year-old woman presented to her local district general hospital with a cough, pleuritic chest pain and intermittent cyanosis. Eight months prior, she underwent a successful pericardial window for recurrent, symptomatic pericardial effusions. On presentation she was hypoxic but haemodynamically stable. Her chest radiograph raised the suspicion of a diaphragmatic hernia, confirmed by CT imaging. This identified herniation through the diaphragm of the transverse colon and left lobe of the liver resulting in cardiac compression and right ventricular dysfunction. She continued to deteriorate and required emergency intubation to allow safe transfer to a tertiary upper gastrointestinal unit. She underwent a laparotomy and repair of the diaphragmatic hernia with an uneventful inpatient recovery. In the literature, diaphragmatic liver herniation is a recognised complication secondary to trauma or congenital defects, however, to our knowledge, there are currently no cases described following pericardial windowing.
Topics: Adult; Down Syndrome; Female; Hernia, Diaphragmatic, Traumatic; Humans; Pericardial Effusion; Pericardial Window Techniques; Postoperative Complications
PubMed: 33257358
DOI: 10.1136/bcr-2020-236078 -
Cardiology in the Young Feb 2021Percutaneous balloon pericardiotomy is a percutaneous procedure that creates a window in the parietal pericardium by balloon dilation. The use of percutaneous balloon...
BACKGROUND
Percutaneous balloon pericardiotomy is a percutaneous procedure that creates a window in the parietal pericardium by balloon dilation. The use of percutaneous balloon pericardiotomy has not been reported well in children.
OBJECTIVES
The objective of this study was to describe the single centre experience of percutaneous balloon pericardiotomy in children.
METHODS
This was a retrospective study to describe all the children aged <20 years undergoing percutaneous balloon pericardiotomy during an 18-year period (2001-2019). Patient characteristics, technical and ultimate procedural success, and repeat interventions were collected.
RESULTS
A total of 13 percutaneous balloon pericardiotomy's were performed in 11 children at the median age of 12 years (range 1.8-19). The etiologies of pericardial effusion were post-pericardiotomy syndrome (n = 4), restrictive cardiomyopathy (n = 1), autoimmune diseases (n = 3), malignancy (n = 2), and idiopathic (n = 1). Two patients received two percutaneous balloon pericardiotomy. The technical success of percutaneous balloon pericardiotomy was 100% with no acute adverse events (balloon rupture or local bleeding). Five (45%) required re-intervention and ultimately three required a surgical pericardial window 6 to 35 days after the percutaneous balloon pericardiotomy. As a result, ultimate procedural success rate was 73% (8/11).
CONCLUSION
Percutaneous balloon pericardiotomy was performed safely with high technical success in children. Percutaneous balloon pericardiotomy may be considered for recurrent and persistent pericardial effusion, before considering a surgical pericardial window.
Topics: Adolescent; Adult; Catheterization; Child; Child, Preschool; Humans; Infant; Pericardial Effusion; Pericardial Window Techniques; Pericardiectomy; Retrospective Studies; Young Adult
PubMed: 33140718
DOI: 10.1017/S1047951120003686 -
Acute and Critical Care Feb 2021Acute pericarditis is caused by various factors, but purulent pericarditis is rare. Primary purulent pericarditis in immunocompetent hosts is very rare in the modern...
Acute pericarditis is caused by various factors, but purulent pericarditis is rare. Primary purulent pericarditis in immunocompetent hosts is very rare in the modern antibiotics era. We report a successfully treated case of primary purulent pericarditis complicated with cardiac tamponade and pneumopericardium in an immunocompetent host. A 69-year-old female was referred from another hospital because of pleuritic chest pain with a large amount of pericardial effusion. She was diagnosed with acute pericarditis accompanied by cardiac tamponade. We performed emergency pericardiocentesis, with drainage of 360 ml of bloody pericardial fluid. The culture grew Streptococcus anginosus, confirming the diagnosis of acute purulent pericarditis. We performed pericardiostomy because cardiomegaly and pneumopericardium were aggravated after removal of the pericardial drainage catheter. The patient received antibiotics for a total of 23 days intravenously and was discharged with oral antibiotic therapy. Purulent pericarditis is one of the rare forms of pericarditis and is lifethreatening. A multimodality approach is required for proper diagnosis and treatment of this disease.
PubMed: 33040519
DOI: 10.4266/acc.2020.00234