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Journal of Cardiothoracic and Vascular... Feb 2021The objective of this study was to describe practice patterns of anesthetic management during pericardial window creation. (Observational Study)
Observational Study
OBJECTIVES
The objective of this study was to describe practice patterns of anesthetic management during pericardial window creation.
DESIGN
Retrospective observational cohort study.
SETTING
Single tertiary cancer center.
PARTICIPANTS
A total of 150 patients treated for cancer between 2011 and 2015 were included in the study.
MEASUREMENTS AND MAIN RESULTS
The primary objective was to evaluate anesthetic management in pericardial window creation. Secondary outcomes were 30-day mortality and overall survival after pericardial window creation. Thirty-day mortality was 19.3%, and median survival was 5.84 months. Higher American Society of Anesthesiologists (ASA) physical status of patients was associated with preinduction arterial line placement (51% ASA 3 v 79% ASA 4; p = 0.002) and use of etomidate for anesthetic induction (34% ASA 3 v 60% ASA 4; p = 0.003). However, there was no association between anesthetic management and presence of tamponade in these patients. Cardiac aspirate volume (per 10 mL: odds ratio [OR], 1.02 [95% CI, 1.0-1.04]; p = 0.026) and intraoperative arrhythmia (atrial fibrillation: OR, 6.76 [95% CI, 1.2-37.49]; p = 0.029; sinus tachycardia: OR, 4.59 [95% CI, 1.25-16.90]; p = 0.022) were associated independently with increased 30-day mortality. High initial heart rate (per 10 beats per minute: hazard ratio [HR], 1.18 [95% CI, 1.05-1.33]; p = 0.005) in the operating room and intraoperative sinus tachycardia (HR, 1.86 [95% CI, 1.15-3.03]; p = 0.012) were associated independently with worse overall survival.
CONCLUSION
Risk of death after pericardial window creation remains high in patients with cancer. Variations in anesthetic management did not affect survival in oncologic patients with pericardial effusions.
Topics: Anesthetics; Cardiac Tamponade; Humans; Neoplasms; Pericardial Effusion; Pericardial Window Techniques; Retrospective Studies
PubMed: 32967792
DOI: 10.1053/j.jvca.2020.08.049 -
Medicine Sep 2020Infection with the severe acute respiratory coronavirus disease 2019 (COVID-19) has been shown to cause multi-organ involvement including cardiopulmonary serosal layers...
RATIONALE
Infection with the severe acute respiratory coronavirus disease 2019 (COVID-19) has been shown to cause multi-organ involvement including cardiopulmonary serosal layers infection and inflammation. As a result, pericarditis and pericardial effusion may occur with or without COVID-19 related respiratory signs. Due to limitations in sensitivity and specificity of current COVID-19 diagnostic studies, cases that trigger high clinical intuition, even with negative serologic and polymerase chain reaction testing results, may necessitate further diagnostic workup to discover the underlying etiology.
PATIENT CONCERNS
Here we present a rare case of pericardial effusion in the setting of asymptomatic COVID-19 infection manifesting with the chief complaint of chest pain.
DIAGNOSIS
While undergoing diagnostic workup, the patients first 2 sets of COVID 19 reverse transcription-polymerase chain reaction (RT-PCR) were negative while a latter RT-PCR test, as well as serology, were positive, leading to the diagnosis of COVID-19 reinfection or subacute presentation of viral infection with pericardial effusion. Echocardiogram depicted large circumferential pericardial effusion with mildly thickened pericardium.
INTERVENTIONS
The patient underwent pericardial window placement followed by ibuprofen administration and discharged from the hospital.
OUTCOMES
During the follow-up visit patient had no symptoms and echocardiogram demonstrated complete resolution of the effusion.
LESSONS
Due to the possible establishment of pericardial effusions and consecutively tamponade even without any COVID-19 related clinical presentation, it is crucial for clinicians to trust their intuition, conduct the appropriate diagnostic tests, find the underlying diagnosis and prevent the devastating consequences.
Topics: Asymptomatic Infections; Betacoronavirus; COVID-19; COVID-19 Testing; Chest Pain; Clinical Laboratory Techniques; Coronavirus Infections; Echocardiography; Electrocardiography; Humans; Male; Middle Aged; Pandemics; Pericardial Effusion; Pericardiocentesis; Pneumonia, Viral; SARS-CoV-2; Treatment Outcome
PubMed: 32925751
DOI: 10.1097/MD.0000000000022093 -
Journal of Medical Case Reports Sep 2020This case report demonstrates pericardial effusion, acute pericarditis, and cardiac tamponade in an otherwise healthy woman who had a positive test result for...
BACKGROUND
This case report demonstrates pericardial effusion, acute pericarditis, and cardiac tamponade in an otherwise healthy woman who had a positive test result for coronavirus disease 2019. Few case reports have been documented on patients with this presentation, and it is important to share novel presentations of the disease as they are discovered.
CASE PRESENTATION
A Caucasian patient with coronavirus disease 2019 returned to the emergency department of our hospital 2 days after her initial visit with worsening chest pain and shortness of breath. Imaging revealed new pericardial effusion since the previous visit. The patient became hypotensive, was taken for pericardial window for cardiac tamponade with a drain placed, and was treated for acute pericarditis.
CONCLUSION
Much is still unknown about the implications of coronavirus disease 2019. With the novel coronavirus disease 2019 pandemic, research is still in process, and we are slowly learning about new signs and symptoms of the disease. This case report documents a lesser-known presentation of a patient with coronavirus disease 2019 and will help to further understanding of a rare presentation.
Topics: Adult; Betacoronavirus; COVID-19; Cardiac Tamponade; Chest Pain; Coronavirus Infections; Female; Humans; Pandemics; Pericardial Effusion; Pericardial Window Techniques; Pericarditis; Pneumonia, Viral; SARS-CoV-2
PubMed: 32907623
DOI: 10.1186/s13256-020-02467-w -
Rheumatology (Oxford, England) Feb 2021
Topics: Biopsy; Echocardiography; Glucocorticoids; Humans; Immunoglobulin A; Male; Microscopy, Fluorescence; Middle Aged; Pericardial Effusion; Pericardial Window Techniques; Pericardiocentesis; Purpura; Skin; Treatment Outcome; Vasculitis
PubMed: 32901253
DOI: 10.1093/rheumatology/keaa390 -
BMJ Case Reports Aug 2020
Topics: Adenocarcinoma; Aged; Appendiceal Neoplasms; Cardiac Tamponade; Female; Heart Neoplasms; Humans; Pericardial Effusion; Pericardial Window Techniques
PubMed: 32816884
DOI: 10.1136/bcr-2020-235878 -
Cardiac Electrophysiology Clinics Sep 2020Accessing the epicardial space without a sternotomy or a surgical pericardial window to treat ventricular arrhythmias in Chagas disease became a medical necessity in... (Review)
Review
Accessing the epicardial space without a sternotomy or a surgical pericardial window to treat ventricular arrhythmias in Chagas disease became a medical necessity in South America. Since the introduction of the dry percutaneous epicardial access approach, epicardial access has been standard procedure for management of ventricular arrhythmias in ischemic and nonischemic cardiomyopathies and atrioventricular accessory pathways after failed conventional endocardial ablation. Understanding the epicardial space and neighboring structures has become an important subject of teachings in electrophysiology. The evolution of complex ablation procedures to treat atrial and ventricular arrhythmias and device interventions to prevent cardioembolic stroke requires thorough understanding of pericardial anatomy.
Topics: Cardiac Imaging Techniques; Catheter Ablation; Epicardial Mapping; Heart Diseases; Humans; Pericardium
PubMed: 32771183
DOI: 10.1016/j.ccep.2020.06.001 -
Cardiac Electrophysiology Clinics Sep 2020The pericardial cavity and its boundaries are formed by the reflections of the visceral and parietal pericardial layers. This space is an integral access point for... (Review)
Review
The pericardial cavity and its boundaries are formed by the reflections of the visceral and parietal pericardial layers. This space is an integral access point for epicardial interventions. As the pericardial layers reflect over the great vessels and the heart, they form sinuses and recesses, which restrict catheter movement. The epicardial vasculature is also important when performing nearby catheter ablation. The phrenic nerve and esophagus are other important structures to appreciate so as to avoid collateral injury. In addition, the Larrey space, or left sternocostal triangle, is a key avascular window through which pericardial access can be safely achieved.
Topics: Catheter Ablation; Coronary Vessels; Electrophysiologic Techniques, Cardiac; Esophagus; Humans; Pericardium; Phrenic Nerve
PubMed: 32771181
DOI: 10.1016/j.ccep.2020.04.003 -
Journal of Cardiac Surgery Oct 2020Pericardial effusion develops due to different etiologies. The main goals of our study are to understand the etiology and determine whether the amount of pericardial...
INTRODUCTION
Pericardial effusion develops due to different etiologies. The main goals of our study are to understand the etiology and determine whether the amount of pericardial effusion is significant in terms of malignancy.
MATERIAL AND METHODS
142 patients with pericardial effusion, who met the criteria between 1 January 2014 and 1 January 2019, were retrospectively analyzed. All of these patients underwent operation with the subxiphoidal approach. The fluid samples were sent to the microbiology and pathology laboratories for evaluation. Patients underwent follow-up after 1 month.
RESULTS
Of the patients included in this study, 72 (61%) of 118 patients were operated on under general anesthesia with a laryngeal mask, and 46 (39%) underwent sedation and local anesthesia. The etiologies found in patients were as follows: effusions resulting from malignancy in 27 (22.9%), idiopathic in 24 (20.3%), cardiac causes (depending on the use of anticoagulants or postoperation) in 22 (18.6%), uremia in 20 (16.9%), infection in 18 (15.3%), and heart failure in 7 patients. The amount of fluid drained from the patients was 661.61 ± 458.34 mL. Out of 27 patients with malignancy, 21 (77.8%) had drainage over 500 mL of effusion fluid, and 6 (22.2%) had drainage under 500 mL. Patients who had positive results tended to have drainage over 500 mL compared with patients who had negative results in terms of malignancy (P = .033).
CONCLUSION
The subxiphoidal approach to pericardial effusion is an easily applicable operation, whether therapeutic or diagnostic. The advantages of the subxiphoidal approach include drainage of all of the fluid and ease of sampling the pericardial fluid. We believe that the amount of fluid drained can lead us to consider malignancy as an etiology.
Topics: Drainage; Female; Humans; Male; Neoplasms; Pericardial Effusion; Pericardial Window Techniques; Retrospective Studies
PubMed: 32668050
DOI: 10.1111/jocs.14839 -
Chirurgia (Bucharest, Romania : 1990) 2020Pericardial effusion, accumulation of fluid in the pericardial sac, may develop in any type of cancer. It was revealed in up to 20% of oncological patients. Method: We...
Pericardial effusion, accumulation of fluid in the pericardial sac, may develop in any type of cancer. It was revealed in up to 20% of oncological patients. Method: We made a retrospective study of patients with pericardial efusion presented in our clinic between 2010 and 2015. We included 76 consecutive patients with indication for peri cardial drainage - we performed on them 80 surgical procedures: pericardocentesis, subxiphoid pericardial window, left paraxifoidian pericardial window, intercostal video-assisted thoracic surgery (VATS) pericardial fenestration, and classical thoracic surgery (fenestration or partial pericardiectomy). We had patients with ages between 28 and 83 years. 23 patients were admitted with cardiac tamponade. The immediate postoperatory survival is 97.3 % and the 30-days-postoperatory survival is 81.5 %. The immediate postoperatory mortality is 2.7% and the 30-days-postoperatory mortality is 8.5%. The immediate prognosis of the patient with malignant pericardial effusion is influenced by the risk of postoperative Low-Cardiac-Output-Syndrome (LCOS), or pericardial decompression syndrome (PDS), which remains the main cause of mortality. The long-term prognosis is related to the type of malignant tumor. The most effective tehnique with the lowest rate of recurrence is pericardo-pleural window done thoracoscopically/ by VATS; pericardocentesis has the highest rate of recurrence - 90% and is associated with high rates of cardiac complications and mortality.
Topics: Adult; Aged; Aged, 80 and over; Cardiac Tamponade; Drainage; Humans; Middle Aged; Neoplasm Recurrence, Local; Neoplasms; Pericardial Window Techniques; Pericarditis; Retrospective Studies; Treatment Outcome
PubMed: 32614289
DOI: 10.21614/chirurgia.115.3.341 -
Medical Archives (Sarajevo, Bosnia and... Apr 2020Widespread opinion that penetrating chest injuries are more urgent, in terms of treatment and care, contributed to underestimation of the urgency of blunt chest trauma,... (Observational Study)
Observational Study
INTRODUCTION
Widespread opinion that penetrating chest injuries are more urgent, in terms of treatment and care, contributed to underestimation of the urgency of blunt chest trauma, which in most cases is treated conservatively. It remains an open question frequency when the injuries of the heart and pericardium are not timely diagnosed and surgically treated.
AIM
To demonstrate the importance of well-timed surgical treatment of blunt chest trauma, when coupled with cardiac and pericardial injuries.
METHODS
At the Thoracic Surgery Clinic of the University Clinical Centre Banja Luka, Bosnia and Herzego vina, during period of 10 years (01.01. 2008 - 31.01.2018.), the total of 66 patients were treated for urgent thoracotomy due to clinically and radiologically unclear findings after blunt chest trauma. In general, diagnostic examinations, apart from laboratory analysis, included radiological imaging and Multi Slice Computed Tomography (MSCT) of the chest, followed by an ultrasound of the heart in cases when sternum was injured or when pericardial tamponade was suspected. Results presented in the study where obtained from the retrospective analysis of patients data. This work presents a retrospective observational cross-sectional study, which results in the assessment of the correctness of a particular diagnostic test.
STATISTICAL METHODS USED
descriptive statistics, counting measures (frequencies and percentages), central tendency measures (arithmetic mean), variability measures (standard deviation).
RESULTS
Sixty six patients were treated with urgent thoracotomy after a blunt trauma of the chest due to the unclear clinical and radiological finding. In the case of 11 patients (10 men and 1 woman), presenting 16.6% of the total sample, pericardial and cardiac injuries were detected and treated intraoperatively. Further, in the case of the one patient, pericardiotomy and suturing of the right heart chamber where performed, with the creation of a pericardial window. Transthoracic echocardiogram was not used as the primary screening module, but rather as a diagnostic test for patients who had unexplained hypotension and arrhythmia. Radiographs of the chest showed cardiomegaly with or without epicardial fat pad sign suggesting a pericardial effusion.
CONCLUSION
Blunt cardiac and pericardial injuries represent a serious therapeutic problem, which, if not treated properly, result in a high mortality rate. Echocardiography is the primary diagnostic method for initial detection of pericardial effusion. Pericardial fluid first accumulates posterior to the heart, when the patient is examined in the supine position. As the effusion increases, it extends laterally and with large effusions the echo-free space expands to surround the entire heart. The size of the effusion may be graded as small ( echo free spaces in diastole <10 mm, corresponding to approxymately 300 ml), moderate (10-20 mm, corresponding to 500 ml), and large ( >20 mm, corresponding to >700 ml). When the ability of the pericardium to stretch is exceeded by rapid or massive accumulation of fluid, any additional fluid causes the pressure with the pericardial sac. Early recognition, pericardiotomy with pericardial window creation and/or ventricular rupture suture remain the "gold standard" in the treatment of blunt cardiac and pericardial injuries.
Topics: Aged; Cardiac Tamponade; Echocardiography; Female; Flail Chest; Fracture Fixation, Internal; Fractures, Bone; Heart Injuries; Humans; Male; Middle Aged; Pericardial Window Techniques; Pericardiectomy; Pericardium; Retrospective Studies; Ribs; Sternum; Suture Techniques; Thoracic Surgery, Video-Assisted; Thoracotomy; Tomography, X-Ray Computed; Wounds, Nonpenetrating
PubMed: 32577052
DOI: 10.5455/medarh.2020.74.115-118