-
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 -
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 -
Brazilian Journal of Cardiovascular... Dec 2019
Comments on "Treatment of Pericardial Effusion Through Subxiphoid Tube Pericardiostomy and Computerized Tomography - Or Echocardiography - Guided Percutaneous Catheter Drainage Methods".
Topics: Drainage; Echocardiography; Humans; Pericardial Effusion; Pericardial Window Techniques; Tomography, X-Ray Computed
PubMed: 31719019
DOI: 10.21470/1678-9741-2019-0331 -
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 -
Journal of Cardiac Surgery Dec 2019Cardiothoracic surgeons are frequently called upon to perform surgical pericardial drainage procedures (pericardial window) for pericardial effusions. These procedures...
PURPOSE
Cardiothoracic surgeons are frequently called upon to perform surgical pericardial drainage procedures (pericardial window) for pericardial effusions. These procedures have therapeutic value, but the diagnostic value of such procedures is debated. We set out to determine the sensitivity of pericardial drainage to detect the disease when cytology, microbiology, and pathology are evaluated.
METHODS
A retrospective chart review of patients who underwent pericardial windows from 1 July 2011 to 1 January 2018 at a single academic institution was conducted. All patients who had undergone a recent trauma or cardiac procedure were excluded. Cytology, microbiology, and pathology were examined. The charts were then carefully reviewed to determine if a clinical diagnosis was reached. Sensitivity was then calculated for all diseases and for those that should have been able to be detected.
RESULTS
One hundred sixty-two patients who had undergone a pericardial drainage procedure were identified; 49 patients were excluded for recent cardiac procedure or trauma. Of the 113 patients who met our inclusion criteria, 56 patients (49.6%) were female with a mean age of 59.7 ± 15.1 years. A diagnosis based on the pathology, microbiology, or cytology was obtained for 27 patients. The most common pathologies detected were adenocarcinoma (11), bacteremia (9), and small cell lung cancer (3); 56 patients had underlying pathologies that would have been possible to detect with either pathology, microbiology, or cytology. The most common detectable diagnoses were adenocarcinoma (20), bacteremia (12), and lymphoma (7). The most common undetectable diagnoses were idiopathic (17), cardiorenal fluid overload (17), and viral (11). The sensitivity of a pericardial drainage procedure for detecting disease was 0.24 for all cases, and 0.48 when restricted to cases where a detectable disease was present.
CONCLUSION
Cytology, microbiology, and pathology for pericardial drainage procedures were unable to detect a diagnosis for 76% of all cases and greater than 50% of cases with the theoretically detectable disease. Pericardial drainage procedures have a clear therapeutic value, but they have limited diagnostic utility.
Topics: Adult; Aged; Drainage; Female; Humans; Male; Middle Aged; Pericardial Effusion; Pericardial Window Techniques; Reproducibility of Results; Retrospective Studies; Sensitivity and Specificity
PubMed: 31714642
DOI: 10.1111/jocs.14337 -
European Journal of Cardio-thoracic... Aug 1997Isolated primary chylopericardum is known to be a rare clinical entity. A 17-year-old girl was diagnosed as isolated primary chylopericardium. She was unresponsive to...
Isolated primary chylopericardum is known to be a rare clinical entity. A 17-year-old girl was diagnosed as isolated primary chylopericardium. She was unresponsive to conservative treatment with pericardial tube drainage and medium chain triglyceride diet. At 2 weeks after the conservative treatment, ligation and resection of the thoracic duct with establishment of a pericardial window through a left thoracotomy was performed. At 6 months, follow-up showed no accumulation of the pericardial fluid. This case also supports that ligation and resection of the thoracic duct with establishment of a pericardial window is the treatment of choice in isolated primary chylopericardium.
Topics: Adolescent; Chylothorax; Diagnosis, Differential; Disease-Free Survival; Echocardiography; Female; Humans; Pericardial Effusion; Pericardial Window Techniques; Thoracotomy
PubMed: 9288526
DOI: 10.1016/s1010-7940(97)00126-7 -
Annals of the Royal College of Surgeons... Oct 2014We present a rare case of a liver volvulus, stomach and transverse colon herniating through the diaphragm. This scenario has not been reported previously. We discuss the...
INTRODUCTION
We present a rare case of a liver volvulus, stomach and transverse colon herniating through the diaphragm. This scenario has not been reported previously. We discuss the presentation and management of this interesting case.
CASE HISTORY
A 65-year-old woman with a history of sarcoidosis and recurrent pericardial effusions, treated previously with a subxiphoid pericardial oval window fenestration, presented with acute upper abdominal pain radiating to the chest. High contrast computed tomography showed a volvulus of the liver with consequent venous congestion, and herniation of the liver, stomach and transverse colon through an anterior diaphragmatic defect. With liver perfusion threatened, an urgent laparoscopic repair was performed. The stomach and transverse colon were reduced, and the twisted left lobe of the liver was unrotated and reduced into the abdominal cavity. A double-sided synthetic mesh was used to repair the defect. The patient made an uneventful recovery.
CONCLUSIONS
This is a novel complication of a patient presenting with abdominal pain with a previous history of pericardial window fenestration. A laparoscopic reduction and repair can be performed safely with excellent postoperative results.
Topics: Abdominal Pain; Aged; Emergency Treatment; Female; Follow-Up Studies; Hernia, Diaphragmatic; Herniorrhaphy; Humans; Intestinal Volvulus; Laparoscopy; Liver; Pericardial Effusion; Pericardial Window Techniques; Radiography; Rare Diseases; Stomach Volvulus; Surgical Mesh; Treatment Outcome
PubMed: 25245721
DOI: 10.1308/003588414X13946184903324 -
The Journal of Thoracic and... Apr 2006
Topics: Aged; Colonic Diseases; Diaphragm; Female; Hernia; Humans; Pericardial Effusion; Pericardial Window Techniques
PubMed: 16580458
DOI: 10.1016/j.jtcvs.2005.12.013 -
Methods (San Diego, Calif.) Sep 2017Pathologists rely on microscopy to diagnose disease states in tissues and organs. They utilize both high-resolution, high-magnification images to interpret the staining...
Pathologists rely on microscopy to diagnose disease states in tissues and organs. They utilize both high-resolution, high-magnification images to interpret the staining and morphology of individual cells, as well as low-magnification overviews to give context and location to these cells. Intravital imaging is a powerful technique for studying cells and tissues in their native, live environment and can yield sub-cellular resolution images similar to those used by pathologists. However, technical limitations prevent the straightforward acquisition of low-magnification images during intravital imaging, and they are hence not typically captured. The serial acquisition, mosaicking, and stitching together of many high-resolution, high-magnification fields of view is a technique that overcomes these limitations in fixed and ex vivo tissues. The technique however, has not to date been widely applied to intravital imaging as movements caused by the living animal induce image distortions that are difficult to compensate for computationally. To address this, we have developed techniques for the stabilization of numerous tissues, including extremely compliant tissues, that have traditionally been extremely difficult to image. We present a novel combination of these stabilization techniques with mosaicked and stitched intravital imaging, resulting in a process we call Large-Volume High-Resolution Intravital Imaging (LVHR-IVI). The techniques we present are validated and make large volume intravital imaging accessible to any lab with a multiphoton microscope.
Topics: Animals; Cell Movement; Fluorescent Dyes; Intravital Microscopy; Mice; Mice, Inbred C57BL; Microscopy, Fluorescence, Multiphoton; Pericardial Window Techniques; Single-Cell Analysis; Time-Lapse Imaging
PubMed: 28911733
DOI: 10.1016/j.ymeth.2017.07.019 -
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