Early-Onset Postcardiac Injury Syndrome after Percutaneous Coronary Intervention Recovered with Steroids / 대한내과학회지

Postcardiac injury syndrome (PCIS) is an inflammatory process that usually occurs within 1 to 6 weeks after an injury to the pericardium, epicardium, or myocardium. As more interventions are performed for complicated coronary artery obstructive lesions, there have been some recent reports on PCIS following percutaneous coronary intervention (PCI). The medical management of PCIS depends on nonsteroidal anti-inflammatory drugs (NSAIDs), in addition to colchicine or steroids. An 80-year-old male patient underwent a PCI. Unfortunately, the guidewire piercing failed but he showed no immediate signs of complication. However, 5 hours after the procedure, he complained of chest discomfort. An electrocardiogram showed widespread ST elevation. Chest X-ray and computed tomography showed pulmonary congestion with pleural effusion, while thoracic echocardiography showed a moderate amount of pericardial effusion. NSAIDs were initiated, but there was no improvement of symptoms. We describe an unusual case of atypical earl onset PCIS after PCI, recovered rapidly by steroids.

Pericarditis aguda complicada con derrame pericárdico: Caso clínico pediátrico / Acute pericarditis, complicated by pericardial effusion in a pediatric patient: case report

La pericarditis aguda es la enfermedad más común del pericardio en la práctica clínica. Supone el 0,1% de todos los ingresos hospitalarios y hasta un 5% de aquellos por dolor torácico. En países desarrollados, la causa suele ser benigna, y son más frecuentes las idiopáticas e infecciosas que las secundarias a pericardiotomía quirúrgica y neoplasias. La tuberculosis es la causa más importante en países en vías de desarrollo. Los síntomas más comunes son el dolor torácico característico y la fiebre. Debido a su benignidad y buena evolución con reposo y tratamiento médico, se puede controlar de forma ambulatoria, teniendo presentes aquellos signos de alarma para vigilar o pacientes de riesgo para evitar complicaciones (derrames importantes, taponamiento cardíaco, recurrencias, etc.). Presentamos un caso clínico de un niño de 7 años con antecedentes de comunicación interauricular cerrada quirúrgicamente 9 meses antes, con un cuadro de pericarditis aguda de evolución favorable.

Acute pericarditis is the most common disease of the pericardium encountered in clinical practice. It is diagnosed in 0.1% of all admissions and 5% of emergency room admissions for chest pain. In developed countries, it is usually due to a benign cause. Idiopathic and infectious pericarditis are more common than secondary to surgical pericardiotomy or neoplastic causes, whereas tuberculosis is the dominant cause in developing countries. The most common symptoms of pericarditis are characteristic chest pain and fever. Since pericarditis presents a benign outcome because of self-limiting and good response to conventional anti-inflammatory therapy, it can be safely managed on outpatient basis unless a specific cause is suspected or the patient has high-risk features to avoid complications such as pericardial effusion, cardiac tamponade or recurrent pericarditis. We report a case of pericarditis, diagnosed 9 months after surgical closure of an atrial septal defect, in a 7-year-old boy with favorable evolution.

Síndrome pospericardiotomía / Pospericardiotomy syndrome

Se describe el caso clínico de un paciente de 45 años de edad, con antecedentes de hipertensión arterial e insuficiencia mitral severa por perforación del velo anterior de la válvula, atendido en el Servicio de Cirugía Cardiovascular Hospital Provincial Docente Clinicoquirúrgico "Saturnino Lora Torres" de Santiago de Cuba, quien fue expuesto a cirugía de sustitución valvular mitral con circulación extracorpórea y se le implantó una prótesis carbomedic 25. A los 28 días presentó un cuadro característico del síndrome pospericardiotomía, por lo cual fue ingresado. Se tomó la conducta terapéutica pertinente y teniendo en cuenta que había evolucionado favorablemente, se le concedió el alta hospitalaria 7 días después.

The case report of a 45 years patient with a history of hypertension and severe mitral failure due to perforation of the anterior veil of the valve, assisted in the Service of Cardiovascular Surgery from "Saturnino Lora Torres" Teaching Provincial Clinical Surgical Hospital in Santiago de Cuba is described. He was exposed to mitral valve substitution surgery with extracorporeal circulation and a prosthesis carbomedic 25 was implanted. After 28 days he presented a characteristic pattern of the pospericardiotomy syndrome, reason why he was admitted to the hospital. The pertinent therapeutic behavior was followed and keeping in mind that he had favorable clinical course, he was discharged after 7 days.

Recurrent Postoperative Effusive-Constrictive Pericarditis Associated with Steroid Discontinuation

Transient effusive-constrictive pericarditis is a rare complication of open-heart surgery, but is increasingly recognized. For patients with both pericardial effusion and constrictive physiology soon after uneventful open-heart surgery, proper treatment remains to be established. We experienced a case of transient effusive-constrictive pericarditis in a 50-year-old woman who underwent aortic valve replacement due to infective endocarditis. Initially, she was treated with both prednisolone and ibuprofen, which resulted in dramatic relief of symptom. However, she suffered from a relapse of pericaridis after rapid steroid discontinuation and was stabilized by re-treatment with steroid.

Comportamento dos marcadores inflamatórios e de injúria miocárdica na cirurgia cardíaca: correlaçäo laboratorial com quadro clínico de síndrome pós-pericardiotomia / Behavior of inflammatory markers of myocardial injury in cardiac surgery: laboratory correlation with the clinical picture of postpericardiotomy syndrome

OBJECTIVE: To verify the association of serum markers of myocardial injury, such as troponin I, creatinine kinase, and creatinine kinase isoenzyme MB, and inflammatory markers, such as tumor necrosis factor alpha (TNF-alpha), C-reactive protein, and the erythrocyte sedimentation rate in the perioperative period of cardiac surgery, with the occurrence of possible postpericardiotomy syndrome. METHODS: This was a cohort study with 96 patients undergoing cardiac surgery assessed at the following 4 different time periods: the day before surgery (D0); the 3rd postoperative day (D3); between the 7th and 10th postoperative days (D7-10); and the 30th postoperative day (D30). During each period, we evaluated demographic variables (sex and age), surgical variables (type and duration , extracorporeal circulation), and serum dosages of the markers of myocardial injury and inflammatory response. RESULTS: Of all patients, 12 (12.5 percent) met the clinical criteria for a diagnosis of postpericardiotomy syndrome, and their mean age was 10.3 years lower than the age of the others (P=0.02). The results of the serum markers for tissue injury and inflammatory response were not significantly different between the 2 assessed groups. No significant difference existed regarding either surgery duration or extracorporeal circulation. CONCLUSION: The patients who met the clinical criteria for postpericardiotomy syndrome were significantly younger than the others were. Serum markers for tissue injury and inflammatory response were not different in the clinically affected group, and did not correlate with the different types and duration of surgery or with extracorporeal circulation

Estudo dos fatores de risco para o desenvolvimento da síndrome pós-pericardiotomia / Study of high risk factors for the occurrence of post-pericardiotomy syndrome

A síndrome pós-pericardiotomia ocorre entre a primeira e a segunda semanas de pós-operatório de cirurgia cardíaca, aparentemente como resposta imunoinflamatória ao trauma transoperatório. Permanece ainda sem definição o padrão-ouro para aferir sua ocorrência. OBJETIVO: Descrever a ocorrência de SPP em amostra de pacientes adultos, avaliando o papel de potenciais fatores de risco, assim como o desempenho diagnóstico da troponina I cardíaca (cTnI) e do fator necrose tumoral alfa...

Post cardiac injury syndrome--one more cause of false positive IgG, IgM antibodies in pleural fluid against antigen-60 of Mycobacterium tuberculosis.

Post cardiac injury syndrome (PCIS) is known to occur following myocardial infarction, cardiac surgery, blunt chest trauma, percutaneous left ventricular puncture and pace-maker implantation. The diagnosis is one of exclusion. We report a case of PCIS following cardiac surgery who showed false positive IgG, IgM antibodies to antigen A60 of Mycobacterium tuberculosis in pleural fluid.

Taponamiento en el síndrome post lesiones cardíacas / Tamponade after cardiac injury syndrome

El Síndrome Pos pericardiotomía, el Síndrome de Dessler y la pericarditis Post traumatismo cardíaco son cuadros clínicos con signo sintomatología similar,con una patogenia autoinmune común.Los pacientes se presentan con fiebre, dolor toráxico,frote pericárdico,leucositosis y eritro elevada.El Taponamiento Cardíaco es infrecuente.Se presenta una caso de Síndrome Pos pericardiotomía con Taponamiento cardíaco recidivante que requirió una ventana pleuropercárdica y respondió al tratamiento con corticoides

Postoperative Effusive Constrictive Pericarditis in Ventricular Septal Defect Repair

Effusive constrictive pericarditis after open heart surgery is a rare complication occuring in 0.2% to 0.3%. Presenting symptoms after surgery are associated with right heart failure and an elevated jugular venous pressure is most common abnormal physical sign. Predisposing factors include hemorrhage, perioperative pericardial injury or inflammation, presence of postpericardiotomy syndrome and open pericardium. Early diagnosis is important because(1) if it is unrecognized, the patient may deteriorate clinically, and(2) if surgery is delayed, the patient may have an increased risk of operative death. Hereby we report a case of effusive constrictive pericarditis after ventricular septal defect repair, in which constriction physiology was suggested by Doppler echocardiography after pericardiostomy.

Comunicación interauricular en edad pediátrica: Lesión residual, secuelas y complicaciones en el post-operatorio de 5 años en el CHM CSS, 1985-1989 / Interauricular communication in pediatric age: Residual lession, sequels and complications in the post-operatory 5 years in CHM-CSS, 1985-1989

Se hace un recuento histórico de la comunicación interauricular (CIA), del desarrollo embrionario del septum interauricular y de los diferentes tipos anatómicos y resulados post-operatorios en 5 años de tratamiento quirúrgico. Se citan los métodos diagnósticos más actualizados hasta el momento, se exponen brevemente el cuadro hemodinámico y estudio cineangiocardiográfico de nuestra rutina en la Sección de Cardiología Pediátrica de CHM-CSS. Las principales técnicas quirúrgicas son brevemente detalladas y por último se analizan la incidencia de lesiones residuales, secuelas y complicaciones en el post-operatorio de esta actividad congénita y el Síndrome de Post-pericardiotomía es descrito (AU.)_

Síndrome postpericardiotomía / Postpericardiotomy syndrome

El síndrome postpericardiotomía puede presentarse en el postoperatorio de cirugía cardíaca. La presentación de los síntomas ocurre en la segunda o tercera semana postoperatoria. Fiebre, disminución de los ruídos cardíacos, frote pericárdico y derrame pleural y/o pericárdico son las principales manifestaciones clínicas. Los mecanismos etiopatogénicos sugeridos para esta reacción febril postoperatoria incluyen: respuesta inflamatoria a la presencia de sangre en la cavidad pericárdica y fenómenos de tipo inmunológicos. Aunque el síndrome postpericardiotomía tiene un curso autolimitado han sido comunicados casos severos con derrame pericárdico importante y taponamiento cardíaco