The timing of pericardial drainage catheter removal and restart of the anticoagulation in patients suffered from perioperative pericardial tamponade during atrial fibrillation catheter ablation and uninterrupted dabigatran: Experiences from 20 cases / 中华心血管病杂志

Objective: To investigate the timing of pericardial drainage catheter removal and restart of the anticoagulation in patients with atrial fibrillation (AF) suffered from perioperative pericardial tamponade during atrial fibrillation catheter ablation and uninterrupted dabigatran. Methods: A total of 20 patients with pericardial tamponade, who underwent AF catheter ablation with uninterrupted dabigatran in Beijing Anzhen Hospital from January 2019 to August 2021, were included in this retrospective analysis. The clinical characteristics of enrolled patients, information of catheter ablation procedures, pericardial tamponade management, perioperative complications, the timing of pericardial drainage catheter removal and restart of anticoagulation were analyzed. Results: All patients underwent pericardiocentesis and pericardial effusion drainage was successful in all patients. The average drainage volume was (427.8±527.4) ml. Seven cases were treated with idarucizumab, of which 1 patient received surgical repair. The average timing of pericardial drainage catheter removal and restart of anticoagulation in 19 patients without surgical repair was (1.4±0.7) and (0.8±0.4) days, respectively. No new bleeding, embolism and death were reported during hospitalization and within 30 days following hospital discharge. Time of removal of pericardial drainage catheter, restart of anticoagulation and hospital stay were similar between patients treated with idarucizumab or not. Conclusion: It is safe and reasonable to remove pericardial drainage catheter and restart anticoagulation as soon as possible during catheter ablation of atrial fibrillation with uninterrupted dabigatran independent of the idarucizumab use or not in case of confirmed hemostasis.

Perfuração subaguda de ventrículo direito por cabo-eletrodo de choque de cardioversor-desfibrilador implantável / Subacute right ventricular perforation by shock lead of implantable cardioverter defibrillator

Relatamos o caso de paciente portador de cardiomiopatia hipertrófica, submetido a implante de cardioversor-desfibrilador implantável, que evoluiu, na primeira semana de pós-operatório, com dor torácica, síncope e choque cardiogênico. À ecocardiografia transtorácica, diagnosticou-se derrame pericárdico e perfuração do ventrículo direito pelo cabo-eletrodo de choque. Foi submetido a toracotomia de urgência e rafia do miocárdio com resolução do quadro. As possíveis razões desse desfecho são discutidas, comparativamente a outros casos na literatura

We report the case of a patient with hypertrophic cardiomyopathy, submitted to an implantable cardioverter defibrillator implant who developed chest pain, syncope, and cardiogenic shock in the first post-operative week. Pericardial effusion and right ventricular perforation by shock lead were diagnosed by transthoracic echocardiography. The patient underwent emergency thoracotomy and myocardial raffia with resolution of the condition. We discuss the possible reasons for this outcome and compare it to other cases in the literature

Identification of diagnostic maneuvers positive for arterial compression in symptomatic or asymptomatic individuals who engage in regular weight training / Identificação de manobras semiológicas positivas para a compressão arterial em indivíduos sintomáticos e assintomáticos que realizam regularmente musculação

Arterial compression syndromes can be identified in asymptomatic individuals using specific diagnostic maneuvers involving palpation of peripheral pulses. OBJECTIVE: To identify diagnostic maneuvers positive for extrinsic compression in the upper and lower limbs of people who exercise regularly. METHODS: The sample consisted of people over 18 years old who had been attending a gym for a minimum of 1 hour per week and for at least 1 month. A data collection instrument comprising 20 questions was administered to the study participants, covering personal characteristics, the types of exercises engaged in and possible symptoms. The Adson, Hyperabduction and Costoclavicular maneuvers and also tests to reveal popliteal artery entrapment were performed. Data from the questionnaires and the maneuver results were analyzed using SPSS v.20.0. RESULTS: The study enrolled 202 volunteers who attended the gyms investigated, comprising 98 women and 104 men aged 18 to 63 (mean of 27 years). One hundred and seventy (84.2%) subjects were asymptomatic and 32 (15.8%) people reported some type of discomfort such as pain, paresthesia or a cool sensation. Ninety of the 202 individuals analyzed (44.6%) exhibited at least one positive maneuver. Total numbers of compressions per subject were as follows: two people (1%) had four positive maneuvers; 19 (9.4%) had three positive maneuvers; 31 (15.3%) had two positive maneuvers, 38 (18.8%) exhibited one positive maneuver and 112 (55 4%) people were positive for none of the maneuvers. The hyperabduction maneuver was the most prevalent maneuver. CONCLUSION: Diagnostic maneuvers positive for extrinsic arterial compression were identified in 44.6% of the asymptomatic individuals analyzed...

As síndromes compressivas arteriais podem ser identificadas em indivíduos assintomáticos por manobras semiológicas específicas, com a palpação dos pulsos periféricos. OBJETIVO: Identificar manobras semiológicas positivas para compressão extrínseca em membros superiores e inferiores em indivíduos que realizam regularmente musculação. MÉTODOS: a amostra consistiu de pessoas maiores de 18 anos que frequentaram, por pelo menos um mês, no mínimo uma hora por semana, a academia. Os participantes da pesquisa preencheram um questionário de 20 questões que abordava características pessoais, exercícios praticados e eventuais sintomas. Foram realizadas as manobras de Adson, Hiperabdução, Costoclavicular e para aprisionamento da artéria poplítea. Os resultados dos questionários e das manobras realizadas foram avaliados com o programa computacional SPSS v.20.0. RESULTADOS: foram incluídos no estudo 202 voluntários que frequentaram as academias escolhidas, sendo 98 mulheres e 104 homens, com idade entre 18 e 63 anos (média de 27 anos). Cento e setenta (84,2%) indivíduos eram assintomáticos e 32 (15,8%) referiram algum tipo de desconforto, como dor, sensação de esfriamento ou parestesia. Dos 202 indivíduos avaliados, 90 (44,6%) apresentaram alguma das manobras positivas. Com relação ao número de compressões, dois indivíduos (1%) apresentaram quatro manobras positivas; 19 (9,4%), três manobras; 31(15,3%), duas manobras; 38 (18,8%), uma manobra, e 112 (55,4%), nenhuma. A manobra de hiperabdução foi a mais prevalente dentre as manobras realizadas. CONCLUSÃO: foram identificadas manobras semiológicas positivas para compressão extrínseca arterial em 44,6% dos indivíduos assintomáticos avaliados...

Pericardite com tamponamento por salminella enteritidis / Salmonella enteritidis pericarditis with tamponade

Relata-se o caso de paciente feminina, 22 anos, sem história médica prévia relevante, admitida no Serviço de Urgência por cansaço progressivo e dor precordial aguda, referindo queixa abdominais há 72 horas. Avaliação médica revela presença de derrame pericárdio moderado. Internada, evolui em tamponamento cardíaco, requerendo pericardiocentese. É determinada a presença de Salmonella enteritidis no líquido pericárdico, e então iniciado tratamento com antibiótico. O prognóstico foi satisfatório, com recuperação total clínica e ecocardiográfica.

Report on a 22 year old female with no relevant prior medical history who was admitted to the Ermergency Department complaining of acute chest pain and progressive fadigue, mentioning abdominal complaints 72 hours previously. A medical evaluation showed moderate pericardial effusion. After admission, this developed into pericardial tamponade, requiring pericardiocentecis. Salmonella enteriditis was identified in the pericardial fluid, starting treatment with antibiotics. The prognosis was satisfactory , with complete clinical and echocardiographic recovery.

Anesthetic management for reentry sternotomy in a patient with a full stomach and pericardial tamponade from left ventricular rupture.

A 57-year-old man presented with chest pain and shortness of breath 1 month after left ventricular aneurysmectomy and ventricular septal defect closure for post-infarct left ventricular aneurysm and ventricular septal defect. Echocardiography revealed a large recurrent ruptured inferior left ventricular aneurysm with high-velocity flow into a 5 cm posterolateral pericardial effusion. Thirty minutes earlier, the patient had eaten a full meal. Rapid sequence induction was performed with midazolam, ketamine, and succinylcholine. Moderate hypotension was treated effectively and the patient tolerated controlled transition to cardiopulmonary bypass. The ventricular defect was oversewn and reinforced with bovine pericardium. The patient had a difficult but ultimately successful recovery. Options for anesthetic management in the setting of tamponade and a full stomach are discussed, with a brief review of the evidence relating to this clinical problem.

Perfuração da artéria coronária durante angioplastia com cavity spilling para o ventrículo direito / Coronary artery perforation with cavity spilling in the right ventricle during angioplasty

A perfuração da artéria coronária é complicação rara, porém muito temida nas intervenções percutâneas cardíacas. O advento das novas técnicas de angioplastia, como as ateroablativas, o aumento dos procedimentos em artérias antes consideradas desfavoráveis para intervenção e o aumento do arsenal antiplaquetário favorecem o aumento dessa complicação. Sua pronta identificação e o tratamento imediato trazem melhoras na sobrevida do paciente. Relata-se o caso de paciente com infarto agudo do miocárdio anterior com oclusão de grande ramo septal anômalo que apresentou perfuração da coronária durante angioplastia, com um tipo de perfuração denominada cavity spilling, com formação de shunt esquerdo-direito, tratado com sucesso.

Cardiac tamponade: A small case series.

The term cardiac tamponade describes a condition in which the heart is compressed by an excess of fluid in the pericardial space, with resulting abnormalities of cardiac function. Cardiac tamponade is a rare cause of sudden death. It is difficult to diagnose both in living and dead. In dead diagnosis is difficult at autopsy in absences of external visible injury & in living person the symptoms of cardiac tamponade are non specific. The symptoms relate principally to the secondary circulatory embarrassment. We present the series of cases with cause of death as cardiac tamponade due to diseases & trauma. These cases demonstrate that focus should always to be given to entire vital organs like heart and possibility of tamponade should be kept in mind.

Pericardite aguda e crônica / Acute and chronic pericarditis

A pericardite é a forma mais comum das doenças do pericárdio e pode se apresentar nas formas aguda e crônica. Frequentemente é idiopática e de evolução benigna. Quando não, as causas mais comuns são tuberculose, neoplasias malignas e doenças autoimunes. O diagnóstico clínico requer a presença de dor precordial típica, atrito pericárdico, elevação difusa do segmento ST e derrame pericárdico. Os exames laboratoriais incluem: ECG, ecocardiograma, RX do tórax e marcadores de inflamação e necrose miocárdica Procedimentos adicionais e internação devem ser considerados para o pacientes de maior risco. Os marcadores de risco são febre >38ºC, evolução subaguda, derrame pericárdico volumoso ou tamponamento cardíaco e ausência de resposta ao tratamento com anti-inflamatórios. O tratamento da pericardite deve ser focar a causa específica, quando identificável. Genericamente, usa-se aspirina ou anti-inflamatórios não hormonais para os casos de etiologia viral ou idiopáticos. A colchicina pode ser útil como droga adicional nos casos recorrentes. A pericardiocentese está indicada nos pacientes com tamponamento cardíaco, quando há chance elevada de tuberculose, pericardite purulenta ou neoplasia. A pericardiectomia fica reservada para os casos de pericardite constrictiva crônica.

Pericarditis is the most common form of pericardial diseases and most of the cases are idiopathic and and follow a benign course. Major nonidiopathic etiologies include tuberculosis, neoplasia and autoimmune diseases.The clinical diagnosis is confirmed when the following criteria are present: typical chest pain, pericardial friction rub, widespread ST-segment elevation, and pericardial effusion. Tests for pericarditis include ECG, echocardiogram, chest radiography and inflammation markers. High-risk patients need tests for etiology search and hospitalization. High-risk patients present fever >38oC, a subacute course, large pericardial effusion or cardiac tamponade and/or failure of antiinflammatory drugs.Treatment should target the specific etiology, if known. Generically, aspirin or a non-steroid anti-inflammatory drug is used for treatment of viral and idiopathic pericarditis. Colchicine is recommended as adjunct therapy for recurrent events. Pericardiocentesis is indicated for cardiac tamponade, high suspicion of tuberculosis, purulent pericarditis or neoplasia. Pericardiectomy is recommended for persistent constriction.

Acute Idiopathic Hemorrhagic Pericarditis with Cardiac Tamponade as the Initial Presentation of Acquired Immune Deficiency Syndrome

This paper presents a case of cardiac tamponade with idiopathic hemorrhagic pericarditis as the initial symptom of human immunodeficiency virus (HIV) infection. A 29-year-old male came to the emergency room with a sudden onset of dizziness. Upon arrival, he was hypotensive although not tachycardic, and his jugular venous pressure was not elevated. His chest X-rays revealed a mild cardiomegaly. Transthoracic echocardiography revealed a large amount of pericardial effusion with a diastolic collapse of the right ventricle, a dilated inferior vena cava with little change in respiration, and exaggerated respiratory variation of mitral inflow velocities, representing echocardiographic evidence of cardiac tamponade. After pericardiocentesis, his blood pressure improved to 110/70 mmHg without inotropics support. Serial 12-lead electrocardiograms during hospitalization revealed upwardly concave diffuse ST-segment elevation followed by a T-wave inversion suggestive of acute pericarditis. Pericardial fluid cytology and cultures for bacteria, mycobacteria, adenovirus, and fungus were all negative. HIV enzyme-linked immunosorbent assay (ELISA) was positive and confirmed by Western blot. The CD4 cell count was 168/mm3. Finally, the diagnosis of cardiac tamponade due to HIV-associated hemorrhagic pericarditis was made. It was concluded that HIV infection should be considered in the diagnosis of unexplained pericardial effusion or cardiac tamponade in Korea.

Primary hypothyroidism with pericardial tamponade.

We report a rare case of pericardial effusion and tamponade in a 10-yr-old child with undiagnosed primary hypothyroidism, who presented to us with delayed milestones, anasarca for 7 mth and respiratory distress for 20 days. The child recovered with ultrasound guided pericardial tap and thyroxine replacement therapy.

Hepatitis isquemica / Ischemic hepatitis

La hepatitis isquémica es una complicación sumamente infrecuente de cirugía cardiovascular. Las biopsias muestran necrosis centrolobulillar. El término de “hepatitis” fue propuesto debido al aumento de transaminasas similar a aquellas de origen infeccioso, e “isquémica” por falla en la perfusión hepática. Posteriormente se definió el término de hepatitis isquémica como cuadro de elevación aguda y reversible(dentro de las 72 horas) de transaminasas de hasta 20 veces el valor normal, asociado a trastornos en la perfusión hepática, luego de haber excluido otras causas de hepatitis aguda o daño hepatocelular. Se describe elcaso de un paciente de 53 años que consulta por dolor epigástrico de 12 h de evolución sin fiebre, náuseas nivómitos, resistente a la medicación. Tenía antecedentes inmediatos de reemplazo de válvula aórtica, y estabaanticoagulado. Evolucionó con shock y fallo multiorgánico. El examen evidenció marcada ictericia y signos detaponamiento pericárdico, asociado a un aumento considerable de enzimas hepáticas. Un ecocardiograma informósignos de taponamiento cardíaco y ausencia de disección aórtica. Se decidió pericardiocentesis, extrayéndose 970 cc. de líquido sanguinolento, y hemodiálisis, con notable mejoría de su estado hemodinámico. Los valores enzimáticos disminuyeron. Los marcadores virales fueron negativos

Ischemic hepatitis is an uncommon cardiovascular surgery complication. Hepatic biopsies show centrolobulillar necrosis. The term “hepatitis” was proposed because of a raise in hepaticenzymes similar with infectious disease, and “ischemic” because of failure in hepatic perfusion. Ischemic hepatitis was then defined as an acute and reversible elevation of hepatic enzymes (within 72 h), associated with disturbance in hepatic perfusion after excluding other causes of acute hepatitis. A 53 year-old male presentedcomplaining of a 12 h epigastric pain, without nausea or vomiting, resistant to medication. He underwent an aortic valve replacement and was under anticoagulation. He suddenly developed shock and multiorgan failure. Jaundice and cardiac tamponade signs were present, associated with elevated hepatic enzymes. A transthoracicechocardiography accounted for cardiac tamponade signs. A pericardiocentesis was performed, removing 970 cc of hemorrhagic fluid, and hemodialysis, with improvement of his hemodynamic status. Hepatic enzymes improved. Viral markers were negative

Reporte de un caso de pericarditis hemorrágica y taponamiento cardíaco asociados a lupus eritematoso sistémico / Hemorrhagic pericarditis and cardiac tamponade in systemic lupus erythematosus. A case report

El lupus eritematoso sistémico es una enfermedad autoinmune inflamatoria capaz de afectar cualquier aparato y sistema. Aunque la pericarditis es la manifestación cardíaca más frecuentemente observada, usualmente no es una situación que comprometa la vida del paciente. El taponamiento cardíaco ocasionado por derrame pericárdico en el lupus es una situación extremadamente rara, con una incidencia no mayor al 2%. Informamos el caso de una mujer de 21 años de edad con taponamiento cardíaco por lupus eritematoso sistémico, asociado a glomerulonefritis rápidamente progresiva, pancreatitis aguda, colecistitis aguda acalculosa, derrame pleural y actividad lúpica hematológica, cutánea y neurológica. El reconocimiento oportuno de esta rara manifestación del lupus puede salvar la vida de un paciente.

Systemic lupus erythematosus is a chronic inflammatory autoimmune disorder that can affect any organ or system. Although pericarditis is the most frequent cardiac manifestation of this entity, usually is not a life threatening situation. Pericardial effusion causing cardiac tamponade is a very rare complication in lupus, with an incidence less than 2%. We report a case of pericardial tamponade due to SLE with severe hemodynamic involvement in a 21-year-old woman associated to rapidly progressive glomerulonephritis, acute pancreatitis, acute acalculous cholecystitis, pleural effusion, hematologic, cutaneous and neurologic lupus activity. Recognition of this rare manifestation of SLE may be life saving.

Scleroderma with cardiac tamponade, hyperthyroidism and incidental papillary thyroid carcinoma

Cardiac tamponade and malignancy are associated with a poor prognosis in Progressive Systemic Sclerosis (PSS). We present the case of a 31-year-old African-Jamaican woman with PSS and a thyroid neoplasm who presented with cardiac tamponade requiring pericardiocentesis. Despite the presence of two poor prognostic markers, she has had a favourable postoperative course.

Relato de caso: tamponamento cardíaco no renal crônico - apresentaçäo longe da clássica / Relate the cases: cardiac tamponate in chronic renal pattent far away from classic presentation

Pericardite urêmica ocorre em torno de 10 porcento a 20 porcento dos pacientes em di'alise, sendo que metade desses desenvolveräo tamponamento cardíaco. Sendo um quadro potencialmente grave e näo täo incomum, foifeito um estudo retrospectivo de 1993 a 1998, com o objetivo de verificar a apresentaçäo clínica e a evoluçäo do tamponamento cardíaco em pacientes urêmicos. Foram encontrados 6 pacientes que nesse período apresentaram tamponamento cardíaco. A apresentaçäo clínica fugiu a clássica, predominando dispnéia, tosse seca ehipotensäo. Os dados clínicos e laboratoriais dos acometidos, tratamento cirúrgico e evoluçäo dos mesmos säo discutidos. Revisäo bibliográfica sobre tratamentoclínicoe cirurgíco da pericardite urêmica é apresentada (au)

Avanços em clínica cardiológica: Parte 1. Pericarditis / Advances in clinical cardiology: Pericardites

O autor fez uma revisäo sobre o tétano abordando os principais estudos referentes a etiologia, epidemiologia, patologia, diagnóstico, quadro clínico, diagnóticos diferenciais, exames laboratoriais subsidiários, tratamento, complicaçöes e profilaxias