Rare case of infective aortitis with aortic rupture and cardiac tamponade in a young child.

Aortitis and aortic dissection are very rare in children. The clinical presentation of aortitis varies across a spectrum, ranging from incidental findings to fatal aortic dissection and rupture. A high index of suspicion is needed to establish an accurate and timely diagnosis. Here, we present an unfortunate case of fatal infective aortitis with aortic rupture and cardiac tamponade in a healthy toddler. Postmortem report implicated Kingella kingae as the causative organism of aortic pseudoaneurysm and rupture, leading to the instantaneous death of the child.

A rare complication of pericardiocentesis: Pneumopericardium.

Pneumopericardium is the presence of air in the pericardial sac. Pneumopericardium after pericardiocentesis has been rarely reported in the literature. In the present case, we report a patient who presented with tamponade physiology during COVID-19 and developed pneumopericardium after emergency pericardiocentesis. Immediate recognition and treatment are crucial and chest x-ray, thorax computerized tomography, and transthoracic echocardiography (TTE) are used for diagnosis.

Hemorrhagic Cardiac Tamponade-An Unusual Threat in the COVID-19 Recovery Phase.

Cardiac tamponade is a rare presentation in patients with COVID-19, which may be induced by the associated exacerbated inflammatory response. The onset of cardiac tamponade may be concomitant with the acute phase of the disease or may develop subsequently as a new health condition secondary to the disease. We report four cases of cardiac tamponade that occurred late after the acute phase of the disease. One of them may be considered a post-acute complication of the disease, and three of them may be classified as a new health condition induced by COVID-19. Only two cases had a history of severe respiratory distress due to COVID-19. In all four cases, pericardiocentesis was imposed, and surprisingly, in every case, hemorrhagic fluid was evacuated. In this case, series, immune-mediated etiology is supported by histopathological results, where the main identified feature was fibrous pericarditis with inflammatory infiltrate. Only one patient included in this report died, and three of them were discharged after anti-inflammatory treatment was initiated.

Effect of waiting time for COVID-19 screening on postoperative outcomes of type A aortic dissection: An institutional study.

BACKGROUND: Since November 2020, all patients undergoing emergency surgery at our hospital have been subjected to preoperative reverse transcription polymerase chain reaction (RT-PCR) screening to prevent nosocomial COVID-19 infection, with admission to the operating room requiring a negative result. Herein, we compared the pre- and postoperative outcomes of acute type A aortic dissection surgery before and after implementing the RT-PCR screening for all patients. METHODS: We compared the postoperative results of 105 patients who underwent acute type A aortic dissection emergency surgery from January 2019 to October 2020 (Group I) and 109 patients who underwent the surgery following RT-PCR screening from November 2020 to March 2022 (Group II). RESULTS: The average waiting time from arrival at the hospital to admission to the operating room was 36 and 81 min in Groups I and II, respectively. Ruptured cardiac tamponade was observed preoperatively in 26.6% and 21.1% of Groups I and II patients, respectively. The preoperative waiting time due to RT-PCR screening did not contribute to the cardiac tamponade. Surgical complications such as bleeding (reopened chest), respiratory failure, cerebral neuropathy, or mediastinitis did not increase significantly. The number of deaths 30 days after surgery (Group I = 13 and Group II = 3) showed no significant difference between the groups. There were no cases of nosocomial COVID-19 infections. CONCLUSIONS: Preoperative COVID-19 screening is an important method to prevent nosocomial infections. The associated waiting time did not affect the number of preoperative ruptures or affect postoperative complications or mortality.

[What's new in pericardial disease?] / Was ist neu bei Perikard-Erkrankungen?

Pericardial disease represents a large diversity of inflammation related injury of the pericardium. Multifactorial causes may contribute to acute and recurrent pericarditis, pericardial effusion without major hemodynamic compromise, cardiac tamponade or constrictive pericarditis. Currently, inflammatory pericardial pathologies are observed in cases of SARS-CoV-2-infection or after vaccination. Beside established anti-inflammatory therapeutic strategies with NSAID, corticosteroids and colchicine, auto-inflammation and inflammasomes seam to offer more specific targets for advanced treatment options.

Life-Threatening Cardiac Tamponade Secondary to COVID-19 Treated with Uniportal Video-Assisted Thoracoscopic Surgery: A Case Report.

BACKGROUND The COVID-19 outbreak emerged in December 2019 in Wuhan, China. COVID-19 is caused by the SARS-CoV-2 coronavirus and mostly affects the respiratory system but can also affect other organs, including the cardiovascular system. Furthermore, the most common cardiac complications include severe left ventricular dysfunction, acute myocardial injury, and arrhythmias. Life-threatening cardiac tamponade and large pericardial effusion are exceedingly rare complications in patients recovered from COVID-19. Previously, this condition was treated with pericardiocentesis, colchicine, and corticosteroids. CASE REPORT We present the case of a 54-year-old man who recovered from a SARS-CoV-2 infection 7 days before presentation and describe a complicated pericardial effusion with life-threatening cardiac tamponade. To the best of our knowledge, this is the first case of pericardial effusion with cardiac tamponade that was successfully treated with single port or uniportal video-assisted thoracoscopic surgery with an excellent outcome. CONCLUSIONS Life-threatening cardiac tamponade with pericardial effusion is an exceedingly rare complication in patients recovered from COVID-19. Generally, patients diagnosed with pericardial effusion undergo a pericardiocentesis procedure. Although there are multiple treatment options for draining pericardial effusion, the recurrence rate with surgical pericardial window formation is the lowest. However, our patient underwent surgery using a uniportal video-assisted thoracoscopic surgery with an excellent outcome.

Cardiac Tamponade After COVID-19 Vaccination.

BACKGROUND: Acute pericarditis is a diffuse inflammation of the pericardial sac with many well-defined etiologies. Acute pericarditis as a vaccine-related adverse event is a rare entity, and the association between pericarditis and the immunogenic response to Coronavirus disease 2019 (COVID-19) vaccines is still being fully characterized. CASE REPORT: A previously healthy 18-year-old man presented with fever, pleuritic chest pain, and shortness of breath 3 weeks after receiving the first dose of a COVID-19 mRNA-based vaccine. The patient was found to have a large pericardial effusion with early tamponade physiology requiring pericardiocentesis. WHY SHOULD AN EMERGENCY PHYSICIAN BE AWARE OF THIS?: As COVID-19 vaccination becomes more prevalent globally, physicians should be aware of pericarditis as a rare but potentially serious adverse reaction. Although a direct causal link cannot be demonstrated, we present this case to increase awareness among emergency physicians of pericarditis as a rare, but potentially serious adverse event associated with COVID-19 vaccination.

Cardiac tamponade and massive pleural effusion in a young COVID-19-positive adult.

COVID-19 has a broad spectrum of cardiac manifestations, and cardiac tamponade leading to cardiogenic shock is a rare presentation. A 30-year-old man with a history of COVID-19-positive, reverse transcription polymerase chain reaction (RT-PCR) done 1 week ago and who was home-quarantined, came to the emergency department with palpitations, breathlessness and orthopnoea. His ECG showed sinus tachycardia with low-voltage complexes, chest X-ray showed cardiomegaly and left pleural effusion and two-dimensional echocardiography showed large pericardial effusion with features suggestive of cardiac tamponade. He was taken up for emergency pericardiocentesis which showed haemorrhagic pericardial fluid. Intercostal drainage insertion was done for left-sided large pleural effusion. After ruling out all the other causes for haemorrhagic pericardial effusion, the patient was started on colchicine, steroids, ibuprofen and antibiotics to which he responded. Both pericardial and pleural effusions resolved completely on follow-up.

Pericardial Diseases in COVID19: a Contemporary Review.

PURPOSE OF REVIEW: Coronavirus disease 2019 (COVID19) involves the heart, including pericardium. This article reviews the possible pathophysiological mechanisms in pericardial involvement in COVID19 and pericardial manifestations of COVID19. It also summarizes the patients with pericarditis secondary to COVID19 and outlines the contemporary treatment strategies in this patient population. RECENT FINDINGS: A high degree of suspicion is required to identify the pericardial involvement in COVID19 patients. It is proposed that an underlying hyperinflammatory reaction in COVID19 leads to pericardial inflammation. Acute pericarditis with or without myocardial involvement is diagnosed on clinical presentation, serum inflammatory markers, electrocardiogram, and echocardiogram. Multimodality imaging may also have an additional diagnostic value. Patients are usually managed medically, but some patients develop a life-threatening pericardial tamponade necessitating pericardial drainage. Pericardial involvement is an important clinical manifestation of COVID19 requiring a proper workup. Timely diagnosis and a specific management plan based on the presentation and concomitant organ involvement usually lead to a complete recovery.

Coronavirus disease 2019 (COVID-19)-associated constrictive pericarditis.

This report documents a rare case of COVID-19-associated constrictive pericarditis (CP) in the setting of a recent COVID-19 infection. A 55-year-old man with a history of hypertension and gout presented with acute hypoxic respiratory failure and was diagnosed with COVID-19 pneumonia with progression to acute respiratory distress syndrome. His hospital course was complicated by a large pericardial effusion; an emergent bedside transthoracic echocardiography was concerning for cardiac tamponade, so pericardiocentesis was performed. A workup with cardiac magnetic resonance imaging showed changes consistent with a diagnosis of CP. Viral and idiopathic aetiologies are the most common cause of CP in the developed world, with COVID-19 now a proposed predisposing viral illness. The virus induces systemic inflammation and pericardial changes that can lead to CP physiology. Imaging modalities including echocardiogram and cardiac magnetic resonance play an integral role in confirming the diagnosis.

Acute Cardiac Tamponade: A Case of Life-Threatening Coronavirus Disease 2019 Complication During Air Medical Transportation.

A 42-year-old man with coronavirus disease 2019 pneumonia was admitted to a small town hospital that did not have intensive care unit (ICU)-level resources available. Twelve hours later, the patient suddenly became agitated, and an extensive anterolateral ST-elevation myocardial infarction was detected by 12-lead electrocardiography and supported by a rise in serum cardiac enzymes. Low blood oxygen saturation (59%) and cardiac ejection fraction (ejection fraction = 20%) reflected criticality that could potentially require a catheterization laboratory, coronary artery bypass graft surgery, and ICU-level resources. After the coordination of physicians with the nearest equipped hospital and air medical crew, a Mil Mi-17 medical helicopter unit was dispatched. About 20 minutes before reaching the destination hospital, his clinical condition declined; his heart was 50 beats/min, his blood pressure was 75/40 mm Hg, and he had jugular vein distention. Muffled heart sounds, decreased electrocardiographic voltage, and the accumulation of pericardial effusion on a bedside ultrasound indicated cardiac tamponade. The air medical crew resuscitated the patient through the interventions of intubation, mechanical ventilation, administration of intravenous fluids, and initiation of an epinephrine infusion. Ultrasound-guided pericardiocentesis was performed in the helicopter, which kept him alive until pericardotomy could be performed at the destination hospital. Unfortunately, after pericardiotomy and coronary artery bypass graft surgery, the patient died 7 days later in the ICU due to severe cardiopulmonary failure.

Bedside Mediastinotomy for Tension Pneumomediastinum With Tamponade in COVID-19.

Tension pneumomediastinum is a rare but life-threatening cause of tamponade. Mechanical ventilation is a described source of tension pneumomediastinum. Here, we present a case of a 72-year-old man who developed cardiovascular collapse from tension pneumomediastinum in the setting of coronavirus disease 2019-related acute respiratory distress syndrome. We successfully performed bedside mediastinotomy and mediastinal tube placement under local anesthetic to alleviate his hemodynamic instability. Bedside mediastinotomy can be used to relieve tension pneumomediastinum in this setting.

Hemorrhagic pericardial effusion leading to cardiac tamponade, as presenting feature of COVID-19 in a young man: a case report.

BACKGROUND: Coronavirus disease 2019(COVID-19) is an acute respiratory illness, caused by Severe Acute Respiratory Syndrome Coronavirus2 (SARS-COV2) which quickly grew to a pandemic in late 2019 and led to substantial public health problems. Among the extrapulmonary manifestations reported, cardiovascular implications are remarkable as they can be potentially lethal. There have been rare reports of pericardial involvement, despite the pronounced cardiovascular complications including acute myocardial injury, myocarditis, arrhythmia, cardiogenic shock and venous thromboembolism. Herein, we reported a young man with cardiac tamponade as the presenting feature of COVID-19.  Case summary: An otherwise healthy 28-year-old man, was admitted with pleuritic chest pain and shortness of breath and was diagnosed with COVID-19 associated cardiac tamponade. Emergency pericardiocentesis yielded large amount of hemorrhagic pericardial effusion which resulted in symptom relief. He was successfully treated with pericardiocentesis followed by anti-viral and anti-inflammatory medications and remained asymptomatic in 1-month follow-up. CONCLUSION: We highlight this case to mention that "hemorrhagic" cardiac tamponade can be a life-threatening complication of COVID-19, which can be treated if diagnosed early. Therefore, clinicians should be fully aware of this cardiac complication to consider in deteriorating COVID-19 patients.

COVID-19 myopericarditis with cardiac tamponade in the absence of respiratory symptoms: a case report.

BACKGROUND: Previous reports have shown various cardiac complications to be associated with COVID-19 including: myocardial infarction, microembolic complications, myocardial injury, arrythmia, heart failure, coronary vasospasm, non-ischemic cardiomyopathy, stress (Takotsubo) cardiomyopathy, pericarditis and myocarditis. These COVID-19 cardiac complications were associated with respiratory symptoms. However, our case illustrates that COVID-19 myopericarditis with cardiac tamponade can present without respiratory symptoms. CASE PRESENTATION: A 58-year-old Caucasian British woman was admitted with fever, diarrhoea and vomiting. She developed cardiogenic shock and Transthoracic echocardiogram (TTE) found a pericardial effusion with evidence of cardiac tamponade. A nasopharyngeal swab showed a COVID-19 positive result, despite no respiratory symptoms on presentation. A pericardial drain was inserted and vasopressor support required on intensive treatment unit (ITU). The drain was removed as she improved, an antibiotic course was given and she was discharged on day 12. CONCLUSIONS: Our case demonstrates that patients without respiratory symptoms could have COVID-19 and develop cardiac complications. These findings can aid timely diagnosis of potentially life-threatening COVID-19 myopericarditis with cardiac tamponade.