Postpericardiotomy syndrome incidence, diagnostic and treatment strategies: experience AT two collaborative centers.

Postpericardiotomy syndrome (PPS) is worsening or new formation of pericardial and/or pleural effusion mostly 1 to 6 weeks after cardiac surgery, as a result of autoimmune inflammatory reaction within pleural and pericardial space. Its incidence varies among different studies and registries (2% to 30%), as well as according to the type of cardiac surgery performed. We conducted this retrospective analysis of PPS incidence and diagnostic and treatment strategies in patients referred for cardiac surgery for revascularization, valvular and/or aortic surgery. We retrospectively analyzed 461 patients referred for an urgent or elective cardiac surgery procedure between 2009 and 2015. PPS diagnosis was established using well defined clinical criteria. Demographic and clinical characteristics were used in regression subanalysis among patients having undergone surgery of aortic valve and/or ascending aorta. Within 6 weeks after cardiac surgery, 47 (10.2%) patients had PPS. The median time from the procedure to PPS diagnosis was 14 days. The incidence of PPS was 26% after aortic valve and/or aorta surgery, and 7.9% and 8.3% after coronary bypass and mitral valve surgery, respectively. Among patients subjected to aortic valve and/or aortic surgery, regression analysis showed significant association of fever, C-reactive protein (CRP) elevation between 5 and 100 mg/L, urgent procedure and postoperative antibiotic use with PPS diagnosis, whereas younger age showed near-significant association. All patients had complete resolution of PPS, mostly after corticosteroid therapy, with only 2 cases of recurrent PPS that successfully resolved after colchicine therapy. Pleural drainage was indicated in 15 (32%) patients, whereas only one patient required pericardial drainage. In conclusion, PPS incidence in our retrospective analysis was similar to previous reports. Patients having undergone aortic valve and/or aortic surgery were most likely to develop PPS. The most relevant clinical criteria for diagnosis in these patients were fever, CRP elevation between 5 and 100 mg/L, and pericardial and/or pleural effusion formation or worsening 2 weeks after cardiac surgery.

Embolism in retinal circulation after invasive cardiovascular procedures.

UNLABELLED: To determine the occurence of embolism in retinal circulation after invasive cardiovascular procedures and the risk of central retinal artery occlusion (CRAO) and branch retinal artery occlusion (BRAO). MATERIAL AND METHODS: During a 3 month period 153 patients (303 eyes)--101 male/52 female--who had undergone coronarography or stent implantation were examined before and 24 hours after the procedure. Best corrected visual acuity (BCVA) was taken, visual field examination was done and fundoscopy was performed. Eyes with the opacities in the anterior segment (corneal leucoma, dense cataracts) were excluded from the study. Prior to invasive procedure none of the patients had embolism in the retinal circulation. RESULTS AND DISCUSSION: Embolism was found in 3 patients (male) who all had hyperlipidemia with normal blood pressure. Two of them had coronarography and one patient had stent implantation. One of the patients had a previous branch retinal vein occlusion (BRVO) that was treated with photocoagulation. They did not report any symptoms. BCVA was the same before and after the procedure. Two of the emboli were located in the first branch of the central retinal artery and one was located in the branch of cillioretinal artery. All of the emboli were transient after 48 hours. CONCLUSION: The study showed that invasive cardiovascular procedures do have the risk of developing transient embolism in retinal circulation. However, there have been reports of CRAO and BRAO after diagnostic cardiac procedures, therefore clinicians should be aware of this potential complication.

Duke Treadmill Score in prioritizing patients for coronary angiography: retrospective study of a Croatian regional hospital.

Aim of the study was to determine the potential of Duke Treadmill Score (DTS) in prioritizing patients for coronary angiography in a transitional country clinical setting. We analyzed 114patients with suspected stable coronary artery disease who underwent exercise treadmill testing, and coronary angiography in Slavonski Brod General Hospital. DTS was calculated from treadmill test as: exercise time--(5 x ST deviation in mm)--(4 x exercise angina). Regarding the score, patients were grouped into three groups of risk for coronary artery disease: low risk, medium risk, and high risk patients. All patients underwent coronary angiography, and were grouped in accordance to the severity of the coronary artery disease into three groups: insignificant, significant, or severe coronary artery disease. All patients scored as high risk DTS had significant or severe coronary artery disease. Medium and low risk DTS patients had insignificant coronary artery disease in 50%, and 90% of cases, respectively. Medium risk patients with significant or severe coronary artery disease were significantly older, and had more frequent history of typical chest pain with higher number of episodes per week (P<0.05), whereas there were no differences regarding gender or presence of risk factors. There were no significant differences among medium risk patients regarding the severity of coronary artery disease in exercise time or ST deviation. However, the presence of limiting exercise angina in medium risk patients was significantly more related with significant and severe coronary artery disease (P<0.05). High risk DTS result showed great potential in stratifying patients for immediate coronary angiography. This scoring system may be used in prioritizing patients for coronary angiography in a transitional clinical setting.