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Deaths Following Cardiac Surgery and Invasive Interventions
Published in Mary N. Sheppard, Practical Cardiovascular Pathology, 2022
When drains are removed post-operatively, there may be torrential bleeding into the opened pericardium due to ventricular rupture, subsequent to preoperative or peri-operative infarction. A common cause of tamponade is leakage from the aortotomy site or the distal anastomosis. Graft disruption due to overwhelming infection is a very rare event.
Cardiac Emergencies in Obstetrics
Published in Sanjeewa Padumadasa, Malik Goonewardene, Obstetric Emergencies, 2021
Sanjeewa Padumadasa, Sanjeewa Rajapakse
Whatever the diagnosis is, resuscitation should be of foremost priority in a collapsed obstetric patient. Pericardiocentesis is the initial treatment in relieving external pressure on the heart and establish cardiac output, if there is associated pericardial effusion with features of impending tamponade. An open thoracotomy is an option if pericardiocentesis fails. However, open thoracotomy carries a poor prognosis in a collapsed patient. Once diagnosed with aortic dissection, the woman should be treated with intravenous nitroprusside and a beta-blocker. Urgent caesarean delivery followed by aortic repair is essential in some women with DeBakey type 1 dissection involving the aortic root in order to avoid haemodynamic stress, progressive aortic expansion and rupture and also in cases of fetal distress. In other types of aortic dissections, emergency aortic repair is performed with the fetus in situ when it is not mature enough, but this carries significant risk to the fetus. If the woman is stable, then initial medical management followed by caesarean delivery and elective aortic repair on a later date is feasible.
Minimally Invasive Atrial Ablation Surgery
Published in Theo Kofidis, Minimally Invasive Cardiac Surgery, 2021
Gehi’s cohort of 101 patients was followed by 24-hour Holter monitoring or implantable looping monitor at 3, 6 and 12 months. Complications included two patients with tamponade, two patients with bleeding (one requiring surgical intervention) and two deaths (one atrialesophageal fistula and one sudden and unexplained, with unrevealing autopsy) (Figure 13.48). Repeat endocardial ablation was performed in 6% of patients. Including repeat ablation, 12-month arrhythmia-free survival was 73% without concomitant antiarrhythmic drug therapy [29].
Meningococcal pericarditis caused by the MenW:cc11 strain in an older adult
Published in Acta Clinica Belgica, 2023
Gaëlle Moerman, D. Verleyen, Ph. Rogiers, J. Hoste, W. Mattheus, K. Floré
Consequently, a transthoracic echocardiography (TTE) was performed, confirming a pericardial effusion (maximum 6 mm in systole, 3.5 mm in diastole). Following the visualization of the pericardial effusion, acetylsalicylic acid (1 g 3 times daily) and colchicine (0,5 mg twice daily) were associated. Because of worsening dyspnoea and chest pain TTE was repeated after three days showing a significant increase in pericardial effusion (20 mm in systole, 16 mm in diastole). There were no signs of tamponade but the vena cava inferior was dilated and its diameter showed decreased respiratory variations. Contractility was preserved. A pericardiocentesis with pericardial drainage was performed at that time with evacuation of 720 cc yellow fluid. Over a period of two days an additional 500 cc fluid was evacuated. Thereafter, TTE showed a resolution of the pericardial effusion and the pericardial drain was removed. Analysis proved the exudative nature of the fluid, with a white cell count of 1345/μL, predominantly neutrophils (95%).
Percutaneous balloon pericardiotomy: efficacy in a series of malignant and nonmalignant cases
Published in Scandinavian Cardiovascular Journal, 2022
Holger H. Sigusch, Wolff Geisler, Ralf Surber, Marc Schönweiß, Jens Gerth
In the case of malignant pericardial effusion and cardiac tamponade, balloon pericardiotomy is a minimally invasive option to the surgical creation of a subxiphoid pericardial window. Percutaneous balloon pericardiotomy effectively drains recurrent pericardial fluid by creation of a pleuro (-abdominal-) pericardial communication [1–14]. The aim in this setting is to facilitate ambulant palliative care of the patients with most often advanced malignant disease. The European guidelines on management of pericardial disease recommend percutaneous balloon pericardiotomy in this context as a class IIb intervention [15]. In nonmalignant pericardial effusion and tamponade, balloon pericardiotomy has been rarely used. This is due to a couple of reasons. First, improved postpericardiocentesis management as proposed by Luis et al. lead to fewer recurrences in patients with nonmalignant effusions [15]. Second, surgical alternatives such as the creation of a subxiphoid pericardial window, video-assisted transthoracic pericardial drainage and pericardiectomy are the preferred options for the more resilient patients, not suffering from underlying malignant disease [3].
Usefulness of neutrophil-to-lymphocyte ratio for predicting acute pericarditis outcomes
Published in Acta Cardiologica, 2022
Fatih Yılmaz, Filiz Kizilirmak Yılmaz, Ali Karagöz, Arzu Yıldırım, Haci Murat Gunes, Ravza Betül Akbas, Süleyman Çağan Efe, İrfan Barutçu
All patients were those who had their first pericarditis episode, and the diagnosis was established based on the presence of at least two out of four criteria according to the most recent guideline [6]. The criteria were as follows: pericardial chest pain, new widespread ST elevation or PR depression on ECG, pericardial effusion and pericardial rubs. Furthermore, chest X-ray and additional supporting findings such as increased inflammatory markers [CRP, erythrocyte sedimentation rate and white blood cell (WBC) count] were also evaluated. Laboratory markers including cardiac enzymes, high-sensitivity CRP (hs-CRP) level and complete blood count (CBC) were the other parameters evaluated in the study. For the CBC analysis, an automated blood counter (Cell-Dyn 3500, Abbott, IL) was used. NLR was defined as the neutrophil count/lymphocyte count in peripheral blood samples. The hs-CRP levels were analyzed with a Beckman Coulter Inc. (Image 800, CA) device employing a cut-off value of 0.5 mg/dL for hs-CRP. Criteria for the diagnosis of recurrence included recurrent pain and one or more of the following signs: fever, pericardial friction rub, changes in ECG, echocardiographic evidence of pericardial effusion, an elevation in WBC count and hs-CRP [6]. Pericardial effusion severity was determined as mild (echo-free space of <10 mm during diastole), moderate (10–20 mm) and large (>20 mm) with two-dimensional echocardiography. The diagnosis of cardiac tamponade was made by a combination of clinical features (pulsus paradoxus, elevated jugular venous pressure and tachycardia) and echocardiographic signs of tamponade.