Delayed cardiac tamponade after simultaneous transcatheter atrial septal defect closure and left atrial appendage closure device implantation: a particular case report

Percutaneous left atrial appendage(LAA)occlusion evolved as an alternative treatment to the patients who are contraindicated or cannot tolerate oral anticoagulants with nonvalvular atrial fibrillation(AF)at risk of stroke or systemic embolism.[1]Abnormal hemodynamic changes in elder atrial septal defect(ASD)patients cause remodeling of the left atrium,which eventually leads to right heart failure.[2]As the ASDs elderly are associated with a higher incidence of AF,simultaneous transcatheter ASD and LAA closure has become a new effective therapeutic strategy.However,only a limited number of articles involving cardiac tamponade complications have been published in the literature.What’s more,previous studies involving early hemodynamically irrelevant pericardial effusion after the procedure attribute to multiple repositioning attempts of LAA occluder or delivery sheath injured the atrial wall.

Delayed cardiac tamponade diagnosed by point-of-care ultrasound in a neonate after peripherally inserted central catheter placement: A case report

BACKGROUND Peripherally inserted central catheters(PICCs)have been increasingly applied worldwide owing to many advantages.Even with these advantages,the related complications should not be ignored,especially in neonates.The available evidence about PICC-related thrombosis was manifold,but the cardiac tamponade,an emergency and life-threatening complication,has been rarely reported.Early recognized cardiac tamponade by ultrasound may reduce mortality.CASE SUMMARY A neonate weighting 2.8 kg was born at 40 wk of gestation.He was admitted to the Surgery Intensive Care Unit due to suspected congenital megacolon.A PICC line was inserted via the left antecubital fossa for the administration of total parenteral nutrition.Three days later,the patient was still on total parenteral nutrition.Cardiac tamponade caused by PICC was found on ultrasound.The patient recovered spontaneously after an emergency pericardiocentesis.CONCLUSION Proficiency in the use of point-of-care ultrasound may save the life of patients,since it enables clinicians to treat patients faster,more accurately,and in a noninvasive way at the point of care.

Clinicopathological study of cardiac tamponade due to pericardial metastasis originating from gastric cancer

AIM： To review the cases reported in the literature, examined their clinicopathological features, and evaluated the efficacy of different therapeutic modalities for this rare condition. METHODS： A search of the MEDLINE database revealed 16 cases of pericarditis carcinomatosa （PC） originating from GC reported in the literature between 1982 and 2005. Additional detailed data were obtained from the authors of these studies for subsequent clinicopathological investigation. We have also described about a case study from our own clinic. RESULTS： The mean age of cases with pericarditis carcinomatosa originating from GC was 54 years. Females were diagnosed at a younger age （46.3 years） compared to males （58 years）. The mean survival period afer diagnosis was 4.5 mo. No statistical differences in the length of survival time were found between different therapeutic modalities, such as drainage, and local and/or systemic chemotherapy after drainage. However, three cases who underwent systemic chemotherapy survived for more than 10 mo. Cases that developed metachronous cardiac tamponade for more than 2 years afer the diagnosis of GC generally survived for a longer period of time, although this was not statistically significant. Multivariate analysis revealed that low levels of carcinoembryonic antigen （CEA）, and CEA and/or cancer antigen 19-9 （CA 19-9） were associated with longer survival. CONCLUSION： Cases with low levels of CEA, and CEA and/or CA 19-9 should undergo systemic chemotherapy with or without local chemotherapy afer drainage.

Cough induced syncope:A hint to cardiac tamponade diagnosis

We report a case of a 75-year-old male with history oflung adenocarcinoma who presented with shortness of breath and frequent episodes of cough-induced syncope. A large pericardial effusion was found on echocardiogram suggestive of cardiac tamponade. Pericardiocentesis was done which improved the dyspnea and eventually resolved the syncope. There are only two other cases reported in the literature with cough-induced syncope in the setting of pericardial effusion or cardiac tamponade. Our clinical vignette also highlights the importance of pulsus paradoxus identification in patients with cough induced syncope to rule out cardiac tamponade since this is the most sensitive physical finding for its diagnosis.

Cardiac tamponade as a rare complication after giant coronary fistula percutaneous closure

We present the case of an unusual complication after percutaneous closure of a giant coronary artery fis-tula. A 76-year-old man with previous admissions due to right heart failure and previous history of atrial fibrillation under acenocumarol, was admitted to our hospital for new onset of symptoms, characterized by progressive dyspnoea and peripheral edema. Physical examination revealed signs of congestive heart failure and a continuous murmur loudest along the lower sternal border. X-Ray showed cardiomegaly due to right chambers dilatation. Transthoracic echocardiography showed right chambers pressure and volume overload, with right ventricular enlargement and dysfunction, tricuspid annulus dilatation and severe tricuspid regurgitation. Cardiac catheterization showed significant elevation of right atrial pressure, as well as significant step-up of oxygen saturation in this chamber. Coronary angiography revealed the presence of a large fistula between the circumflex coronary artery (CCA) and coronary sinus (CS), with severe dilation of the CCA (maximum diameter20 mm). An Amplatzer? PDA was implanted in a distal elbow of the fistula with initailly good results. Anticoagulant therapy was then reinitiated, and a few days later, the patient developed clinical worsening of heart failure and dyspnoea. Echocardiogram showed significant pericardial effusion. Pleuropericardial window was then made draining a500 cm3 of bloody pericardial effusion. The postoperative outcome was excellent, with symptomatic relief and no signs of heart failure.

Cardiac Tamponade Associated with Blunt Cardiac Injury: Its Definitive Management in the Emergency Department

Cardiac tamponade secondary to blunt cardiac injury is an extremely serious and life-threatening condition that the emergency physician is required to make definitive and appropriate management and resuscitation. Although blunt cardiac injury includes a wide spectrum of pathological conditions, cardiac tamponade due to blunt trauma is rarely seen because most of the patients with cardiac rupture die at the scene or before arrival at the hospital. Definitive surgical repair is commonly necessary following pericardial decompression if the patient is too unstable with impending cardiac arrest. Bringing the patient to definitive surgery as soon as possible is crucial for the chance of survival to the emergency physician. We describe two cases of cardiac tamponade resulting from blunt chest trauma successfully treated with a definitive management and surgical repair.

First report of cardiac tamponade in pediatric-onset mixed connective tissue disease

Mixed Connective Tissue Disease (MCTD) is relatively rare in children and typically presents with constitutional symptoms, rash, Raynaud’s phenomenon, and musculoskeletal symptoms. Cardiac involvement is an infrequent complication of MCTD usually occurring in the form of pericarditis without tamponade physiology. However, we present a case of a 10-year-old, previously healthy, African American male who developed pericarditis and tamponade as an initial manifestation of MCTD. One month prior to diagnosis, the child was hospitalized for fevers, knee pain and knee swelling. Arthrocentesis revealed leukocytosis yet no laboratory evidence of an infectious etiology. He was discharged on naproxen with a presumptive diagnosis of post-infectious arthritis. Over the next two weeks, the child was evaluated several times for intermittent, left-sided, chest pain. Electrocardiograms and chest radiographs were found to be normal. His non-steroidal anti-inflammatory medications were continued for supposed musculoskeletal chest pain. Ultimately the child was admitted for fever, chest pain and a pericardial effusion on echocardiogram. Within two days, symptoms progressed to include orthopnea and jugular venous distension. Pulsus paradoxus was demonstrable on exam and electrical alternans on cardiac monitor. Repeat echocardiogram revealed an increased effusion with tamponade physiology necessitating pericardiocentesis. Coincidentally, the patient began demonstrating Raynaud’s phenomenon and auto-antibodies supportive of MCTD returned positive. Symptoms improved on corticosteroids. This case illustrates the importance of considering an acute and critical process in an otherwise chronically evolving disease. It serves as the first report of such an occurrence in pediatriconset MCTD.

Cardiac tamponade as the initial manifestation of severe hypothyroidism: A case report

Background: Hypothyroidism is a commonly seen condition. The presence of pericardial effusion with cardiac tamponade as initial manifestation of this endocrinological condition is very unusual. Objectives: In hypothyroidism pericardial fluid accu-mulates slowly, allowing adaptation and stretching of the pericardial sac, sometimes accommodating a large volume. Case Report: A 39 year-old female presented with chest pain, dyspnea and lower extremity edema for 1 day. Bradycardia, muffled heart sounds and severe hypertension were noticed. Chest radiograph showed an enlarged cardiac silhouette. A bedside echocardiogram revealed a cardiac tamponade, later she developed sudden hypotension and bradycardia that resolved after pericardiocentesis of 1 liter of pericardial fluid. The further laboratory evaluation revealed a TSH value of 69.3 miU/L and low T3 and free T4. The patient later developed reaccumulation of pericardial fluid with the need for creation of pericardial window. Conclusion: When the classic Beck’s triad is not present and bradycardia accompanies a cardiac tamponade, hypothyroidism should be strongly suspected. The requirement for thyroid hormone supplement is critical and is well reported. There is a chance of recurrence even after starting levothyroxine supplementation;and the associated hypertension usually requires treatment with more than one drug.

Primary gastric signet ring cell carcinoma presenting as cardiac tamponade

Primary gastric signet ring cell carcinoma presenting as cardiac tamponade is difficult to diagnosis early. Patients are generally asymptomatic until the disease is advanced. General practitioners usually focus on the initial symptoms related to pericarditis and pericardial effusion. We report a case of signet-ring cell carcinoma of the stomach presenting as cardiac tamponade with pericarditis and pericardial effusion but without any gastrointestinal symptoms. A 49-year old woman was admitted because of progressive dyspnea and cough. Chest X-ray revealed an increased cardiothoracic ratio and a small amount of bilateral pleural effusion. Two dimensional ultrasonographic echocardiography pericardial effusions with atrial and right ventricular early diastolic collapse were found, establishing the diagnosis of cardiac tamponade. Pericardiocentesis was performed and 420 mL of bloody ?uid was taken. The patient died of respiratory failure and cardiac arrest on October 28, 2009. Post-mortem examination revealed diffuse gastric mucosa erosion and edema with stomach mucosa incrassation in the greater curvature. The primary lesion was histopathologically diagnosed as signet-ring cell carcinoma of the stomach.

Lifesaving Emergency Sternotomy in Traumatic Cardiac Tamponade in a Teaching Hospital in Ghana: Survival of Two Rare Cases

Introduction: Patients presenting with cardiac injuries from gunshot wounds and blunt chest trauma have high mortality, without any observed survival benefit when presenting with cardiac tamponade. Cardiac tamponade is a life-threatening hemodynamically significant compression of the heart by a sudden or gradual accumulation of collections in the pericardial space that incites and overrides the body’s compensatory mechanism. Clinical Case: We present and discuss the successful management and survival of two patients with traumatic cardiac tamponade from gunshot wounds to the precordium who underwent successful lifesaving median sternotomy at a Teaching Hospital in Ghana with a new Cardiovascular and Thoracic Surgery Unit. Discussion: Usually the diagnosis of cardiac tamponade from traumatic haemopericardium is made by clinical findings which though may not always be present especially after blunt chest trauma. EFAST is a reliable tool for diagnosing and following cardiac tamponade. Median sternotomy is the standard procedure in these patients to access and repair cardiac injury either with or without cardiopulmonary bypass. Conclusion: Emergency median sternotomy in patients with cardiac tamponade from chest trauma especially after EFAST diagnosis can be lifesaving even in less resourced centres.

Cardiac Tamponade: Epidemioclinical, Therapeutic and Evolutionary Aspects at the University Hospital of Brazzaville

Objectives: Contribute to improving the management of cardiac tamponade in Congo. Background: Cardiac tamponade is an acute or subacute compression of the heart chambers by pericardial effusion responsible for uncertain prognosis for patients. The objective of this study is to help improve the management of patients with cardiac tamponade. Patients and Methods: We conducted a retrospective and descriptive study at the University Hospital of Brazzaville, from January 2015 to December 31, 2019. Included were all patients hospitalized for cardiac tamponade. Epidemioclinical, therapeutic and evolutionary data were analyzed. Results: An overall of 14 patients were divided into 9 men (64.2%) and 5 women (35.7%), i.e. a sex ratio of 1.8. The mean age of patients was 34.2 ± 15.1 years old (18 years to 64). The most represented comorbidity was hypertension (n = 2;14.3%). The most frequent clinical sign was dyspnea (n = 14;100%). The ECG showed diffuse and concordant repolarization disturbances (n = 14;100%), sinus tachycardia (n = 13;92.8%), microvoltage (n = 12;85.7%). Cardiomegaly was constant (n = 14;100%). In terms of transthoracic ultrasound, we found: diastolic compression of the right ventricle (RV) (n = 12;85.7%), dilation of the inferior vena cava (IVC) (n = 12;85.7%). Treatment consisted of crystalloid vascular filling in all patients, pericardial puncture (n = 7;50%), surgical drainage (n = 12;85.7%), anti-tuberculosis drugs (n = 11;78, 6%), antimitotics could be administered in one case (n = 1;7.2%). Two cases of death were recorded, i.e. 14.3%. Conclusion: Cardiac tamponade, although it is a rare condition, remains a serious pathology and difficult to manage in our context.

Case Report of Cardiac Tamponade Due to Acute Chagas Disease after Misdiagnosis of Visceral Leishmaniasis Based on Serology

Protozoan diseases such as Visceral Leishmaniasis (VL) have re-emerged in Northern Brazil and cases of Chagas Disease also occur. This VL increase leads to early therapy for the public. Confirmatory parasitological diagnoses in VL are performed by bone marrow or spleen aspiration, but ELISA, IFA or immunochromatographic tests for antibody detection are easily performed and can be used in the presence of clinical signs as confirmatory for specific therapy. This approach is successful in providing therapy and prevention of death in VL, but there is a chance of confusion with the emerging disease, Chagas Disease (CD), due to cross-reacting and similar clinical pictures, as in this case. Both VL and CD presented many asymptomatic or oligosymptomatic cases, complicating the picture. Our case report emphasizes these aspects. Positive serology, with an IIF titer of 1/160, and epidemiological correlation, suggests the diagnosis of VL and imposes antimony therapy. Despite the unfavorable evolution and signs of cardiac involvement, the presence of pericarditis and cardiac tamponade confirmed by the echocardiogram suggests CD. We reassessed the profiles of a suggested CD serology, the diagnosis was corrected and treatment with CD specific benznidazole. The good evolution started with benznidazole corroborates the diagnosis of CD and discards the hypothesis of double infection.

Pericardiocentesis with cisplatin for malignant pericardial effusion and tamponade

AIM:To evaluate the role and outcome of pericardiocentesis with intrapericardial cisplatin instillation for malignant pericardial effusion resulting from esophageal cancer. METHODS:We retrospectively studied 7 patients who underwent pericardiocentesis with intrapericardial cisplatin instillation for malignant pericardial effusion resulting from esophageal cancer.After pericardiocentesis,we performed catheterization of the pericardial space under ultrasonogram guidance.Malignant etiology of the pericardial fluid was confirmed by cytological examination.Subsequently,cisplatin(10 mg in 20 mL normal saline) was instilled into the pericardial space. RESULTS:The mean total volume of the aspirated effusion fluid was 782±264 mL(range,400-1200 mL) . The drainage catheter was successfully removed in all patients,and the mean duration of pericardial drainagewas 7.7±2.7 d(range,5-13 d) .No fluid reaccumulation was observed.Mean survival time was 120±71 d(range,68-268 d) . CONCLUSION:Pericardiocentesis along with catheter drainage appears to be a safe and effective for pericardial malignant effusion and tamponade,and cisplatin instillation prevents recurrence.

Coxsackievirus B infection presenting as a hemorrhagic pericardial effusion causing tamponade

The coxsackievirus is well known for its vastly differing clinical presentations.Patients with coxsackievirus usually present with a viral prodrome which can then progress to the cardiac symptoms of chest pain and/or palpitations.Most patients improve quickly with simply supportive care and nonsteroidal anti-inflammatory medications.

Pericardial effusion with tamponade – an uncommon presentation leading to the diagnosis of eosinophilic granulomatosis polyangiitis: A case report

BACKGROUND Eosinophilic granulomatosis polyangiitis(EGPA)is a small vessel necrotizing vasculitis that commonly presents as peripheral eosinophilia and asthma;however,it can rarely manifest with cardiac involvement such as pericarditis and cardiac tamponade.Isolated pericardial tamponade presenting as the initial symptom of EGPA is exceedingly rare.Early diagnosis and appropriate treatment are crucial to prevent life-threatening outcomes.CASE SUMMARY 52-year-old woman with no past medical history presented with progressive dyspnea and dry cough.On physical exam she had a pericardial friction rub and bilateral rales.Vital signs were notable for tachycardia at 119 beats per minute and hypoxia with 89%oxygen saturation.On laboratory exam,she had 45%peripheral eosinophilia,troponin elevation of 1.1 ng/mL and N-terminal prohormone of brain natriuretic peptide of 2101 pg/mL.TTE confirmed a large pericardial effusion and tamponade physiology.She underwent urgent pericardial window procedure.Pericardial and lung biopsy demonstrated eosinophilic infiltration.Based on the American College of Radiology guidelines,the patient was diagnosed with EGPA which manifested in its rare form of cardiac tamponade.She was treated with steroid taper and mepolizumab.CONCLUSION This case highlights that when isolated pericardial involvement occurs in EGPA,diagnosis is recognized by performing pericardial biopsy demonstrating histopathologic evidence of eosinophilic infiltration.

干性心包穿刺术中损伤冠状动脉致心脏压塞1例

干性心包穿刺术作为建立心外膜通路的关键技术,自1996年首次报道至今已广泛应用于室性心动过速等存在心外膜通路介导的复杂心律失常的治疗之中。近年来,随着室性心律失常消融在全国的逐步推广及普及,该技术临床需求日益增大。然而,干性心包穿刺术操作极富挑战性,常遇到穿刺操作相关并发症,对患者的生命安全造成了巨大威胁。本文报道1例干性心包穿刺时损伤冠状动脉分支导致心脏压塞的病例,通过及时给予冠状动脉内球囊扩张进行压迫止血,成功解除了患者的生命危险,为将来临床中出现相似病例的处理提供宝贵的临床经验和依据。

心房颤动患者射频消融术中心脏压塞的防治研究进展

目前射频消融术已取代药物治疗成为房颤患者的一线治疗方案,术中发生心脏压塞为患者最常见的致命性并发症,且该恶性事件的绝对数量随手术的广泛开展而不断增多。临床对心脏压塞的充分认识和及时处理意义重大,本文就此并发症的诊断、抢救治疗流程、预后及预防策略等方面作出综述。

心律失常射频消融术并发心脏压塞患者围手术期抢救护理的范围综述

目的对心律失常行射频消融术患者围手术期发生心脏压塞的危险因素及抢救护理进行范围综述,为完善围手术期管理、改善患者预后提供参考。方法采用Arksey和O`Malley的范围综述方法为框架,检索中国知网、中国生物医学文献数据库、维普中文科技期刊数据库、万方数据库、Cochrane Library、PubMed、Web of Science、Embase、CINAHL数据库中发表的心律失常患者行射频消融术并发心脏压塞的相关研究,检索时限为建库至2024年1月31日。对纳入文献进行筛选、汇总,并对危险因素进行归纳总结,得出针对危险因素的抢救护理对策。结果最终纳入11篇文献,研究设计以病例对照为主,多数研究纳入射频消融术中及术后发生的心脏压塞,少数研究仅纳入术中心脏压塞。心律失常患者行射频消融术围手术期并发心脏压塞的发生率为0.61%~2.3%,且不同研究中心报告发生率差异较小,影响因素主要包括患者因素、合并疾病及治疗因素、射频消融术操作相关因素、机构相关因素。抢救护理对策有(1)迅速识别,精准处置;(2)人员、设备急救准备;(3)抢救护理技术应用等。结论心律失常患者射频消融术并发心脏压塞受患者、手术操作及组织因素的影响,未来可综合现有研究结果构建心脏压塞风险预测模型,为临床早期识别风险并制订相应的预防策略提供参考。

Autotransfusion in the management of cardiac tamponade occurring during catheter ablation of atrial fibrillation

acute cardiac tamponade occurs in 0.1%-2% of patients undergoing catheter ablation of atrial fibrillation （AF） in experienced centers.1-4 Once it is diagnosed, emergency pericardiocentesis is required.5 With the intervention, sternotomy and open surgical repair can be avoided in the most patients6. Generally, pericardial blood is reinjected directly back into the patient through the femoral venous sheath in order to invert hemodynamic instability promptly.

1例急性心肌梗死患者急诊经皮冠状动脉介入治疗术后并发亚急性心脏破裂的护理体会

本文总结1例急性ST段抬高型心肌梗死患者急诊经皮冠状动脉介入治疗(PCI)术后并发亚急性心脏破裂的救治及护理经验。针对患者危重症状,早期快速识别和诊断,及时采取急救处理,加强病情观察和护理配合,控制患者不适症状,有效降低心脏破裂的风险,为患者的生命安全提供保障。