Introduction: Structural valve degeneration (SVD) of bioprosthetic tricuspid valves within six months of implantation is exceedingly rare and presents significant management challenges. We describe the diagnostic evaluation and successful transcatheter tricuspid valve-in-valve (ViV) implantation for a bioprosthetic tricuspid valve failure occurring within two months of surgery. Case: A 53-year-old woman presented with acute dyspnea and orthopnea two months after a 33-mm Mitris Resilia tricuspid valve replacement for severe tricuspid regurgitation. Her history included mild aortic insufficiency and non-obstructive coronary artery disease. Transthoracic echocardiography revealed a large pericardial effusion with tamponade physiology, necessitating urgent pericardiocentesis. Transesophageal echocardiography demonstrated early SVD of the bioprosthetic valve, with poor leaflet coaptation, a central coaptation gap, and restricted anterior leaflet mobility. Extensive evaluation excluded infectious and autoimmune etiologies: blood cultures, inflammatory markers, viral serologies, thyroid function, and pericardial fluid cytology were unremarkable. Despite pericardial drainage, right atrial pressures remained elevated (mean 19 mmHg) on repeat right heart catheterization. Following a comprehensive heart team evaluation, a 29-mm Edwards Sapien valve was deployed via right internal jugular venous access within the failing surgical valve under fluoroscopic and echocardiographic guidance. Intraprocedural TEE demonstrated immediate reduction of tricuspid regurgitation severity to trace with a mean gradient of 1 mmHg. The patient had an uncomplicated recovery and was discharged the following day. Conclusion: This case represents one of the earliest reported tricuspid bioprosthetic valve failures requiring intervention within two months of implantation. The exact mechanism of SVD remains unclear; proposed theories include non-calcific mechanisms such as early mechanical leaflet fatigue, material or manufacturing defects, or technical factors related to surgical implantation. The comprehensive negative workup supports intrinsic valve material failure rather than infectious or inflammatory processes. The successful transcatheter ViV approach demonstrates excellent technical feasibility with immediate hemodynamic improvement, confirming its role as a viable alternative to high-risk redo surgery in early valve failure.

Case Description: A 69-year-old female with rheumatoid arthritis (RA) on methotrexate, rituximab, and prednisone presented with pleuritic chest pain, fever and cough. Vitals were stable. EKG showed diffuse ST elevation with PR depression, suggestive of pericarditis. TTE showed no pericardial effusion. She was discharged on colchicine. She returned 6 days later with worsening chest pain, dyspnea, and orthopnea. Vitals: BP 96/63 mm Hg, pulse 88 bpm. Exam revealed increased work of breathing, muffled heart sounds, no murmurs, no JVD. EKG showed low-voltage QRS with electrical alternans. CXR revealed bilateral opacities and cardiomegaly. CRP was 18.6 mg/dL, ESR 44 mm/hr, and Mycoplasma IgM was positive. Repeat TTE showed a moderate pericardial effusion (2 cm) near the RV free wall. There was no RV diastolic collapse, but >25% MV E-wave respiratory variation was seen. Cardiology was consulted and she underwent ultrasound-guided pericardiocentesis, draining 450 cc serosanguinous fluid. Fluid analysis showed exudative effusion (WBC 24,194, protein 5.5 g/dL, LDH 1,642). Rheumatology was consulted who suspected immunosuppression-related M. pneumoniae pericarditis. Immunosuppressants were held. She was treated with doxycycline, colchicine, and ibuprofen. With normal follow-up TTEs, pericardial drain was removed. She was discharged in stable condition after 7 days. Discussion: This case demonstrates a cardiac tamponade due to rapid accumulation of moderate pericardial fluid from immunosuppresion-induced Mycoplasma pneumoniae pericarditis. Tamponade may occur with moderate effusions with rapid accumulation or in low-pressure like diuretic-use or dry tamponade post-procedure. Pericardial effusion aetiologies include idiopathic, malignancy, infection, uremia, connective tissue disease, surgery. Viral pericarditis is most common infection, often due to Coxsackievirus or Influenza. Bacterial causes like S. pneumoniae or S. aureus may lead to purulent effusion. M. pneumoniae typically mimics viral pericarditis and may be overlooked. Without Mycoplasma IgM testing, diagnosis and treatment may be delayed. ESC’s 2014 guidance for triaging cardiac tamponade patients recommends urgent pericardiocentesis for scores >6; our patient’s score was 11.5, supporting intervention. This case emphasizes the importance of considering atypical pathogens like M. pneumoniae in immunocompromised hosts with pericarditis and using clinical scoring and imaging for timely intervention.

Description of Case: A 53 year old female with past medical history of autoimmune thyroid disease post-thyroidectomy (not on levothyroxine for over one year), chronic lower extremity edema, generalized anxiety disorder, hysterectomy, and cholecystectomy, presented with 2 day history of progressive bilateral leg swelling and right lower extremity erythema. She reported worsening exertional dyspnea and orthopnea over several months. She denied chest pain, syncope, fever, chills, nausea, or diaphoresis. Initial labs were notable for anemia with a hemoglobin of 8.3, potassium 3.3, elevated TSH 38.21, with a low free T3 1.8 and low free T4 0.25, normal BNP 36 and elevated D-dimer 1.32. Chest X-ray showed cardiomegaly with mild perihilar pulmonary congestion. EKG showed normal sinus rhythm and nonspecific findings of an old anterior myocardial infarction. Transthoracic echocardiogram (TTE) revealed a large pericardial effusion with right atrial and right ventricular collapse, consistent with cardiac tamponade. Urgent pericardiocentesis was performed under echocardiographic and fluoroscopic guidance, and 500 mL of straw-colored pericardial fluid was aspirated. Post-procedural TTE confirmed complete resolution of the effusion and normalization of cardiac chamber function without evidence of residual tamponade physiology. The pericardial fluid was sent for diagnostic analysis which was exudate. A pericardial drain was left in place and removed after 24 hours. Plan is for repeat TTE in 2 weeks. Discussion: Hypothyroidism is a known but rare cause of large pericardial effusions and tamponade. This case underscores that while pericardial effusion is a relatively common finding in hypothyroidism, progression to tamponade is rare due to the typically slow accumulation of fluid. However, delayed recognition or additional stressors can tip a patient into hemodynamic compromise. Clinicians should maintain a high index of suspicion for pericardial effusion in patients with long-standing or untreated hypothyroidism presenting with dyspnea or hemodynamic instability. Prompt echocardiographic evaluation and thyroid hormone replacement are essential for optimal outcomes.

Historically, purulent pericarditis was a recognized complication of bacterial infections, commonly due to pneumonia. However, with widespread antibiotic use it has become a rarity. It is defined as a localized infection of the pericardial space with gross or microscopic purulence and now mostly seen in cases of nosocomial bloodstream infection, thoracic surgery, and immunosuppression. Haemophilus influenzae ( H influenzae) , a gram-negative bacilli, is a rare cause of purulent pericarditis. A 62-year-old female presented to the emergency room with a one-day history of non-radiating, achy chest pain worse with lying down. She was febrile at 38.4 °C and mildly tachycardic. ECG showed diffuse ST-elevation (Figure 1). Laboratory values were significant for WBC 13.6 k/μL, ESR 106 mm/hr, and CRP 30.48 mg/dL. Chest CT revealed new trace pericardial fluid or thickening possibly from trace pericardial fluid or pericarditis. Blood cultures grew H influenzae and she was started on IV ceftriaxone. She became hypotensive and echocardiogram showed normal left ventricular systolic function and a moderate-sized, circumferential pericardial effusion with compression of right ventricle consistent with tamponade (Figure 2). She underwent emergent pericardiocentesis which drained 260 mL of purulent fluid (Figure 3). Pericardial fluid studies showed WBC of 107.5 k/μL with 100% neutrophils. Pericardial fluid culture remained negative. Following initial drain removal, her hospital stay was complicated by cardiac arrest, recurrent pericardial effusions requiring repeat drain placement and a pericardial window, which resulted in a right ventricle laceration. She slowly recovered and was discharged home with a four-week course of levofloxacin. Bacterial pericarditis caused by H influenzae is remarkably rare, regardless of strain. Purulent pericarditis is most frequently caused by Staphylococcus aureus. Presentation may include fever, dyspnea, chest pain, tachycardia, and cough. ECG may have typical findings of pericarditis with diffuse ST-segment elevation. Diagnosis is established by drainage of the pericardial fluid for culture and microscopy. Management of purulent pericarditis is centered on adequate pericardial drainage and antimicrobials according to microbiology data. High clinical suspicion with prompt diagnosis and treatment can improve patient outcomes. Drainage options include pericardiocentesis, pericardial window, and partial or total pericardiectomy

Background: Purulent pericarditis is a rare, often life-threatening infection of the pericardial space, characterized by the accumulation of pus. Seeding of the pericardium may occur through hematogenous or contiguous spread from an intrathoracic, myocardial, or subdiaphragmatic focus. Streptococcus pneumoniae is the most common intrathoracic bacterial source, although infection has become exceedingly rare in the modern era of pneumococcal vaccination and antibiotics. Constrictive physiology (CP) is a known complication of purulent pericarditis although the exact incidence is unknown. Case Summary: A middle-aged woman presented with chest pain. Initial imaging showed no evidence of pneumonia or pericardial effusion. A repeat echocardiogram after approximately 16 hours demonstrated the development of cardiac tamponade and obstructive shock. Emergent pericardiocentesis yielded purulent fluid, which grew Streptococcus pneumoniae . Despite hemodynamic improvement, she subsequently developed CP, which was diagnosed with cardiac catheterization and cardiac magnetic resonance (CMR). Discussion: This case illustrates an uncommon and critical presentation of purulent pericarditis in a previously healthy adult without initial evidence of pneumonia or an identifiable infectious source. The patient’s rapid progression to cardiac tamponade and obstructive shock highlights the importance of early recognition, timely pericardial drainage, and targeted antimicrobial therapy. Additionally, the classic signs of CP were seen just days after the development of pericardial disease. Cardiac catheterization is the gold standard diagnostic tool because enhanced ventricular interdependence by analysis of the left ventricular and right ventricular pressure contours during the respiratory cycle is highly sensitive and specific. However, CMR offers a non-invasive diagnostic adjunct by revealing pericardial thickness, pericardial contrast enhancement, and ventricular coupling during real-time cine imaging. This complementary information can help guide treatment decisions on medical therapy versus surgical intervention. Take Home Messages: Purulent pericarditis is a rare condition that may present without a clear infectious source. It may be complicated by the development of CP and both cardiac catheterization and CMR are important diagnostic tools.

Description of Case: A 66-year-old man with polysubstance use and chronic kidney disease presented with dyspnea, chest pain, urinary retention, and abscesses one week after high-risk sexual activity and ongoing methamphetamine use. Labs demonstrated leukocytosis (40.95 x 10^3/uL), elevated creatinine (3.2 mg/dL), HS-troponin (22 ng/L), and prostate-specific antigen (PSA) (229 ng/mL). Periareolar eschar and an indurated knee lesion were noted (Figure 1). His ECG showed diffuse ST-segment elevations and PR depressions (Figure 2). Transthoracic echocardiogram revealed normal biventricular function and a moderate pericardial effusion without tamponade physiology (Figure 3A). Left heart catheterization revealed non-obstructive coronary artery disease. He was found to be in septic shock requiring significant fluid resuscitation and vasopressor support. Continuing antibiotics, he underwent incision and drainage of both abscesses. Blood, wound, and urine cultures grew methicillin-resistant Staphylococcus aureus (MRSA). Antibiotics were narrowed, and colchicine and aspirin were started for pericarditis after renal function improved. Transesophageal echocardiogram ruled out endocarditis. Persistent positive blood cultures, tachycardia, and leukocytosis prompted imaging to investigate other sources of infection, including the prostate, indicated by elevated PSA and recent ano-rectal intercourse. A CT scan revealed a large pericardial effusion and prostatic abscesses. While tamponade physiology remained absent, pericardiocentesis and drainage of prostatic abscesses were performed for source control. They yielded large volume purulent fluid drainage (Figure 3B), positive for MRSA, and sterile prostate drainage, respectively. After the pericardial drain output decreased, it was removed, and he continued an extended course of antibiotics, resulting in rapid improvement. Discussion: We report a case of a patient with purulent MRSA pericarditis. Although exceedingly rare, it poses a significant risk of morbidity and mortality, mainly due to cardiac tamponade potential. Recent literature includes sporadic cases, indicating a mortality rate of about 60% and tamponade progression in 42-77% of cases. The use of antibiotics has greatly reduced incidence of purulent pericarditis. Historically, this condition can spread contiguously or hematogenously, both of which are possible here. Prompt recognition and drainage is essential for timely treatment and effective source control.

A 40-year-old male with past medical history of Methicillin-resistant staphylococcus aureus endocarditis treated with open valve replacement of tricuspid valve and resection of aortic valve vegetation, history of deep vein thrombosis with Inferior Vena Cava filter placement, history of IV drug use, acute cholecystitis requiring percutaneous cholecystostomy tube placement, type 2 diabetes mellitus on chronic insulin therapy, hypertension, hyperlipidemia, degenerative spine disease who presents to an urgent care facility due to hallucinations. At the urgent care facility, imaging showed a pericardial effusion for which he was sent to our hospital. A CT chest without contrast on admission showed a large pericardial effusion, redemonstrated on transthoracic echocardiogram. Patient underwent subxiphoid pericardial window creation with pericardial drain placement with cardiothoracic surgery, draining a total of 2265ml of murky yellow fluid over 7 days. Pericardial fluid grew Candida Auris, for which the patient was treated with 10 days of intravenous micafungin initiated on admission day 6. Candida auris has been recognized to cause a wide range of infections, with pericarditis being an infrequent occurrence. Fungal pericarditis is an uncommon infection, with a reported prevalence of 1.4% based on one review, which makes Candida pericarditis with pericardial effusion even rarer. Like our patient, 50% are immunocompetent and only 50% present with classical symptoms of chest pain, fever, and dyspnea. These factors contribute significantly to diagnostic delay, with fungal pericarditis accurately recognized in only 15.8% of cases within 48 hours of presentation, with empiric treatment initiated in 35.6% of cases within 48 hours. The mortality rate associated with Candida or fungal pericarditis is 50%, and the timely initiation of antifungal treatment has demonstrated a statistically significant improvement in patient survival(p = 0.0011). IV echinocandins are first-line treatment for suspected invasive candidiasis in non-neutropenic patients. There is low-quality evidence regarding the duration of antifungal treatment, however, the latest 2016 Infectious Disease Society of America update on Candida infections recommends two weeks of treatment. This is a grey area that requires clinical trials to establish evidence-based guidelines.

There are no widely accepted guidelines for mediastinal chest tube removal following cardiopulmonary bypass (CPB) surgery and management is highly variable. The aim of this retrospective study was to review our institutional routine of mediastinal chest tube removal on postoperative day (POD) one. We retrospectively reviewed patients undergoing CPB surgery from January 1, 2023 to December 31, 2023, with mediastinal chest tube removal on POD 1. Variables examined included age, operation, chest tube output, postoperative complications, hospital length of stay, discharge tests, and readmission within 30days.Two hundred thirteen patients underwent CPB surgery of which 158 (74%) had their mediastinal chest tubes removed on POD 1 (study group). Patient age was median 1.6years (range 2days to 39years). Top 3 operations included27 atrial septal defect repair, 26 ventricular septal defect repair, and 24 left ventricular outflow tract operations. Postoperative duration of mediastinal chest tube was median 22h (range 11-36). Mediastinal chest tube output from midnight to removal was median 0.29mL/kg/hr (range 0-1.23). Four major postoperative complications: 2 unplanned cardiac reoperation, 1 unplanned cardiac catheterization, and 1 permanent pacemaker placement for heart block. Fourteen patients (9%) had small pericardial effusions on discharge echocardiogram. Average postoperative hospital length of stay was 7 ± 11days; median 4days (range 2-78). Ten patients (6%) readmitted within 30days of discharge. Four patients (2.5%) with pericardial effusions; three (2%) required pericardial drain. Thus, early mediastinal chest tube removal following CPB surgery was rarely associated with pericardial effusion requiring intervention.

The Anaesthetic Challenge in Open Pericardial Drainage in Severe Hypothyroidism: A Strategical Approach

Postoperative Pericarditis After Cardiac Surgery in Adult Congenital Heart Disease

Pneumopericardium is relatively rare but potentially fatal in premature babies. When a massive pneumopericardium leads to cardiac tamponade, emergent pericardiocentesis is often required to save lives. In some cases, the placement of a pericardial drain for continuous drainage may be necessary. However, for very low birth weight or extremely low birth weight preterms, there is a lack of appropriately sized pericardial drain tubes, posing a clinical challenge. We report a case of a very low birth weight preterm baby, born at 1016grams, who developed pneumopericardium. We successfully treated the pneumopericardium using a 22-gauge intravenous catheter.

BackgroundAcute kidney injury (AKI) is a frequent and serious complication following surgery for acute type A aortic dissection (ATAAD). Nitric oxide (NO) may reduce AKI incidence through renal-protective mechanisms, but evidence in the ATAAD population remains limited. This trial aims to evaluate whether perioperative administration of NO can reduce the incidence of postoperative AKI in this population.MethodsThis single-center, randomized, parallel-group superiority trial will enroll 106 adult patients undergoing ATAAD emergency surgery. Participants will be randomly allocated in a 1:1 ratio to either receive 60 parts per million of NO during cardiopulmonary bypass and for 12 h post-surgery, or to receive standard care without NO. The primary outcome is AKI incidence within 48 h postoperatively, defined by Kidney Disease: Improving Global Outcomes (KDIGO) criteria. Secondary outcomes include AKI severity, urine output, vasoactive-inotropic score, neutrophil gelatinase-associated lipocalin levels, sequential organ failure assessment score, ventilator support duration, intensive care unit (ICU) and hospital length of stay, and major adverse kidney events, cumulative mediastinal and pericardial drainage volume.DiscussionThis trial will evaluate whether perioperative NO administration can reduce early AKI and improve renal and clinical outcomes in high-risk ATAAD patients. Findings may provide evidence for a novel nephroprotective strategy in aortic surgery.Trial registrationClinicalTrials.gov NCT06622291. Registered on June 26, 2024.Supplementary InformationThe online version contains supplementary material available at 10.1186/s13063-025-08986-5.

Reports of child and young adult superior vena cava (SVC) stent placement, safety, and long-term patency are limited, particularly in children without congenital heart defects (CHDs). To characterize technical success, safety, and long-term outcomes of SVC stent placement in children and young adults without co-existing congenital heart defects. Additionally, to demonstrate the ability of SVC stent placement to maintain central venous access in patients with difficult access. Institutional Review Board (IRB) approved retrospective review of children and young adults without CHDs who underwent SVC stent placement between 2014 and 2024 was performed. SVC stenosis/occlusion was determined by pre-procedure imaging (chest computed tomography (CT) or magnetic resonance imaging (MRI)), and confirmed with venography and intravascular ultrasound. Symptomatic patients were defined as patients with facial or neck swelling, bulging neck or chest wall collaterals, and dependence on central venous access with narrowed or occluded central venous pathways. Nineteen patients (n = 11 F, n = 8M) without CHDs had SVC stents placed. All had SVC stenosis or occlusion secondary to chronic central venous access. Mean age was 16.5years (3 - 20years, interquartile range 7.375years) and mean weight was 50kg (15.8 - 115.2kg, interquartile range 32.6kg). Ten percent (2/19) presented with acute SVC syndrome. In total, 21% (4/19) required sharp recanalization. Twenty-four total stents were placed; 21 (88%) were bare metal and three were covered. One major complication of SVC tearing occurred during sharp recanalization, which led to hemopericardium/cardiac tamponade. This complication was successfully treated with a pericardial drain and deployment of a second stent across the vessel injury. Median patient follow-up time was 15months (0.5-88months, interquartile range 53months). Seventy-four percent (15/19) had imaging follow-up (chest CT or venography) to assess stent patency, with a mean imaging follow-up of 11months (3days-86months, interquartile range 11months). Three patients required re-intervention(s): two required venoplasty to allow for catheter exchange, and one required venoplasty for recurrent facial and upper extremity swelling. The mean time to re-intervention was 16months (2-28). There were no complications during repeat interventions. All patients maintained central venous access for the duration of required treatment or throughout the entire study period. SVC stent placement in children and young adults without CHDs has a favorable safety profile and is an effective solution for preserving critical central venous access for necessary therapy in chronically ill children.

Background Pericardial effusion (PE) is a rare condition in neonates and usually due to central venous catheters. Infective pericarditis is an extremely rare condition in neonates. Methods We describe a case of a preterm neonate with infective Escherichia coli pericarditis. Results A preterm female neonate born at 34 weeks of gestation with a birth weight of 1600 grams was admitted because of respiratory distress. The patient was managed using a high-flow nasal cannula. She did not receive a central venous catheter or antibiotics. The outcome was good and the patient was discharged on day 14. On day 18, she was readmitted because of fever and shortness of breath. Blood sample culture was positive for Escherichia coli. On day 21, the patient presented signs of heart failure. Chest radiography showed cardiomegaly. Cardiac ultrasound showed pre tamponade. Our patient was managed with pericardial drainage and cefotaxime administration. The outcome was good and further follow-up was unremarkable. Conclusions Even though rare, infective pericarditis should be suspected in neonates who show deterioration in respiratory and hemodynamic status even if they do not have central venous catheter.

Pericardial drainage and continuous irrigation for a patient with purulent pericarditis caused by Streptococcus anginosus

The PIEZO1 and PIEZO2 membrane proteins form uniquely structured calcium permeable nonselective cation channels dedicated to mechanical force sensing in eukaryotic cells. In this review of the scientific literature, we address PIEZOs in the heart. PIEZOs enable the formation of the aortic valve, cardiac vasculature, and pericardial drainage. In the established heart, they enable baroreceptor pressure sensing and reflex regulation of the heart rate and influence the heart's size and stiffness through roles in cardiac myocytes and cardiac fibroblasts. Therefore, mechanical force sensing by PIEZOs participates in normal cardiac development and function. There is also interest in PIEZOs in pathophysiology, when the structure and mechanical properties of the heart often change. Studies in rats and mice suggest that experimentally induced cardiac stress and injury cause PIEZO upregulation that is adverse. Similar changes may occur in human heart disease, creating potential for therapeutic benefit through PIEZO modulation. This is a productive, accelerating, and exciting new research topic with importance for our understanding of the heart and its diseases.

Extra-renal complications are severe in Shiga toxin-producing E. coli hemolytic uremic syndrome (STEC-HUS), with pericardial effusion being rare and inadequately characterized. This study aimed to describe the clinical and biological data, management strategies, and risk factors associated with pericardial effusion in children with STEC-HUS. This multicentric retrospective study included all consecutive children under 18years who developed pericardial effusion during STEC-HUS in France between 2017 and 2022. Paired comparisons were made with control children presenting STEC-HUS in the same centres, before and after the index cases. A total of 15 cases were identified. The pericardial effusion group exhibited significantly more extra-renal manifestations compared to 30 control cases. Leukocyte counts were higher in the pericardial effusion group (22.2 G/L vs. 14.5 G/L, p = 0.002), as were hematocrit levels (30.1% vs. 24.2%, p = 0.02). Fourteen children received eculizumab, and 8 out of 15 required pericardial drainage. Two patients died from non-cardiac causes. Myopericarditis was identified in 5 cases, and 5 of the 14 patients had normal troponin levels during the initial phase. Children with pericardial effusion during STEC-HUS exhibited more extra-renal manifestations and biological markers indicative of severe HUS at presentation. These findings suggest that patients with severe STEC-HUS and extra-renal manifestations requiring intensive care should be routinely screened for pericardial effusion.

BACKGROUND Pericarditis is a frequently encountered complication of systemic lupus erythematosus (SLE). However, cardiac tamponade resulting from massive pericardial effusion is a rare sequela. Risk factors for cardiac tamponade in SLE include female sex, reduced serum complement, and positive anti-nucleosome antibody at diagnosis. Management options for cardiac tamponade, such as pericardiocentesis and pericardial window, are tailored to the individual, and clear guidelines for when to proceed with invasive intervention are lacking. CASE REPORT We present a case of cardiac tamponade associated with an SLE exacerbation in a 38-year-old woman, associated with fever, dyspnea, and pleuritic chest pain. A chest radiograph demonstrated a large left pleural effusion obscuring a widened mediastinum suspicious for pericardial effusion. After a trial of medical therapy, the patient developed new atrial fibrillation, hypotension, and tachycardia, and proceeded to pericardiocentesis following which 1.6 liters of pericardial fluid was drained over the following 24 hours. Disease control was achieved with high-dose pulsed corticosteroids and cyclophosphamide and there was no recurrence of the effusion. CONCLUSIONS This appears to be one of the largest volumes of pericardial drainage described in the literature in the setting of SLE. Cardiac tamponade can occur at any stage of the disease course in SLE. Large pleural effusions can mimic symptoms of pericardial effusion and make diagnosis challenging. Definitive management can be achieved using a combination of invasive and medical therapy. Risk factors for the development of cardiac tamponade should be identified early in the course of an SLE exacerbation to ensure prompt treatment and avoid further complications.

This study aimed to analyze the risk factors associated with healthcare-associated infections (HAIs) in individuals who underwent post-coronary artery bypass grafting (CABG) and to develop a predictive model for infection risk assessment. Clinical data were retrospectively collected from patients who underwent CABG at our hospital between January 2019 and December 2023. Data sources included the hospital infection surveillance system, hospital information system, and a questionnaire for HAIs in patients after cardiac surgery. Patients were divided into an infection group and a non-infection group based on whether they developed HAIs during the postoperative hospitalization period. Logistic regression was used to identify independent risk factors and to develop a risk prediction model. The predictive performance of the model was assessed using receiver operating characteristic curve analysis. Independent risk factors for HAIs post-CABG included diabetes (odds ratio [OR] = 1.467), preoperative white blood cell count (OR = 0.117), preoperative albumin levels (OR = -0.146), intraoperative blood transfusion (OR = 0.001), presence of an indwelling drainage tube (OR = 0.864), drainage volume (OR = 0.003), duration of ventilator use (OR = 0.656), and central venous catheterization time (OR = 0.103). The predictive model was established as: Ln (P/1-P) = -2.230 + 1.467 * diabetes + 0.117 * preoperative white blood cell count -0.146 * preoperative albumin + 0.001 * intraoperative blood transfusion + 0.864 * drainage tube indwelling + 0.003 * drainage volume + 0.656 * ventilator use time + 0.103 * central venous catheterization time. The Hosmer-Lemeshow test indicated a good model fit with observed values. Receiver operating characteristic curve analysis demonstrated that the model achieved an area under the curve of 0.970, with a sensitivity of 90.5% and a specificity of 92.1%. The independent risk factors for HAIs after CABG were diabetes, body mass index, preoperative white blood cell count, intraoperative blood transfusion volume, duration of pericardial and mediastinal drainage tube placement, total drainage volume, duration of mechanical ventilation, and duration of central venous catheterization. The developed risk prediction model demonstrated high accuracy in estimating postoperative HAI risk.

Acute rheumatic fever (ARF) is a complication of streptococcal pharyngitis that can present with cardiac, joint, skin, and neurological symptoms. Cardiac manifestations most often involve valvular dysfunction, but can also include myocarditis or pericarditis. Although advances in healthcare have reduced the prevalence of streptococcal pharyngitis, and subsequently ARF, individual cases and outbreaks can still occur. We present a case of rheumatic myopericarditis in a 60-year-old White male who initially presented to the emergency department with sore throat for 6 days. Initial workup was largely unremarkable, and no microbiological testing was performed at that time. He was diagnosed with presumed viral pharyngitis and discharged home with supportive care. He returned 1 week later with pleuritic mid-sternal chest pain and dyspnea. Laboratory tests were significant for elevated inflammatory markers, cardiac enzyme markers, anti-streptolysin O titers, and Streptococcus pyogenes bacteremia. Further evaluation revealed pericarditis, moderate pericardial effusion without tamponade, and reduced systolic function without valvular disease. The patient was diagnosed with rheumatic myopericarditis. Management included pericardial drainage, guideline-directed medical therapy for systolic heart failure and pericarditis, and primary treatment and secondary prevention of ARF with antibiotics. Currently, the patient's cardiac function has recovered, and he regularly follows up with his medical care team. Although less common in present times, clinicians are encouraged to consider streptococcal pharyngitis and ARF on the differential diagnosis for patients presenting with pharyngeal symptoms and subsequent cardiac manifestations, with or without valvular dysfunction. Primary and secondary prevention of ARF is paramount to maintaining the low incidence of this disease.