Postpericardiotomy Syndrome Research Articles

Baseline characteristics, management and long-term outcomes of different etiologies of cardiac tamponade evaluated in a cohort of 340 patients.

IntroductionStudies on the etiology of cardiac tamponade (CT) are scarce or lacking follow-up, and usually include small or highly selected groups of patients.AimTo evaluate the various etiologies and outcomes of CT in a cohort of patients treated in a tertiary care hospital encompassing cardiology, cardiac surgery and intensive care units.Material and methodsWe retrospectively analyzed all adult patients hospitalized in the Silesian Centre for Heart Diseases in Zabrze (Poland) between January 2008 and December 2018, who required therapeutic pericardiocentesis or pericardiotomy due to CT. All various etiologies of CT were presented and assigned to the main etiology groups. For each group basic characteristics, in-hospital management, in-hospital and up to 2-year mortality were analyzed.ResultAmong 340 patients with CT, 56% were men. The leading etiology groups included patients after invasive cardiac procedures, patients following postpericardiotomy (PCT) syndrome and the patients with neoplasm. Patients with end stage renal failure, PCT and iatrogenic CTs were the most disease burdened groups. The highest need for advanced therapy and in-hospital mortality were observed for the acute myocardial infarction group, in contrast to PCT.ConclusionsWithin our cohort of patients, the invasive cardiac procedures overtake neoplastic causation of cardiac tamponade. The worst in-hospital prognosis was noted for CT following acute myocardial infarction and both iatrogenic invasive cardiac and cardiac surgery procedures. The highest long-term mortality was recorded for patients with end stage renal failure and the neoplastic group.

Risk factors of postpericardiotomy syndrome after heart valve surgery

Risk factors of postpericardiotomy syndrome after heart valve surgery

Right axillary artery cannulation for venoarterial extracorporeal membrane oxygenation: a retrospective single centre observational study.

Our goal was to assess the safety, outcomes and complication rate of axillary artery cannulation for venoarterial extracorporeal membrane oxygenation (VA-ECMO). A retrospective analysis was conducted on data obtained from the review of medical charts of all consecutive patients undergoing VA-ECMO implantation between January 2013 and December 2017 at a teaching hospital. Only patients with right axillary VA-ECMO implantation in a non-emergency setting were included. Post-procedural outcomes and local and systemic complications were analysed. One hundred and seventy-four [131 male (75.3%), 43 female (24.7%); mean age 56.8 ± 15.1 years] patients underwent femoral-axillary VA-ECMO. Indications were cardiogenic shock from any cause (n = 78, 44.8%) or post-cardiotomy syndrome (n = 96, 55.2%). Fifty-three (30.5%) patients died while on VA-ECMO support. At the time of VA-ECMO ablation, 89 (51.1%) patients had recovered; 13 (7.5%) patients were bridged to a long-term mechanical support device and 19 (10.9%) patients underwent heart transplants. Thirty-day and 1-year mortality was 36.2% (n = 63) and 49.4% (n = 86), respectively. The 1-year survival rate of patients who were weaned from VA-ECMO support was 72.7% (n = 88). The complications of axillary cannulation were bleeding (n = 7, 4%), local infection (n = 3, 1.7%), upper limb ischaemia (n = 2, 1.1%) and brachial plexus injury (n = 1, 0.6%). Left ventricle unloading was required for 9 (5.2%) patients. The median duration of VA-ECMO support was 7 (range 1-26) days. Right axillary artery cannulation is a safe and reliable method for VA-ECMO support with a low rate of local complications. In the absence of a control group with femoro-femoral cannulation, no definitive conclusion about the superiority of axillary over femoral cannulation can be drawn.

Abstract 13168: Cardiac Magnetic Resonance Imaging in a Phase 2 Study of Rilonacept in Recurrent Pericarditis

Introduction: The magnitude of pericardial delayed hyperenhancement (DHE) by cardiac magnetic resonance imaging (CMR) illustrates the severity of inflammation in pericarditis. We report exploratory CMR data from an open-label Phase 2 study of rilonacept (IL-1α/IL-1β inhibitor) in recurrent pericarditis (RP). Methods: Patients (pts) with idiopathic RP or post-pericardiotomy syndrome (PPS) enrolled in the study. A subset had CMR at baseline (BL) and final visit (FV, 6 mo). Pain (NRS) and inflammation (CRP) were also collected. CMR images were graded (none, mild, moderate, or severe DHE) by a central core lab blinded to clinical data. Results: Of 25 study pts, 11 had CMR at BL and FV; 6 active idiopathic RP, and 5 corticosteroid (CS)-dependent non-active RP (4 idiopathic, 1 PPS). At BL, DHE was severe (3), moderate (2), and none (1) in active RP pts and moderate (1) or mild/none (4) in CS-dependent pts (Figure 1). At FV, DHE was improved (2), resolved (2; one pt example in Figure C/D), or unchanged (2) in active RP pts and was improved (1), resolved (1), unchanged (2) or worsened from none to mild (1) in CS-dependent pts. DHE improvements were associated with decreased pain and CRP and occurred despite discontinuation of CS or reduction in dose level. One pt with severe DHE at baseline and mild DHE at FV experienced a recurrence ~8 weeks after rilonacept discontinuation and enrolled a second time with severe DHE; the patient had reduced CRP and pain NRS during both enrollments and ended the second enrollment with moderate DHE. Conclusions: Serial CMR demonstrated improvement in pericardial DHE after 6 mo of rilonacept treatment, consistent with clinical improvement, while corticosteroids were tapered/discontinued. Recurrence in one pt with incompletely resolved DHE after 6 months of rilonacept treatment could indicate that a longer treatment duration is warranted in patients with unresolved DHE. These preliminary results may inform future CMR-guided treatment studies in RP.

Single center experience of pediatric percutaneous balloon pericardiotomy.

Percutaneous balloon pericardiotomy is a percutaneous procedure that creates a window in the parietal pericardium by balloon dilation. The use of percutaneous balloon pericardiotomy has not been reported well in children. The objective of this study was to describe the single centre experience of percutaneous balloon pericardiotomy in children. This was a retrospective study to describe all the children aged <20 years undergoing percutaneous balloon pericardiotomy during an 18-year period (2001-2019). Patient characteristics, technical and ultimate procedural success, and repeat interventions were collected. A total of 13 percutaneous balloon pericardiotomy's were performed in 11 children at the median age of 12 years (range 1.8-19). The etiologies of pericardial effusion were post-pericardiotomy syndrome (n = 4), restrictive cardiomyopathy (n = 1), autoimmune diseases (n = 3), malignancy (n = 2), and idiopathic (n = 1). Two patients received two percutaneous balloon pericardiotomy. The technical success of percutaneous balloon pericardiotomy was 100% with no acute adverse events (balloon rupture or local bleeding). Five (45%) required re-intervention and ultimately three required a surgical pericardial window 6 to 35 days after the percutaneous balloon pericardiotomy. As a result, ultimate procedural success rate was 73% (8/11). Percutaneous balloon pericardiotomy was performed safely with high technical success in children. Percutaneous balloon pericardiotomy may be considered for recurrent and persistent pericardial effusion, before considering a surgical pericardial window.

Management and outcome of acute and recurrent pericarditis during pregnancy

Abstract Background Pericarditis in pregnancy is uncommon. Treatment options, including NSAIDs and long term gluco-corticosteroids (CS) have extensive side-effects, while data on the use of Colchicine in pregnant women who suffer from pericarditis is limited. Objective To evaluate the management and outcome of active pericarditis during pregnancy in both acute (AP) and recurrent pericarditis (RP) patients. Methods and results Twelve pregnant women (14 pregnancies) with active pericarditis were followed prospectively in our cardiology-pregnancy clinic; 6 with AP and 8 with RP. Etiology: 11 idiopathic, 2 post-pericardiotomy syndrome and 1 Q fever. Maternal age on presentation was 27±4y vs. 33±3y in RP vs AP respectively. Average gestational age upon diagnosis was lower in RP than in AP (18 weeks, range 6–30 vs 26 weeks, range 5–35). In the RP group, 7/8 women (87%) were treated with CS compared with 2/6 women (33%) in the AP group; 3 women in RP group (37%) failed to respond to subsequent treatment with azathioprine and 1 patient was treated successfully with Anakinra. Colchicine was prescribed in 13/14 (93%) of pregnancies, average colchicine exposure during pregnancy was 25±15 weeks. Recurrence during pregnancy: 6/8 (75%) of RP; 2/6 (33%) of the AP, all of them on CS. All pregnancies culminated in a live birth with a mean gestational age on delivery of 37±1.4 weeks. Average birthweight was 3267±507 grams. There were no fetal anomalies or developmental delays after a mean follow-up of 2.7 years. All newborns and maternal outcomes were normal. On long term follow-up after delivery RP patients treated with colchicine developed less recurrences. Conclusion Active pericarditis is associated with a high recurrence rate during pregnancy despite treatment with CS. Colchicine use in pregnant women with active pericarditis appears to be safe. Funding Acknowledgement Type of funding source: None

Colchicine: An Ancient Drug with Multiple Benefits.

The history of colchicine dates to ancient Egyptians when it was used for alleviation of swelling and pain. Although its popularity varied throughout the years, colchicine has been a mainstay for the treatment of several diseases, mainly rheumatic and cardiac ones. The mechanism of action of the drug involves several intracellular and extracellular targets, although interaction with tubulin is the most described. Based on several clinical trials and meta-analyses, colchicine is safely recommended as a monotherapy or as an add-on for the treatment and prevention of recurrent pericarditis, post-pericardiotomy syndrome, gout, pseudogout, familial Mediterranean fever (FMF), and Behçet's disease (BD). Notably, drug safety has been noted during pregnancy and lactation. Besides its major indications, colchicine has shown efficacy and safety in the treatment of various conditions. Because the indications for using colchicine in the prevention of certain conditions such as acute coronary syndrome, stroke, and hepatic cirrhosis and treatment of others such as pneumonia and psoriasis are still debatable, further research works are needed.

Prediction of survival of patients in cardiogenic shock treated by surgically implanted Impella 5+ short-term left ventricular assist device.

Short-term mechanical circulatory support is a life-saving treatment for acute cardiogenic shock (CS). This multicentre study investigates the preoperative predictors of 30-day mortality in CS patients treated with Impella 5.0 and 5.5 short-term left ventricular assist devices. Data of patients in CS (n = 70) treated with the Impella 5 (n = 63) and 5.5 (n = 7) in 2 centres in Berlin between October 2016 and October 2019 were collected retrospectively. CS was caused by acute myocardial infarction (n = 16), decompensated chronic heart failure (n = 41), postcardiotomy syndrome (n = 5) and acute myocarditis (n = 8). Before implantation 12 (17%) patients underwent cardiopulmonary resuscitation and 32 (46%) patients were ventilated. INTERMACS level 1, 2 and 3 was established in 35 (50%), 29 (41%) and 6 (9%) of patients, respectively. The mean preoperative lactate level was 4.05 mmol/l. The median support time was 7 days (IR= 4-15). In 18 cases, the pump was removed for myocardial recovery, in 22 cases, durable left ventricular assist devices were implanted, and 30 patients died on support. The overall 30-day survival was 51%. Statistical analysis showed that an increase in lactate per mmol/l [odds ratio (OR) 1.217; P = 0.015] and cardiopulmonary resuscitation before implantation (OR 16.74; P = 0.009) are predictors of 30-day survival. Based on these data, an algorithm for optimal short-term mechanical circulatory support selection is proposed. Impella treatment is feasible in severe CS. Severe organ dysfunction, as well as the level and duration of shock predict early mortality. An algorithm based on these parameters may help identify patients who would benefit from Impella 5+ support.

Trends in Mortality and Costs of Pediatric Extracorporeal Life Support

Extracorporeal life support (ECLS) has been used for >30 years as a life-sustaining therapy in critically ill patients for a variety of indications. In the current study, we aimed to examine trends in use, mortality, length of stay (LOS), and costs for pediatric ECLS hospitalizations. We performed a retrospective cohort study of pediatric patients (between the ages of 28 days and <21 years) on ECLS using the 2008-2015 National Inpatient Sample, the largest all-payer inpatient hospitalization database generated from hospital discharges. Nonparametric and Cochran-Armitage tests for trend were used to study in-hospital mortality, LOS, and hospitalization costs. Of the estimated 5847 patients identified and included for analysis, ECLS was required for respiratory failure (36.4%), postcardiotomy syndrome (25.9%), mixed cardiopulmonary failure (21.7%), cardiogenic shock (13.1%), and transplanted graft dysfunction (2.9%). The rate of ECLS hospitalizations increased 329%, from 11 to 46 cases per 100 000 pediatric hospitalizations, from 2008 to 2015 (P < .001). Overall mortality decreased from 50.3% to 34.6% (P < .001). Adjusted hospital costs increased significantly ($214 046 ± 11 822 to 324 841 ± 25 621; P = .002) during the study period despite a stable overall hospital LOS (46 ± 6 to 44 ± 4 days; P = .94). Use of ECLS in pediatric patients has increased with substantially improved ECLS survival rates. Hospital costs have increased significantly despite a stable LOS in this group. Dissemination of this costly yet life-saving technology warrants ongoing analysis of use trends to identify areas for quality improvement.

Relationship between history of previous surgeries and pericardial involvement in patients undergoing cardiac surgery

Objective: We aimed to define whether timing and multiple surgeries have an impact on development of postpericardiotomy syndrome (PPS) and its complications. Methods: We retrospectively analyzed clinical and operative data of 40 patients with signs of PPS after cardiac surgery. Among them, 9 patients had signs of effusion (E) only and 31 patients had adhesive/ constrictive/constrictive-effusive (C) pericardial involvement. Results: Patients in E only group had significantly larger E size (p=0.03), higher white blood cell count (p=0.014) and tendency to higher sedimentation rate (SR) as compared to C group. We found significantly longer period of hospital stay (p=0.042), higher number of redo surgeries (1.33(0.88) vs 0.67(0.50), p=0.008) and longer time past since latest surgery (102.91(97.49) vs. 0.14(0.38) months, p&amp;lt;0.0001) in patients with C as compared to patients with E. Correlation analysis demonstrated positive correlation between E amount and SR (r=0.66, p0.008), and its negative correlation with number of reoperations (r=-0.83, p=-0.0001) and time related to operation (r=-0.69, p=0.001); while thickening of pericardium was related positively with C-reactive protein (r=0.59, p=0.026), and time related to operation (r=0.51, p=0.004). In our small preliminary selected series of patients undergoing cardiac surgery, PPS was complicated by signs of tamponade in 2.5% of patients and constriction in 7.5%. Conclusion: Thus, postpericardiotomy effusions are associated with the shorter time from surgery and less number of redo-surgeries, and inflammation, while adhesive pericardial involvement more often develops in patients with longer period after surgery and thickening of pericardium is positively associated with increase of C-reactive protein levels and time related to operation. Key words: pericardial effusion, constriction, cardiac surgery procedures

Case of diagnosis of late postpericardiotomy syndrome after aortocoronal and mammary coronary bypass

Postpericardiotomy syndrome (PCTS) develops after cardiosurgical operations as part of the non-specific systemic inflammatory responses syndrome of the body (SIRS) and manifests signs of general intoxication and symptoms of involvement in the autoimmune inflammatory process of pulmonary pleurae and/or pericardial layer to form efflux in the pleural and/or pericardial cavities. PCTS is not a rare pathological condition and often accompanies heart surgeries, especially those which are carried out under cardiopulmonary bypass. However, it can occur in the guise of lung and pleura diseases, cardiac decompensation and other complications of cardiological diseases and cardiosurgical interventions. In the light of the specificity of the therapy of this syndrome, its correct and timely diagnosis is intended to alleviate the already unsatisfactory condition of the patient who has undergone heart surgery and his postoperative prognosis. Although this pathology was described in the middle of the last century, its methods of treatment are still under discussion, in particular the effectiveness of glucocorticosteroids and colchicine is compared and the use of the latter for the prevention of PCTS is considered. This paper presents the case history of PCTS tolerant to hormone therapy and managed with colchicine.

Pleural Effusions After Congenital Cardiac Surgery Requiring Readmission: A Systematic Review and Meta-analysis

Patients with congenital heart disease (CHD) are surviving longer thanks to improved surgical techniques and increasing knowledge of natural history. Pleural effusions continue to be a complication that affect many surgical patients and are associated with increased morbidity, many times requiring readmission and additional invasive procedures. The risks for development of pleural effusion after hospital discharge are ill-defined, which leads to uncertainty related to strategies for prevention. Our primary objective was to determine, in patients with CHD requiring cardiopulmonary bypass, the prevalence of post-surgical pleural effusions leading to readmission. The secondary objective was to identify risk factors associated with post-surgical pleural effusions requiring readmission. We identified 4417 citations; 10 full-text articles were included in the final review. Of the included studies, eight focused on single-ventricle palliation, one looked at Tetralogy of Fallot patients, and another on pleural effusion in the setting of post-pericardiotomy syndrome. Using a random-effect model, the overall prevalence of pleural effusion requiring readmission was 10.2% (95% CI 4.6; 17.6). Heterogeneity was high (I2 = 91%). In a subpopulation of patients after single-ventricle palliation, the prevalence was 13.0% (95% CI 6.0;21.0), whereas it was 3.0% (95% CI 0.4;6.75) in patients mostly with biventricular physiology. We were unable to accurately assess risk factors. A better understanding of this complication with a focus on single-ventricle physiology will allow for improved risk stratification, family counseling, and earlier recognition of pleural effusion in this patient population.

Inflammation May be the Future of Cardiovascular Risk Reduction: Does Colchicine have a Current Indication?

Inflammation as a cardiovascular risk factor has attracted increasing attention . The current standard of care for decreasing the occurrence of cardiovascular events includes controlling risk factors such as hypertension and maximizing the lowering of low-density lipoprotein cholesterol (LDL-C). However, a recent study demonstrated decreased cardiovascular risk with the anti-inflammatory agent canakinumab and created more interest in decreasing cardiovascular risk by decreasing inflammation. Canakinumab is not yet approved and will undoubtedly be very expensive, so interest in an established medication such as colchicine, which is inexpensive to produce, is appropriate if evidence-based benefit is adequately confirmed. Colchicine has existing indications for gout and familial Mediterranean fever and for decreasing the incidence of postpericardiotomy syndrome. If an evidence-based benefit in decreasing cardiovascular risk can be demonstrated for colchicine, it will be of significant importance. Meta-analyses and observational studies have provided evidence to suggest that colchicine decreases cardiovascular risk because of its anti-inflammatory effects. However, randomized controlled trials (RCTs) are needed, and the recently published COLCOT (Colchicine Cardiovascular Outcomes Trial) showed definite benefit on cardiovascular outcomes in adults who had experienced a myocardial infarction within the previous 30days. Sufficient evidence now supports the use of colchicine for secondary prevention in patients at the highest cardiovascular risk who continue to have cardiovascular events despite good blood pressure control and maximum LDL-C reduction. Nevertheless, more RCTs will be necessary before widespread general use of colchicine in cardiovascular disease prevention can be recommended. The current acquisition cost issues with colchicine also need to be resolved.

Perioperative glycemic control in patients with coronary artery disease and diabetes mellitus type 2 undergoing coronary artery bypass grafting: results of pilot study

BACKGROUND: According to different studies, diabetes mellitus type 2 (DM2) is associated with higher mortality after undergoing coronary artery bypass grafting (CABG). Perioperative hyperglycaemia, even in non-DM2 patients, is associated with adverse outcomes after CABG. Thus, successful perioperative blood glucose control (BGC) is mandatory to reduce the risk of death and postoperative complications. Nowadays, the most effective method for BGC in the operating room is still unknown.&#x0D; AIMS: To assess the continuous glucose monitoring (CGM) efficacy in association with insulin pump therapy in patients with coronary artery disease (CAD) and DM2 undergoing CABG in intra- and early postoperative periods.&#x0D; METHODS: The study involved 97 patients undergoing isolated CABG. Patients were divided into two groups: 48 patients with DM2 and 49 patients without DM2. In both groups of patients, we used CGM in intra- and early postoperative periods (72 hours). In some patients with DM2, CGM was associated with insulin pump therapy (MiniMed Paradigm Veo 554/754) to successfully control postoperative glucose level. Besides commonly used tests (such as HbA1C and lipid profile), we analysed high sensitive C-reactive protein (hs-CRP) levels before surgery, and then at 1 hour, 12 hours and 7 days after CABG in order to estimate their prognostic value.&#x0D; RESULTS: During the 48 hours after CABG, there was a trend towards having higher glucose levels in both groups of patients with and without DM2 according to CGM. In patients with DM2, the glucose level was significantly increased (р0,05). Insulin pump therapy resulted in glycemic control improvement in early follow-up (72 hours). Moreover, there were no hypoglycaemic episodes in patients on insulin pump therapy and also in patients prescribed bolus insulin therapy. We revealed the trend towards lower rate of postpericardiotomy syndrome (PCTS) in patients on insulin pump therapy compared to patients prescribed bolus insulin therapy in the early postoperative period (p=0,1). Hs-CRP level was lower in patients with DM2 who were on insulin pump therapy compared to patients prescribed bolus insulin therapy in the early postoperative period (р0,05). This most likely confirms that insulin pump therapy decreases systemic inflammatory response.&#x0D; CONCLUSIONS: Thus, we demonstrated the CGM feasibility, safety and efficacy in association with insulin pump therapy in patients with DM2 undergoing CABG.

Adverse events and survival with postpericardiotomy syndrome after surgical aortic valve replacement

ObjectivesPostpericardiotomy syndrome (PPS) is a relatively common complication after cardiac surgery. However, long-term follow-up data on the adverse events and mortality of PPS patients requiring invasive interventions are scarce. MethodsWe sought to assess the occurrence of mortality, new-onset atrial fibrillation (AF), cerebrovascular events, and major bleeds in PPS patients requiring medical attention in a combination database of 671 patients who underwent isolated surgical aortic valve replacement with a bioprosthesis (n = 361) or mechanical prosthesis (n = 310) between 2002 and 2014 (Cardiovascular Research Consortium—A Prospective Project to Identify Biomarkers of Morbidity and Mortality in Cardiovascular Interventional Patients [CAREBANK] 2016-2018). PPS was defined as moderate if it resulted in delayed hospital discharge, readmission, or medical therapy because of the symptoms; and severe if it required interventions for the evacuation of pleural or pericardial effusion. ResultsThe overall incidence of PPS was 11.2%. Median time to diagnosis was 16 (interquartile range, 11-36) days. Severe PPS was diagnosed in 3.6% of patients. Severe PPS seemed to be associated with higher mortality (hazard ratio, 2.01; 95% confidence interval, 1.03-3.91; P = .040). Moderate or severe PPS increased the risk of new-onset AF during the early postoperative period (hazard ratio, 1.72; 95% confidence interval, 1.12-2.63; P = .012). No significant associations were found between PPS and cerebrovascular events or major bleeds during the follow-up. ConclusionsPatients with PPS requiring invasive interventions are at increased risk for mortality unlike those with mild to moderate forms of the disease. PPS requiring medical attention is associated with a higher AF rate during the early postoperative period but has no significant effect on the occurrence of major stroke, stroke or transient ischemic attack, or major bleeds during long-term follow-up.

The impact of colchicine in preventing postpericardiotomy syndrome; a double-blind clinical trial study

Introduction: Post-pericardiotomy syndrome is a relatively common complication after open heart surgery. In recent years, colchicine had a good effect on treatment of the pericarditis. Objectives: This study aimed to study the effect of colchicine to prevent post-pericardiotomy syndrome in patients who had open heart surgery. Patients and Methods: This double-blind clinical trial study was conducted on 240 patients undergone open heart surgery. Eligible patients were selected by simple sampling and randomly divided into two groups; 120 subjects in the experimental group receive colchicine (1 mg for patients greater than 70 kg and 0.5 mg for patients lower than 70 kg) and 120 subjects in the control group who received the placebo. Patients were followed up regarding the incidence of post-pericardiotomy syndrome after the surgery during hospitalization and in follow up visits in one month and six months after hospital discharges. Results: In total, the incidence rate of post-pericardiotomy syndrome was 33.7% (81 subjects). A significant difference of post-pericardiotomy syndrome between two groups was seen. We found post-pericardiotomy syndrome in 12.1% (29 patients) of colchicine group versus 21.6% (52 patients) in the placebo group (chi-square test). The incidence rate based on the Kaplan-Meier curve, in the second week to one month after the surgery, was lower in colchicine group while in third to the sixth month it had a constant trend. Conclusion: Colchicine is effective for prevention the post-pericardiotomy syndrome without any life-threatening complication.

Postpericardiotomy Syndrome after Cardiac Operations.

The postpericardiotomy syndrome (PPS) is an important cause of morbidity and mortality following heart operation. This systematic review reviewed the literature regarding PPS. It was found to occur on day 18.3 ±15.9 after cardiac operations, most often after coronary artery bypass grafting, and mitral valve replacement. The most common symptoms were new/worsening pericardial effusions, pleuritic chest pain, and fever. The inflammation markers, such as C-reactive protein and erythrocyte sedimentation rate, were found to increase significantly in each patient who had these parameters examined. The subjects were managed conservatively in 472 (83.5%) patients, by surgical pericardial drainage in 85 (15.0%) patients, by thora-/pericardio-centesis in 3 (0.5%) patients, and were under surveillance without being treated in 5 (0.9%) patients. Conservative treatment was likely to be associated with a higher recovery rate. Surgical trauma and cardiopulmonary bypass trigger the systemic inflammatory response, which results in antiheart autoantigen release, and the deposited immune complex could be found in the pericardial, pleural, and lung tissues, thereby provoking the occurrence of PPS. Therapeutic options for the refractory cases are long-term oral corticoids or pericardiectomy. Surgical intervention was warranted in 2.6% of the cases due to cardiac tamponade.

P1340 Clinical report: alert to iatrogenia

Abstract Background Leftatrial appendageclosure is an alternative to systemic anticoagulation for stroke prevention in appropriate atrial fibrillation patients,however, it is not without complications. Most complications arise during the procedure and in the following days, however they can also be extended over time and therefore, we must be alert. Case summary We present the clinical case of a 68-year-old man admitted to our hospital three weeks after being discharged due to a percutaneous closure of the left appendage complicated with a pericardial tamponade resolved mediated pericadiocentesis with pericarditis clinic with persistent severe pericardial effusion. After a week without being able to remove the drainage tube, he required pericardiotomy due to superinfection with adequate subsequent evolution. In the following weeks he presented a recurrent left pleural effusion that required several evacuating thoracocentesis. After last thoracocentesis, he presented a cardiac perforation showing the catheter lodged in the pulmonary artery in the chest Computed Tomography, so he was again submitted to cardiac surgery for catheter extraction. Finally after stabilization, the patient could be discharged and after 6 months of follow-up he is stable and without new complications. Discussion Post-cardiac injury syndromes is a group of inflammatory pericardial syndromes including post-myocardial infarction pericarditis, post-pericardiotomy syndrome and post-traumatic pericarditis iatrogenic or not, that’s include pericarditis after invasive cardiac interventions. It is presumed that these syndromes have an autoimmune pathogenesis triggered by an initial damage and after a latent period of a few weeks are revealed. Our patient evidence of pericardial effusion with elevated CRP several weeks after a cardiac injury due to perforated during a percutaneous closure of the left appendage complicated with a pericardial tamponade resolved mediated pericadiocentesis. The persistent effusion motivated he imposibility of removed pericadiocentesis tube, and it superinfecction required an urgent pericardiotomy. After pericardial window, the effusion continued into the left pleural. The perforation of cardiac cavities after an evacuatorythoracocentesis is a described but unusual complication that requires surgical removal. Our patient survived a pericardiocentesis, several evacuatorythoracocentesis and two cardiac surgeries, all after a percutaneous closure of the left appendage. Conclusion Any invasive procedure presents a risk of iatrogenic complication, especially in elderly patients with comorbidities. We must be alert and start a treatment as soon as possible to solve the problem. Abstract P1340 Figure. Chest-CT_EECHO2019

Complication of glucocorticoid therapy of post-pericardiotomy syndrome after aortic valve replacement

<h3></h3> В статье рассмотрен клинический случай постперикардиотомного синдрома у пациента 66 лет после протезирования аортального клапана. Через месяц после операции по данным эхокардиографии отмечены признаки перикардита (выпот до 50 мл, фибринозный компонент). Кратковременная терапия преднизолоном привела к ухудшению хронической сердечной недостаточности, дилатации левого желудочка до 180 мл и снижению фракции выброса до 44% из-за минералокортикоидного действия преднизолона. Требовалось усиление терапии, направленной на подавление активности ренин-ангиотензин-альдостероновой системы. Принято решение о переводе больного на сакубитрил/валсартан в дозе 100 мг 2 раза/день. Через 1 месяц лечения эхокардиографические показатели вернулись к значениям до назначения преднизолона (конечный диастолический объем — 160 мл, фракция выброса — 53%). Сакубитрил/валсартан может быть рекомендован в случае дестабилизации течения хронической сердечной недостаточности для усиления терапии как препарат, обладающий более высокой эффективностью по сравнению с ингибиторами ангиотензинпревращающего фермента.

Functional features of innate immunity in the development of postpericardiotomy syndrome in patients after coronary artery bypass grafting

Objective: to study the functional characteristics of innate immunity in the formation of postpericardial syndrome (PPS) in patients undergoing coronary artery bypass graft ing (CABG).Materials and methods: the study involved 60 people, 40 of them made up the main group of patients with coronary artery disease, which retrospectively aft er 1 month of observation was divided into 2 groups. Group I CABG and PPS, group II CABG without PPS. The control group consisted of 20 patients without IHD. Before surgery, aft er 5, 14 days and 1 month, the expression of toll-like receptors (TLRs) 2, 4, 9, the content of CD16+ and Granzyme B lymphocytes, the HCT test and serum α-defensin were evaluated in blood cells. Statistical analysis of the results of the study was carried out using the program Statistica 12.0 (StatSoft , USA). The difference in mean values between groups was evaluated by the Mann-Whitney test. Statistical signifi cance was considered signifi cant at p ≤ 0.05.Results: when comparing the initial indices of the main groups and the control group, an increase in the expression of TLRs 2, 4, 9 was revealed. An increase in the content of CD16+, as well as an increase in the cytotoxic activity of natural killers and an increase in the production of α-defensin.Conclusions: on the basis of the study, activation of the cellular link of innate immunity, an increase in the cytotoxic potential of natural killers and a signifi cantly high level of α-defensin both before and aft er CABG were revealed, which can play an important role in the development of PPS.