Significant Pericardial Effusion Research Articles

Delayed cardiac tamponade following catheter ablation of frequent premature ventricular complexes: a case report

BackgroundCardiac tamponade is a potentially fatal complication after catheter ablation of ventricular arrhythmias. It often happens during or shortly after the procedure and needs urgent treatment. Here, we present a very incredible case about delayed cardiac tamponade after ablation of premature ventricular complexes.Case presentationA 66-year-old woman who underwent successful catheter ablation of right ventricular outflow tract origin premature ventricular complexes. Nineteen days after ablation, the patient experienced sudden syncope. Upon arriving at our hospital, she was “confused and shock”. Transthoracic echocardiography revealed hemorrhagic cardiac tamponade, which was considered due to a delayed tiny perforation in the heart induced by the previous ablation. Following an emergent pericardiocentesis to drain a 200 mL hemorrhagic effusion, the patient’s hemodynamics improved significantly. The patient was discharged after a 2-week hospitalization for investigating other probable causes with negative results. No signs of pericardial effusion recurred in a follow-up time of 12 months.ConclusionThis case report demonstrated, for the first time, that very late post-procedural cardiac tamponade might occur after catheter ablation of ventricular arrhythmias, even without antithrombotic treatment.

State-of-the-art Review: Interventional Onco-Cardiology

To discuss invasive cardiovascular procedures as they relate to onco-cardiology, as well as recent additions to anti-cancer therapies and their subsequent effect on cardiovascular toxicity. The development of immune checkpoint inhibitors and chimeric antigen receptor T cell therapy has been linked to cardiotoxicity and represents an emerging area of concern. Recent advances in transcatheter valve replacement have shown benefits compared with surgical management regardless of malignancy type, stage, or treatment. With the increasing use of immunotherapy and increasing recognition of cardiotoxicity, there is a need for identifying mortality-improving strategies. The use of a transcatheter approach for aortic valve replacement looks to be a safer alternative when compared with surgical replacement despite the presence of cancer. Pericardial disease is frequent in the cancer population and pericardiocentesis represents a valid option for the treatment of significant pericardial effusions. Endomyocardial biopsy is performed for various indications in the cancer population and is the gold standard for diagnosing myocarditis and infiltrative diseases.

Causes and prognosis of symptomatic pericardial effusions treated by pericardiocentesis in an Asian academic medical centre.

This study aimed to investigate the causes, clinical management and outcomes of clinically significant pericardial effusions, and evaluate the practice of pericardiocentesis within an academic medical centre in Singapore, a multiethnic country in Southeast Asia. Consecutive patients undergoing pericardiocentesis at a single Asian academic medical centre were identified. Patient demographics, echocardiographic findings, investigations, pericardiocentesis procedural details and clinical progress were tracked using a comprehensive electronic medical records system. Of 149 patients who underwent pericardiocentesis, malignancy (46.3%) was the most common cause of pericardial effusions, followed by iatrogenic postsurgical complications (17.4%). 77.3% of effusions were large and 69.8% demonstrated tamponade physiology. Pericardiocentesis guided by echocardiography and fluoroscopy was successful in 99.3% of patients and had a complication rate of 2.0%. Likelihood of effusion recurrence and survival to discharge was determined by the aetiology of the pericardial effusion. 24.6% of malignant effusions recurred, and the survival rate 12 months after drainage of a malignant pericardial effusion was 45.0%. Short-term mortality was highest among patients presenting with tamponade due to acute aortic syndromes and those with myocardial rupture due to ischaemic heart disease. Cancer and iatrogenic complications were the most common causes of pericardial effusion in this large cohort of Singapore patients. Pericardiocentesis has a high success rate and relatively low complication rate. Prognosis and clinical course after pericardiocentesis are determined by the underlying cause of the pericardial effusion.

Impact of point-of-care ultrasound on the hospital length of stay for internal medicine inpatients with cardiopulmonary diagnosis at admission: study protocol of a randomized controlled trial\u2014the IMFCU-1 (Internal Medicine Focused Clinical Ultrasound) study

BackgroundPoint-of-care ultrasound (POCUS) is emerging as a reliable and valid clinical tool that impacts diagnosis and clinical decision-making as well as timely intervention for optimal patient management. This makes its utility in patients admitted to internal medicine wards attractive. However, there is still an evidence gap in all the medical setting of how its use affects clinical variables such as length of stay, morbidity, and mortality.Methods/designA prospective randomized controlled trial assessing the effect of a surface POCUS of the heart, lungs, and femoral and popliteal veins performed by an internal medicine physician during the first 24 h of patient admission to the unit with a presumptive cardiopulmonary diagnosis. The University of Melbourne iHeartScan, iLungScan, and two-point venous compression protocols are followed to identify left and right ventricular function, significant valvular heart disease, pericardial and pleural effusion, consolidation, pulmonary edema, pneumothorax, and proximal deep venous thrombosis. Patient management is not commanded by the protocol and is at the discretion of the treating team. A total of 250 patients will be recruited at one tertiary hospital. Participants are randomized to receive POCUS or no POCUS. The primary outcome measured will be hospital length of stay. Secondary outcomes include the change in diagnosis and management, 30-day hospital readmission, and healthcare costs.DiscussionThis study will evaluate the clinical impact of multi-organ POCUS in internal medicine patients admitted with cardiopulmonary diagnosis on the hospital length of stay. Recruitment of participants commenced in September 2018 and is estimated to be completed by March 2020.Trial registrationAustralian and New Zealand Clinical Trial Registry, ACTRN12618001442291. Registered on 28 August 2018.

P252 Incidental finding of a chronic left ventricular pseudoaneurysm years after surgical aortic valve replacement

Abstract Case presentation A 35-years old female was referred to our outpatient clinic with unclear thoracic pain and dyspnea. Clinical chemistry testing was unremarkable. Electrocardiography (ECG) showed T-wave inversion in the anterior-lateral leads. Chest X-ray displayed an oval bulge on the left border of the heart. The physical exam revealed a systolic murmur on top of the closing click sound of a mechanical aortic valve prothesis which had been implanted nine years ago. Since that time, the patient had not had regular checkups and the actual consultation was motivated by her aggravating symptoms only. Findings. In transthoracic echocardiography, the mechanical aortic valve prothesis exhibited an acceptable peak velocity of 2.7 m/s with a mean gradient of 18 mm Hg and only mild paravalvular regurgitation. The native mitral and tricuspid valves were functionally and morphologically normal. Left and right ventricle were of normal systolic and diastolic function and normal size. No signs of pericardial effusion were detected. However, a big (40x22mm) saccular structure with a narrow (10 mm) neck was visible at the apex of the left ventricle, see left panel of figure. At the neck, a bidirectional flow between the saccular structure and the left ventricle was detected with a peak velocity of 2,5 m/sec indicating the presence of a pseudoaneurysm. Its linings were calcified and free of discernable thrombus formation, although the flow inside was turbulent as evidenced in the contrast echocardiogram, see right panel of figure. Subsequently, CT-imaging confirmed the diagnosis and surgical resection of the pseudoaneurysm was successfully performed 10 days later. The surgeon noted that the walls of the resected cavity contained thrombotic masses despite respective negative findings on CT and echo. The postoperative course was uneventful, and the patient was discharged in good condition with normal left and right ventricular function and no regional left ventricular wall abnormalities. A year later, she was however re-admitted with prosthetic aortic valve stenosis due to thrombus formation on one the leaflets in the second trimester of a pregnancy. Discussion This is an exceptional case of chronic left ventricular pseudoaneurysm following aortic valve replacement. Since the patient had no history of myocardial infarction or of other potential causes that could explain the formation of a pseudoaneurysm, it is likely to be a remnant of venting the left ventricle during the original surgical procedure. The patient had been unattended and asymptomatic for several years which allowed chronification as indicated by the calcifications of the inner linings. Still, immediate surgical repair was mandatory due to the high risk of rupture and thromboembolism. Abstract P252 Figure.

224 Malignancy associated pericardial effusion- do we need to drain them all?

Abstract On Behalf Cardiac Team, Department of Medicine, Queen Elizabeth Hospital Background Management of significant pericardial effusion in cancer patients is controversial. These patients have poor prognosis, and avoiding unnecessary intervention is important. Close monitoring of symptoms and echocardiogram is often a reasonable option, but inherits risk of cardiac tamponade. Whether pericardial drainage by means of percutaneous pericardiocentesis or surgical pericardiotomy could prevent future deterioration or affect survival is unknown. Purpose To evaluate the benefit of elective pericardial drainage in malignancy associated pericardial effusion without echocardiographic or clinical evidence of tamponade effect. Methods From 1st Jul 2014 to 31st Dec 2017, all patients with new onset malignancy-associated pericardial effusion with size more than 1cm were retrospectively analyzed. Patients with clinical or echocardiographic evidence of cardiac tamponade were excluded. We compared pericardial drainage versus monitoring for short-term (30-day), mid-term (90-day) and long term (1 year) survival without need for drainage. Results 101 patients were retrospectively analyzed. 40 (39.6%) patients underwent drainage. Overall median survival free from drainage was 4 months. There were no significant difference in short-term (30-day), mid-term (90-day) and long term (1-year) survival free from drainage or mortality between treatment and monitoring group. Size of pericardial effusion did not predict mortality or future need of drainage. Chemotherapy was associated with improved 30-day mortality (RR 0.53 CI 0.32-0.87 p = 0.025) but not survival free from drainage or longer term mortality. Conclusion Close monitoring could be a feasible strategy in cancer patients with significant pericardial effusion without tamponade effect. Baseline characteristics Factor Drainage (n = 40) monitoring (n = 61) p-value method of drainage pericardiocentesis alone 17 NA pericardiotomy alone 13 both 10 Male 19 (47.5%) 27 (44.3%) 0.749 mean size (cm) 1.93 2.77 <0.001 mean age 60.9 63.1 0.357 on chemotherapy 27 (67.5%) 38 (62.3%) 0.593 Abstract 224 Figure. Survival free from drainage

Hirurško lečenje tamponade srca razvijene kod dva pacijenta sa karcinomom pluća terminalnog stadijuma

Introduction: Although tamponade due to pericardial effusion that develops in advanced stage lung cancer is rare, it is a life-threatening complication. Case report: 59 and 72 years old 2 female patients diagnosed with cardiac tamponade were hospitalized in Cardiology Clinic of Balækesir State Hospital. Massive pericardial effusion that caused diastolic collapse of right ventricle was detected in their echocardiographies. Inoperable lung cancer was diagnosed as a result of bronchoscopy performed due to pathologies observed in their radiograms. Despite repeated pericardiocentesis, fluid continued to accumulate rapidly. Hence, pericardioperitoneal window was formed through subxiphoid route to obtain continuous drainage in both patients. Significant pericardial effusion didn't develop in echocardiographies in the 2nd and the 6th-month post-operative follow-ups. Conclusion: Subxiphoid pericardioperitoneal window is a simple, safe and effective surgical procedure. It may be performed in some patients with malignant tamponade

Water bottle sign of pericardial effusion on chest radiograph.

Water bottle sign of pericardial effusion on chest radiograph.

Effusive-Constrictive Pericarditis: Doppler Findings.

To review the echo-Doppler findings in effusive-constrictive pericarditis (ECP). ECP corresponds to the coexistence of a hemodynamically significant pericardial effusion and markedly reduced compliance of the pericardium, manifested by constrictive physiology post-pericardiocentesis. We summarize herein the recent observations regarding the prevalence of ECP based on echocardiography as well as the pre- and post-pericardiocentesis echo-Doppler features of ECP. ECP diagnosed by echocardiography was seen in approximately 15% of patients with ECP pre- and post-pericardiocentesis echo-Doppler findings sharing features with both cardiac tamponade and constrictive pericarditis. ECP post-pericardiocentesis is common but its natural history in the current era might be better than previously reported. Further studies and (particularly simultaneous echocardiography-cardiac catheterization) are still critically needed to better understand the underlying hemodynamics of ECP. Moreover, it remains to be determined whether pre- and post-pericardiocentesis echo-Doppler findings can be used to prognosticate or to guide therapy of those undergoing pericardiocentesis.

PRIMARY RIGHT ATRIAL CARDIAC ANGIOSARCOMA INITIALLY PRESENTING AS SYNCOPE

SESSION TITLE: Tuesday Fellows Case Report Posters SESSION TYPE: Fellow Case Report Posters PRESENTED ON: 10/22/2019 01:00 PM - 02:00 PM INTRODUCTION: Primary cardiac Angiosarcomas are extremely rare, with incidence of about 0.056% (1). These tumors pose significant diagnostic dilemma due to rarity and varied clinical features at presentation. We report our experience while treating a patient with primary right atrial cardiac angiosarcoma who initially presented with syncope. CASE PRESENTATION: A 45-year-old Spanish woman presented to the emergency room after an episode of syncope. She reported having shortness of breath, sweating and fatigue for 2 weeks prior to the incident. A chest radiograph revealed an enlarged cardiac silhouette, and computed tomography (CT) showed an enhancing mass along the right cardiac border, measuring 4.6 cm by 5.9 cm (Image 1). An Echocardiogram showed a right atrial mass (Image 2) with significant pericardial effusion. Percutaneous CT guided biopsy showed a vascularized mass and the patient underwent an exploratory surgery and removal of tumor. Cytological analysis of the mass failed to provide a diagnosis. 11 months from the surgery, the patient presented with shortness of breath and intense right leg pain. A CT scan of the chest revealed aggressive recurrence of the tumor with cardiac/mediastinal mass invading the right atrium, the right ventricle, the inferior vena cava, the main pulmonary trunk, right middle lobe bronchus and the aorta. There was extensive mediastinal adenopathy as well as right sided pleural effusion (Image 3). There was another mass seen in the right femur and it was biopsied, with a histo-pathological analysis confirming metastatic angiosarcoma. She was started on paclitaxel with a dose of 80 mg/m2 weekly, and tolerated it well. She continues to follow up with Oncology. DISCUSSION: Primary cardiac Angiosarcomas are rare tumors and are usually metastatic at the time of diagnosis. Cardiac Angiosarcomas can present with varying symptoms, these clinical features depend on the tumor size, location, and the extent of the local or distant spread. This tumor affects the right atrium commonly, a feature that is distinct from Atrial Myxoma which usually affects the left atrium. This knowledge can aid clinicians in suspecting an aggressive disease early. Resection, in combination with adjuvant treatment including chemotherapy, radiotherapy, and molecular targeted therapies give the best chance for prolonging survival. Chemotherapeutic regimens include anthracyclines, taxanes or ifosfamide (2). Doxyrubicin based treatments although well known for their cardiotoxic adverse effects have been used as the standard treatment for locally advanced and metastatic disease (3) often with local radiotherapy. CONCLUSIONS: In conclusion, primary Cardiac Angiosarcomas have a rapidly progressive and fatal course with mean survival of 6-11 months from diagnosis. Early diagnosis, with multimodality approach tailored to each patient gives the best chance of prolonged survival. Reference #1: Lam KY, Dickens P, Chan AC. Tumors of the heart. A 20-year experience with a review of 12,485 consecutive autopsies. Arch Pathol Lab Med. 1993 Oct;117(10):1027-31 Reference #2: Schur S, Hamacher R, Brodowicz T. Pazopanib in Primary Cardiac Angiosarcoma of the Right Atrium: A Case Report. Case Reports in Oncology 2016;9(2):363–367. Reference #3: Penel N, Bui BN, Bay J-O, et al. Phase II Trial of Weekly Paclitaxel for Unresectable Angiosarcoma: The ANGIOTAX Study. Journal of Clinical Oncology 2008;26(32):5269–5274. DISCLOSURES: No relevant relationships by Yizhak Kupfer, source=Web Response No relevant relationships by Namrita Malhan, source=Web Response No relevant relationships by Ravikaran Patti, source=Web Response No relevant relationships by Vignesh Ponnusamy, source=Web Response No relevant relationships by Ankur Sinha, source=Web Response No relevant relationships by Parita Soni, source=Web Response

The initial U.S. experience with the Tempo active fixation temporary pacing lead in structural heart interventions.

This multicenter retrospective study of the initial U.S. experience evaluated the safety and efficacy of temporary cardiac pacing with the Tempo® Temporary Pacing Lead. Despite increasing use of temporary cardiac pacing with the rapid growth of structural heart procedures, temporary pacing leads have not significantly improved. The Tempo lead is a new temporary pacing lead with a soft tip intended to minimize the risk of perforation and a novel active fixation mechanism designed to enhance lead stability. Data from 269 consecutive structural heart procedures were collected. Outcomes included device safety (absence of clinically significant cardiac perforation, new pericardial effusion, or sustained ventricular arrhythmia) and efficacy (clinically acceptable pacing thresholds with successful pace capture throughout the index procedure). Postprocedure practices and sustained lead performance were also analyzed. The Tempo lead was successfully positioned in the right ventricle and achieved pacing in 264 of 269 patients (98.1%). Two patients (0.8%) experienced loss of pace capture. Procedural mean pace capture threshold (PCT) was 0.7 ± 0.8 mA. There were no clinically significant perforations, pericardial effusions, or sustained device-related arrhythmias. The Tempo lead was left in place postprocedure in 189 patients (71.6%) for mean duration of 43.3 ± 0.7 hr (range 2.5-221.3 hr) with final PCT of 0.84 ± 1.04 mA (n = 80). Of these patients, 84.1% mobilized out of bed with no lead dislodgment. The Tempo lead is safe and effective for temporary cardiac pacing for structural heart procedures, provides stable peri and postprocedural pacing and allows mobilization of patients who require temporary pacing leads.

Percutaneous left atrial appendage closure in a patient with haemophilia and atrial fibrillation: a case report.

Background Atrial fibrillation (AF) is the most common cardiac arrhythmia and is a major cause of embolic stroke. In patients with hereditary bleeding disorders such as haemophilia, management of AF particularly anticoagulation can be quite challenging. Left atrial appendage (LAA) closure is an emerging option in AF patients who are not eligible for oral anticoagulation therapy because of contraindications or high bleeding risk.Case summary A 67-year-old man with permanent AF and haemophilia was referred for further evaluation of our cardiology clinic by his primary haematologist. The CHA2DS2-VASc score was estimated to be 3 and the HAS-BLED score was 3. Due to high risk of bleeding, we decided to perform percutaneous LAA closure instead of oral anticoagulation. Pre-procedural cardiac computerized tomography angiography and transoesophageal echocardiography were performed for measurements of LAA dimensions and exclude LAA thrombus. Percutaneous LAA occlusion was performed using a 28-mm AmplatzerTM AmuletTM device. The final result was excellent without significant residual leak, pericardial effusion, and embolic complication. Clopidogrel 75 mg/day and aspirin 81 mg/day for 1 month with adequate FVIII prophylaxis and then only aspirin 81 mg/day for 2 months were recommended. No antiplatelet was given after 3 months. The patient did not report any thrombotic or haemorrhagic adverse events and there were no complications related to implanted device after 1 year of follow-up.Discussion In patients with hereditary bleeding disorders such as haemophilia, management of AF particularly anticoagulation can be quite challenging. In this report, we present a case of percutaneous LAA occlusion using AmplatzerTM AmuletTM device in a patient who has haemophilia and permanent AF. LAA closure has the potential to be more cost effective as compared to oral anticoagulation therapy due to lesser necessity of clotting factor infusion.

Pericardial Effusion Associated With Sirolimus Use After Renal Transplantation: A Single-Center Case Series

Pericardial effusion and cardiac tamponade following renal transplantation have been recognized as a potentially serious complications associated with the use of sirolimus for immunosuppression. Our study aims to analyze the development of sirolimus-associated pericardial effusion.Patients who underwent renal transplantation at our institution between 2001 and 2014 were reviewed and the correlation between sirolimus exposure and pericardial effusion was determined. Nineteen out of 792 patients who received a renal transplant over this 14-year period (incidence 2.4%) developed symptomatic pericardial effusion (determined by the need for pericardiocentesis or a pericardial window). All patients had a pre-transplantation cardiac workup, including echocardiogram, which did not reveal the presence of pericardial effusion. Our cohort of patients is mostly male (57.9%) and Caucasian (73.7%), which is consistent with the makeup of transplant recipients at our center. The mean age was 52.42 years at the time of transplantation. The development of symptomatic pericardial effusions occurred at a mean of 5.06 (.5–9.8) years after renal transplant while on sirolimus therapy. Sirolimus levels at diagnosis were 5.19–7.47 ng/mL. No significant pericardial effusion (resulting in tamponade physiology) recurred after therapeutic intervention, including cessation of sirolimus with or without pericardial drainage. This study is the largest single-center report of the possible association between pericardial effusion in renal transplant recipients who received sirolimus. Due to the widespread use of sirolimus in organ transplantation, clinicians must remain vigilant for this potential cardiac complication.

Targeted Cancer Therapies With Pericardial Effusions Requiring Pericardiocentesis Focusing on Immune Checkpoint Inhibitors

Case reports have reported immune checkpoint inhibitors (ICI), especially nivolumab, are associated with recurrent pericardial effusions. Our objective was to determine how often patients being treated with ICI develop hemodynamically significant pericardial effusion requiring pericardiocentesis compared with other cancer therapeutics and whether the survival of patients who underwent pericardiocentesis differs according to ICI use versus standard cancer therapeutics. Our institutional review board approved catheterization laboratory data collection for all pericardiocenteses performed and all patients receiving ICI from January 1, 2015 to December 31, 2017. Retrospective review of the electronic medical record was performed to identify cancer therapeutics given preceding pericardiocentesis. Log-rank analysis was performed to compare survival in patients requiring pericardiocentesis between those on ICI and those not on ICI. Overall, 3,966 patients received ICI of which only 15 pericardiocenteses were required, including 1 repeat pericardiocentesis in a patient on nivolumab. The prevalence of pericardiocentesis among patients on ICI was 0.38% (15/3,966). Eleven pericardiocenteses were performed after nivolumab infusion, 3 after pembrolizumab, and 1 after atezolizumab, with pericardiocentesis prevalences for each agent of 0.61% (11/1,798), 0.19% (3/1,560), and 0.32% (1/309), respectively. One hundred and twenty pericardiocentesis were performed on patients receiving other cancer therapeutics although no therapeutic agent was associated with more pericardiocenteses than nivolumab. In conclusion, the prevalence of hemodynamically significant pericardial effusions and ICI administration is uncommon, and survival durations after pericardiocentesis for patients receiving ICI and those not receiving ICI are similar, suggesting that frequent echocardiographic monitoring for pericardial effusions is not necessary.

Intraoperative Management to Prevent Cardiac Collapse in a Patient With a Recurrent, Large-volume Pericardial Effusion and Paroxysmal Atrial Fibrillation During Liver Transplantation: A Case Report

BackgroundPericardial effusion is a common feature of end-stage liver disease. In this case report we describe the intraoperative management of recurrent pericardial effusion, without re-pericardiocentesis, to prevent circulatory collapse during a critical surgical time-point; that is, during manipulation of the major vessels and graft reperfusion. MethodsA 47-year-old woman with hepatitis B was scheduled to undergo deceased donor liver transplantation (LT). A large pericardial effusion was preoperatively identified using transthoracic echocardiography (TTE). The patient also had paroxysmal atrial fibrillation. Two days before surgery, preemptive pericardiocentesis was performed and the 1150-mL effusion was drained. Intraoperatively, recurrence of the large pericardial effusion was identified using transesophageal echocardiography (TEE). During inferior vena cava manipulation, the surgeon consulted the anesthesiologist to evaluate the hemodynamic changes in the patient. After 3 attempts, the transplant team was able to determine the most appropriate anastomosis site, defined as that with the least impact on cardiac function. To prevent the development of severe postreperfusion syndrome, 10% MgSO4 (2 g) was gradually infused 20 minutes before portal vein declamping, and immediately before graft reperfusion a 100-μg bolus of epinephrine was administered. ResultsDuring graft reperfusion, there was no evidence of heart chamber collapse or flow disturbance, as seen on the TEE findings. Postoperatively, the patient recovered completely and was discharged from the hospital. Six months after surgery, there was no sign of pericardial effusion on follow-up TTE. ConclusionOur intraoperative strategy may prevent cardiac collapse in patients with pericardial effusion detected during LT. Intraoperative TEE plays an important role in guiding hemodynamic management.

More than Meets the Eye: An Interesting Case of Cardiac Tamponade

This interesting case highlights the presentation of a 68-year-old Latino male with coronary artery disease and coronary artery bypass graft surgery eight years who presented with non-specific respiratory symptoms. At the time of his initial evaluation he was noted to have persistent bigeminy and a 5 beat run of ventricular tachycardia. During his hospital stay he was again noted to have marked arrhythmias, with a 40 beat run of ventricular tachycardia. Urgent echocardiogram was obtained and revealed significant pericardial effusion compressing his right ventricle. On cardiac catheterization patient was found to have a patent graft but trasudative pericardial fluid causing tamponade and arrhythmia both which completely resolved after drainage. Learning Objective 1: Recognize ventricular arrhythmias as an atypical presentation of pericardial effusion and cardiac tamponade. Learning Objective 2: Appreciate the utility of echocardiogram in elucidating etiologies of non-sustained ventricular tachycardia.

Role of real time-three dimensional transesophageal echocardiography in left atrial appendage closure with LACBES® devices.

Catheter-based left atrial appendage closure (LAAC) has recently become an innovative strategy for preventing embolic events in patients with nonvalvular atrial fibrillation (AF). There is limited information on optimal sizing for LAAC with the recently developed LACBES® device. The aim of the present study was to assess the role of real time-three dimensional transesophageal echocardiography (RT-3D TEE) for LACBES® device selection during LAAC. A total of 22 patients with nonvalvular AF and indications for LAAC were enrolled in the study. All patients underwent LAAC with LACBES® devices. TEE was performed in all patients 3 days prior to the procedure, during the procedure, and 3 months and 1 year following the procedure. Interatrial septal puncture, exchange of the sheath and release of the device were performed under the guidance of RT-3D TEE. The LAA ostium and landing zone dimensions measured by RT-3D TEE were better correlated with the device size used for occlusion (r=0.60, P=0.003) than those measured with two dimensional TEE or LAA contrast angiography. There were no clinically significant residual shunts, pericardial effusion or tamponade following occlusion. All patients had the device well-seated and presented no evidence of closure-associated complications during the follow-up. No cases of peri-procedural stroke or mortality were observed during a mean follow-up period of 12 months. In conclusion, RT-3D TEE is a reliable and effective imaging modality to guide LAAC using LACBES® devices in patients with nonvalvular AF at high risk of cardioembolic events.

57-Year-Old Man With Atypical Chest Pain

57-Year-Old Man With Atypical Chest Pain

Does the position of the drains after open heart surgery make a difference? A clinical randomized trial

BackgroundPericardial effusion remains a common clinical problem after cardiac surgery. Adequate postoperative drainage can be obtained by posterior pericardial drainage through a posterior tube, along with conventional drainage of the anterior mediastinum. MethodsThree hundred patients, who underwent cardiac surgery, were enrolled in a prospectively randomized study. Group A (150 patients) had two retrosternal drains and group B (150 patients) had two retrosternal drains, one retrosternal and one retro-cardiac. ResultsEarly pericardial effusion developed in 5 (3.4%) patients in group A and 2 (2.9%) in group B (P = 0.76). Early posterior pericardial effusion occurred in 5 (3.4%) patients of group A whereas no patients had early posterior pericardial effusion in Group B (P = 0.024). Fourteen (9.5%) patients from group A had late posterior pericardial effusion, compared to 1 (0.7%) patient from group B (P = 0.001). Three patients from group A had late posterior cardiac tamponade whereas no patients from group B had late posterior cardiac tamponade (P = 0.013). ConclusionsThe use of a drain placed in the posterior pericardial cavity is simple and safe and appears to be sufficient for posterior drainage. This reduces not only the high incidence of late significant pericardial effusion but also reduce early pericardial effusion and tamponade.

P3517Occurrence and predictors of readmission due to significant pericardial effusion after heart valve surgery

P3517Occurrence and predictors of readmission due to significant pericardial effusion after heart valve surgery