A 27-year-old male with congenital hypoplastic aorta developed post-pericardiotomy syndrome presenting as cardiac tamponade one month after CABG, which resolved with drainage and colchicine.
Case Report (n=1)
Highlights the need for a high index of suspicion for post-pericardiotomy syndrome and cardiac tamponade in younger patients presenting with vague symptoms after cardiac surgery.
Abstract Introduction Pericardial effusions are common after cardiac surgery, often presenting as part of post-pericardiotomy syndrome (PPS). PPS is an immune mediated syndrome, and younger patients are at a higher risk, with an observed incidence as high as 24% in patients under 54 years of age. Rapid development of pericardial effusion, regardless of size of effusion, is highly correlated with risk of cardiac tamponade. Case Presentation A 27 year old male with history of congenital hypoplastic aorta, hypertension, hyperlipidemia, poorly controlled Type 1 diabetes mellitus, hypothyroidism, CKD initially presented with chest pain. BP on presentation was 190/68 mmHg. Troponins were elevated to 4586. EKG demonstrated normal sinus rhythm, left ventricular hypertrophy and deep T wave inversions in lateral leads. CTA chest ruled out aortic dissection. Cardiac catheterization demonstrated diffuse coronary stenosis, with 90% focal stenosis of left anterior descending artery. He was thought to have NSTEMI type 1 in the setting of spontaneous coronary artery dissection versus plaque rupture. Given extensive coronary stenosis and small caliber coronary vasculature, possibly in the setting of aortic hypoplasia, he underwent coronary artery bypass (CABG) with left internal mammary artery (LIMA) graft to LAD rather than percutaneous intervention. A month later, he presented with a one day history of nausea and one witnessed episode of syncope. He denied chest pain, pleurisy or dyspnea. He was hemodynamically stable with a pulse of 80 bpm, BP 146/66 mmHg, temperature 98.3 °F, and respiratory rate of 18/minute. Chest radiograph showed an interval increase in cardiac size. CTA chest showed large loculated pericardial fluid collection measuring 16.2 cm x 5 cm x 9 cm along the inferior aspect of the heart abutting the diaphragm and associated right ventricular collapse. The patient underwent emergent pericardial drain placement for tamponade and was noted to have an inferior pericardial effusion with internal septations on ultrasonography. His pericardial drain put out a total of 270 cc of sanguineous fluid. Pericardial fluid analysis revealed leucocytes. There was no growth on culture. He was treated with 0.6 mg of colchicine twice daily for 3 weeks with resolution of his pericardial effusion. Discussion Post-pericardiotomy syndrome is a common complication of cardiac surgery. Risk factors include younger age, hypertension, female sex, valvular surgery and pleural incision. A high index of suspicion is required for early diagnosis in younger, relatively healthier patients who may present with minimal or vague symptoms. This abstract is funded by: None
Kumar et al. (Fri,) conducted a case report in Post-pericardiotomy syndrome presenting as cardiac tamponade (n=1). Pericardial drain placement and colchicine was evaluated. A 27-year-old male with congenital hypoplastic aorta developed post-pericardiotomy syndrome presenting as cardiac tamponade one month after CABG, which resolved with drainage and colchicine.
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