Acute Pleuropericarditis After Coronary Stenting A Case Report

Abstract

leuropericarditis has a variety of causes, which include viral or bacterial infections, autoimmunity, malignant neoplasm, and other cardiac insults, such as myocardial infarction and surgery or trauma to the heart. The syndrome of pleuropericarditis with fever, pleuritic chest pain, and elevated inflammatory markers secondary to cardiac injury is referred to as post-cardiac injury syndrome (PCIS). PCIS is an inflammatory process involving the pleura and pericardium and includes 2 distinct entities: post-myocardial infarction syndrome secondary to myocardial infarction and post-cardiotomy syndrome secondary to cardiac surgery or trauma. 1 PCIS after open-heart surgery is rather common and the incidence is reported as 10-50%. 2 Recently, a few reports have described PCIS occurring as a rare complication after endovascular procedures such as percutaneous coronary intervention (PCI) and trans-venous temporary/permanent pacing. [3][4][5][6][7] We present a case of acute pleuropericarditis which occurred after successful coronary stenting with atypically early onset for PCIS. Case ReportA 72-year-old male hypertensive patient was admitted to hospital because of stable effort angina pectoris which appeared 2 months before admission. Treadmill stress test reproduced his chest symptoms, accompanied with reversible significant ST-segment depression in an electrocardiogram (ECG). Echocardiogram showed concentric left ventricular hypertrophy and mild left ventricular asynergy in the inferior wall. Coronary angiography revealed total occlusion in the middle right coronary artery (RCA) and 75% stenosis in the proximal RCA (Fig 1), and the distal RCA was filled through collateral circulation from the left coronary artery. The patient subsequently underwent PCI for the RCA. A 0.014 inch Miracle 3 g guidewire (Getz Bros) and a 0.014 inch PT Graphix guidewire (Boston Scientific) were used to cross the total occlusion lesion, with the aid of a microcatheter (Excelsior; Boston Scientific). The guidewire was replaced by a more flexible 0.014 inch BMW guidewire (Guidant Corporation) through the Excelsior. The lesion was predilated using a 2.0×15 mm Victo-X balloon catheter (Nippon Sherwood). Because the intravascular ultrasound examination indicated a large volume of plaque causing moderate stenoses in almost the full length of the proximal to middle RCA, 3 Cypher stents (2.5× 28 mm, 3.0×33 mm, 3.5×23 mm; Johnson & Johnson) were used from the distal to the ostium of the RCA. Adjunctive postdilatation was performed with 3.0 mm and 3.5 mm stent balloons. Thus, the 75% stenotic and total occlusion lesions were successfully dilated to 0%. There were not any immediate clinical or angiographic signs of complications throughout the procedure.Four hours after PCI, the patient complained of a mild chest pain which was augmented by deep breathing. However, his blood pressure, pulse pressure, and arterial oxygen saturation were maintained stable and ECG indicated no significant changes from his reference ECG before PCI. Thus, he was given non-s...

Postcardiac Injury Syndrome after Percutaneous Coronary Intervention

“…Dressler anticipated a contemporary theory explaining the pathophysiology of PCIS, i.e., the induction of antiheart antibodies against autoantigens that are exposed following cardiac injury 9,10. An alternative hypothesis suggests that the leakage of blood into the pericardial space causes the PCIS 2-5. In our case, the drained pericardial effusion contained some red blood cells, suggesting that bleeding into the pericardial space had occurred.…”

“…By contrast, our patient developed pericardial and pleural effusions three hours after the PCI, which is quite rare. Another case of rapid onset (4 hours) of PCIS symptoms after PCI was reported by Setoyama, et al5 The authors explained that this rapid onset of PCIS was due to stimulation of the immune system by a recent myocardial injury prior to the PCI. In our case, the patient had chest pain for a month prior to presentation and an early onset of PCIS, which might be explained by a similar mechanism.…”

“…Abnormal laboratory findings include a leukocytosis, elevated inflammatory markers, and chest X-ray abnormalities with or without pulmonary infiltrates 1-4. The most common cause of PCIS is major cardiac surgery 5. The reported incidence of PCIS following cardiac surgery varies from 15 to 30% 6.…”

Postpericardiotomy syndrome after cardiac surgery

“…Although PPS most commonly occurs after cardiac surgeries and especially frequently after the most extensive procedures, numerous case reports concerning more unusual triggers of PPS have been previously published. A picture similar to PPS has followed penetrating injuries of the chest [52,88,89], gunshots of the thoracic area [52,90,91], nonpenetrating trauma to the chest [92][93][94][95], left ventricular puncture [96,97], pulmonary embolism [98], pacemaker implantation with epicardial leads [99][100][101], transvenous pacemaker implantation [40,41,[102][103][104][105][106][107][108][109][110][111][112][113][114], coronary artery perforation during balloon angioplasty [115], uncomplicated coronary angioplasty and stenting [116][117][118][119][120][121][122][123][124], percutaneous mitral balloon valvuloplasty [125], atrial radiofrequency ablation [126][127]…”

A presentation of postcardiac injury syndrome after successful chronic total occlusion percutaneous coronary intervention using dissection re‐entry techniques

“…PCIS after open‐heart surgery is common with an incidence of 10–50% . However, the incidence of pericardial complications after percutaneous coronary intervention (PCI) is less than 0.2% . We present a case of acute pericarditis, which occurred after a successful complex PCI.…”