Staphylococcal pericarditis following percutaneous transluminal coronary angioplasty

Sankari, Abdul; Kumar, Ananth; Kabins, Sherwin A.; Chandna, Harish; Lieb, David C.

doi:10.1002/(sici)1522-726x(200005)50:1<71::aid-ccd15>3.0.co;2-v

Cited by 12 publications

(6 citation statements)

References 11 publications

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“…The most common pathogen of purulent pericarditis associated with PCI is Staphylococcus aureus, but Pseudomonas aeruginosa can also cause stent infection. 9,10 In the present case, neither of these pathogens appeared to cause pleuropericarditis, because prophylactic cefazolin sodium could have possibly prevented staphylococcal infection. Corticosteroids, rather than piperacillin sodium, was effective for the improvement of symptom and laboratory data of inflammation.…”

Section: Discussionmentioning

confidence: 50%

“…The causes include PCIS and a stent bacterial infection because of Staphylococcus aureus or Pseudomonas aeruginosa. [3][4][5][8][9][10] The diagnosis of PCIS depends on the characteristic clinical features. The principal features of PCIS are prior injury of the pericardium and/or myocardium, latent period between the injury and the development of pericarditis or pleuropericarditis, fever, leukocytosis, elevated ESR and serum CRP level, and remarkable steroid responsiveness.…”

Section: Discussionmentioning

confidence: 99%

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Acute Pleuropericarditis After Coronary Stenting A Case Report

Setoyama

Furukawa

Abe

et al. 2006

Circ J

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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...

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Section: Discussionmentioning

confidence: 50%

Section: Discussionmentioning

confidence: 99%

Acute Pleuropericarditis After Coronary Stenting A Case Report

Setoyama

Furukawa

Abe

et al. 2006

Circ J

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“…Of the 4,523 patients who underwent PCIs during the study period, 222 (4.9%) required readmission within 30 days for the following causes: reasons unrelated to index admission or PCI (41.4%), cardiac reasons unrelated to PCI (39.2%), PCI-related complications (13.5%) and non-cardiac reasons related to the index admission (5.9%). Infectious complications occurring after percutaneous transluminal coronary angioplasty (PTCA) are extremely rare [5]. In a study of 147 patients undergoing blood culture testing immediately after PCI, 26 (17.7%) had a detectable bacteremia 12 h after the procedure.…”

Section: Discussionmentioning

confidence: 99%

“…There have only been a few reported cases of groin infection following femoral artery repuncture for a coronary angioplasty [8]. A case of bacterial pericarditis developed 1 week after coronary angioplasty and stent implantation [5], two cases of septic arthritis of the knee secondary to probable femoral endarteritis, and another with infected hematoma of the groin. Splenic abscesses have not been perceived as common complication after PCI [8].…”

Section: Discussionmentioning

confidence: 99%

Ruptured Splenic Abscess following Percutaneous Transluminal Angioplasty in a 40-Year-Old Man

Rajasekharan¹,

Jayapal²

2012

Case Rep Gastroenterol

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The incidence of splenic abscesses is currently 0.14–0.7% with a reported mortality of 0–47%. The diagnosis of splenic abscess which has ruptured into the abdomen is often overlooked because of its rarity and its misleading clinical presentations. Percutaneous coronary interventions (PCIs) and coronary stenting procedures increased from 184,000 to 885,000 (from 335 to 1,550) and from 3,000 to 770,000 (from 5 to 1,350 per one million inhabitants), respectively. A 40-year-old Asian male presented to our emergency department with upper abdominal pain 5 days after a percutaneous transluminal coronary angioplasty. Clinical examination raised the possibilities of acute pancreatitis and intraabdominal sepsis. An initial ultrasound of the abdomen and blood tests were negative. A computed tomography scan of the abdomen revealed a splenic abscess that had ruptured into the abdomen. Pus culture revealed a multidrug-resistant strain of Klebsiella pneumoniae that was sensitive to meropenem. The patient recovered quickly after open surgical drainage and antibiotic therapy. As this is the second case of splenic abscess and the first case report of a ruptured splenic abscess following a PCI, it will be rational to administer a short course of antibiotic prophylaxis for high-risk immunocompromised patients who are undergoing percutaneous transluminal coronary intervention.

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“…Reports of infectious complications following coronary angioplasty with stent implantation are scarce, 1 and include purulent pericarditis, 2 endocarditis 3 and coronary artery abscess formation, 4 which often carry a fatal outcome 3,4 . Appropriate therapeutic measures should be taken as early as possible.…”

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confidence: 99%

Echocardiographic Imaging of Coronary Artery Abscess Following Stent Implantation

et al. 2004

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coronary artery abscess, echocardiographyReports of infectious complications following coronary angioplasty with stent implantation are scarce, 1 and include purulent pericarditis, 2 endocarditis 3 and coronary artery abscess formation, 4 which often carry a fatal outcome. 3,4 Appropriate therapeutic measures should be taken as early as possible. The present report demonstrates that echocardiography can successfully image a coronary artery abscess developing after stent implantation. Case ReportA 53 year old diabetic and hypercholesterolemic male patient was admitted for unstable angina nine years after undergoing coronary artery bypass grafting, with left internal mammary artery bypass to the left anterior descending and diagonal branch, and a vein graft to the marginal branch of the circumflex artery. Cardiac catheterization showed patent grafts to the left anterior descending and diagonal branch. The vein graft to the marginal branch had distal 90% stenosis. A Jomed covered stent was successfully deployed in the vein graft and the patient was discharged. Two days later he developed fever (38 • C) but was hospitalized only three days later. Blood cultures were positive for staphylococcus aureus and he was treated with intravenous antibiotics according to the sensitivity of the microorganism. Transthoracic echocardiography (Sequoia 256, Acuson, Mountain View, CA, Probe 3VC) revealed a localized inhomogeneous collection surrounding the stent, which could be directly visualized ( Fig. 1A and B). Transesophageal echocardiography (TE-V5M) demonstrated echogenic masses consistent with necrotic tissue and thrombi, typical of a phlegmon surrounding the patent stent with normal flow in the graft ( Fig. 1C and D). The patient was taken to the Figure 1. Transthoracic parasternal long axis view (A) and apical four chamber view (B), demonstrating a cystic structure (5 cm diameter) consistent with an abscess surrounding the stent (arrow) at the posterior surface of the left atrium. Transesophageal echocardiography demonstrating echogenic masses consistent with necrotic tissue and/or thrombi within the suspected abscess (C) and unobstructed flow through the stent (D). RV = right ventricle; LV = left ventricle; AO = aorta; LA = left atrium; AB = abscess.

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Staphylococcal pericarditis following percutaneous transluminal coronary angioplasty

Cited by 12 publications

References 11 publications

Acute Pleuropericarditis After Coronary Stenting A Case Report

Acute Pleuropericarditis After Coronary Stenting A Case Report

Ruptured Splenic Abscess following Percutaneous Transluminal Angioplasty in a 40-Year-Old Man

Echocardiographic Imaging of Coronary Artery Abscess Following Stent Implantation

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