The first post-cardiac injury syndrome reported following transcatheter aortic valve implantation: a case report

Abstract

BackgroundPost-cardiac injury syndrome is a form of secondary pericarditis with or without pericardial effusion, which typically occurs weeks to months following an injury to the heart or pericardium. Disease activity can be followed with serial testing of inflammatory markers e.g. C-reactive protein (CRP) and/or sedimentation rate, electrocardiogram, and echocardiography.Case summaryA 79-year-old woman was admitted with chest pain, dyspnoea at rest, cough, and low degree fever. The patient had undergone transcatheter aortic valve implantation (TAVI) 6 months before admission. Inflammatory markers were increased and a chest X-ray and computed tomography (CT) showed a minimal left pleural effusion. An empirical antibiotic treatment and ibuprofen to control chest pain were started on the presumption of an acute bronchitis. Despite 15 days of different antibiotic protocols the markers of inflammation remained increased. A positron emission tomography with computed tomography and cardiac magnetic resonance imaging showed signs of an aseptic pericarditis. After having excluded any infectious, metabolic, drug-induced or neoplastic genesis we considered the diagnosis of late onset autoimmune-mediated pericarditis. Subsequently, treatment was promptly initiated with colchicine and prednisone. The patient reported clinical improvement in the following days and the CRP value continuously decreased.DiscussionTo the best of our knowledge, this is the first reported case of post-cardiac injury syndrome after TAVI. It should be considered in those patients who have persistent chest pain, fever, fatigue, and elevated inflammatory markers after a TAVI procedure, even though it may occur weeks or months after the intervention. A triple therapy with colchicine, ibuprofen, and low-dosage steroids may be used for persistent symptoms.

Temporal Trend, Prevalence, Predictors, and Outcomes of Pericardial Diseases in Patients Undergoing Transcatheter Aortic Valve Repair

“…PD is emerging as a rare but important complication of TAVR. The true incidence of AP in patients undergoing TAVR is not known at this time as the medical literature hinges solely on case reports [10,11]. However, PE as a complication from TAVR has been studied more extensively.…”

“…Compared to SAVR, TAVR is associated with a lower risk of bleeding and atrial fibrillation (Afib) although the short-term risk of reintervention, paravalvular leak, valve thrombosis, and pacemaker (PM) implantation remains high [8]. Pericardial diseases (PD) -acute pericarditis (AP) and pericardial effusion (PE) -is an additional complication of TAVR as a part of post-cardiac injury syndrome (PCIS) although there is a paucity of data, which are limited to few case studies and review articles [9][10][11]. To elucidate this rare but important complication of TAVR, we analyzed an eight-year (2011-2018) trend of prevalence, predictors, and outcomes of PD in patients undergoing TAVR using the National Inpatient Sample (NIS) database.…”

A case report of pleuro‐pericardial effusion in a patient on hemodialysis and a cardiac pacemaker

“…Aspirin, nonsteroidal anti-inflammatory drugs (NSAID), colchicine, and steroids are commonly used drugs in the treatment of PCIS. 9 There are numerous causes of PPEF in general and more so in patient with ESRD on dialysis. Our patient had pericardial effusion, exudative lymphocyte-rich PLEF with elevated pH, which was negative for infectious causes and malignancy, and systemic upset with elevated inflammatory markers, and all this occurred after pacemaker insertion with latency, and all responded favorably to a short course of oral steroids.…”

“…Majority of the patients with PCIS have benign course, and PPEF don't recur, especially after appropriate use of anti‐inflammatory drugs like colchicine. Aspirin, nonsteroidal anti‐inflammatory drugs (NSAID), colchicine, and steroids are commonly used drugs in the treatment of PCIS 9 …”

Postcardiac injury syndrome, peripheral hematoma of ascending aorta, and cerebral infarction after PCI: a case report

“…Postcardiac injury syndrome (PCIS) is an inflammatory response syndrome characterized by pericardial effusion with or without pleural effusion that is caused by cardiac injuries, usually myocardial infarction (MI) or cardiac surgeries [1,2]. In recent years, with rapid advancement in the number, difficulty, and techniques of interventional cardiovascular procedures, such as cardiac pacemaker implantation [3], atrial-fibrillation radiofrequency ablation [4], transcatheter aortic-valve implantation (TAVI) [5], and percutaneous coronary intervention (PCI) treatment [6], postoperative PCIS has been reported. Although previous incidences of PCIS have been discussed, there have not yet been reports of PCIS accompanied by peripheral hematoma of the ascending aorta and acute cerebral infarction after PCI.…”