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Fatal cerebral thrombosis after pericardiectomy
Qin Jiang1, Tao Yu2, Keli Huang2
1Department of Cardiac Surgery, Sichuan Provincial People's Hospital, Affiliated Hospital of University of Electronic Science and Technology, No.32, West Second Section First Ring Road, Chengdu, 610072, China. jq349@163.com.
International Journal of Emergency Medicine
|October 11, 2024
Summary
A rare case of fatal cerebral thrombosis after pericardiectomy for constrictive pericarditis highlights the need for aggressive anticoagulation. This complication stemmed from factors including nonpliable pericardium and pro-coagulable states.
Area of Science:
- Cardiovascular Surgery
- Neurology
- Thrombosis Research
Background:
- Pericardiectomy for constrictive pericarditis is generally safe.
- Thrombosis is a rare but serious complication post-pericardiectomy, often linked to low cardiac output.
Purpose of the Study:
- To report a fatal case of cerebral thrombosis following pericardiectomy.
- To elucidate the specific contributing factors in this rare event.
Main Methods:
- Case report of a patient undergoing pericardiectomy for constrictive pericarditis.
- Diagnosis of cerebral thrombosis confirmed by endovascular mechanical thrombectomy.
- Analysis of contributing factors including pericardial restriction, thermal injury, and arrhythmias.
Main Results:
- The patient developed fatal cerebral thrombosis despite successful thrombectomy and preparation for decompressive craniectomy.
- Contributing factors identified: persistent nonpliable pericardium, pro-coagulable state from radiofrequency ablation, and postoperative atrial fibrillation with rapid ventricular rates.
- These factors led to mural thrombus formation and subsequent cerebral embolism.
Conclusions:
- Prompt and aggressive anticoagulation prophylaxis is strongly recommended for patients undergoing pericardiectomy.
- Vigilant monitoring for thrombotic events is crucial in the postoperative period.
