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Published on: July 21, 2013
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.
Insights
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.
Background:
Pericardiectomy due to constrictive pericarditis is usually safe procedure. There was a rare event of thrombosis after pericardiectomy, which was mainly accounted by low-cardiac-output syndrome.
Case Presentation:
Here, we report the case undergoing pericardiectomy after constrictive pericarditis, with fatal cerebral thrombosis after pericardiectomy confirmed by endovascular mechanical thrombectomy. Even though recanalization was completed and suggestive decompressive craniectomy was in preparation, the patient still died for cerebral hernia due to severe edema. The causes of cerebral thrombosis after pericardiectomy in this case was accounted by the persistence of nonpliable pericardium encasing the left ventricular wall limited local myocardium motor, pro-coagulable state due to thermal transmission during decortication like radiofrequency ablation under the condition of postoperative atrial fibrillation and rapid ventricular rates precipitated the information of mural thrombus in cardiac cavity and migration into the main branch of the aortic arch.
Conclusion:
The protocol of prompt aggressive anticoagulation prophylaxis would be vigilantly recommended for the patients undergoing pericardiectomy.
