PDF(Pubmed)
Abstract：
BACKGROUND: Nowadays, percutaneous procedures are expanding in use, and this comes with complications associated with the procedure itself. Cardiac tamponade is rare but may be life threatening since it can involve hemodynamic instability. It is known that after pleural effusion during a percutaneous procedure, pericardiocentesis should be used as drainage of the cavity. However, that does not achieve hemostasis in some cases, and in those patients who are hemodynamically unstable, a sealing agent to promote hemostasis might be useful, like thrombin.
METHODS: We present a case report of 89-year-old patient with history of melanoma undergoing treatment with pembrolizumab, who attended the emergency department referring chest pain (intensity 5/10) and palpitations that have lasted hours. He had TnTUs 554/566 ng/L and an echocardiogram that showed dilated right chambers, hypertrophy and global hypokinesia of the left ventricle, increased filling pressures of the left ventricle and pulmonary hypertension. Myocarditis associated with pembrolizumab was suspected, so high dose steroids were initiated and endomyocardial biopsy was conducted, resulting in iatrogenic cardiac tamponade. To determine the etiology of the suspected myocarditis, an endomyocardial biopsy was performed. Unfortunately, an intraprocedural complication arose: pleural effusion resulting in iatrogenic cardiac tamponade, leading to hemodynamic instability. It required immediate pericardial drainage via subxiphoid puncture, obtaining a 550 mL hematic debit. Clinical manifestations raised suspicion of tamponade, prompting a bedside echocardiogram for a definitive diagnosis. Despite these efforts, the patient remained hemodynamically unstable, and due to the elevated surgical risk, intrapericardial thrombin was employed to achieve successful hemostasis.
CONCLUSIONS: Cardiac tamponade is a life-threatening condition that can sometimes be induced iatrogenically, resulting from percutaneous interventions. Despite limited evidence regarding this therapeutic strategy, in patients experiencing iatrogenic cardiac tamponade with hemodynamic instability and high surgical risk, the administration of intra-pericardial thrombin could be contemplated.
METHODS: We present a case report of 89-year-old patient with history of melanoma undergoing treatment with pembrolizumab, who attended the emergency department referring chest pain (intensity 5/10) and palpitations that have lasted hours. He had TnTUs 554/566 ng/L and an echocardiogram that showed dilated right chambers, hypertrophy and global hypokinesia of the left ventricle, increased filling pressures of the left ventricle and pulmonary hypertension. Myocarditis associated with pembrolizumab was suspected, so high dose steroids were initiated and endomyocardial biopsy was conducted, resulting in iatrogenic cardiac tamponade. To determine the etiology of the suspected myocarditis, an endomyocardial biopsy was performed. Unfortunately, an intraprocedural complication arose: pleural effusion resulting in iatrogenic cardiac tamponade, leading to hemodynamic instability. It required immediate pericardial drainage via subxiphoid puncture, obtaining a 550 mL hematic debit. Clinical manifestations raised suspicion of tamponade, prompting a bedside echocardiogram for a definitive diagnosis. Despite these efforts, the patient remained hemodynamically unstable, and due to the elevated surgical risk, intrapericardial thrombin was employed to achieve successful hemostasis.
CONCLUSIONS: Cardiac tamponade is a life-threatening condition that can sometimes be induced iatrogenically, resulting from percutaneous interventions. Despite limited evidence regarding this therapeutic strategy, in patients experiencing iatrogenic cardiac tamponade with hemodynamic instability and high surgical risk, the administration of intra-pericardial thrombin could be contemplated.
摘要：
背景：如今，经皮手术正在扩大使用，这伴随着与手术本身相关的并发症。心脏填塞很少见，但可能危及生命，因为它可能涉及血液动力学不稳定。众所周知，在经皮手术中胸腔积液后，心包穿刺术应用作腔的引流。然而,在某些情况下不能实现止血，在那些血流动力学不稳定的患者中，促进止血的密封剂可能是有用的，比如凝血酶.
方法：我们提供一例89岁有黑色素瘤病史的患者接受派姆单抗治疗的病例报告，他曾在急诊科就诊，指的是持续数小时的胸痛(强度5/10)和心悸。他有TnTU554/566ng/L和超声心动图显示右腔扩张，左心室肥大和整体运动减少，左心室充盈压增加和肺动脉高压。怀疑与pembrolizumab相关的心肌炎，所以开始使用高剂量类固醇并进行心内膜活检，导致医源性心脏填塞.为了确定疑似心肌炎的病因，进行了心内膜活检.不幸的是,术中出现并发症：胸腔积液导致医源性心包填塞，导致血流动力学不稳定。需要通过剑突下穿刺立即进行心包引流，获得550毫升血液借方。临床表现怀疑填塞，提示床边超声心动图进行明确诊断。尽管做出了这些努力,患者血流动力学仍然不稳定，由于手术风险增加,心包内凝血酶用于成功止血.
结论：心脏填塞是一种危及生命的疾病，有时可以通过医源性诱发，由于经皮干预。尽管关于这种治疗策略的证据有限，在经历医源性心脏压塞并伴有血流动力学不稳定和高手术风险的患者中，可以考虑给予心包内凝血酶.
方法：我们提供一例89岁有黑色素瘤病史的患者接受派姆单抗治疗的病例报告，他曾在急诊科就诊，指的是持续数小时的胸痛(强度5/10)和心悸。他有TnTU554/566ng/L和超声心动图显示右腔扩张，左心室肥大和整体运动减少，左心室充盈压增加和肺动脉高压。怀疑与pembrolizumab相关的心肌炎，所以开始使用高剂量类固醇并进行心内膜活检，导致医源性心脏填塞.为了确定疑似心肌炎的病因，进行了心内膜活检.不幸的是,术中出现并发症：胸腔积液导致医源性心包填塞，导致血流动力学不稳定。需要通过剑突下穿刺立即进行心包引流，获得550毫升血液借方。临床表现怀疑填塞，提示床边超声心动图进行明确诊断。尽管做出了这些努力,患者血流动力学仍然不稳定，由于手术风险增加,心包内凝血酶用于成功止血.
结论：心脏填塞是一种危及生命的疾病，有时可以通过医源性诱发，由于经皮干预。尽管关于这种治疗策略的证据有限，在经历医源性心脏压塞并伴有血流动力学不稳定和高手术风险的患者中，可以考虑给予心包内凝血酶.
