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When Pericarditis Saves a Life: Surgical Management of a Ventricular Pseudoaneurysm
Session:
CASOS CLÍNICOS DE INTERVENÇÃO (PERCUTÂNEA E CIRÚRGICA)
Speaker:
Catarina Novo
Congress:
CPC 2025
Topic:
H. Interventional Cardiology and Cardiovascular Surgery
Theme:
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Subtheme:
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Session Type:
Sessão de Casos Clínicos
FP Number:
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Authors:
Catarina Relvas Novo; Mariana Campos; Belisa Gomes; João Pedro Monteiro; Rodolfo Pereira; Nelson Santos; Paulo Neves
Abstract
<p><span style="font-size:8.5pt"><span style="font-family:Arial,sans-serif"><span style="color:#000000">This case report describes a 70-year-old man admitted to the emergency department for cardiorespiratory arrest. After two cycles of advanced life support and emergent drainage of a hematic pericardial effusion, suspected to be the cause of cardiac tamponade, spontaneous circulation was restored. The patient was stabilized and transferred to the intensive care unit (ICU), where he was treated for multidrug-resistant pneumonia and required invasive ventilation for nine days. Serial transthoracic echocardiograms revealed a persistent pericardial effusion, diagnosed as pericarditis, leading to the initiation of corticosteroid therapy.</span></span></span></p> <p><span style="font-size:8.5pt"><span style="font-family:Arial,sans-serif"><span style="color:#000000">On day 11, the patient was clinically stable and transferred to the cardiology ward for further evaluation. A computed tomography (CT) scan unexpectedly identified a pseudoaneurysm of the right ventricle, prompting urgent surgical intervention. During surgery, adhesive pericarditis was noted. Dissection and anterior pericardiotomy revealed a pseudoaneurysm on the inferior surface of the right ventricle, surrounded by clots. The pseudoaneurysm’s neck, measuring less than 1 cm in diameter, was successfully excluded using a simple suture reinforced with double Teflon pledgets.</span></span></span></p> <p><span style="font-size:8.5pt"><span style="font-family:Arial,sans-serif"><span style="color:#000000">Surgery mitigated the risk of rupture and provided insights into the case. It is hypothesized that the ventricular pseudoaneurysm resulted from inadvertent perforation during pericardiocentesis, with preexisting adhesions containing the injury and preventing hemorrhage. Although the pericardial effusion’s role in the cardiac arrest remains uncertain, the associated inflammatory response likely averted catastrophic bleeding</span></span></span></p>
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