Llubani Redi, Böhm Michael, Imazio Massimo, Fries Peter, Khreish Fadi, Kindermann Ingrid
Department for Internal Medicine III, Cardiology, Angiology and Intensive Care Medicine, Saarland University Medical Center, Homburg, Germany.
Department of Medical Sciences, University Cardiology, AOU Città della Salute e della Scienza di Torino and University of Torino, Torino, Italy.
Eur Heart J Case Rep. 2018 Sep 28;2(4):yty107. doi: 10.1093/ehjcr/yty107. eCollection 2018 Dec.
Post-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.
A 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.
To 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.
心脏损伤后综合征是一种继发性心包炎，可伴有或不伴有心包积液，通常发生在心脏或心包损伤后的数周或数月。疾病活动情况可通过对炎症标志物（如C反应蛋白（CRP）和/或血沉）、心电图及超声心动图进行系列检测来跟踪。
一名79岁女性因胸痛、静息时呼吸困难、咳嗽及低热入院。该患者在入院前6个月接受了经导管主动脉瓣植入术（TAVI）。炎症标志物升高，胸部X线和计算机断层扫描（CT）显示左侧有少量胸腔积液。基于急性支气管炎的推测，开始了经验性抗生素治疗及使用布洛芬控制胸痛。尽管采用了15天不同的抗生素治疗方案，但炎症标志物仍持续升高。正电子发射断层扫描计算机断层显像及心脏磁共振成像显示有无菌性心包炎的迹象。在排除了任何感染性、代谢性、药物性或肿瘤性病因后，我们考虑诊断为迟发性自身免疫介导的心包炎。随后，立即开始使用秋水仙碱和泼尼松进行治疗。患者在接下来的几天里报告临床症状有所改善，CRP值持续下降。
据我们所知，这是首例TAVI术后心脏损伤后综合征的报道病例。对于TAVI术后出现持续胸痛、发热、疲劳及炎症标志物升高的患者，即使可能在干预数周或数月后发生，也应考虑该病。对于持续症状可采用秋水仙碱、布洛芬和低剂量类固醇的三联疗法。
