Jiang Qin, Yu Tao, Huang Keli, Huang Bing, Huang Xiang, Hu Shengshou
Department 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.
Department of Neurology, Sichuan Provincial People's Hospital, Chengdu, China.
Int J Emerg Med. 2024 Oct 11;17(1):156. doi: 10.1186/s12245-024-00729-8.
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.
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.
The protocol of prompt aggressive anticoagulation prophylaxis would be vigilantly recommended for the patients undergoing pericardiectomy.
因缩窄性心包炎进行心包切除术通常是安全的手术。心包切除术后发生血栓形成的情况罕见，主要由低心排血量综合征引起。
在此，我们报告一例缩窄性心包炎后接受心包切除术的病例，经血管内机械取栓术证实心包切除术后发生致命性脑血栓形成。尽管再通已完成且准备进行减压性颅骨切除术，但患者仍因严重水肿导致脑疝死亡。该病例心包切除术后脑血栓形成的原因是包裹左心室壁的坚韧心包持续存在限制了局部心肌运动，在术后房颤和快速心室率的情况下，像射频消融一样的心包剥脱术中的热传递导致促凝状态，促使心腔内形成壁血栓并迁移至主动脉弓主要分支。
对于接受心包切除术的患者，强烈建议采取积极的抗凝预防方案。
