Browsing by Author "Ilic, I. (57210906813)"

Background: Pericardiocentesis is both therapeutic and diagnostic invasive procedure, guided by echocardiography and/or angiography. It can be done using subcostal or apical approach. One of the major complications of pericardiocentesis is coronary artery laceration with an incidence of less than 1%. Diagnosis of such lacerations is often made by invasive coronary angiography or urgent thoracotomy. Computed tomography angiography is used to determine the extent of bleeding and hemopericardium, but its potential for detailed evaluation of bleeding site is somewhat underestimated. Case presentation: We present a rare case of distal obtuse marginal (OM) artery perforation resulting from apical pericardiocentesis that was diagnosed with CT angiography (CTA) further treated with coronary guidewire particle embolization. A 49-year-old male patient who had undergone ascending aorta and aortic arch reconstruction after an aortic dissection Type A was evaluated with echocardiography before being discharged from our hospital. A loculated pericardial effusion was identified, necessitating pericardiocentesis. The clinical course was further complicated by hemopericardium due to coronary laceration. The hemorrhage was managed with coronary guidewire segment embolization which led to immediate improvement in hemodynamic status. The patient was discharged seven days after intervention. Conclusion: Coronary artery perforation is a rare, albeit life-threatening complication of pericardiocentesis that requires urgent surgical or percutaneous intervention. CTA can provide important diagnostic information on perforation location and help in deciding whether embolization or open-heart surgery is needed to address ongoing bleeding. 2025 Ostojic, Antonic and Ilic.

Background: There is a common assumption that patients with coronary slow flow (CSF) have an excellent prognosis in the absence of coronary artery stenoses. Little is known about whether a history of previous coronary events affects the long-term survival in this population. In this retrospective, observational study, we assessed the possible association of a previous coronary event and long-term prognosis in patients with CSF but without significant coronary artery stenoses. Methods: A total of 141 patients (70 male; median age: 59 years, range: 33–78 years) with CSF and normal coronary angiograms were included in the study. Patients were followed up for all-cause mortality during a period of 47 ± 22 months. Results: Previous myocardial infarction (MI) was reported by 16 (11%) patients who had similar left ventricular ejection fraction (LVEF) as those without previous MI (51 ± 16 vs. 53 ± 16%, p = 0.595). Patients with previous MI more often had an abnormal resting electrocardiogram (69 vs. 40%, p = 0.03), while there were no significant differences in other baseline clinical characteristics (p > 0.05 for age, gender, risk factors, pharmacological treatment). In univariate Cox analysis, only previous MI was associated with unfavorable long-term survival (log-rank p = 0.012), while an abnormal electrocardiogram, LVEF, and other clinical variables were not (log-rank p > 0.05, for all). Kaplan–Meier analysis revealed unfavorable long-term survival in patients with CSF and a history of previous MI. Conclusion: In patients with CSF and an otherwise normal coronary angiogram, a history of a previous MI is associated with unfavorable long-term outcomes. © 2019, Springer Medizin Verlag GmbH, ein Teil von Springer Nature.