Heart Stent Patient Experiences Pericardial Effusion at 68 – Combined Surgical and Medication Approach Delivers Positive Results
In the medical field, unexpected complications can arise even after routine procedures. This case study follows a 68-year-old male patient who, despite undergoing previous cardiac interventions, faced a new challenge—pericardial effusion following a heart stent procedure. Through a combination of timely surgical intervention and targeted medication therapy, the patient achieved a successful recovery.
Case Overview
Patient: Male, 68 years old
Condition: Pericardial effusion following coronary intervention
Hospital: Shandong Third Provincial Hospital
Admission Date: December 2021
Treatment: Pericardiocentesis with catheter drainage + medication therapy
Duration: Hospital stay of 6 days, followed by regular outpatient follow-ups
Outcome: Complete symptom relief and stable recovery
Initial Consultation
In December 2021, the patient presented at the outpatient clinic complaining of recurring chest tightness and pain. He described episodes lasting several minutes, partially relieved by nitroglycerin spray and sublingual medications. Despite being on a regimen of aspirin, ticagrelor, metoprolol, and rosuvastatin, his symptoms persisted. His medical history revealed a complex coronary artery disease background, including triple-vessel disease and left main stem involvement.
Two years prior, he had undergone two separate stent placements—first in the right coronary artery with four stents, and later in the circumflex and intermediate branches. During the most recent hospitalization, a repeat coronary angiogram was planned to assess the chronic total occlusion (CTO) in the left anterior descending artery (LAD), with the goal of revascularization.
Initial tests, including blood work and echocardiography, showed normal cardiac enzyme levels and a left ventricular ejection fraction (LVEF) of 45%. Mild aortic regurgitation and small pericardial effusion were noted, but no immediate concern was raised.
Treatment Process
Coronary Angiography Attempt
On the third day of hospitalization, coronary angiography was performed. The previously implanted stents in the circumflex and intermediate branches remained patent, while the right coronary artery showed mild in-stent stenosis. However, the LAD remained occluded. A percutaneous coronary intervention (PCI) was initiated to open the occlusion.
Despite using a Fielder XT guidewire and multiple microcatheter techniques, the interventional team was unable to cross the occlusion. Various other wires and balloons were attempted over a four-hour period, but without success. Post-procedure, the patient developed signs of hemodynamic instability—chest discomfort, diaphoresis, hypotension, and bradycardia—prompting suspicion of cardiac tamponade.
Diagnosis and Intervention
An urgent echocardiogram confirmed moderate pericardial effusion, raising concerns of a coronary perforation. A pericardiocentesis was immediately performed via a subxiphoid approach under ultrasound guidance. Approximately 50 ml of bloody pericardial fluid was drained, and a drainage catheter was left in place.
Following the procedure, the patient's vital signs stabilized. His medication regimen was adjusted to include sacubitril/valsartan, isosorbide mononitrate, nicorandil, and dapagliflozin, which were continued for three days before discharge.
Recovery and Follow-Up
At discharge, the patient was advised to return for follow-up visits at two weeks, one month, three months, and six months. He adhered well to the schedule.
At the two-week mark, echocardiography showed a marked reduction in pericardial effusion, with LVEF improving to 46%. By the three-month visit, LVEF had further improved to 48%, and no significant fluid accumulation was observed. The patient reported no chest discomfort and resumed normal daily activities without limitations.
Post-Operative Care Recommendations
To ensure a full recovery, the patient was advised to:
- Maintain cleanliness around the puncture site
- Avoid bathing or strenuous activity until complete healing
- Follow a heart-healthy diet, avoiding spicy or irritating foods
- Continue prescribed medications and attend all follow-up appointments
Clinical Insights
This case highlights the importance of prompt diagnosis and intervention in managing post-procedural complications. Patients with a history of coronary artery disease, especially those with comorbidities such as diabetes and hypertension, are at increased risk of multi-vessel disease and procedural complications.
While percutaneous interventions carry inherent risks, early detection and appropriate management—such as timely echocardiography and pericardiocentesis—can significantly improve outcomes. With proper care and follow-up, patients can achieve full recovery and maintain a good quality of life.