Title : An Uncommon case of pericarditis after transcatheter aortic valve replacement: The first reported case in Korea
Abstract:
Although transcatheter aortic valve replacement (TAVR) has become a favorable option for severe aortic stenosis in older patients, post-procedural complications still exist. Commonly known complications include paravalvular leakage, vascular injury, stroke, and conduction abnormalities. There have also been rare reports of pericarditis from post-cardiac injury syndrome (PCIS) after TAVR. PCIS is associated with cardiac surgery or trauma, and it has been speculated that certain immune complexes deposit on the pleura and pericardium inducing inflammation. Previous reports state female sex or a history of coagulopathy as possible risk factors for development of post-TAVR PCIS, but these risk factors still need to be studied.
We report a case of an 84-year-old Asian female who developed pericarditis immediately after TAVR. The patient’s chief complaint was dyspnea and chest pain that developed three days after the procedure. Lab showed an increased CRP level of 10.7mg/dl, and elevated troponin of 669pg/mL with normal CK-MB levels. Initial echocardiogram showed minimal amount of pericardial effusion, but serial echocardiographic follow-up showed a significantly increased amount of pericardial effusion (Figure 1).
Under the impression of pericarditis due to postcardiac injury syndrome, she was initially treated with an NSAID, ibuprofen 600mg three times a day, and colchicine 0.6mg once a day. However, due to refractory symptoms, a high dose steroid of 0.5mg/kg per day of prednisone was initiated and the patient described progressive relief of symptoms. Prednisone was slowly tapered over weeks. Five months after discharge, the patient’s CRP, cardiac enzyme and NT pro BNP levels had normalized. Chest x-ray showed no pleural effusion. Echocardiogram showed resolved pericardial effusion, but remaining constrictive physiology that was to be followed up on an outpatient basis. In patients with chest pain and fever, post-TAVR PCIS should be a mandatory differential diagnosis, and detection of pericardial effusion by echocardiography may be essential in making the diagnosis.
