Background

Pneumopericardium is a rare air-leak syndrome caused by abnormal presence of air in the pericardial space, with potentially high risk of morbidity and mortality. Clinically, it can be divided in non-tension and tension pneumopericardium, the latter resulting in a decreased cardiac output and circulatory failure. Scant data are available on non-traumatic tension pneumopericardium in non-ventilated patients.

Objectives

To describe a case of tension pneumopericardium and review the pertinent literature.

Methods

Case report and review of the literature (Pubmed search) of non-traumatic and non-ventilated pneumopericardium in children.

Results

Case: A 2-month-old infant developed cardiac tamponade due to tension pneumopericardium 11 days after cardiac surgery. The prompt treatment with pericardium drainage resolved the critical clinical conditions.

Literature review: 55 cases of pneumopericardium retrieved, a minority of which were tension pneumopericardium (17/55, 30.9%). Patients with tension pneumopericardium were predominantly males 12/16 (75.0%) with a mean age of 4.8 years. Most of the patients with non-tension pneumopericardium were children (21/38, 55.3%); patients with tension pneumopericardium were mainly newborns (6/17, 35.3%). The etiologies are reported in Figure 1. Conservative treatment was performed in all cases of non-tension pneumopericardium and pericardiocentesis in all other cases. Overall, the majority of the patients survived (41/51, 80.3%); with a lower survival rate among patients with tension pneumopericardium (62.5% vs 88.6%).

Conclusion

Pneumopericardium is a rare condition with a higher mortality rate in patients with tension pneumopericardium which requires immediate diagnosis and treatment. In non-ventilated patients tension pneumopericardium presents in younger ages, especially in patients with a history of surgery and leukemia.

Background

Background. Neuro-cognitive deficits affect nearly 50% of children with complex congenital heart diseases (CHD). Newly acquired brain injury in CHD children affect 30% postoperatively.

Objectives

Objective. We determined GFAP levels during surgery and for the first 24h after surgery to find out the pivotal timepoint of brain injury during the perioperative period of CHD surgeries.

Methods

Methods. We studied 43 children: 9 univentricular physiology (UNIV); 16 septal defects (SD); 5 transpositions of the great arteries (TGA), 4 tetralogies of Fallot (TOF), and 9 surgical controls. GFAP was measured by ELISA during surgeries and intensive care stay.

Results

Results. In controls, mean GFAP (ng/ml) before, after at least 30 min from anesthesia induction, and after surgery were 0.14 ± 0.05, 0.13 ± 0.05, 0.16 ± 0.07, respectively. In CHD patients all GFAP levels collected during intensive care stay were significantly lower than the maximum GFAP level recorded during cardiopulmonary bypass (CPB): at 6h 0.26 ± 0.16; 12h 0.25 ± 0.16; 24h 0.27 ± 0.17 vs. the maximum GFAP 1.69 ± 1.74 during surgery (p<0.001, Wilcoxon Signed Rank Test). There were no GFAP differences between time points in all children. In 10% of the intensive care samples (4 patients: 1 SD, 1 TOF, 2 UNIV), GFAP reached the supposed cut-off for clinical evidence of brain injury (0.46 ng/ml).

Conclusion

Conclusions. The highest GFAP values were recorded during the CPB run at the end of rewarming rather than in the early post-operative phase. Neurodevelopmental studies are ongoing to correlate GFAP levels to children outcome.