Ann Thorac Surg 2007;84:1074
© 2007 The Society of Thoracic Surgeons
Correspondence
Tuberculous Pericarditis After Coronary Artery Bypass Graft
Mohammed W. Khalil, FRCSa,
Pradip K. Sarkar, FRCSb
a Department of Cardiothoracic Surgery, Nottingham City Hospital, Nottingham, NG5 1PB United Kingdom
b Department of Cardiothoracic Surgery, Northern General Hospital, Sheffield, S5 7AU United Kingdom
(Email: wesam{at}doctor.com; sarkarp2000{at}yahoo.co.uk).
To the Editor:
We read with interest Tuladhar and colleagues’ [1] article describing the case of tuberculous (TB) pericardial effusion after coronary artery bypass grafting in a 47-year-old Asian. We would like to reiterate this phenomenon by indicating that we did publish an article in July 2006 describing the same type of case in a 75-year old Asian who underwent coronary artery bypass grafting in our center [2]. In our case report, we emphasized the rapidity at which it occurred after the surgery, as well as the fact that it was fatal, despite a pericardiectomy after constrictive pericarditis developed. Our patient died 6 weeks postcoronary artery bypass grafting.
Similar to the case reported by Tuladhar and colleagues [1], our patient had no symptoms of TB at initial presentation and none of the tests suggested that he had any. There was also no clear history of TB in the past, except a strong Heaf test reaction approximately 20 years prior, which suggested a previous infection or exposure to the mycobacterium at that time. We did not start our patient on anti-TB treatment until late, as we did not have a high index of suspicion, because as we also indicated in our article, no report of TB reactivation after heart surgery was previously reported.
Therefore we agree with the authors that in Asian patients who come from areas endemic of TB, even in the absence of constitutional symptoms, a recurrent pericardial effusion following coronary artery bypass grafting may warrant empirical anti-TB treatment until tests proving or disproving the diagnosis are finalized.
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References
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- Tuladhar SM, Noursadeghi M, Boyle JJ, Friedland JS, Hornick P. Tuberculous pericardial effusion after coronary artery bypass graft Ann Thorac Surg 2006;82:1519-1521.[Abstract/Free Full Text]
- Khalil M, Grech E, Mohammed AI, Cooper G, Sarkar P. Rapid Development of fatal TB constrictive pericarditis after cardiac surgery J Card Surg 2006;21:417.[Medline]
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