We describe the case of 89-year-old man who was treated in our hospital for anterior STEMI. Successful recanalization of the middle segment of the LAD with the implantation of one DES was performed within three hours of infarction onset. Several hours after admission patient developed a new paroxysm of atrial fibrillation. Control echocardiographic examination revealed a new onset of moderate pericardial effusion due to a covered rupture of the free wall of the left ventricle. The heart team recommended a conservative approach because of the very high perioperative risk.

Due to the gradual increase of pericardial effusion with circulatory compromitation an echo-guided pericardiocentesis was performed on the fourth day of hospitalization via an apical approach, with the aspiration of 400 ml of the blood. Because of persistent significant blood loss through the pericardial drain, the drain was repositioned toward the apex of the left ventricle (site of the rupture) and activated thrombin was sterilely applied intrapericardially with excellent immediate result.

After managing other related complications (renal failure without the need of  RRT, respiratory infection), the patient was discharged in a good condition to home care on the 20th day.

Two months after discharge, due to persistent atrial fibrillation, the antithrombotic medication was adjusted to clopidogrel and reduced-dose dabigatran. Eleven days later the patient developed a new cardiac tamponade requiring a second pericardiocentesis and coagulation factor i.v. substitution. After discontinuation of anticoagulation no further pericardial bleeding has occurred. 

During subsequent outpatient follow-ups the patient remains in good condition with no more episodes of a new pericardial effusion.

I am 47 years old and have been working at the cardiology clinic at St. Anna's University Hospital in Brno since 2002 and, since 2021, also at the Center for Cardiovascular and Transplant Surgery in Brno, Czech Republic. I am currently the head physician at the ICU. I specialize in intensive care, echocardiography, coronary and structural heart interventions, and mechanical cardiac support. I work with an excellent team of colleagues. My hobbies include sports in particular.