What is your next step? A case of large pericardial effusion during pregnancy

Excerpt

A 35-year-old female patient with a known, stable severe pericardial effusion came to our pericardial disease outpatient clinic for disease management during pregnancy. Patient’s medical history was significant for atrial septal defect correction with heterologous patch pericardium at age 18, complicated by asymptomatic pericardial effusion 2 weeks after surgery, resolved in 3 months. In the following years, moderate (10–20 mm tele-diastolic size) asymptomatic pericardial effusion relapsed and was managed conservatively. No specific etiology was found. At the age of 30, the pericardial effusion became severe (> 20 mm), basically asymptomatic and 1400 cc of pericardial fluid was drained in another center. C-reactive protein (CRP), viral serology, autoimmunity markers, and IgA anti-tissue transglutaminase as well as ECG were normal. After pericardiocentesis, the effusion recurred, remaining stable (> 20 mm) and asymptomatic. Even without a clear pericarditis picture, colchicine, aspirin, and then steroids were started in the woman’s original center. In the next 5 years, the patient was followed in our center, and the therapy was gradually tapered, in the context of absence of clinical or laboratory signs of active pericarditis, to prednisone 2.5 mg die, colchicine 0.5 mg die and aspirin 500 mg bid. Effusion remained stable and asymptomatic. Upon evaluation at the end of the fourth month of pregnancy, the pericardial effusion was very severe (40 mm), without clinical or echocardiographic signs of tamponade. Inflammatory markers, thyroid function, and fetal growth were normal. Patient body weight at the end the first trimester was 58 kg. The ongoing therapy comprehended prednisone 2.5 mg die, colchicine 0.5 mg die, and aspirin 500 mg bid. …