Letter to the Editor Uncommon presentation of postcardiac injury syndrome: Acute pericarditis after percutaneous coronary intervention Baris Gungor ⁎ , Ekrem Ucer, İzzet Celal Erdinler Dr. Siyami Ersek Thoracic and Cardiovascular Surgery Research and Training Hospital, Department of Cardiology, Istanbul, Turkey Received 16 February 2007; accepted 25 April 2007 Available online 16 August 2007 Abstract Postcardiac injury syndrome (PCIS) is a common complication after cardiac surgery and myocardial infarction which is defined as a late developing pleuropericarditis accompanied by a friction rub, elevated inflammation markers and pericardial or pleural effusion. Although almost all of the cases follow a major cardiac operation or myocardial infarction, and are called as postpericardiotomy syndrome (PPS) and postmyocardial infarction syndrome (PMIS), unusual presentations after minor cardiac insults, have also been reported in the literature. We have described an unusual case of PCIS with typical clinical, laboratory, echocardiographic findings that occurred after a prolonged and complicated stent implantation procedure. © 2007 Elsevier Ireland Ltd. All rights reserved. Keywords: Postcardiac injury syndrome; Pericarditis; Percutaneous coronary intervention 1. Introduction Postcardiac injury syndrome (PCIS) is a frequent clinical entity developing as a complication of cardiac surgery and myocardial infarction which is also named as postpericardiot- omy syndrome and Dresslers's syndrome. The syndrome includes pleuritic chest pain, low-grade fever, elevated inflammation markers and pericardial and/or pleural effusion [1]. Though late forms of PCIS after cardiac surgery are well recognized, there also exists rare cases of early PCIS developed after minor cardiac procedures. Herein, we report a case of early PCIS complicating percutaneous coronary intervention. 2. Case presentation A fifty-four years old male patient was referred to our institution for percutaneous revascularization of two coro- nary artery lesions. He had been suffering from anginal chest pain of grade 2 according to the Canadian Cardiovascular Surgeons Classification for the last two months. His medical history was unremarkable except for an untreated dyslipide- mia. The findings on the physical examination and blood tests on admission were normal. Subsequently the patient was pretreated with aspirin 300 mg, clopidogrel 300 mg and enoxaparin 80 mg. The coronary angiogram revealed two critical lesions affecting the middle segment of the anterior descending artery and the proximal segment of the first diagonal artery. And also, a sharp angulation over 90° where the left main coronary artery bifurcates and continues as left anterior descending was noticed. A 2.5 × 13 mm sirolimus eluting stent (CYPHER®, Johnson & Johnson, Cordis Corp. Cordis Europa NV) was deployed to the diagonal artery. The prementioned angulation of the artery and poor back-up of the guiding catheters made the passage of the 3.0 × 18 mm stent into the descending artery impossible. This condition necessitated deep intubation of LAD with left Judkins catheter by which direct stent deployment with an inflation pressure of 12 atm was performed successfully. TIMI grade III flow was established without any vascular complications like dissection or rupture after this 2 h lasting prolonged and complicated procedure (Fig. 1). Bedside transthoracic echocardiography performed immediately after the proce- dure showed normal left ventricular function and no International Journal of Cardiology 128 (2008) e19 – e21 www.elsevier.com/locate/ijcard ⁎ Corresponding author. Selamiali Mah. Yeniocak Sok., No: 2/3 PK: 34664, Uskudar/Istanbul Turkey. Tel.: +90 216 3347068, +90 532 3064063 (Gsm); fax: +90 216 4592766. E-mail address: drbarisgungor@gmail.com (B. Gungor). 0167-5273/$ - see front matter © 2007 Elsevier Ireland Ltd. All rights reserved. doi:10.1016/j.ijcard.2007.04.159