Recurrent Pleuropericardial Effusions Following Amplatzer Amulet Left Atrial Appendage Occlusion: A Case of Post-Cardiac Injury Syndrome

Post-cardiac injury syndrome (PCIS) is an inflammatory pleuropericardial syndrome that may follow myocardial, pericardial, or iatrogenic cardiac injury.Although pericardial effusion is a recognized complication of left atrial appendage occlusion (LAAO), recurrent pleuropericardial inflammation after LAAO is less commonly described.We report a patient with persistent atrial fibrillation who underwent uncomplicated LAAO with a 28-mm Amplatzer Amulet device (Abbott Medical, Plymouth, MN, USA) following a recent hemorrhagic stroke.Post-implantation transesophageal echocardiography demonstrated appropriate device positioning without peridevice leak or pericardial effusion.Within two weeks, the patient developed chest pain, dyspnea, electrocardiographic ST-segment elevations, markedly elevated CRP, and a large hemorrhagic pericardial effusion with tamponade requiring drainage of 780 mL of frank blood.The subsequent course was characterized by recurrent unilateral left exudative pleural effusions requiring repeated thoracenteses and chest tube drainage, followed by recurrence of both pleural and pericardial effusions.Serial microbiologic and cytologic studies were negative, and imaging demonstrated no evidence of malignancy.Colchicine was discontinued following an interval hospitalization, after which pleuropericardial effusions and systemic inflammation recurred.Following pleural drainage and reinitiation of colchicine, CRP declined from 87.8 mg/L (<8 mg/L) to 22.5 mg/L (<8 mg/L), respiratory symptoms resolved, and the patient was discharged home on room air.The temporal relationship to LAAO, recurrent pleuropericardial involvement, inflammatory response, exclusion of alternative etiologies, and clinical course were consistent with PCIS.This case highlights PCIS as an important consideration in patients presenting with recurrent pleural or pericardial effusions after LAAO while emphasizing the need to exclude mechanical device complications.