Israel Medical Association Journal

Pleural effusion is a common finding after coronary bypass graft surgery. Rarely, patients may develop loculated effusions, which may potentially lead to cardiac chamber compression. We report a rare case of loculated right pleural effusion (LRPE) that resulted in right atrial compression, leading to cardiac tamponade physiology, which resolved completely after emergent surgical drainage of the pleural effusion. This case underscores the need for early implementation of echocardiography in the postoperative management of hemodynamically unstable patients following cardiac surgery.

Late arrival ST-segment elevation myocardial infarction (STEMI) is defined as a patient-related delay > 12 hours. It is estimated to represent a significant portion of STEMI patients. As reflected by society guidelines, this group of patients impose great therapeutic challenge, namely due to controversy in the literature regarding optimal care, together with major adverse clinical outcomes [1]. In addition to a possible myocardial infarction (MI), mechanical complications include ventricular septal defect (VSD), left ventricular (LV) free wall, or papillary muscle rupture. Prompt diagnosis and intervention are crucial to improve outcomes as post-infarction ventricular septal defect (PIVSD) carries a high mortality rate. We describe the successful management of a large VSD complicated by cardiogenic shock in a latecomer STEMI patient with complex coronary artery disease (CAD).