ABSTRACT
Nickel allergy was detected in approximately 15% of the population.
Despite this rate, very few patients developed symptoms related to
nickel allergy after cardiac device insertion. In this case report,
pericardial effusion due to nickel allergy that develops after the
insertion of Atrial Septal Defect (ASD) device is described. The patient
was discharged with ibuprofen. In some cases, dramatic conditions up to
the tampon after effusion may develop. These patients responded to
high-dose steroid; however, devastating side effects developed. However,
more detailed and comprehensive advanced research is needed on this
subject.
1-INTRODUCTIONNickel allergy was detected in approximately 15% of the population.
Despite this rate, very few patients developed symptoms related to
nickel allergy after cardiac device insertion. This phenomenon is not
clearly understood. However, most authors report that these devices can
still be used safely. Most patients present with nonspecific symptoms
such as chest pain and palpitations. Amplatzer septal ocluder, usually
containing nickel from cardiac devices in patients. It responds to
anti-inflammatory therapy.
In this case presentation, nickel allergy developed after attachment of
Atrial Septal Defect (ASD) device; we will describe the diagnosis,
follow-up and treatment of the patient with pericardial effusion.2-CASE PRESENTATIONA 43-year-old female patient has no known chronic diseases. She has had
shortness of breath and fatigue for a long time. The patient who applied
to the cardiology outpatient clinic; physical examination FINDINGS:
systolic murmur, fixed s2 mating ECG: right bundle branch, laboratory
parameters were in the normal range. Echocardiography (ECHO): Ef: 65%,
secundum asd (25 mm diameter defect), dilation in the right heart
cavities (pasp: 45). Transesophageal echocardiogram (TEE) findings:
secundum asd (24 mm defect) (figure 1,2,3). Asd was decided to be closed
percutaneously with the device.Device was found to be properly placed.
(figure 4,5 ) No pathological transition was observed with TEE. There
was no complication.
The patient came for control 1 month later. The physical examination
findings of the patient were normal. In the control echo there was no
transition in the closing device in ias. Pericardial effusion was
observed in the posterior wall of 0.4 cm and in the right ventricle, 0.7
cm. In the tee, the effusion was observed next to the right atrium. It
was observed that the device did not erode the atrium wall. (figure
6,7). In the control echoes of the patient, it was determined that
effusion regressed and there was no deterioration in his clinic. The
patient was discharged with ibuprofen 800 mg 1 * 1.3-DISCUSSION AND CONCLUSIONIn some cases, dramatic conditions up to the tampon after effusion may
develop. These patients responded to high-dose steroid; however,
devastating side effects developed (in one case, high-dose
steroid-related sepsis and death have been reported).As the current
clinical condition of our patient is stable, we did not consider high
dose steroid treatment considering the existing side effects. However,
more detailed and comprehensive advanced research is needed on this
subject.Keywords: Nickel allergy, Atrial
septal defect closure device, Amplatzer device