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Gorton AJ, Keshavamurthy S, Lowry C, Sekela ME. Caught in the Act: A Recurrent Tamponade After Coronary Artery Bypass Grafting With Culprit Lesion Identified on Computed Tomography Angiogram. Cureus 2023; 15:e49278. [PMID: 38143632 PMCID: PMC10746957 DOI: 10.7759/cureus.49278] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/22/2023] [Indexed: 12/26/2023] Open
Abstract
Delayed cardiac tamponade after cardiac surgery is a rare complication with significant diagnostic challenges. The recurrence of cardiac tamponade physiology after initial intervention creates another degree of difficulty in the management of already medically complex patients. We present the case of a 65-year-old male who underwent four-vessel coronary artery bypass grafting that was complicated by the delayed presentation of cardiac tamponade requiring mediastinal exploration. Following this he developed a recurrence of cardiac tamponade with bleeding from a vein graft identified on multiphase spiral computed tomography angiography.
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Affiliation(s)
- Andrew J Gorton
- Department of Surgery, Division of Cardiothoracic Surgery, University of Kentucky, Lexington, USA
| | - Suresh Keshavamurthy
- Department of Surgery, Division of Cardiothoracic Surgery, University of Kentucky, Lexington, USA
| | - Conor Lowry
- Department of Radiology, University of Kentucky, Lexington, USA
| | - Michael E Sekela
- Department of Surgery, Division of Cardiothoracic Surgery, University of Kentucky, Lexington, USA
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Abstract
BACKGROUND Pericardial effusions resulting in cardiac tamponade (CT) are uncommon after open heart surgery (OHS) and are associated with significant morbidity and mortality. Characteristics and outcomes of patients who develop postoperative CT are poorly defined. Our objective was to further analyze the population at risk for developing postoperative CT, identify potential perioperative and surgical risk factors, and evaluate the impact of CT on patient outcomes. METHODS A retrospective analysis of 4,561 consecutive patients undergoing OHS at our institution was performed. Patients with clinical suspicion of pericardial effusion following surgery were evaluated by transthoracic or transesophageal echocardiography, and clinical parameters were analyzed. RESULTS Forty-eight (1%) of the 4,561 patients were found to have echocardiographic evidence of a moderate or large pericardial effusion, of whom 36 (74%) had evidence of CT. The mean age of the patients with CT was 61 years. Coronary artery bypass grafting (CABG) had been performed in 24% of these patients, valve +/- CABG in 73%, and other OHS procedures in 3%. The incidence of CT following CABG alone was 0.2%, whereas it was 0.6% after valve +/- CABG. Females had a higher risk for developing CT, and this occurred earlier in the postoperative period when compared with men. Aspirin, heparin, or warfarin were given to 84% of patients within 3 days of surgery. Mean time to diagnosis of CT was 10 +/- 1 days after OHS. Prior to diagnosis of CT, the maximum international normalized ratio (INR) and partial thromboplastin time (PTT) were 2.7 +/- 0.3 and 68 +/- 5 seconds, respectively. Forty-nine percent of pericardial effusions were posterior and 46% were circumferential; one-third of the effusions were considered large by echocardiography. There was one in-hospital cardiovascular death. CONCLUSIONS CT after OHS is more common following valve surgery than CABG alone and may be related to the preoperative use of anticoagulants. Females appear to be at higher risk for developing early postoperative CT. When diagnosed and treated promptly, postoperative CT should not significantly increase mortality.
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Affiliation(s)
- Jeffrey T Kuvin
- Department of Medicine, Tufts New England Medical Center Hospitals, Tufts University School of Medicine, Boston, Massachusetts 02111, USA
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Mangi AA, Palacios IF, Torchiana DF. Catheter pericardiocentesis for delayed tamponade after cardiac valve operation. Ann Thorac Surg 2002; 73:1479-83. [PMID: 12022536 DOI: 10.1016/s0003-4975(02)03495-1] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
BACKGROUND Late tamponade is a rare cause of morbidity and mortality after cardiac valve operation. We describe our recent experience with this entity. METHODS This is a single institution, procedure-matched, retrospective review of patients undergoing pericardiocentesis more than 7 days after cardiac operation, during a 7-year period. RESULTS Pericardiocentesis for delayed tamponade was performed in 43 of 9,612 patients. Although isolated valve operation accounted for 17% of all patients overall, 76% of patients undergoing pericardiocentesis (33 of 43) had undergone isolated valve operation. The average age in this group was 58 years, compared to an average of 68 years in all patients. Patients presented with tamponade an average of 18 days after operation. Positive predictors included elevated prothrombin time on presentation. Of the patient cohort 75% presented with dyspnea, 61% with inability to diurese, and 61% with hypotension. Echocardiography detected effusions in all patients, but specific echocardiographic signs of tamponade were present in only 30%. Of the patients, 97% were successfully treated by pericardiocentesis. All were safely restarted on warfarin. One patient required pericardial window. CONCLUSIONS Delayed cardiac tamponade is more common after isolated valve operation, as opposed to coronary artery bypass grafting and valve/coronary artery bypass grafting. It tends to occur in the third postoperative week in younger patients who are aggressively anticoagulated. Pericardiocentesis with catheter placement is highly effective, and patients can be reanticoagulated safely. This series underestimates the incidence of late tamponade, as some patients may present to outside facilities. The diagnosis is aided by a high degree of suspicion.
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Affiliation(s)
- Abeel A Mangi
- Division of Cardiac Surgery, Massachusetts General Hospital, Harvard Medical School, Boston 02114, USA
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4
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García Fuster R, Llorens R, Melero JM, Barba J, di Stefano S, Legarra JJ, Alegría E. [Pericardial hematoma 2 years after coronary surgery]. Rev Esp Cardiol 1997; 50:58-61. [PMID: 9053948 DOI: 10.1016/s0300-8932(97)73177-4] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
Cardiac tamponade is a life-threatening complication after cardiac surgery which may develop in the early or late postoperative period. The latest have been defined arbitrarily as the ones occurring after the 7th postoperative day. They are less common than the early ones and most of the cases have been reported up to six months after the operation. They usually determine diagnostic difficulties that can negatively influence the prognosis. Because of its atypical late appearance, a case of a 65 year old man is presented who developed a postpericardiotomy syndrome and subsequently a pericardial clot nearly two years after aortocoronary bypass grafting.
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Affiliation(s)
- R García Fuster
- Servicio de Cirugía Cardiovascular, Clínica Universitaria, Facultad de Medicina, Universidad de Navarra
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5
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Abstract
Cardiac tamponade following open heart surgery is well described, although, fortunately, uncommon. Unlike more classical "primary" tamponade, the clinical features are not specific, and this can delay diagnosis. In practice, the threshold for investigation must be low, and echocardiography has been invaluable in the detection and localization of pericardial collections. Several factors are believed to contribute to the likelihood of postoperative tamponade, but the mechanisms are not clearly understood. Resternotomy, under general anesthesia, or subxiphoid pericardiotomy, under local or general anesthesia, are effective forms of treatment. However, recent success with the use of percutaneous pericardiocentesis under echocardiographic guidance has shown that postoperative tamponade can be treated safely and effectively by this method.
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Affiliation(s)
- J B Ball
- The Cardiothoracic Centre--Liverpool NHS Trust, Liverpool, UK
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Russo AM, O'Connor WH, Waxman HL. Atypical presentations and echocardiographic findings in patients with cardiac tamponade occurring early and late after cardiac surgery. Chest 1993; 104:71-8. [PMID: 8325120 DOI: 10.1378/chest.104.1.71] [Citation(s) in RCA: 94] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/29/2023] Open
Abstract
Cardiac tamponade, a potentially lethal complication following cardiac surgery, may present either early or late postoperatively and may be difficult to diagnose due to atypical clinical, hemodynamic, or echocardiographic findings. To determine the frequency and clinical features of postoperative cardiac tamponade, we performed a review of 510 consecutive patients who underwent cardiac surgery. The incidence of postoperative cardiac tamponade was 2.0 percent (10/510 patients) and occurred following valvular, bypass, and aortic surgery. Nine of ten patients had either atypical clinical, hemodynamic, and/or echocardiographic findings. The diagnosis of tamponade was made 1 to 30 days (mean = 8.5 days) postoperatively. Presenting symptoms were often mild and nonspecific. Classic signs including hypotension, pulsus paradoxus greater than 12 mm Hg, and elevated jugular venous pressure were present in 7, 6, and 5 patients, respectively. Right heart hemodynamics revealed elevated and equalized diastolic pressures in three of six patients. Two-dimensional echocardiography revealed selective compression of the left ventricle (LV) (four patients), right ventricle (RV) (one patient), left atrium (LA)/RV (one patient), LA/LV (one patient), LA/LV/RV (one patient), all four chambers (one patient), and no diastolic collapse of any chamber (one patient). There was often an absence of anterior pericardial fluid (six patients) with tethering of a portion of the RV to the chest wall anteriorly (five patients). Coagulation parameters were "supratherapeutic" in only three of eight patients who were receiving systemic anticoagulants at the time of diagnosis. The initial diagnosis was confused with congestive heart failure in one patient, pulmonary embolism in three patients, acute myocardial infarction in two patients, and sepsis in one patient. Eight of ten patients survived; all of these patients underwent surgical removal of fluid and/or hematoma in the operating room. We conclude that postoperative tamponade after cardiac surgery may have varied clinical and hemodynamic presentations, often due to selective chamber compression by loculated fluid or clot. Due to its frequently atypical features and presentation that may simulate other disorders, the diagnosis of tamponade should be considered whenever hemodynamic deterioration or signs of low output failure occur in the postcardiotomy patient.
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Affiliation(s)
- A M Russo
- Division of Cardiology, Cooper Hospital/University Medical Center, UMDNJ/Robert Wood Johnson Medical School, Camden
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7
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Wong PS, Pugsley WB. Raised international normalised ratio (INR): is it a cause or an effect of late cardiac tamponade? BRITISH HEART JOURNAL 1992; 68:212-3. [PMID: 1389740 PMCID: PMC1025017 DOI: 10.1136/hrt.68.8.212] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
Abstract
Two cases of late cardiac tamponade after valve replacement surgery are reported: both patients were treated with oral anticoagulants (warfarin) after operation. An erratic response in the international normalised ratio (INR) was found before the diagnosis of late tamponade. It is suggested that this response of the INR may be an early indicator of late cardiac tamponade rather than a cause.
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Affiliation(s)
- P S Wong
- Department of Cardiothoracic Surgery, Middlesex Hospital, London
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8
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Abstract
Late pericarditis following myocardial infarction, cardiac surgery, or trauma is referred to as postmyocardial infarction syndrome (PMIS) or postcardiotomy syndrome (PCS), respectively. The term postcardiac injury syndrome (PCIS) is used to encompass both these entities. PCIS is characterized by fever, pleuropericardial pain, pericarditis, and pulmonary involvement. Abnormal laboratory findings include leukocytosis, high sedimentation rate, and chest x-ray abnormalities of pleural effusion with or without pulmonary infiltrates. Evidence supports an immunopathic etiology; viruses may play a contributing role. The course is benign but rare complications include tamponade, constriction, anemia, and coronary bypass graft occlusion. Anti-inflammatory agents are helpful; indo-methacin and steroids are preferably avoided. Rarely, PMIS-like syndrome may occur following pulmonary embolism. Anticoagulation and steroids have been used successfully in the latter situation.
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Affiliation(s)
- A H Khan
- Division of Cardiology, Memorial Hospital of Rhode Island, Pawtucket 02860
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D'Cruz IA, Kensey K, Campbell C, Replogle R, Jain M. Two-dimensional echocardiography in cardiac tamponade occurring after cardiac surgery. J Am Coll Cardiol 1985; 5:1250-2. [PMID: 3872897 DOI: 10.1016/s0735-1097(85)80033-4] [Citation(s) in RCA: 49] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/07/2023]
Abstract
Cardiac tamponade is an important complication after cardiac surgery, yet little has been published on the echocardiographic diagnosis of this situation. The two-dimensional echocardiograms of 11 patients who required surgical relief of cardiac tamponade complicating cardiac surgery were therefore reviewed. Four had nonloculated pericardial effusions surrounding both ventricles. The other seven patients had a loculated posterior pericardial effusion; in three of these the effusion altered left ventricular posterior wall contour so that it was concave toward the effusion in the long-axis view; in two, a strikingly abnormal motion of the left ventricular posterior wall was noted, such that the width of the posterior pericardial space diminished in systole and widened abruptly in early diastole. The quantity of pericardial contents (fluid, blood or clot) evacuated surgically was smaller than usually encountered in patients with tamponade due to various "medical" conditions. Thus, unlike tamponade with other pericardial effusions, tamponade after cardiac surgery is due to a pericardial effusion that is smaller in volume, often loculated posteriorly and associated with certain unique two-dimensional echocardiographic features.
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10
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Abstract
Late cardiac tamponade is an infrequent complication of pediatric cardiac surgery. It is usually accompanied by the postcardiotomy syndrome and can occur after open or closed cardiac operations. It may occur despite treatment of the postcardiotomy syndrome. Five children were treated for late cardiac tamponade. All were treated initially with anti-inflammatory drugs; four also required pericardiocentesis, and two of these required subsequent creation of a pericardial window. One patient died due to delay in performing operative decompression. Late cardiac tamponade can be a lethal complication in children.
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11
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Abstract
Cardiac tamponade is a rare complication of the postpericardiotomy syndrome in the absence of anticoagulation therapy. Three cases are presented where cardiac tamponade developed as a result of the postpericardiotomy syndrome with normal coagulation parameters. The pericardial effusions were serous in two and serosanguinous in the third case. Pericardial fluid studies were consistent with an exudate. The effusion resolved following a single pericardial tap and short-term corticosteroid therapy in one case. Repeated pericardiocentesis and drainage via an indwelling catheter were required in the other two cases.
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12
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Borkon AM, Schaff HV, Gardner TJ, Merrill WH, Brawley RK, Donahoo JS, Watkins L, Weiss JL, Gott VL. Diagnosis and management of postoperative pericardial effusions and late cardiac tamponade following open-heart surgery. Ann Thorac Surg 1981; 31:512-9. [PMID: 7247542 DOI: 10.1016/s0003-4975(10)61340-9] [Citation(s) in RCA: 49] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/24/2023]
Abstract
The clinical and laboratory findings of 28 patients identified as having late pericardial effusions were examined. Eleven of these patients were asymptomatic; 9 patients had moderate symptoms including fatigue, malaise, weight gain, and dyspnea on exertion, and 8 patients with similar symptoms had evidence of cardiac tamponade. Ten patients underwent right heart catheterization in the intensive care unit; normal hemodynamics were confirmed in 4 and cardiac tamponade in 6 patients. Pericardiocentesis was effective in decompressing cardiac tamponade in 7 of 8 patients. One patient required operative subxiphoid drainage after unsuccessful pericardiocentesis. In addition, 5 patients with moderate clinical symptoms and pericardial effusions, who did not have cardiac tamponade, underwent pericardiocentesis because of a need for chronic anticoagulant therapy. The remaining patients were managed successfully by observation, discontinuation of warfarin when possible, fluid restriction, and diuretic therapy. All but 1 patient was symptomatically improved. A diagnostic and therapeutic schema is presented as an aid to early recognition of this troublesome and potentially lethal complication.
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13
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Ofori-Krakye SK, Tyberg TI, Geha AS, Hammond GL, Cohen LS, Langou RA. Late cardiac tamponade after open heart surgery: incidence, role of anticoagulants in its pathogenesis and its relationship to the postpericardiotomy syndrome. Circulation 1981; 63:1323-8. [PMID: 7226478 DOI: 10.1161/01.cir.63.6.1323] [Citation(s) in RCA: 66] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/24/2023]
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14
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Marx P, Jaffe C, Laks H, Wolfson S. Delayed post-cardiac-surgery tamponade producing localized right atrial compression. CATHETERIZATION AND CARDIOVASCULAR DIAGNOSIS 1981; 7:275-82. [PMID: 7285106 DOI: 10.1002/ccd.1810070307] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/24/2023]
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15
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16
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Hardesty RL, Thompson M, Lerberg DB, Siewers RD, O'Toole JD, Salerni R, Bahnson HT. Delayed postoperative cardiac tamponade: diagnosis and management. Ann Thorac Surg 1978; 26:155-64. [PMID: 666426 DOI: 10.1016/s0003-4975(10)63659-4] [Citation(s) in RCA: 17] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
Abstract
Symptoms and signs of decreased cardiac output associated with an elevated venous pressure should alert one to the possibility of delayed cardiac tamponade. Enlargement of the cardiothoracic ratio shown by serial roentgenograms and demonstration of significant pericardial effusion by echocardiogram or radionuclide angiocardiography support the diagnosis. Erratic response of the prothrombin time to administration of warfarin and abnormal results of liver function test are additional clues to its diagnosis. Right heart catheterization documents the presence of tamponade and excludes other diagnostic considerations. Operative decompression of the pericardial space can be accomplished by pericardicentesis, subxiphoid pericardiotomy, median sternotomy, or thoracotomy. Hemodynamic observations following the relief of tamponade assure that an adequate therapeutic procedure has been performed.
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17
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Hochberg MS, Merrill WH, Gruber M, McIntosh CL, Henry WL, Morrow AG. Delayed cardiac tamponade associated with prophylactic anticoagulation in patients undergoing coronary bypass grafting. J Thorac Cardiovasc Surg 1978. [DOI: 10.1016/s0022-5223(19)41332-9] [Citation(s) in RCA: 29] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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18
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Fernando HA, Friedman HS, Lajam F, Sakurai H. Late cardiac tamponade following open-heart surgery: detection by echocardiography. Ann Thorac Surg 1977; 24:174-7. [PMID: 879899 DOI: 10.1016/s0003-4975(10)63729-0] [Citation(s) in RCA: 16] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
Late cardiac tamponade following open-heart operation is a potentially lethal complication that is often difficult to diagnose. A case of cardiac tamponade occurring two weeks after left ventricular aneurysmectomy and coronary bypass surgery is reported. Despite opening of the anterior pericardium during operation, echocardiography revealed characteristic findings, which permitted prompt recognition of this disorder.
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19
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Orzan F, Guttin J, Dear WE. Atypical late cardiac tamponade after mitral valve replacement: case presentation with hemodynamic and echocardiographic observations. CATHETERIZATION AND CARDIOVASCULAR DIAGNOSIS 1977; 3:297-303. [PMID: 912739 DOI: 10.1002/ccd.1810030313] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
A patient developed oliguria, peripheral edema, and dyspnea 5 days after mitral valve replacement. Chest roentgenogram and echocardiogram suggested pericardial effusion. Although pulsus paradoxus was absent, cardiac tamponade was suspected and subsequently confirmed during pericardiocentesis. Before pericardiocentesis right and left ventricular diastolic pressures were equal, as well as intrapericardial and right atrial pressures. The left ventricular cavity was reduced in size on the echocardiogram. Interventricular septal motion was normal. Pericardiocentesis normalized the hemodynamics and allowed the left ventricle to reexpand. Certain atypical features are tentatively explained as the combined effect of constrictive and effusive components caused by intrapericardial hemorrhage.
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Merrill W, Donahoo JS, Brawley RK, Taylor D. Late cardiac tamponade: A potentially lethal complication of open-heart surgery. J Thorac Cardiovasc Surg 1976. [DOI: 10.1016/s0022-5223(19)40013-5] [Citation(s) in RCA: 32] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
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Lee ME, Neptune WB. Cardiac tamponade complicating closure of a median sternotomy. Chest 1976; 70:84-6. [PMID: 1084254 DOI: 10.1378/chest.70.1.84] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022] Open
Abstract
A case of intraoperative cardiac tamponade manifested during closure of a median sternotomy is presented. We postulate that cardiac tamponade was caused by acute dilatation of the cardiac chambers as a result of intraoartic balloon pumping in a patient with aortic and mitral regurgitation. It has been shown experimentally that acute rises in ventricular end-diastolic pressure result in increased intrapericardial pressure and that if a certain point on the pericardial pressure-volume curve is reached, cardiac tamponade will occur. Sternotomy closure was accomplished easily as soon as the need for intra-aortic balloon pumping diminished.
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Hrom S, Soczek-Michalska J, Biederman A, Rydlewska-Sadowska W. Recurrent cardiac tamponade after replacement of three heart valves. A case report. SCANDINAVIAN JOURNAL OF THORACIC AND CARDIOVASCULAR SURGERY 1976; 10:11-4. [PMID: 1273554 DOI: 10.3109/14017437609167763] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
Abstract
Delayed pericardial effusion and cardiac tamponade are rare late complications of open-heart surgery. A case after replacement of all three heart valves with the Björk-Shiley tilting disc valves with an unusual clinical course is presented in the following. Unsuccessful subsequent medical treatment, subsequent surgical intervention and its results are described and discussed. The need of further reports on similar observations is emphasized.
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McCabe JC, Engle MA, Ebert PA. Chronic pericardial effusion requiring pericardiectomy in the postpericardiotomy syndrome. J Thorac Cardiovasc Surg 1974. [DOI: 10.1016/s0022-5223(19)41753-4] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Lawrence MS, Wright R. Tamponade in Dressler's syndrome with immunological studies. BRITISH MEDICAL JOURNAL 1972; 1:665-6. [PMID: 4552462 PMCID: PMC1787775 DOI: 10.1136/bmj.1.5801.665] [Citation(s) in RCA: 16] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/11/2023]
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28
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Burnside J, Daggett WM, Austen WG. Coronary artery rupture by a mitral valve prosthesis after closed chest massage. Ann Thorac Surg 1970; 9:267-71. [PMID: 5413751 DOI: 10.1016/s0003-4975(10)65502-6] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/15/2023]
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29
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