Echocardiography. 2008 Jul;25(6):658-61.
Left ventricular collapse secondary to pericardial effusion treated with pericardicentesis and percutaneous pericardiotomy in severe pulmonary hypertension
Aqel RA, Aljaroudi W, Hage FG, Tallaj J, Rayburn B, Nanda NC.
Division of Cardiovascular Disease, University of Alabama at Birmingham, Birmingham, Alabama, USA. raed.aqel@med.va.gov
A 61-year-old white female, a Jehovah's Witness, with severe pulmonary hypertension, presented with worsening heart failure symptoms. She had a pericardial effusion with left ventricular (LV) diastolic collapse on transthoracic echocardiography. She was not a candidate for surgical pericardial window and therefore underwent pericardiocentesis and percutaneous balloon pericardiotomy with remarkable improvement in her clinical condition and with no recurrence of the effusion. LV diastolic collapse, an atypical presentation of cardiac tamponade, is commonly seen in postoperative patients with localized pericardial effusions. However, outside the surgical setting, isolated LV diastolic collapse is rare. Our case is one of the first cases described in the literature of LV diastolic collapse in the setting of severe pulmonary hypertension treated successfully with pericardiocentesis and percutaneous balloon pericardiotomy.
J Card Surg. 2008 May-Jun;23(3):256-8.
Cardiac tamponade due to a ruptured aneurysm of the sinus of valsalva.
Weijerse A, van der Schoot MJ, Maat LP, Bruning TA, Geleijnse ML, Bogers AJ.
Department of Cardio-thoracic Surgery, Thoraxcentre, Erasmus Medical Centre, Rotterdam, The Netherlands.
BACKGROUND AND AIM: A sinus of Valsalva aneurysm (SVA) is a rare cardiac anomaly. Rupture of a SVA often causes hemodynamic instability due to intracardiac shunting or cardiac tamponade, therefore immediate diagnosis and urgent treatment are required. METHODS: We report an 18-year-old female with cardiac tamponade due to rupture of a localized aneurysm of the right coronary sinus of Valsalva. No other congenital or acquired cardiac anomalies were found. Neurological observation precluded urgent surgery with heparinization and extracorporeal circulation. RESULTS: Semi-urgently the SVA was successfully resected. CONCLUSIONS: Semi-urgent surgery for a ruptured aneurysm of the Sinus of Valsalva was successful. In selected cases off pump surgery can be contemplated.
J Am Soc Echocardiogr. 2007 Dec;20(12):1415.e1-2. Epub 2007 Jul 10.
Left atrial appendage collapse as a sole feature of cardiac tamponade after cardiac surgery: a case report.
Yamano T, Nakatani S, Nakamura T, Sawada T, Azuma A, Yaku H, Matsubara H.
Department of Cardiology, National Cardiovascular Center, Suita, Osaka, Japan.
We report on a postoperative patient with cardiac tamponade caused by posteriorly localized pericardial effusion. In this case, transthoracic echocardiography only suggested mild left atrial compression. However, transesophageal echocardiography demonstrated significant collapse of the left atrial appendage that completely disappeared after pericardial drainage. The left atrial appendage collapse should be a valuable diagnostic sign in this setting. Transesophageal echocardiography would surely be valuable in diagnosing postoperative cardiac tamponade as a result of localized effusion when clinical symptoms and transthoracic echocardiographic findings are atypical.
Circulation. 2007 Jun 5;115(22):e603-6.
Images in cardiovascular medicine. Conservative treatment of a left atrial hematoma and a localized tamponade occurring during treatment of coronary total occlusion.
Tavano D, Carlino M, Pisani M, Colombo A.
San Raffaele Scientific Institute, Via Olgettina 60, 20132, Milan, Italy.
J Cardiothorac Vasc Anesth. 2005 Dec;19(6):775-6.
Hemodynamic instability after cardiac surgery: transesophageal echocardiographic diagnosis of a localized pericardial tamponade.
Sangalli F, Colagrande L, Manetti B, Avalli L, Celotti S, Maniglia P, Formica F, Paolini G, Pesenti A.
Department of Anesthesia and Intensive Care, Ospedale San Gerardo dei Tintori, University of Milano-Bicocca,
Milano, Italy. f.sangalli@hsgerardo.org
Catheter Cardiovasc Interv. 2005 Dec;66(4):562-5.
Delayed abrupt tamponade by isolated left atrial compression following coronary artery perforation during coronary angioplasty.
Barbeau GR, Sénéchal M, Voisine P.
Department of Cardiology, Laval Hospital, Québec, Canada. gerald.barbeau@med.ulaval.ca
Cardiac tamponade following coronary artery perforation during percutaneous coronary intervention is a rare but potentially life-threatening complication. When associated with Ellis type III coronary perforations, tamponade develops rapidly during the intervention. In contrast, Ellis type I and II coronary perforations, because of their contained nature, are usually managed conservatively and rarely result in tamponade. We report two unusual cases of delayed but abrupt tamponade caused by localized left atrial compression after contained coronary artery perforation following angioplasty. This complication is an extremely rare event. Etiology, diagnostic modalities, and management are discussed. Copyright (c) 2005 Wiley-Liss, Inc.
Cardiol Rev. 2005 Jul-Aug;13(4):214-7.
Left ventricular cardiac tamponade in the setting of cor pulmonale and circumferential pericardial effusion. Case report and review of the literature.
Gollapudi RR, Yeager M, Johnson AD.
Division of Cardiovascular Diseases, Scripps Clinic, La Jolla, CA, USA. gollapudi.raghava@scrippshealth.org
Circumferential pericardial effusion typically results in biventricular tamponade and equalization of intracardiac and pericardial pressure during diastole. However, tamponade may involve the right or left ventricle. While isolated left ventricular cardiac tamponade (LVCT) can occur as a postoperative complication from localized posterior pericardial effusions, circumferential pericardial effusions leading to LVCT are rare. We report a case of a patient with severe pulmonary hypertension, a large nonloculated pericardial effusion, and LVCT, which was probably due to a chronic undifferentiated connective tissue disorder. This case illustrates that when evaluating patients with circumferential pericardial effusions and associated pulmonary hypertension, the typical findings of cardiac tamponade (pulsus paradoxus, right ventricular diastolic compression and hypotension) may be masked. The echocardiogram must be reviewed carefully as it may reveal left ventricular diastolic compression, the hallmark of LVCT, which may significantly compromise left ventricular filling and cardiac output.
Cardiol Rev. 2005 Jul-Aug;13(4):214-7.
Left ventricular cardiac tamponade in the setting of cor pulmonale and circumferential pericardial effusion. Case report and review of the literature.
Gollapudi RR, Yeager M, Johnson AD.
Division of Cardiovascular Diseases, Scripps Clinic, La Jolla, CA, USA. gollapudi.raghava@scrippshealth.org
Circumferential pericardial effusion typically results in biventricular tamponade and equalization of intracardiac and pericardial pressure during diastole. However, tamponade may involve the right or left ventricle. While isolated left ventricular cardiac tamponade (LVCT) can occur as a postoperative complication from localized posterior pericardial effusions, circumferential pericardial effusions leading to LVCT are rare. We report a case of a patient with severe pulmonary hypertension, a large nonloculated pericardial effusion, and LVCT, which was probably due to a chronic undifferentiated connective tissue disorder. This case illustrates that when evaluating patients with circumferential pericardial effusions and associated pulmonary hypertension, the typical findings of cardiac tamponade (pulsus paradoxus, right ventricular diastolic compression and hypotension) may be masked. The echocardiogram must be reviewed carefully as it may reveal left ventricular diastolic compression, the hallmark of LVCT, which may significantly compromise left ventricular filling and cardiac output.
J Ultrasound Med. 2005 Jun;24(6):873-6.
A case of posterior loculated tamponade masquerading as an atrial mass on transesophageal echocardiography.
Makaryus AN, Matayev S, Rosman D.
Division of Cardiology, North Shore University Hospital, Manhasset, New York 11030, USA.
No Abstract.
Catheter Cardiovasc Interv. 2004 Nov;63(3):339-45.
Atypical hemodynamic manifestations of cardiac tamponade.
Sharma N, Panchal V, Kalaria VG.
Krannert Institute of Cardiology, Clarian Cardiovascular Center, Department of Medicine, Indiana University, Indianapolis, Indiana 46202, USA.
Clinical examination and transthoracic echocardiography play a vital role in the management of patients with pericardial effusion and cardiac tamponade physiology. We report patients in advanced phase 3 cardiac tamponade with variant clinical and hemodynamic presentations. These atypical cardiac tamponade cases include: A patient with severe aortic valve regurgitation who lacked pulsus paradoxus; a patient with systemic sclerosis without hypotension; and a patient with pulmonary hypertension lacking right heart collapse on echocardiography. Recognition of these atypical clinical and hemodynamic manifestations of cardiac tamponade will avoid undue delay in the treatment.
Am J Cardiol. 2002 Dec 1;90(11):1183-6.
Diagnosis, management, and clinical outcome of cardiac tamponade complicating percutaneous coronary intervention.
Fejka M, Dixon SR, Safian RD, O'Neill WW, Grines CL, Finta B, Marcovitz PA, Kahn JK.
Division of Cardiology, William Beaumont Hospital, Royal Oak, Michigan 48073, USA.
Cardiac tamponade is an uncommon but life-threatening complication of percutaneous coronary intervention (PCI). The purpose of the present study was to characterize the incidence, management, and clinical outcome associated with this complication. We analyzed a prospective database of 25,697 PCIs performed at William Beaumont Hospital (Royal Oak, Michigan) between October 1993 and December 2000. Cardiac tamponade was observed in 31 of 25,697 PCI procedures (0.12%). Cardiac tamponade was diagnosed in the catheterization laboratory in 17 of 31 patients (55%), and 14 patients (45%) had a delayed presentation (mean time from PCI 4.4 hours). Cardiac tamponade was twice as frequent after use of atheroablative devices compared with percutaneous transluminal coronary angioplasty and stenting (0.26% vs 0.11%, p <0.05). All patients with immediate cardiac tamponade had coronary artery perforation. In 11 of 14 patients with delayed tamponade (79%), no actual site of perforation could be identified. A moderate or large pericardial effusion was observed in 20 patients, and 9 had small effusions without typical echocardiographic features of tamponade. Pericardiocentesis was performed in 30 patients; 19 patients (61%) were treated successfully with aspiration alone, but 12 patients (39%) required further emergency surgical intervention. In-hospital complications included death (42%), emergency surgery (39%), myocardial infarction (29%), and transfusion (65%). Cardiac tamponade is an uncommon but important complication of PCI and is associated with high mortality and morbidity. Most cases are recognized in the catheterization laboratory, but delayed cardiac tamponade may occur and must be considered as a cause of late hypotension after PCI.
Int J Cardiol. 2002 May;83(2):195-7. Links Acute superior vena cava and right atrial tamponade in an infant after open heart surgery.Pierli C, Iadanza A, Del Pasqua A, Fineschi M. Early postoperative localized cardiac tamponade occurred in a 4-month old infant after ventricular septal defect repair. The clinical findings were as for acute superior vena cava syndrome. The diagnosis was accurately made using echocardiography and measurement of the superior vena cava and right atrial pressure. Surgical revision was necessary to remove a large clot from the superior vena cava-right atrium junction.
J Am Soc Echocardiogr. 2001 Dec;14(12):1220-3.
Localized pericardial tamponade: difficult echocardiographic diagnosis of a rare complication after cardiac surgery.
Ionescu A, Wilde P, Karsch KR.
Department of Cardiology, Bristol Royal Infirmary, Bristol, UK. Ionescu@cf.ac.uk
We report 2 cases of localized pericardial tamponade occurring soon after cardiac surgery, in which the diagnosis could not be made with transthoracic echocardiography. Computed tomography and transesophageal echocardiography, respectively, were necessary, and this underlies the importance of alternative imaging modalities when this condition is suspected. A high index of suspicion is crucial for reaching the correct diagnosis.
J Am Soc Echocardiogr. 2001 Dec;14(12):1220-3.
Localized pericardial tamponade: difficult echocardiographic diagnosis of a rare complication after cardiac surgery.
Ionescu A, Wilde P, Karsch KR.
Department of Cardiology, Bristol Royal Infirmary, Bristol, UK. Ionescu@cf.ac.uk
We report 2 cases of localized pericardial tamponade occurring soon after cardiac surgery, in which the diagnosis could not be made with transthoracic echocardiography. Computed tomography and transesophageal echocardiography, respectively, were necessary, and this underlies the importance of alternative imaging modalities when this condition is suspected. A high index of suspicion is crucial for reaching the correct diagnosis.
Masui. 2000 Dec;49(12):1377-9.
Localized right atrial tamponade after aortic valve replacement.
Nagata C, Ichinose K, Yanagi F, Kozuma S, Goto S.
Department of Anesthesia, Kumamoto Rosai Hospital, Kumamoto 866-8533.
A 78-year-old man developed isolated right atrial tamponade 15 hours following aortic valve replacement. There were excessive postsurgical bleeding, low blood pressure, and low cardiac output. Volume expansion and inotropic therapy did not increase blood pressure. There were no cardiomegaly and echo-free space. Diagnosis was made by appearance of pulsus paradoxus and transthoracic echocardiography and confirmed by surgery. The clinical picture was improved dramatically after surgical removal of the hematoma. Right atrial tamponade leads to a unique clinical conglomeration of hemodynamic and echocardiographic features. Constant attention to this entity is necessary to make a timely diagnosis.
Heart. 2000 Nov;84(5):514.
Isolated left atrial tamponade following circumflex artery angioplasty.
Kadner A, Chen RH, Collard CD, Adams DH.
No Abstract
Cathet Cardiovasc Diagn. 1998 Sep;45(1):61-3.
Complete left atrial obliteration due to localized tamponade after coronary artery perforation during PTCA.
Dardas PS, Tsikaderis DD, Makrigiannakis K, Saripoulos P, Toumbouras M.
Department of Cardiology and Cardiac Surgery, Geniki Kliniki, Thessaloniki, Greece.
Coronary artery perforation is a rare but important complication of percutaneous revascularization (PTCA). Clinical events following coronary perforation may include cardiac tamponade. After bypass graft operation (CABG), however, cardiac tamponade with subsequent hemodynamic instability is unusual due to the development of pericardial adhesions. We report an unusual case of localized tamponade after coronary artery perforation during PTCA in a patient with previous CABG.
Presse Med. 1998 Mar 28;27(12):567-70.
Tamponade in patients with systolic left ventricular dysfunction. An atypical presentation.
Vayre F, Lardoux H, Bourdarias JP, Pezzano M, Dubourg O.
Service de Cardiologie, Hôpital Ambroise Paré, Boulogne.
BACKGROUND: Left ventricular failure has been described following surgery due to localized compression of the left ventricle and in case of diastolic left ventricular dysfunction after pericardiotomy or pericardiocentesis. CASE REPORTS: Global heart failure was observed in 3 patients with dilated cardiopathy who developed tamponade. Systolic left ventricular dysfunction was caused by ischemic heart disease in one patient and secondary to anthracyclin chemotherapy in the two others. The effusion was successfully removed with pericardiocentesis in all three cases. No specific complications were observed. DISCUSSION: Although exceptional, tamponade may occur in patients with signs of left ventricular failure.
Eur J Cardiothorac Surg. 1996;10(12):1136-8.
Localized intraoperative cardiac tamponade.
Asham EH, Pepper J.
Academic Unit of Cardiothoracic Surgery, The Royal Brompton National Heart and Lung Institute, London, England.
A 65-year-old lady had undergone mitral and aortic valve replacement following an open mitral valvotomy and aortic valve exploration 5 years earlier. At reoperation, following sternotomy, extensive adhesions were encountered and it was decided to perform minimal dissection of the heart. Both the aortic and mitral valves were replaced using 23 mm and 29 mm St. Jude bileaflet valves, respectively. At the end of the procedure it was difficult to wean the patient off bypass as her mean arterial pressure dropped and the heart became dilated. It was found that a tamponade had developed, as a result of bleeding from the vent site in the pulmonary artery, and dissected a plane between the heart and the adherent pericardium. Her condition improved dramatically as the tamponade was released and she came off cardiopulmonary bypass with no inotropic support.
Masui. 1996 Aug;45(8):998-1001.
The efficacy of transesophageal echocardiography during the pericardial drainage of the cardiac tamponade after cardiac surgery.
Kikumoto K, Ohnishi Y, Kuro M.
Department of Anesthesiology, National Cardiovascular Center, Suita.
For two cases of cardiac tamponade following cardiac surgery, the approaches for pericardial drainage were determined by the transesophageal echocardiography under general anesthesia. In most cases of cardiac tamponade after cardiac surgery the pericardial effusion is regional and localized due to adhesions of pericardium. Therefore subxiphoid incision approach of pericardial drainage cannot often be accomplished. In these cases transesophageal echocardiography can image the presence, location and size of the pericardial effusion and is an available method to determine the approach of pericardial drainage.
Am J Card Imaging. 1996 Jul;10(3):204-6.
Unusual presentation of late regional cardiac tamponade after aortic surgery.
Jadhav P, Asirvatham S, Craven P, Howell E, Sivaram CA, Kamalesh M, Chandrasekaran K.
Division of Cardiology, University of Oklahoma Health Science center, Oklahoma City 73190-3048, USA.
Localized pericardial effusion leading to cardiac tamponade is seen occasionally in patients after cardiac surgery. This condition may be difficult to diagnose clinically because of unusual presenting symptoms and absence of conventional signs of cardiac tamponade. A case of localized pericardial effusion with presenting symptoms of fever and increasing fatigue is described in this study. The definitive diagnosis was made using transesophageal echocardiography. Surgical drainage of localized effusion resulted in prompt hemodynamic and symptomatic improvement.
Kyobu Geka. 1994 Aug;47(9):758-61.
Localized cardiac tamponade after aortic valve replacement: a case report.
Isoda N, Nakamura C, Watanabe T, Aoyama K, Inazawa K, Iijima Y, Washio M, Hoshi H, Masakane N.
Second Department of Surgery, Yamagata University School of Medicine, Japan.
We report a case of localized cardiac tamponade after aortic valve replacement. A 56-year-old man had an aortic valve replacement for his aortic valve steno-insufficiency. At 3-postoperative day, severe hypotension occurred, causing acute renal failure. There were no cardiomegaly, high central venous pressure, nor echo-free space. A mass shadow, appearing on chest X-ray at 37-postoperative day, was diagnosed as a localized tamponade by means of a computed tomography and a radioangiography at 38 postoperative day. After the spontaneous drainage of old bloody effusion from the partially opened wound in mid-line, his cardiac and renal failure improved rapidly. When the hematoma is localized, computed tomography is most diagnostic while conventional echo-cardiography often fails to show echo-free spaces.
Am Heart J. 1994 Apr;127(4 Pt 1):913-8.
Diagnosis of cardiac tamponade after cardiac surgery: relative value of clinical, echocardiographic, and hemodynamic signs.
Chuttani K, Tischler MD, Pandian NG, Lee RT, Mohanty PK.
Department of Medicine, New England Medical Center, Tufts University School of Medicine, Boston, Mass 02111.
Early detection and treatment of cardiac tamponade is crucial in management of patients after cardiac surgery. Because of the atypical features of this condition and paucity of data on relative frequency of different signs, we evaluated the sensitivity of various clinical, echocardiographic, and hemodynamic signs. We retrospectively evaluated the relative frequency of clinical, echocardiographic, and hemodynamic signs in 29 patients with cardiac tamponade after cardiac surgery. In our study 66% had a localized, posterior pericardial effusion, and the other 34% had circumferential pericardial effusion. In the whole group 24% of patients had hypotension, and pulsus paradoxus was noted in 48%, right atrial collapse in 34%, right ventricular diastolic collapse in 27%, left ventricular diastolic collapse in 65%, and left atrial collapse in 13%. Elevation with equalization of pressures was noted in 81% patients. In the patient group with circumferential pericardial effusion and cardiac tamponade 40% patients were hypotensive and 50% patients had pulsus paradoxus. RA collapse was present in 70%, RV diastolic collapse in 70%, and LV diastolic collapse in 20%. Elevated diastolic pressures with equalization of these pressures was present in 71%. In the group with regional pericardial effusion and cardiac tamponade hypotension was present in 16% and pulsus paradoxus in 47%. RA collapse was present in 16%, RV diastolic collapse in 5%, LV diastolic collapse in 89%, and LA collapse in 21% of the patients with regional tamponade. Elevated diastolic pressures with equalization of these pressures was noted in 86% of the patients. Our observations indicate that among patients who have undergone cardiac surgery the presentation of cardiac tamponade is usually atypical.
J Am Coll Cardiol. 1993 Sep;22(3):907-13.
Left ventricular diastolic collapse in regional left heart cardiac tamponade. An experimental echocardiographic and hemodynamic study.
Schwartz SL, Pandian NG, Cao QL, Hsu TL, Aronovitz M, Diehl J.
Department of Medicine, New England Medical Center, Tufts University School of Medicine, Boston, Massachusetts 02111.
OBJECTIVES. This study was designed to describe the hemodynamic abnormalities associated with the appearance of left ventricular diastolic collapse in the setting of regional left heart cardiac tamponade. BACKGROUND. Cardiac tamponade after heart surgery is frequently associated with localized pericardial effusion. Although right ventricular diastolic collapse and right atrial collapse are reliable echocardiographic findings in patients with circumferential pericardial effusion and tamponade, they are often not present in postoperative patients with localized pericardial effusion and regional left heart tamponade. Left ventricular diastolic collapse has been described in such patients, but the degree of hemodynamic alteration that exists with this finding is not known. METHODS. Acute regional left heart tamponade was produced 14 times in seven spontaneously breathing anesthetized dogs by infusing fluid into an isolated compartment created in the pericardial space adjacent to the left ventricular free wall. Continuous echocardiographic imaging and hemodynamic monitoring of left ventricular, systemic arterial, right atrial, pulmonary capillary wedge and pericardial pressures were performed. Measurements at baseline were compared with those made at the onset of left ventricular diastolic collapse and at decompensated tamponade. RESULTS. Left ventricular diastolic collapse was noted in all 14 episodes of regional tamponade. It occurred when pressure in the left pericardial compartment exceeded left ventricular diastolic pressure by 3.0 +/- 1.9 mm Hg. At the onset of left ventricular diastolic collapse, cardiac output and mean arterial pressure were significantly reduced from the control value (p < 0.05). Systolic hypotension was noted only twice at this stage, respiratory variation in systolic pressure > 10 mm Hg only once. The appearance of this sign was also associated with elevated left heart filling pressures. CONCLUSIONS. Left ventricular diastolic collapse is a reliable sign of regional left ventricular tamponade and is associated with a reduction in cardiac output. This echocardiographic finding usually occurs before the development of arterial hypotension and pulsus paradoxus. Thus, left ventricular diastolic collapse is potentially more reliable than hypotension or pulsus paradoxus in the diagnosis of regional left ventricular tamponade.
Circulation. 1993 May;87(5):1738-41.
Cardiac tamponade. A clinical or an echocardiographic diagnosis?
Fowler NO.
Division of Cardiology, University of Cincinnati College of Medicine, Ohio 45267-0542.
In most patients, cardiac tamponade should be diagnosed by a clinical examination that shows elevated systemic venous pressure, tachycardia, dyspnea, and paradoxical arterial pulse. Systemic blood pressure may be normal, decreased, or even elevated. The diagnosis is confirmed by echocardiographic demonstration of moderately large or large circumferential pericardial effusion and in most instances, of right atrial compression, abnormal respiratory variation in right and left ventricular dimensions, and in tricuspid and mitral valve flow velocities. Pulsus paradoxus may be absent with left ventricular dysfunction, atrial septal defect, regional tamponade, and positive-pressure breathing. Systemic venous pressure may be normal with localized tamponade of the left atrium or ventricle. Patients with moderately large or large pericardial effusions may have echocardiographic evidence of right atrial compression without clinical signs of elevated venous pressure or pulsus paradoxus. The majority of these patients have mild or moderate tamponade and if not subjected to pericardial drainage, should be observed closely. In some of these patients, when the etiology is known and the disease can be treated effectively with medication, e.g., nonsteroidal anti-inflammatory agents or adrenal corticosteroids in Dressler's syndrome or relapsing pericarditis, pericardial drainage may not be necessary.
Eur Heart J. 1993 Feb;14(2):230-4.
Pericardial clot after open heart surgery: its specific localization and haemodynamics.
Beppu S, Tanaka N, Nakatani S, Ikegami K, Kumon K, Miyatake K.
National Cardiovascular Center, Research Institute and Hospital, Osaka, Japan.
Transoesophageal echocardiography disclosed a localized pericardial blood clot compressing the right atrium (RA) and/or right ventricle (RV) in 15 patients suffering from low cardiac output failure soon after open-heart surgery. The left ventricular end-diastolic diameter was small (38.4 +/- 10.1 mm) and its fractional shortening normal (34.9 +/- 10.2%). These findings suggested cardiac tamponade as a result of pericardial clot. However, the 'y' trough of the RA pressure tracing was prominent, which is not characteristic of typical cardiac tamponade, but rather of constrictive pericarditis. This implies therefore that the pathophysiology of cardiac tamponade by pericardial clot differs from that of tamponade by fluid. Emergency open-chest removal of the pericardial clot was performed in seven patients, with good results. Pericardial clot produces low cardiac output soon after open-heart surgery, but its location is specific and its haemodynamics are not characteristic of cardiac tamponade.
Zhonghua Yi Xue Za Zhi (Taipei). 1992 Mar;49(3):203-6.
Delayed localized right atrial tamponade by intrapericardial hematoma after aortic valve replacement: a case report.
Liou JY, Chen CH, Wang SP, Chang MS.
Department of Medicine, Veterans General Hospital-Taipei, Taiwan, R.O.C.
Cardiac tamponade, early or late after cardiac surgery, is an uncommon while a potentially lethal condition in which the classic signs of tamponade may be absent. High index of suspicion and rapid diagnosis are mandatory for life-saving decompressive therapy. We herein reported a case of delayed localized right atrial tamponade caused by loculated intrapericardial hematoma 26 days after aortic valve replacement, which was recognized immediately by transthoracic two-dimensional echocardiography. The clinical status improved dramatically after surgical removal of the hematoma.
Arch Mal Coeur Vaiss. 1991 Sep;84(9):1361-4
Late cardiac tamponade by localized compression of the left cavities after heart valve surgery. Apropos of 2 cases
Albat B, Picard E, Messner-Pellenc P, Thevenet A.
Service de chirurgie cardiovasculaire, hôpital Aiguelongue, CHU, Montpellier.
The authors report two cases of left cardiac failure occurring three and ten months after aortic valve replacement. Echocardiography established the diagnosis of localized compression of left heart chambers by hemopericardium. Surgical drainage dramatically improved patients with a follow-up of 4 years and 18 months. The authors emphasize the interest of left thoracotomy for drainage and discuss the etiology.
Circulation. 1991 Jun;83(6):1999-2006.
Left ventricular diastolic collapse. An echocardiographic sign of regional cardiac tamponade.
Chuttani K, Pandian NG, Mohanty PK, Rosenfield K, Schwartz SL, Udelson JE, Simonetti J, Kusay BS, Caldeira ME.
Department of Medicine, Tufts University School of Medicine, Boston, MA.
BACKGROUND. Cardiac tamponade after cardiac surgical procedures is often associated with hemodynamically significant localized pericardial effusions. The localized collection of pericardial effusion in the postoperative period and the atypical presentation of cardiac tamponade limit the use of conventional clinical and echocardiographic signs usually seen with a circumferential pericardial effusion. Observation of left ventricular diastolic collapse in the echocardiogram of a patient with postoperative regional cardiac tamponade prompted us to explore the frequency of this sign in regional cardiac tamponade. METHODS AND RESULTS. We retrospectively analyzed the echocardiograms of 18 patients with postoperative cardiac tamponade for the following echocardiographic findings: right atrial collapse, right ventricular diastolic collapse, left atrial collapse, and left ventricular diastolic collapse. Three of the 18 patients had circumferential pericardial effusion, and 15 had loculated pericardial effusion; in 10, the effusion was predominantly posterior, and in the other five, it extended laterally or inferiorly. The conventional echocardiographic signs of cardiac tamponade such as right atrial collapse, right ventricular diastolic collapse, and left atrial collapse were present in only 3, 1, and 3 of these 15 patients, respectively, but all exhibited left ventricular diastolic collapse. Increasing pressure within the compartment of a loculated pericardial effusion reaching the limit of pericardial distensibility and consequent transient reversal of transmural left ventricular pressure during diastole are most likely the basis for diastolic collapse of the thick-walled ventricle in a setting of regional cardiac tamponade. CONCLUSIONS. We conclude that left ventricular diastolic collapse is a frequent sign of regional cardiac tamponade and could be a useful marker of tamponade in postoperative patients.
J Appl Physiol. 1990 Sep;69(3):924-31.
Experimental cardiac tamponade: correlation of pressure, flow velocity, and echocardiographic changes.
Cohen ML.
Department of Medicine, New York University Medical Center, New York 10016.
Seven episodes of experimental cardiac tamponade were induced in five anesthetized closed-chest dogs. Simultaneous pericardial and intracavitary pressures were synchronized with superior vena caval and transvalvular pulsed-Doppler flow tracings. The earliest indication of tamponade was the development of a negative transmural right atrial pressure that occurred during early ventricular diastole and was associated with echocardiographic evidence of right atrial collapse. This was also associated with reversal of diastolic flow in the superior vena cava and with diminished early diastolic flow velocity across the tricuspid as well as the mitral valve. During more advanced cardiac tamponade, the transmural right atrial pressure became negative during both early and late ventricular diastole as well as during isovolumic ventricular systole. This was associated with a disappearance of early diastolic ventricular filling and right ventricular diastolic collapse as observed on two-dimensional echocardiography. In hypotensive cardiac tamponade (cardiac output diminished by 70%), the decreased transmural right atrial pressure that developed during ventricular systole was accompanied by diminished antegrade flow in the superior vena cava. In advanced and hypotensive tamponade, ventricular filling occurred mainly during atrial contraction.
Med J Aust. 1989 Dec 4-18;151(11-12):621-5.
Fatal and non-fatal stingray envenomation.
Fenner PJ, Williamson JA, Skinner RA.
Ambrose Medical Group, North Mackay, Qld.
A fatality occurred in a previously healthy 12-year-old boy after a penetrating chest injury from a stingray barb. The injury occurred under freak circumstances. Death was a result of cardiac tamponade which was secondary to venom-induced, localized myocardial necrosis and spontaneous perforation, six days after the direct penetration of the right ventricle by the barb. Three other cases of less serious stingray envenomation are described which illustrate the significant localized morbidity that may occur without immediate wound exploration and toilet after adequate anaesthesia. We also report a study of a series of 100 minor stingray envenomations which, when treated, resulted in no morbidity. It is possible that local infiltration with 1% plain lignocaine may have a direct counteraction against stingray venom that remains in the wound area. Stingray venom has insidious, but powerful, localized tissue necrosing properties in humans.
J Am Coll Cardiol. 1988 Mar;11(3):572-8.
Doppler echocardiography in cardiac tamponade: exaggerated respiratory variation in transvalvular blood flow velocity integrals.
Leeman DE, Levine MJ, Come PC.
Charles A. Dana Research Institute, Boston, Massachusetts.
Pulsed Doppler echocardiography has been used previously to demonstrate marked changes in transvalvular blood flow velocities during cardiac tamponade in laboratory animals and a small number of patients. To further assess the respiratory changes in transvalvular blood flow during tamponade, pulsed Doppler tracings of flow velocity profiles across all four cardiac valves were recorded during inspiration and expiration in 13 patients during cardiac tamponade, in 6 of the 13 patients after relief of tamponade by pericardiocentesis and in 8 normal control subjects. Flow velocity integrals were calculated for each valve during inspiration and expiration. In the setting of cardiac tamponade, inspiration caused an 85 +/- 46% increase in the flow velocity integral across the pulmonary valve, an 81 +/- 34% increase across the tricuspid valve, a 33 +/- 13% decrease across the aortic valve and a 35 +/- 8% decrease across the mitral valve. These phasic respiratory changes were markedly reduced after relief of tamponade (p less than 0.05 compared with tamponade) and were observed to only a minimal extent in the normal individuals (p less than 0.01 compared with tamponade). The exaggerated respiratory variations in transvalvular flow velocity integrals suggest that Doppler evaluation may be a valuable tool in the diagnosis of cardiac tamponade. Transmitral Doppler indexes of left ventricular filling during cardiac tamponade revealed that inspiration caused a shift to increased filling during late diastole, with a greater contribution of atrial systole to total left ventricular filling. These Doppler indexes did not vary significantly with respiration in the group studied after relief of tamponade or in the control group.(ABSTRACT TRUNCATED AT 250 WORDS)
Arch Surg. 1978 Jun;113(6):764-6.
Localized tamponade of the right atrium and right ventricle: induction of intracardiac right-to-left shunting after the use of a Gott shunt
Miller DC, Oyer PE, Ricks W, Cipriano PR, Shumway NE.
After repair of a traumatic tear of the descending aorta, using a Gott shunt between the left ventricle and the distal descending aorta, a patient was readmitted with profound postural cyanosis and dyspnea. Catheterization showed right-to-left shunting at the atrial level caused by extrinsic deformation of the right atrium and right ventricle. Sternotomy showed selective pericardial tamponade on the right side of the heart caused by a localized collection of organizing thrombus and old blood. The previously unsuspected large patent foramen ovale was closed. This complication represents a form of iatrogenic cyanosis tardice and is thought to be attributable to the method of shunting used during the first operation. Moreover, this complication should be easily preventable if the pooled blood and clot in the most dependent portion of the pericardial cavity is adequately evacuated.
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