Localized Cardiac Tamponade after Open-Heart Surgery

Abstract

Purpose: To describe the clinical presentation and echocardiographic findings associated with localized tamponade after open-heart surgery.
Methods: Retrospective analysis of a case series with a surgically proven diagnosis.
Results: Among 23 patients with surgically proven localized cardiac tamponade after elective open-heart surgery, 5 patients (22%) died in the ICU from multiorgan failure. At the time of diagnosis (median delay: 2 days; range: 0–8 days), shock was present in 19 patients, 8 of them being hypotensive. Transthoracic echocardiography (TTE) depicted the localized cardiac tamponade in 3 of 4 examined patients, whereas transesophageal echocardiography (TEE) was always conclusive. The right atrium was primarily involved, solely (n = 11) or with the right ventricle (n = 5), whereas the left cardiac cavities were less frequently compressed (left atrium: n = 6, left ventricle: n = 1). The free wall curvature of the involved cardiac chamber was consistently inverted, and blood flow turbulences were depicted in 12 patients. Surgical removal of the compressive hematoma improved the clinical status of 18 patients (78%) who were discharged from the hospital.
Conclusion: Since localized tamponade complicating open-heart surgery has various, non-specific clinical presentations and TTE is not diagnostic, indications of TEE must be liberal in this setting to prompt diagnosis and surgical reoperation.