Cardiac Tamponade Causing Predominant Left Atrial and Ventricular Compression After Left Ventricular Assist Device Placement

Abstract

Patient: Male, 47-year-old Final Diagnosis: Left-sided cardiac tamponade Symptoms: Back pain • dyspnea • hypotension Medication: — Clinical Procedure: — Specialty: Anesthesiology Objective: Unusual clinical course Background: Cardiac tamponade is a life-threatening condition that occurs when pericardial fluid accumulates in the pericardial sac, causing compression of the heart and obstructive shock. This hemodynamic event typically occurs in right-sided cardiac chambers due to the low pressures of the right atrium and right ventricle. Patients undergoing left ventricular assist device (LVAD) placement are at particularly high risk of pericardial effusion development and potential cardiac tamponade because of the need for postoperative anticoagulation. Case Report: A 47-year-old man underwent LVAD placement for deteriorating biventricular function. After several days of stability postoperatively, he experienced dyspnea and had evidence of increasing hemodynamic compromise. He was immediately taken to the operating room, where transesophageal echocardiography showed near-complete collapse of the left atrium and left ventricle with preservation of the right heart chamber sizes in the setting of a large heterogenous posterior pericardial effusion. With swift surgical intervention, the cardiac tamponade was successfully evacuated and the patient regained hemodynamic stability. Conclusions: Cardiac tamponade can present overtly or covertly, and should be high on the list of differential diagnoses in a patient with deterioration in hemodynamic status after cardiac surgery, especially after LVAD placement. Although cardiac tamponade usually affects right-sided cardiac chambers, the left-sided chambers can also be involved. Isolated left-sided cardiac tamponade is rare but can occur in the presence of a loculated posterior pericardial effusion, as seen in this patient.