Controlled pericardiocentesis in patients with cardiac tamponade complicating aortic dissection: Experience of a centre without cardiothoracic surgery

Cruz, Inês; Stuart, Bruno; Caldeira, Daniel; Morgado, Gonçalo; Gomes, Ana Catarina; Almeida, Ana Rita; Loureiro, María José; João, Isabel; Cotrim, Carlos; Pereira, Hélder

doi:10.1177/2048872614549737

Cited by 32 publications

(15 citation statements)

References 16 publications

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“…Urgent direct aortic repair together with intraoperative pericardial draining is the recommended treatment approach for these patients [15]. Preoperative controlled pericardiocentsis can be lifesaving when managing patients with critical cardiac tamponade complicating acute Stanford type A AAD, especially when cardiac surgery is not immediately available [16].…”

Section: Discussionmentioning

confidence: 99%

Two Intriguing Cases of Stanford Type A Acute Aortic Dissection

Ahmed

Nair

Lak

et al. 2020

Cureus

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Stanford type A acute aortic dissection (AAD) is a life-threatening illness that presents with chest pain and hemodynamic instability. Prompt and accurate evaluation and management are critical for survival as it is a cardiac surgical emergency. We aim to highlight the physicians about this potentially fatal condition, by reporting two cases of Stanford type A AAD, with atypical presentations that were initially misdiagnosed.

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Section: Discussionmentioning

confidence: 99%

Two Intriguing Cases of Stanford Type A Acute Aortic Dissection

Ahmed

Nair

Lak

et al. 2020

Cureus

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“…5 The average time from arrival to diagnosis has been reported as high as 200 min. 6 Cardiac tamponade may be present in 18.7% of cases 7 and is associated with more than 90% mortality without early surgical intervention. 7 Because of poor pericardial compliance, acute accumulation of even minimal fluid can cause tamponade physiology.…”

Section: Discussionmentioning

confidence: 99%

A Case for the Use of Transesophageal Echocardiography in the ED Treatment of Cardiac Arrest

Rublee

Yang

Eisinger

et al. 2020

Chest

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“…When the pressure within the aortic wall exceeds a critical limit rupture occurs, either into the pericardium with cardiac tamponade or into the pleural space or mediastinum (9). Emergency aortic repair together with intra-operative pericardial drainage is the recommended treatment approach.…”

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confidence: 99%

“…Pericardiocentesis is the treatment of choice for cardiac tamponade caused by various diseases, but in case of hemopericardium complicating AD drainage can aggravate the leak or rupture (11). However, according to the recent published guidelines for the diagnosis and management of patients with thoracic aortic disease, preoperative pericardiocentesis can be lifesaving when managing patients with cardiac tamponade with pulseless electrical activity or refractory hypotension complicating acute type A aortic dissection, especially when cardiac surgery is not immediately available (9,12).…”

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confidence: 99%

A case of ascending aortic dissection mimicking acute myocardial infarction and complicated with pericardial tamponade

Hawatmeh

Arqoub

Isbitan

et al. 2016

Cardiovasc. Diagn. Ther.

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A 60-year-old male with past medical history of hypertension, presented to emergency department complaining of chest pain for 2 hours, the pain was described as tearing, substernal pain and was radiating to the neck and shoulders and associated with nausea and sweating. Initial vital signs showed Blood pressure of 120/90 mmHg in right arm, and 110/70 mmHg in left arm, Heart rate of 90 beat per minute, Respiratory rate was 18 breath per minute, temperature of 37.6 ℃ and Oxygen saturation of 95% breathing ambient air. Physical exam was significant for jugular venous distension and cardiac exam showed normal heart sounds, an early diastolic murmur, 3/6 in intensity, best heard on left 3 rd intercostal space without radiation, and no S3 or S4 gallop. Initial lab results showed a white blood cell count of 8.1 k/μL, hemoglobin of 12.2 g/dL, platelets of 177 k/μL, creatinine of 1.19 mg/dL, AST of 30 IU/L, ALT of 29 IU/L, initial set of troponin I was 0.02 ng/mL. Twelve lead electrocardiogram (EKG) showed ST segment elevations in inferior leads ( Figure 1). Emergent coronary angiography was done and revealed normal coronary arteries without evidence of dissection ( Figure 2). After the catheter was pulled back across the aortic valve, an aortic root angiogram was performed and showed aortic insufficiency (grade 3), and an aortic dissection flap that started in the ascending aorta and progressed through to the descending aorta ( Figure 3); this was classified as a Stanford type A (DeBakey type I). A bedside transthoracic echocardiogram was also performed after cardiac catheterization, and showed an EF of 40 % with inferior wall hypokinesia, a dilated aortic root with an evidence of intimal tear in the ascending aorta and moderate aortic regurgitation. In addition, mild pericardial effusion was also noted.Vascular surgery team was immediately consulted, and an aortic computed tomography (CT) scan was done and revealed a Stanford type A (DeBakey type I) aortic Abstract: Acute aortic dissection (AD) is the most common life-threatening disorder affecting the aorta with an incidence that ranges between 5 to 30 cases per million people per year. The symptoms of aortic dissection may be variable and can mimic other more common conditions such as myocardial ischemia. We report a case of a 60-year-old male who presented with inferior wall ST-elevation myocardial infarction (MI).Emergent coronary angiography revealed an ascending aortic dissection with normal coronary arteries. In addition, his aortic dissection was complicated with pericardial tamponade. The patient was managed with an immediate surgical repair, after that he had an uncomplicated postoperative course and was discharged in a stable condition. This case report illustrates the importance of having a high index of suspicion for AD in cases of chest pain. If AD is suspected in a patient with acute coronary syndrome (ACS), confirming the diagnosis with the appropriate imaging studies should be done as quickly as possible, as misdiagnosis with ACS may lead to the inappr...

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Controlled pericardiocentesis in patients with cardiac tamponade complicating aortic dissection: Experience of a centre without cardiothoracic surgery

Abstract: Preoperative controlled pericardiocentesis can be lifesaving when managing patients with critical cardiac tamponade (pulseless electrical activity or refractory hypotension) complicating acute type A aortic dissection, namely when cardiac surgery is not immediately available.

Cited by 32 publications

References 16 publications

Two Intriguing Cases of Stanford Type A Acute Aortic Dissection

Two Intriguing Cases of Stanford Type A Acute Aortic Dissection

A Case for the Use of Transesophageal Echocardiography in the ED Treatment of Cardiac Arrest

A case of ascending aortic dissection mimicking acute myocardial infarction and complicated with pericardial tamponade

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