Delayed cardiac tamponade after open heart surgery - is supplemental CT imaging reasonable?

Abstract

BackgroundCardiac tamponade is a severe complication after open heart surgery. Diagnostic imaging is challenging in postoperative patients, especially if tamponade develops with subacute symptoms. Hypothesizing that delayed tamponade after open heart surgery is not sufficiently detected by transthoracic echocardiography, in this study CT scans were used as standard reference and were compared with transthoracic echocardiography imaging in patients with suspected cardiac tamponade.MethodTwenty-five patients after open heart surgery were enrolled in this analysis. In case of suspected cardiac tamponade patients underwent both echocardiography and CT imaging. Using CT as standard of reference sensitivity, specificity, positive and negative predictive values of ultrasound imaging in detecting pericardial effusion/hematoma were analyzed. Clinical appearance of tamponade, need for re-intervention as well as patient outcome were monitored.ResultsIn 12 cases (44%) tamponade necessitated surgical re-intervention. Most common symptoms were deterioration of hemodynamic status and dyspnea. Sensitivity, specificity, positive and negative predictive values of echocardiography were 75%, 64%, 75%, and 64% for detecting pericardial effusion, and 33%, 83%, 50, and 71% for pericardial hematoma, respectively. In-hospital mortality of the re-intervention group was 50%.ConclusionDiagnostic accuracy of transthoracic echocardiography is limited in patients after open heart surgery. Suplemental CT imaging provides rapid diagnostic reliability in patients with delayed cardiac tamponade.

Diagnostic value of transthoracic echocardiography and computerized tomography for surgically confirmed late tamponade after cardiac surgery

“…On the other hand, transesophageal echocardiography is also not preferred for extubated early postoperative patients, as it is considered a semi‐invasive investigation. On that account, contrast‐enhanced computerized tomography (cCT) represents an appropriate and noninvasive modality for imaging the thoracic and mediastinal structures …”

A Pictorial Review on the Role of 64-Slice HD MDCT in Detecting Post CABG Cardiothoracic Complications

“…Also there were seven patients with pericardial effusion. Ashikhmina AE et al [17] & Floerchinger B et al [18] stated that pericardial effusion is common in patients after open heart surgery due to postoperative bleeding or post-cardiotomy syndrome. They stated that up to 60% patients often presented with pericardial effusion.…”

“…The graft related surgical complications of coronary arteries include spasm [3], graft thrombosis [4] [5], malposition, kinking [5] [6], and iatrogenic complications such as retained clips, aneurysm and pseudoaneurysm of graft and ascending aorta, ostium stenosis and occlusion of coronary artery after Bentall procedure [6]- [9]. The non-graft related surgical complications include pleural and pericardial effusion [10]- [17], sternal and mediastinal infections [16]- [19], mediastinal hematomas [18] [19], and pulmonary embolism [3]- [20]. Many authors have demonstrated that CT is an invaluable tool in the assessment of post-operative complications after CABG as it is accurate, reproducible, short time, but with a diagnostic level of radiation dose to the patient [1]- [9].…”

Chest Ultrasound: A New, Easy, and Radiation-Free Tool to Detect Retrosternal Clot After Pediatric Cardiac Surgery

“…Although their incidence currently is unknown, retrosternal clots after cardiac surgery requiring a sternotomy are common, 4 and diagnosis using transthoracic echocardiography and transesophageal echocardiography may not be easy. Chest ultrasound may be useful in these circumstances.…”