Late cardiac tamponade following open-heart surgery: Diagnosis and Treatment

Solem, Jan Otto; Kugelberg, Jan; Ståhl, Elisabeth; Olin, Christian

doi:10.3109/14017438609106489

Cited by 16 publications

(9 citation statements)

References 3 publications

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“…Diagnostic use of CT in cardiac tamponade dates back several decades, and in a review published by Glock et al21 in 1983, it has been stated that a definitive diagnosis of late cardiac tamponade (after postoperative day 3) can be made using right heart catheterization and mono-and bidimensional echocardiography, and computerized axial tomography may represent an interesting, noninvasive, and safe imaging technique. In 1986, Solem et al22 reported that echocardiography failed to detect late tamponade in one of five patients (defined to be after postoperative day 6) in their series, and CT provided considerably accurate results regarding the volume and localization of the pericardial collection in all patients.…”

mentioning

confidence: 99%

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

2019

J Card Surg

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Background: Late tamponade after cardiac surgery is a clinically obscure condition presenting significant diagnostic challenges, since it may be difficult to detect using routine imaging studies. This study is aimed to investigate the diagnostic value of transthoracic echocardiography (TTE) and contrast-enhanced computerized tomography (cCT) in the diagnosis of late tamponade following open-heart surgery.Methods: A total of 88 patients who underwent reoperation after cardiac surgery with suspected late cardiac tamponade were included in this retrospective study.All the patients had TTE and cCT examinations before reoperation. The diagnostic values of these imaging modalities were investigated using surgically confirmed late tamponade as the standard.Results: The sensitivity, specificity, positive predictive value, negative predictive value, and accuracy of an optimal cutoff value of greater than 3.1 cm pericardial fluid thickness on cCT images for predicting surgically confirmed late tamponade were 91.4%, 66.6%, 97.4%, 36.3%, and 89.7%, respectively. Accordingly, the sensitivity, specificity, positive predictive value, negative predictive value, and accuracy of TTE for the diagnosis of late tamponade were 34.1%, 50.0%, 90.3%, 5.2%, and 35.2%, respectively. The cCT provided false-negative results in seven patients (8%), while this figure was 54 (61.4%) for that of TTE.Conclusion: Computerized tomography imaging seems to represent a superior imaging technique in terms of visualizing the intrapericardial fluid collections after cardiac surgery and has the potential to readily diagnose late tamponade and effectively prevent unnecessary morbidity and mortality. K E Y W O R D S cardiac surgery, computerized tomography, late tamponade, transthoracic echocardiography

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confidence: 99%

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

2019

J Card Surg

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“…Infections leading to costochondritis, pericarditis, and fa tal septicaemia have been reported to occur in pericardio centesis both without (11,16) and with an indwelling cathe ter (10). Even though the catheter remained in the pericardi al space for more than 24 hours in 85% of our patients, only one infection occurred.…”

Section: Discussionmentioning

confidence: 58%

Complications of Percutaneous Pericardiocentesis under Fluoroscopic Guidance

Duvernoy¹,

Borowiec²,

Helmius³

et al. 1992

Acta Radiol

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Complications in 352 cases of fluoroscopy-guided percutaneous pericardiocentesis accomplished through an indwelling catheter were reviewed following surgery and non-surgery. Thirteen major complications were found, namely 3 cardiac perforations, 2 cardiac arrhythmias, 4 cases of arterial bleeding, 2 cases of pneumothorax in children, one infection, and one major vagal reaction. No significant difference in complications was found between pericardiocenteses for pericardial effusions after cardiac surgery (n = 208) and those for effusions of non-surgical (n = 144) origin. Fluoroscopy-guided pericardiocentesis by the subxiphoid approach with placement of an indwelling catheter is a safe method for achieving pericardial drainage in both surgical and non-surgical effusions. Accidental cardiac perforation with a fine needle is a minor complication as long as the needle is directed towards the anterior diaphragmatic border of the right ventricle and drainage is achieved with a reliable indwelling catheter.

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“…The effusion can be circumferential or loculated and is usually posterior to the left ventricle 2,3 . Because symptoms and signs are often variable and non‐specific, 3,4 bedside ultrasound is again useful for diagnosis. The classical echocardiographic signs of right atrial collapse and right ventricular diastolic collapse are more often seen in circumferential tamponade, whereas left ventricular diastolic collapse is more common in regional tamponade 3 .…”

Section: Discussionmentioning

confidence: 99%

Ultrasound for primary confirmation of mechanical capture in emergency transcutaneous pacing

Tam

2003

Emergency Medicine

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Clinical confirmation of mechanical capture in emergency transcutaneous pacing is sometimes difficult because of weak pulse volume or interference from skeletal muscle contractions. This report is of a case of using bedside ultrasound for primary confirmation of emergency transcutaneous pacemaker capture, and for differentiating between causes of persistent hypotension despite successful pacing. The technique of ultrasound‐guided transcutaneous pacing is described.

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Late cardiac tamponade following open-heart surgery: Diagnosis and Treatment

Cited by 16 publications

References 3 publications

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

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

Complications of Percutaneous Pericardiocentesis under Fluoroscopic Guidance

Ultrasound for primary confirmation of mechanical capture in emergency transcutaneous pacing

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