Routine postoperative computed tomography is superior to cardiac ultrasonography for predicting delayed cardiac tamponade

Kamada, Keisuke; Wakabayashi, Naohiro; Ise, Hayato; Nakanishi, Sentaro; Ishikawa, Natsuya; Kamiya, Hiroyuki

doi:10.1007/s10554-020-01820-w

Cited by 2 publications

(2 citation statements)

References 12 publications

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“…Advanced CT-scanners may also deliver cine CT-images and important information about the function and dynamics of the heart and pericardium [20]. Cardiac magnetic resonance imaging may be useful in particular when regional tamponade is suspected in hemodynamically stable postoperative patients [35,[39][40][41][42].…”

Section: Discussionmentioning

confidence: 99%

Pericardial tamponade, a diagnostic chameleon: from the historical perspectives to contemporary management

Kaemmerer

Alkhalaileh²,

Suleiman³

et al. 2023

J Cardiothorac Surg

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Background Pericardial tamponade (PT) early after cardiac surgery is a challenging clinical entity, not infrequently misrecognized and often only detected late in its course. Because the clinical signs of pericardial tamponade can be very unspecific, a high degree of initial suspicion is required to establish the diagnosis. In addition to clinical examination the deployment of imaging techniques is almost always mandatory in order to avoid delays in diagnosis and to initiate any necessary interventions, such as pericardiocentesis or direct cardiac surgical interventions. After a brief overview of how knowledge of PT has developed throughout history, we report on an atypical life-threatening cardiac tamponade after cardiac surgery. A 74-year-old woman was admitted for elective biological aortic valve replacement and aorto-coronary-bypass grafting (left internal mammary artery to left anterior descending artery, single vein graft to right coronary artery). On the 10th postoperative day, the patient unexpectedly deteriorated. She rapidly developed epigastric pain radiating to the left upper abdomen, and features of low peripheral perfusion and shock. There were no clear signs of pericardial tamponade either clinically or echocardiographically. Therefore, for further differential diagnosis, a contrast-enhanced computed tomography scan was performed under clinical suspicion of acute abdomen. Unexpectedly, active bleeding distally from the right coronary anastomosis was revealed. While the patient was prepared for operative revision, she needed cardiopulmonary resuscitation, which was successful. Intraoperatively, the source of bleeding was located and surgically relieved. The subsequent postoperative course was uneventful. Conclusions In the first days after cardiac surgery, the occurrence of life-threatening situations, such as cardiac tamponade, must be expected. Especially if the symptoms are atypical, the entire diagnostic armamentarium must be applied to identify the origin of the complaints, which may be cardiac, but also non-cardiac. Central message A high level of suspicion, immediate diagnostic confirmation, and rapid treatment are required to recognize and successfully treat such an emergency (Fig. 5). Perspective Pericardial tamponade should always be considered as a complication of cardiac surgery, even when symptoms are atypical. The full range of diagnostic tools must be used to identify the origin of the complaints, which may be cardiac, but also non-cardiac (Fig. 5).

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Section: Discussionmentioning

confidence: 99%

Pericardial tamponade, a diagnostic chameleon: from the historical perspectives to contemporary management

Kaemmerer

Alkhalaileh²,

Suleiman³

et al. 2023

J Cardiothorac Surg

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“… 17 We found a clear preference for TEE in ventilated patients, while both CT and TEE were equally favoured in case of non-ventilated patients. Kamada et al 18 performed a retrospective analysis evaluating the efficacy of routine postoperative CT and echocardiography in assessing patients expressing symptoms of delayed (>72 hours) cardiac tamponade. With a 20 mm effusion cut-off, they found 96% specificity for ruling out a delayed tamponade with CT compared with 66% specificity with TTE.…”

Section: Discussionmentioning

confidence: 99%

Variations in current clinical practice of postoperative pericardial effusion: a questionnaire study

Dinter

Wollersheim

et al. 2023

Open Heart

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ObjectivePostoperative pericardial effusion (PPE) occurs frequently after cardiac surgery, potentially leading to life-threatening cardiac tamponade. Specific treatment guidelines are currently lacking, possibly leading to variations in clinical practice. Our goal was to assess clinical PPE management and evaluate variation between centres and clinicians.MethodsA nationwide survey was sent to all interventional cardiologists and cardiothoracic surgeons in the Netherlands, regarding their preferred diagnostic and treatment modality of PPE. Clinical preferences were explored utilising four patient scenarios, each with a high/low echocardiographic and clinical suspicion of cardiac tamponade. Scenarios were also stratified by three PPE sizes (<1 cm, 1–2 cm, >2 cm).ResultsIn total, 46/140 interventional cardiologists and 48/120 cardiothoracic surgeons responded (27/31 contacted centres). Cardiologists favoured routine postoperative echocardiography in all patients (44%), whereas cardiothoracic surgeons preferred routine imaging after specific procedures, especially mitral (85%) and tricuspid (79%) valve surgery. Overall, pericardiocentesis (83%) was preferred over surgical evacuation (17%). Regarding all patient scenarios, cardiothoracic surgeons significantly preferred evacuation compared with cardiologists (51% vs 37%, p<0.001). This was also observed with cardiologists employed in surgical centres compared with non-surgical centres (43% vs 31%, p=0.02). Inter-rater analysis varied from poor to near-excellent (к 0.22–0.67), suggesting varying PPE treatment preferences within one centre.ConclusionThere is significant variation in the preferred management of PPE between hospitals and clinicians, even within the same centre, possibly due to the lack of specific guidelines. Therefore, robust results of a systematic approach to PPE diagnosis and treatment are needed to formulate evidence-based recommendations and optimise patient outcome.

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Routine postoperative computed tomography is superior to cardiac ultrasonography for predicting delayed cardiac tamponade

Cited by 2 publications

References 12 publications

Pericardial tamponade, a diagnostic chameleon: from the historical perspectives to contemporary management

Pericardial tamponade, a diagnostic chameleon: from the historical perspectives to contemporary management

Variations in current clinical practice of postoperative pericardial effusion: a questionnaire study

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