?Tamponade? following cardiac surgery: terminology and echocardiography may both mislead

Abstract

Haemodynamically significant pericardial collections occurring early following cardiac surgery rarely cause classical clinical or echocardiographic features of tamponade. Recognition of this as a separate diagnostic entity is necessary to ensure appropriate surgical intervention is not delayed.

An evaluation of diagnostic sensitivity of transthoracic echocardiography in diagnosis of post-cardiac surgery tamponade

“…[5] In addition, it has been suggested that TEE provides more valuable information in cases of localized tamponade and that it may reveal some additional findings that cannot be seen via TTE. [23,24] This may be supported by the results of İmren et al [13] in which TTE had a 60% false negativity rate (almost the same as the findings of our study and those of Price et al [9] ). However, they based their diagnostic confirmation on the results of TEE results since their surgical results were highly concordant with the TEE findings.…”

“…[4] A number of previous studies have focused on trying to determine to what extent echocardiographic evaluations provide reliable information in the diagnosis of postoperative cardiac tamponade. For example, Price et al [9] seem to have been the first to analytically describe the limited capability of echocardiography in the diagnosis of this condition. In their study, they divided the patients into two groups according to the time of revision and reported that there were no classic echocardiographic features of tamponade in up to 80% of the patients within the first 72 hours.…”

“…[1,3,8,9,[12][13][14][15] Furthermore, the mortality rate after reoperation ranged from 3.5-37.5%, depending on the patient characteristics along with the inclusion and exclusion criteria. In our study, mortality occurred in 28 patients (38.3%) with LCOS, with respiratory pathologies being the most frequent causes.…”

“…Therefore, when the usual echocardiographic findings of tamponade are not present, surgeons must decide whether to continue monitoring the patient and risk further surgical delay. [6] Although TTE specificity rates ranging from 30-90% have been previously reported, [7][8][9][10][11] these reports lacked the sensitivity rate that could have served as a diagnostic reference to prove or disprove post-cardiac surgery tamponade. In this study, surgical confirmation was considered as the base of reference for calculating both the specificity and sensitivity of TTE in the diagnosis of post-cardiac surgery tamponade, and those rates were compared with a combination of the most commonly observed clinical findings.…”

Postpericardiotomy syndrome and its complications: prevalence, clinical significance and management

“…The main complications of PPS are development of tamponade and constrictive pericarditis (1)(2)(3)(4)(5)(6). Tamponade complicates PPS in 6.4% and constrictive pericarditis in 2-3% of patients (11,12). We aimed to summarize current evidence on prevalence, clinical significance, outcomes and management of postpericardiotomy syndrome developing after cardiac surgery and its complications -tamponade and constrictive pericarditis.…”