Abstract
BackgroundCardiac tamponade is a rare but severe complication of pericardial effusion with a poor prognosis. Prompt diagnosis using transthoracic echocardiography allows guiding initial therapeutic management. Although etiologies are numerous, cardiac tamponade is more often due to a hemopericardium. Rarely, a coronary injury may result in such a hemopericardium with cardiac tamponade. Coronary artery aneurysm are the main etiologies but blunt, open chest trauma or complication of endovascular procedures have also been described.Case presentationA 83-year-old hypertensive man presented for dizziness and hypotension. The patient had oliguria and mottled skin. Transthoracic echocardiography disclosed a circumferential pericardial effusion with a compressed right atrium, confirmed by contrast-enhanced thoracic CT scan. A pig-tail catheter allowed to withdraw 500 mL of blood, resulting in a transient improvement of hemodynamics. Rapidly, recurrent hypotension prompted a reoperation. An active bleeding was identified at the level of the retroventricular coronary artery. The pericardium was thickened with several "sharping" calcified plaques in the vicinity of the bleeding areas. On day 2, vasopressors were stopped and the patient was successfully extubated. Final diagnosis was a spontaneous cardiac tamponade secondary to a coronary artery injury attributed to a "sharping"calcified pericardial plaque.ConclusionCardiac tamponade secondary to the development of a hemopericardium may develop as the result of a myocardial and coronary artery injury induced by a calcified pericardial plaque.
Highlights
Cardiac tamponade is a rare but severe complication of pericardial effusion with a poor prognosis
Cardiac tamponade secondary to the development of a hemopericardium may develop as the result of a myocardial and coronary artery injury induced by a calcified pericardial plaque
We report on a patient presenting with cardiac tamponade secondary to a myocardial and coronary artery injury related to an erosive pericardial calcification, who had a favorable outcome after surgical decompression
Summary
Cardiac tamponade is a life-threatening complication of pericardial effusions. Prompt diagnosis using transthoracic echocardiography allows guiding initial therapeutic management [1,2]. We report on a patient presenting with cardiac tamponade secondary to a myocardial and coronary artery injury related to an erosive pericardial calcification, who had a favorable outcome after surgical decompression. Hypotension resumed despite increasing doses of Norepinephrine (up to 0,7 μg/kg/min) and the pericardial drainage remained productive (450 ml/hour of fresh blood). This prompted a reoperation under extracorporeal circulation. An active bleeding was identified at the level of the retroventricular coronary artery and of the epicardial surface which was Figure 1 Contrast-enhanced thoracic CT scan: circumferential pericardial effusion without other anormalities, in particular aortic lesion. Final diagnosis was a spontaneous cardiac tamponade secondary to a coronary artery injury attributed to a “sharping"calcified pericardial plaque
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