Fatal Acute Cardiac Tamponade after Balloon Angioplasty for Central Venous Stenosis, a Case Report

Abstract

We report a 40-year-old woman who developed a fatal acute cardiac tamponade after balloon angioplasty for central venous stenosis (CVS) related to hemodialysis. Retrograde and antegrade recanalization followed by balloon angioplasty was carried out through the right-femoral and left internal jugular vein approach. The interventional procedure of recanalization and balloon angioplasty was uneventful with satisfactory angiographic result of the central venous. However, the patient suffered sudden-onset shortness of breath and tachycardia, followed by bradycardia and cardiac arrest, apneic and coma immediately after the procedure. Acute cardiac tamponade was suspected and confirmed by emergency echocardiography. Urgent pericardiocentesis and indwelling catheter placement was performed with 200 ml hemorrhagic pericardial effusion aspirated. However, resuscitation was only successful in relatively stablity of blood pressure and heart rate. The patient remained in a coma and was admitted to the Intensive Care Unit (ICU) for further rescue, but still died two days later. Death was determined to be due to cardiac tamponade secondary to perforation of the right atrium by balloon dilation of the stenotic cava-atrial junction. It is an under-reported case of fatal acute cardiac tamponade happened during the balloon angioplasty for CVS in hemodialysis patients.