Postoperative left atrial compression diagnosed by transesophageal echocardiography

Abstract

M ULTIPLE INVESTIGATORS have demonstrated that cardiac tamponade can present in an atypical fashion after cardiac surgery. 1-6 The classical features of pulsus paradoxus, distended neck veins and equalization of pulmonary capillary wedge, pulmonary artery diastolic, and right atrial pressures may not occur when isolated chambers of the heart are compressed by a clot. 7-a° This case report describes a patient who developed tamponade after cardiac surgery from a clot located behind the left atrium. The patient's hemodynamic deterioration and clinical signs were not consistent with classical tamponade. Transesophageal echocardiography (TEE) was used to diagnose the tamponade and determine its precase location. Surgical exploration was performed, and a large blood clot behind the left atrium was evacuated. There was no other significant localized clot in the pericardium, and hemodynamic status quickly improved when the clot was removed.