Acute Pericardial Tamponade Research Articles

Insuficiencia cardíaca aguda

DefinitionHeart failure is a syndrome produced by a decrease in the heart's pumping capacity that entails signs and symptoms of congestive heart failure and low cardiac output. It is a severe medical condition that requires urgent therapy. Clinical manifestationsIt may occur as a new-onset heart failure or as a decompensation of previous chronic heart failure. Acute myocardial dysfunction (ischaemic, inflammatory or toxic), acute valve insufficiency and pericardial tamponade are among the most frequent acute primary cardiac causes of heart failure. Diagnosis and treatmentThe main medical tests that must be performed are: ECG, chest x-ray, echocardiogram, and laboratory assessment with natriuretic peptides. Treatment and clinical diagnosis must be made simultaneously, mainly to restore hemodynamic stability, taking care of the triggering factors as well. Depending on the clinical manifestations the treatment may include diuretic, vasodilator, vasopressor, and inotropic agents. Ventilatory and mechanical circulatory support may also be needed.

Is there a correlation between late re-exploration after cardiac surgery and removal of epicardial pacemaker wires?

BackgroundRe-exploration for bleeding accounts for increased morbidity and mortality after major cardiac operations. The use of temporary epicardial pacemaker wires is a common procedure at many departments. The removal of these wires postoperatively can potentially lead to a serious bleeding necessitating intervention.MethodsFrom Jan 2011 till Dec 2015 a total of 4244 major cardiac procedures were carried out at our department. We used temporary epicardial pacemaker wires in all cases. We collected all re-explorations for bleeding and pericardial tamponade from our surgical database and then we focused on the late re-explorations, meaning on the 4th postoperative day and thereafter, trying to identify the removal of the temporary pacemaker wires as the definite cause of bleeding. Patients’ records and medication were examined.ResultsThirty-nine late re-explorations for bleeding, consisting of repeat sternotomies, thoracotomies and subxiphoid pericardial drainages, were gathered. Eight patients had an acute bleeding incidence after removal of the temporary wires (0.18%). In four of these patients, a pericardial drainage was inserted, whereas the remaining patients were re-explorated through a repeat sternotomy. Two patients died of the acute pericardial tamponade, three had a blood transfusion and one had a wound infection. Seven out of eight patients were either on dual antiplatelet therapy or on combination of aspirin and vitamin K antagonist.ConclusionsA need for re-exploration due to removal of the temporary pacemaker wires is a very rare complication, which however increases morbidity and mortality. Adjustment of the postoperative anticoagulation therapy at the time of removal of the wires could further minimize or even prevent this serious complication.

Pericardial Tamponade in an Adult Suffering from Acute Mumps Infection.

Here, we report a case of a 51-year-old man with acute pericardial tamponade requiring emergency pericardiocentesis after he suffered from sore throat, headache, malaise, and sweats for two weeks. Serological analyses revealed increased mumps IgM and IgG indicating an acute mumps infection whereas other bacterial and viral infections were excluded. In addition, MRI revealed atypical swelling of the left submandibular gland. Whereas mumps has become a rare entity in children due to comprehensive vaccination regimens in western civilizations, our case highlights mumps as an important differential diagnosis also in adults, where the virus can induce life-threatening complications such as pericardial tamponade.

Management Issues in Intensive Care Units for Infants and Children with Heart Disease.

Admission of infants and children with cardiac disease to the neonatal (NICU) and pediatric ICU (PICU) is ever increasing in India (30-50 % of all admissions). The commonest indication for admission to the NICU or PICU is acute deterioration of cardiac disease. This includes: acute heart failure, hypercyanotic spells, arrhythmias, pericardial tamponade and sick cardiac neonates who need urgent intervention. Other increasingly frequent indications for ICU admission include heart failure with concomitant chest infection and impending respiratory failure and, severe cyanotic heart disease with various stroke syndromes. It is thus essential that a pediatrician be comfortable with the ICU management of such children and that low cost ICU modalities be utilized in order to reach out to as many children as feasible. It is heartening that there is renewed interest in inexpensive therapies like noninvasive ventilation and therapeutic hypothermia.

Abstract 678: Thoracic Aortic Dissection in Hypertensive Myh11r247c Mice Is Regulated by Gsk3β Signaling Pathway.

Acute ascending aortic dissections cause premature deaths due to pericardial tamponade. Mutations in the gene for smooth muscle specific myosin heavy chain (MYH11) causes aortic dissections with minimal aortic dilation, whereas mutations in fibrillin-1 (FBN1) causing Marfan syndrome is characterized by aneurysm formation before dissections occur. We hypothesize that distinct pathways might be responsible for the aortic dissections. Results: Mice with a homozygous Myh11 missense variant (R247C), Myh11R247C, do not have aortic enlargement and do not die prematurely of aortic dissections. Increased blood pressure induced by high salt diet and L-NAME in the Myh11R247C mice leads to sudden death that occur within 2 weeks due to acute aortic dissection and pericardial tamponade in more than 20% (9/39) of the animals (P=0.02, comparing to the death rate (1/45) in WT mice). Increased SMC proliferation and accumulation of proteoglycans are observed in the aortas of the hypertensive Myh11R247C mice. RNA Seq analysis of the Myh11R247C aortas with and without hypertension indicated targets of the Wnt pathway were increased and pathway analysis with DAVID Bioinformatics Resources identified the focal adhesion pathway was highly involved (P<0.01). Immunoblot analysis of aortic lysates confirmed increased activation of FAK and AKT, along with phosphorylation (inactivation) of GSK3β when hypertension was induced. To further inhibit GSK3β in the hypertensive Myh11R247C, the GSK3β inhibitor SB216763 was given immediately before and with hypertension induction. The death rates in Myh11R247C mutant mice but not in WT mice increased to 50% from 20% (P=0.02, N=22). Conclusion: FAK/AKT/GSK3β signaling pathway probably plays a pivotal role in acute aortic dissections in hypertensive Myh11R247C mutant mice. The SMC proliferation and proteoglycan accumulation could be important cellular pathological changes responsible for aortic dissections.

Cardiac tamponade as the initial presentation of Hodgkin's lymphoma in a young female

Introduction: Hodgkin’s lymphoma can affect the heart both as primary and as a metastatic condition. Pericardial compromise is a common finding over the course of the disease, and the manifestations can range from pericarditis to pericardial tamponade. Pericardial tamponade is a life-threatening condition that requires immediate treatment, and is rarely the initial presentation of Hodgkin’s lymphoma. We present a case of a young female with Hodgkin’s lymphoma initially presenting as acute pericardial tamponade.

Presentation of pericardial hydatid cyst as acute cardiac tamponade

We report a case of a 47-year-old man with isolated pericardial hydatid cyst (without myocardial involvement) that presented as acute pericardial tamponade. After initial investigation and transthoracic echocardiography, emergent pericardial drainage was performed for downgrading the urgency of a definitive treatment for a hydatid cyst. A computed tomography examination after the pericardial drainage showed a pericardial cyst without heart muscle involvement, making the treatment possible through anterior thoracotomy and without performing cardiopulmonary bypass. Complete surgical removal of the cyst was performed. The postoperative course was uneventful. The patient received postoperative albendazole treatment. He remained asymptomatic and no recurrence was observed during a 1-year follow-up period.

Transcatheter aortic valve implantation complicated by acute pericardial tamponade.

Transcatheter aortic valve replacement (TAVR) is now an accepted standard of care for patients with symptomatic severe aortic stenosis who are not candidates for surgery or have high surgical risk. Despite its more widespread adoption as a treatment option and increasing experience of centers, TAVR is still associated with several complications. We therefore report a case of TAVR complicated by acute pericardial tamponade, one of the most severe potential complications of this procedure. We describe the way we approached the problem and we try to give a potential take-home message for others who might encounter such a situation in their own cath lab.

Iatrogenic Ascending Aorta Dissection during Diagnostic Coronary Angiography: Rare but Life-Threatening.

Dissection of the ascending aorta is a very rare but life-threatening complication during diagnostic angiography. We present a case of an elderly woman who underwent an elective diagnostic coronary angiography, complicated with an iatrogenic ascending aorta dissection that did not involve the coronary arteries but originated 4 cm distal of the aortic valve. The patient developed cardiogenic shock due to acute pericardial tamponade and so immediate, life-saving cardiac surgery with implantation of a supracoronary graft was successfully performed. A biopsy from the excised aorta showed loss of smooth muscle cells and accumulation of basophilic ground substance, clear features of cystic media necrosis. This is believed to be the underlying cause of the dissection besides a nonselective injection of the right coronary artery.

Pulmonary Artery Perforation by Plug Anchoring System After Percutaneous Closure of Left Appendage

Patients receiving oral anticoagulant therapy for atrial fibrillation who are at high risk of bleeding are increasingly referred for percutaneous left atrial appendage exclusion. Although effective, this procedure is not free from risk. We report a case of pericardial tamponade due to pulmonary artery tear caused by a trespassing anchoring hook of an AGA plug. Intraoperatively, no actual bleeding was found from the left appendage, a proof of its complete occlusion by the device. The patient underwent successful surgical repair and radio-frequency ablation of atrial fibrillation was performed by pulmonary veins encircling.

Right aortic arch and Kommerell's diverticulum associated with acute aortic dissection and pericardial tamponade

The right-sided aorta associated with an aberrant left subclavian artery is a rare anomaly of the aortic branches in the upper mediastinum. We present a 62-year-old patient suffering from an acute dissection of the ascending aorta associated with hemopericardium. In this case, there was also aneurysmal dilatation of the origin of the left subclavian artery, known as diverticulum of Kommerell.

Visualization of hypoxemic coronary perfusion despite full retrograde extracorporeal circulatory life support

Figure 1: CT angiography of the chest illustrating the aforementioned phenomenon of incomplete coronary perfusion during retrograde ECLS: contrast agent was injected through a central venous catheter placed in the right jugular vein. A CT scan was performed after haemodynamic stabilization of the patient. At this time, flow of the ECLS was 3.8 l/min with a corresponding static arterial blood pressure of 69 mmHg and a central venous pressure of 6 mmHg. Under these conditions, there is no visible contrast agent in the left ventricle of the non-ejecting heart. Despite full retrograde flow provided by the veno-arterial ECLS, the aortic root is not completely filled with the contrast agent. Figure 2: CT angiography of the chest: pericardial drains and osteosynthetic material are visible after preceding sternotomy. Emergency surgery was necessary after an attempt to place a left ventricular probe of a cardiac resynchronization device, causing a left ventricular laceration with an acute pericardial tamponade and subsequent resuscitation. ECLS implantation was followed by immediate transfer to the operating room. No left ventricular ejection at the time of imaging. Note: despite full ECLS support with retrograde arterial flow, hypoxemic blood without the contrast agent pours from the left ventricle into the aortic root and the left coronary artery.

Transesophageal Echocardiography in the Diagnosis of Acute Pericardial Tamponade During Hiatal Hernia Repair

q i c h t d t t r m WHEN MEDICAL TREATMENT of hiatal hernia is unsuccessful (eg, worsened symptoms of gastroesophageal reflux) or when there is progressive enlargement of the hernia defect, surgical repair is indicated.1 Among several surgical techniques described for hiatal hernia repair, the Nissen fundoplication has been superior, with symptomatic improvement occurring in 85%-90% of patients.2,3 This procedure entails rapping the gastric fundus around the distal esophagus and astroesophageal junction to reinforce them.2 Laparoscopic erformance of Nissen fundoplication shortens hospital stay ompared with performing the surgery with an open laparotmy.4 A relatively recent selective addition to the procedure is mplantation of a mesh graft to decrease the diaphragmatic efect. This provides an additional mechanical barrier and, herefore, is thought to decrease recurrence.3 In general, Nissen fundoplication is a safe procedure. However, life-threatening complications have been described and include injury to the stomach and spleen, bleeding complications, and injury to neighboring organs.5-7 This report describes the case of a patient who developed pulseless bradycardia during a modified Nissen fundoplication with mesh graft implantation. The cause of the electromechanical dissociation was an acute pericardial tamponade. This evolved from an accidental perforation of the right ventricle by a spiral tack used to affix the mesh graft to the diaphragm to close the hernia defect more securely. The diagnosis of pericardial tamponade was made by transesophageal echocardiography (TEE).

Post-mortem MSCT diagnosis of acute pericardial tamponade caused by blunt trauma to the chest in a motor-vehicle collision

Post-mortem MSCT diagnosis of acute pericardial tamponade caused by blunt trauma to the chest in a motor-vehicle collision

Acute pericardial tamponade due to screw-in atrial lead heart perforation

A case of peri-procedural perforation of right atrium following the implantation of atrial screw-in lead in a 74-year-old man is reported. The perforation caused acute pericardial tamponade and worsening of the patient's clinical and haemodynamic conditions. Urgent surgical intervention with lead extraction was performed.

Pericardial tamponade after left posterolateral thoracotomy for left upper lobectomy for pulmonary aspergilloma

Pericardial tamponade limits diastolic filling of the heart; therefore, a high venous pressure is required to fill the ventricle. In presence of cardiac tamponade, therapeutic agents and manoeuvres that results in venodilation or vasodilation can severely compromise diastolic filling of the heart and might result in rapid cardiac decompensation. Equalization of central venous pressure and pulmonary artery diastolic pressure or equalization of pressures in all four chambers during diastole confirms cardiac tamponade. Transthoracic echocardiography can detect the site of tamponade and assist in pericardiocentesis. We describe acute pericardial tamponade in a young man who underwent left posterolateral thoracotomy for left upper lobectomy. Intraoperatively, mobilization of the left upper lobe was frequently associated with hypotension. Postoperatively, the patient suffered two more episodes of hypotension. The episodes of hypotension were attributed to surgical manipulation and epidural blockade. Hemodynamics normalized after discontinuing epidural infusion, volume resuscitation and lobectomy. On third postoperative day, the patient developed cardiovascular collapse; arterial blood pressure and central venous pressure were 70/50 and 12 mmHg. Investigations showed haziness of left lung, and severe respiratory acidosis. On opening of the left thoracotomy wound, pericardial tamponade was diagnosed. A pericardial window was created and tamponade was released with that the hemodynamics normalized. Episodes of unexplained hypotension after left upper lobectomy suggest a cardiac etiology and acute pericardial tamponade is a possibility which should be released immediately otherwise it can result in fatal outcome.

Pericardial Tamponade after Superior Vena Cava Stent: Are Nitinol Stents Safe?

Placement of a single new-generation nitinol stent resulted in acute pericardial tamponade in a 70-year-old man with superior vena cava syndrome.

Late Cardiac Perforation After Transcatheter Closure of Patent Foramen Ovale Mimicking Acute Type A Aortic Dissection

We report a rare case of late cardiac perforation after percutaneous closure of patent foramen ovale with the Cardia Star device (Cardia, Gent, Belgium), which presented as acute pericardial tamponade and was initially misdiagnosed as acute type A aortic dissection. The clinical course was dramatic in our patient and might have resulted in sudden death without prompt surgical treatment. The clinicians involved in treating a patient with acute, unexplained cardiac tamponade should be aware of late cardiac perforation occurring after percutaneous patent foramen ovale closure.

Device closure of residual shunt after percutaneous closure of patent foramen ovale

To summarise our experiences of device closure of residual shunt after transcatheter closure of patent foramen ovale (PFO). Since October 1997 implantation of a second closure device was attempted in 40 patients with a moderate or large residual shunt after implantation of a PFO closure device. The mean age of the patients was 51 years. Implantation of a second closure device was technically successful in 39/40 patients (98 %). The following devices were implanted: Premere (n=20), Amplatzer PFO (n=13), STARFlex (n=4), Helex (n=1), Angelwings (n=1). During a mean follow-up of 36+/-29 months complete closure was achieved in 27 patients (69 %). The remaining shunt was small in nine patients, moderate in one and large in two. One patient with a moderate and one patient with a large residual shunt received a third device. The third patient was sent to surgery. One patient died 21 days after implantation of a third closure device due to acute pericardial tamponade. No other complications occurred. Transcatheter implantation of a second closure device after PFO closure is feasible. Complete closure can be achieved in the majority of patients.

A young woman with multiple cardiac mass lesions

A 22-year-old woman presented with breathlessness, weight loss and anorexia of 6 months’ duration. Clinical examination was suggestive of mild to moderate cardiomegaly with systolic murmur. Routine laboratory investigations revealed normal cardiac enzymes. An electrocardiogram revealed T-wave inversion in lead II, III, aVF and I, aVL and V4–6. A chest radiograph showed widened mediastinal shadow with minimally multilobulated rightand left-sided margins of cardiac and mediastinal silhouette. No obvious calcifications or altered density difference was seen in this region. Twodimensional echo cardiography (not shown) revealed