Cardiac Tamponade Research Articles

Alcohol septal ablation gone wrong- case report of a complication of hypertrophic obstructive cardiomyopathy treatment

Alcohol Septal Ablation (ASA) is an interventional procedure that involves injecting ethanol into a targeted septal artery, inducing localized tissue necrosis, and subsequently reducing septal thickness. Our experience highlights this method as an effective therapeutic intervention for symptomatic HOCM patients, providing relief from symptoms and enhancing cardiac function, reducing Left Ventricular Outflow Tract (LVOT) gradient. However, potential complications such as arrhythmia, Left Anterior Descending (LAD) dissection, cardiac tamponade, and coronary artery spasm are rare but necessitate careful patient selection and vigilant post-procedural monitoring. It is a reasonable therapeutic option especially in older patients with favourable coronary anatomy in the absence of mitral valve disease and if it is performed by an experienced operator. We present a case of a 68-year-old man with Hypertrophic Obstructive Cardiomyopathy (HOCM), elevated LVOT gradient, and symptoms despite optimal medical therapy. He underwent alcohol septal ablation which was complicated by alcohol leakage likely via collateral circulation into the distal left anterior descending artery and obliteration of the vessel.

Sex Differences in DeBakey Type I/II Acute Aortic Dissection Outcomes: The Tokyo Acute Aortic Super-network

BackgroundSex differences in the clinical presentation and outcomes of DeBakey type I/II (Stanford type A) acute aortic dissection (AAD) remain unclear. ObjectivesThe authors aimed to determine the impact of sex on the clinical presentation and in-hospital outcomes of surgically or medically treated patients with type I/II AAD. MethodsWe studied 3,089 patients with type I/II AAD enrolled in multicenter Japanese registry between 2013 and 2018. The patients were divided into 2 treatment groups: surgical and medical. Multivariable logistic regression was used to examine the association between sex and in-hospital mortality. ResultsIn the entire cohort, women were older and more likely to have hyperlipidemia, previous stroke, altered consciousness, and shock/hypotension at presentation than men. Women had higher proportions of intramural hematomas and type II dissections than men. In the surgical group (n = 2,543), men had higher rates of preoperative end-organ malperfusion (P = 0.003) and in-hospital mortality (P = 0.002) than women. Multivariable analysis revealed that male sex was associated with higher in-hospital mortality after surgery (OR: 1.71; 95% CI: 1.24-2.35; P < 0.001). In the medical group (n = 546), women were older and had higher rates of cardiac tamponade (P = 0.004) and in-hospital mortality (P = 0.039) than men; no significant association between sex and in-hospital mortality was found after multivariable adjustment (OR: 0.95; 95% CI: 0.56-1.59; P = 0.832). ConclusionsMale sex was associated with higher in-hospital mortality for type I/II AAD in the surgical group but not in the medical group. Further research is needed to understand the mechanisms responsible for worse surgical outcomes in men.

A rare case of obstructive shock due to cardiac tamponade in a term pregnancy

Background Obstructive shock due to cardiac tamponade is a rare, life-threatening occurrence in the peripartum period. Etiologies include preeclampsia, infection, autoimmune conditions, and malignancy. Early recognition of the underlying disease process allows for multidisciplinary treatment and a favorable outcome. Case A 33 year-old presented for cardiac tamponade identified in the peripartum period. She was diagnosed with preeclampsia with severe features immediately prior to her repeat Cesarean delivery and received magnesium prophylaxis. Postoperatively, she developed hypotension, tachycardia, and shortness of breath and was found to have a pericardial effusion with tamponade physiology. She underwent pericardial drain placement which was initially successful. However, she had recurrent symptomatic tamponade and thus a pericardial window was performed resulting in improvement of her symptoms. Workup revealed pericardial inflammation possibly secondary to a viral source, and she was successfully treated with anti-inflammatory therapy. Conclusion We hypothesize that this patient’s cardiac tamponade was caused by inflammatory pericarditis exacerbated by severe preeclampsia. Preeclampsia is a disease characterized by cardiovascular remodeling and fluid shifts in other compartments and thus is theorized to have contributed to this patient’s effusion. Cardiac tamponade should be considered in the differential for any parturient presenting with hypotension and shortness of breath.

Right atrial infarction causing recurrent cardiac rupture and cardiac tamponade

Abstract An 81-year-old female with acute myocardial infarction experienced repeated cardiac tamponade. Computed tomography showed multiple nodular lesions in adipose tissue around right atrium (RA). The autopsy revealed RA infarction with a hematoma extending from RA to adventitia adipose tissue.

Application Effect of Multi-Dimension Nursing Combined with GRACE Scoring System in Patients with Atrial Fibrillation after Green Precision Catheter Radiofrequency Ablation

Objective: To explore the application effect of multi-dimensional nursing combined with the Global Registry of Acute Events (GRACE) scoring system in the nursing of patients with atrial fibrillation after radiofrequency ablation with green precision catheter radiofrequency ablation. Methods: A total of 274 patients diagnosed with atrial fibrillation undergoing green precision catheter radiofrequency ablation were collected from the Department of Cardiology at our hospital in a retrospective study. After the inclusion, exclusion, diagnostic criteria and physical examination, all the subjects underwent green precision catheter radiofrequency ablation. According to various nursing methods that were adopted, they were divided into two groups with 7–14 days of nursing intervention by digital randomization: the study group (multi-dimensional nursing combined with GRACE scoring system evaluation, n = 136 cases) and the control group (postoperative routine nursing, n = 138 cases). The MOS item short from health survey (SF-36) score, Hamilton anxiety scale (HAMA) score, Hamilton depression scale (HAMD) score, complication rates and the nursing quality of the two groups were observed. Results: After multi-dimensional nursing combined with the GRACE in-hospital scoring system for stratified nursing in the study group, SF-36 scores in both groups increased after conventional nursing in the control group, but there was a statistical difference between the study group and the control group (p &lt; 0.05). HAMA score and HAMD score decreased, and there were statistical differences between the study group and the control group (p &lt; 0.05). The comparison between the study group and the control group showed that “Cardiac tamponade”, “Atrioventricular block”, “Peripheral vascular injury” and the total incidence of complications were statistically different (p &lt; 0.05). The basic satisfaction, number of satisfaction and total satisfaction rate of the study group were higher than those of the control group, and the difference was statistically significant (p &lt; 0.05). Conclusions: Multi-dimensional nursing combined with the GRACE scoring system in the nursing care of patients with atrial fibrillation after radiofrequency ablation with the green precision catheter, improves the quality of life, alleviates negative emotions, reduces the incidence of complications, and results in better quality of nursing care.

Variability in Interpretation of Echocardiographic Signs of Tamponade: A Survey of Emergency Physician Sonographers

BackgroundCardiac tamponade is associated with high mortality, and making the diagnosis is a core skill of emergency physicians. Proper diagnosis relies on specific clinical and echocardiographic findings. It is not known whether expert sonographers consistently recognize echocardiographic signs of tamponade. ObjectivesTo assess whether expert sonographers agree on echocardiographic signs of tamponade. MethodsA 20-question survey consisting of 18 cine loops and 2 still images was distributed to the Academy of Emergency Ultrasound Section of the Society for Academic Emergency Medicine. Respondents answered “yes” or “no” to whether there was echocardiographic evidence of tamponade. Subgroup analyses of demographics and echocardiographic views were reported. The data were analyzed using Krippendorff's alpha (α) to assess interrater reliability (IRR) between respondents. ResultsEighty-four physicians responded and 56 completed the survey. All partial and completed surveys were analyzed. The overall IRR was poor (α = 0.60, 95% confidence interval [CI] 0.44–0.76). Residency graduation within 5 years (α = 0.66, 95% CI 0.5–0.8) was associated with higher IRR compared with those > 5 years (α = 0.53, 95% CI 0.37–0.69). The highest IRR was observed when images of mitral valve inflow pulse-wave Doppler (α = 0.81, CI 0.70–0.92) were used and the poorest IRR was on images from the parasternal short view (α = 0.28, 95% CI 0.05–0.49). ConclusionThere was poor agreement among expert emergency medicine sonographers in identifying echocardiographic signs of cardiac tamponade from a single cine loop or clip without clinical context. Further investigation is warranted to understand differences in recognition of clinical tamponade.

Infeksi Multipel Organ Tuberkulosis Ekstrapulmonal pada Anak yang disertai Malnutrisi Tipe Marasmus

Mycobacterium tuberculosis infection in organs outside the lungs is a case that occurs quite often, especially in children, one example is TB pleurisy and TB pericarditis which can cause complications in the form of cardiac tamponade, shock and death. Mtb infection in children generally shows non-specific symptoms, and can even show negative bacteriological results. This case will be described regarding Mtb infection in a 16-year-old girl who was clinically diagnosed with pericardial effusion, bilateral pleural effusion, impending cardiac tamponade et causa pericarditis. Malnutrition was also found in this child which could be a risk factor for infection.

Ruptured Noncoronary Sinus of Valsalva Aneurysm Presenting As Sudden Onset Heart Failure

Sinus of Valsalva Aneurysm (SOVA) is a rare congenital or acquired cardiac anomaly. SOVA can remain undiagnosed till it ruptures and can present as acute heart failure, acute coronary syndrome or cardiac tamponade [1]. The aneurysm usually involves the right coronary sinus and ruptures into the Right Atrium (RA) or Right Ventricle (RV) leading to significant left to right shunting and can subsequently cause acute heart failure. Management involves multimodality imaging to verify anatomy followed by surgical resection and repair [2].

The comparison between the novel technique and conventional method in the catheter ablation of premature ventricular contractions originating from the free wall of tricuspid annulus.

This study aimed to assess the safety and effectiveness of a novel technique for catheter ablation in patients with premature ventricular contraction (PVC) from the free wall of tricuspid annulus (TV). We hypothesized that the novel technique is more efficacious than the traditional approach. We retrospectively investigated 59 consecutive patients with PVC originating from the free wall of TV between January 2013 and November 2021. The patients were divided into two groups: the reversed S-curve technique group (RST, n = 26) and the reversed C-curve technique group (RCT, n = 33). The RST under the support of a steerable sheath was used in RST group, while the RCT under the support of a nonsteerable sheath was used in the RCT group. Systematic mapping and radiofrequency ablation were preferentially performed under the valve in all patients. Compared to the RCT group, total procedural time and fluoroscopic exposure time were significantly shorter in RST group. Two patients experienced cardiac tamponade in the RCT group, while no complications were observed in RST group (p = .498). The success rate was significantly higher in RST group compared to RCT group (81.9% vs. 100%, p = .029). Three patients in RCT group failed to ablate during the operation but were successfully ablated using the novel method. During regular follow-up, no patients in the RST group had a recurrence, while three patients in the RCT group did (p = .274). It suggests that the reserved S-curve technique, supported by a steerable sheath, is a feasible and effective method for ablating PVC originating from the free wall of TV.

Disseminated Meningococcal Disease Complicated with Cardiac Tamponade in a 2-Month-Old Infant

Disseminated Meningococcal Disease Complicated with Cardiac Tamponade in a 2-Month-Old Infant

Effectiveness and Safety of an Outpatient Program for Percutaneous Left Atrial Appendage Occlusion.

Left atrial appendage occlusion (LAAO) is a safe and effective alternative to oral anticoagulation for thromboprophylaxis in patients with nonvalvular atrial fibrillation. Technological development in devices and imaging techniques, as well as accumulated experience, have increased procedural success rates and decreased complications. Same-day discharge protocols have been proposed in the field of structural heart disease, but this approach has not been studied in detail for the LAAO procedure. The aim of this study is to assess the safety and efficacy of an outpatient program for LAAO when compared to the conventional treatment approach. We present a retrospective, non-randomized single-center study of 262 consecutive patients undergoing LAAO. Patients were divided into two groups, the first (n = 131) followed a conventional protocol (CP), and the second (n = 131) an outpatient protocol (OP). The primary composite endpoint comprised MACCE (death, stroke, and bleeding), cardiac tamponade, vascular complication, or attendance in the emergency department after hospital discharge at 30 days. The overall success rate was 99.6%, with a periprocedural complication rate of 2.29%. With regards to the CP versus OP group, there were no differences between incidences of the primary composite endpoint (6.1% PC vs. 3.0% PA, p = 0.24), or after an analysis, with propensity score matching. No differences were observed in the individual endpoints. There was a decrease in hospital length of stay in the same-day discharge group (p < 0.01). A same-day discharge LAAO program is safe, effective, and feasible when compared to the conventional strategy. Moreover, it reduces hospital length of stay, which might have clinical and economic benefits.

Hemopericardium after coronary artery stenting: clinical observations and literature review

Currently, at least 5,000,000 patients with coronary artery disease undergo percutaneous coronary interventions with stent implantation every year in the world, and more than 200,000 in Russia. Dissection and perforation of the coronary artery are quite rare, but they are very dangerous complications leading to the development of hemopericardium with cardiac tamponade, cardiogenic shock, myocardial infarction, various arrhythmias and death. The frequency of cardiac tamponade in interventional cardiology, according to various authors, ranges from 0.1 to 3.0% of all interventions. The frequency of deaths cited in the literature also varies greatly (0–20–40%). At the same time, there are no special registers that accumulate data on coronary artery perforations in concrete countries and in the world as a whole. Unfortunately, today, there is still no clear algorithm for identifying high-risk patients, the necessary timing of their intensive follow-up is not clear, and the criteria for choosing between conservative, angiosurgical and operative treatment tactics are not defined. In addition to a literary review of recent sources on this topic, the article presents 3 clinical cases of hemopericardium development in elderly patients at different times after percutaneous interventions, with different symptoms and with different outcomes. The observations illustrate the variability of symptoms, the complexity of diagnosis and treatment, and also touch upon the issues of a multidisciplinary approach with the participation of specialists of different profiles (X-ray angiosurgeons, cardiac surgeons, intensive care specialists, cardiologists and doctors of functional diagnostics).

The Narrative of an Aberrant Pericardiocentesis Catheter in the Heart: A Case Report on the Surgical Management of an Iatrogenic Left Ventricle Perforation

Pericardiocentesis catheter placement is a procedure for treating pericardial effusion and has a low complication rate. Inadvertent intraventricular perforation of a pericardiocentesis catheter is an uncommon yet a known complication of the procedure. Failure to establish adequate hemostasis during the removal of the foreign body could be catastrophic. Generically, puncture of a pericardiocentesis catheter into the ventricular space is tolerable, but the failure to achieve hemostasis in the ventricular wall amounts to injurious effects accounted to the size and caliber of the drain. Here we describe a case in which a pigtail catheter (8F) accidentally penetrated the left ventricle while attempting to drain pericardial effusion. The patient was brought to the surgical theater where the cardiac surgeon performed an off-pump left anterolateral thoracotomy and extracted the drain successfully. Pledgetted sutures (Prolene 3-0) were placed under tension and the knots were placed, thereby achieving excellent hemostasis of entry point of perforation. During the postoperative course, neither the x-ray of the chest nor an echocardiograph demonstrated hemothorax or pericardial tamponade. Five days later, the patient was discharged from our hospital.

Intra-Cardiac versus Transesophageal Echocardiographic Guidance for Left Atrial Appendage Occlusion with a Watchman FLX Device.

This study aimed to compare the peri-procedural success and complication rate within a large registry of intra-cardiac echocardiography (ICE)- vs. transesophageal echocardiography (TEE)-guided left atrial appendage occlusion (LAAO) procedures with a Watchmann FLX device. Data from 772 LAAO procedures, performed at 26 Italian centers, were reviewed. Technical success was considered as the final implant of a Watchmann FLX device in LAA; the absence of pericardial tamponade, peri-procedural stroke and/or systemic embolism, major bleeding and device embolization during the procedure was defined as a procedural success. One-year stroke and major bleeding rates were evaluated as outcome. ICE-guided LAA occlusion was performed in 149 patients, while TEE was used in 623 patients. Baseline characteristics were similar between the ICE and TEE groups. The technical success was 100% in both groups. Procedural success was also extremely high (98.5%), and was comparable between ICE (98.7%) and TEE (98.5%). ICE was associated with a slightly longer procedural time (73 ± 31 vs. 61.9 ± 36 min, p = 0.042) and shorter hospital stay (5.3 ± 4 vs. 5.8 ± 6 days, p = 0.028) compared to the TEE group. At one year, stroke and major bleeding rates did not differ between the ICE and TEE groups. A Watchmann FLX device showed high technical and procedural success rate, and ICE guidance does not appear inferior to TEE.

Disseminated Meningococcal Disease Complicated with Cardiac Tamponade in a 2-Month-Old Infant

Disseminated Meningococcal Disease Complicated with Cardiac Tamponade in a 2-Month-Old Infant

Acute Myeloid Leukaemia Presenting with Cardiac Tamponade: A Case Report and Review of the Literature

Acute Myeloid Leukaemia Presenting with Cardiac Tamponade: A Case Report and Review of the Literature

Posterior pericardial window: a simple and reproducible technique in order to prevent pericardial tamponade in paediatric cardiac surgery.

Pericardial tamponade, which increases postoperative mortality and morbidity, is still not uncommon after paediatric cardiac surgery. We considered that posterior pericardiotomy may be a useful and safe technique in order to reduce the incidence of early and late pericardial tamponade. Herein, we present our experience with creation of posterior pericardial window following congenital cardiac surgical procedures. This retrospective study evaluated 229 patients who underwent paediatric cardiac surgical procedures between June 2021 and January 2023. A posterior pericardial window was created in all of the patients. In neonates and infants, pericardial window was performed at a size of 2x2 cm, whereas a 3x3 cm connection was established in elder children and young adults. A curved chest tube was placed and positioned at the posterolateral pericardiophrenic sinus. An additional straight anterior mediastinal chest tube was also inserted in every patient. Transthoracic echocardiographic evaluations were performed daily to assess postoperative pericardial effusion. A total of 229 (135 male, 94 female) patients were operated. Mean age and body weight were 24.2 ± 26.7 months and 10.2 ± 6.7 kg, respectively. Eight (3.5%) of the patients were neonates where 109 (47.6%) were infants and 112 (48.9%) were in childhood. Fifty-two (22.7%) re-do operations were performed. Six (2.6%) patients underwent postoperative surgical re-exploration due to surgical site bleeding. Any early or late pericardial tamponade was not encountered in the study group. Posterior pericardial window is an effective and safe technique in order to prevent both the early and late pericardial tamponade after congenital cardiac surgery.

Factors associated with procedure-related cardiac tamponade.

Factors associated with procedure-related cardiac tamponade.

Acute cardiac tamponade following thoracoscopic lobectomy: a case report and literatures review

Thoracoscopic lobectomy is a common surgical procedure for the treatment of lung cancer. With the continuous development of surgical techniques and medical devices, complications after thoracoscopic lobectomy are less and less, and cardiac tamponade is even rarer. This case is a 62-year-old woman who underwent thoracoscopic left upper lobectomy for a left upper lobe nodule. The patient developed acute cardiac tamponade on postoperative day 2, and symptoms resolved after pericardiocentesis. However, 20 h later, the patient underwent emergency surgery for re-developed acute cardiac tamponade, which was found to be a coronary tear. A review of the literature suggested that cardiac tamponade is more common in left lung surgery than right lung surgery. Pericardiocentesis can resolve initial acute cardiac tamponade, but pericardiotomy may be urgently needed after recurrence.

Child abuse with multiple sharp foreign bodies penetrating the chest wall causing hemothorax and cardiac tamponade in two separate occasions: Case report.

We present a case of repeated child abuse causing left-sided hemothorax and cardiac tamponade on two separate occasions. A 14-year-old cerebral palsy male presented with left-sided hemothorax and multiple metallic foreign bodies in the chest wall managed by small limited incision, removal of the foreign bodies and chest tube. One week later, he came to our emergency department (ER) with multiple chest wall foreign bodies and tamponade managed by median sternotomy, removal of the foreign bodies, one of them was in the LAD. He had a smooth postoperative course and the case is under investigation.