心脏介入性治疗并发心脏压塞的原因分析、诊断与治疗

目的总结心脏介入性治疗过程中发生心脏压塞诊断和处理的经验和教训。方法回顾分析快速性心律失常射频消融术、经皮冠状动脉腔内成形术(PTCA)及支架术以及先天性心脏病封堵术中心脏压塞的临床特点、诊断及处理。结果18例与心脏介入性诊治操作有关的心脏压塞患者,17例为急性心脏压塞,1例在术后72小时延迟出现。18例中9例与射频消融术有关;5例与PTCA有关;3例与先天性心脏病房间隔缺损修补术有关;1例与临时起搏器安装术有关。共有3例死亡。结论心脏介入性治疗可引起即刻和迟缓性两类心脏压塞,多与操作不当有关。及时诊断与处理非常重要,心包穿刺引流是首选方法,必要时应及时切开心包减压或开胸修补。     

心脏介入性治疗术并发急性心脏压塞的临床表现和处理

目的 探讨心脏介入手术并发急性心脏压塞的临床特征和防治要点。方法 回顾性分析在心脏介入治疗中并发急性心脏压塞的患者4例，并重点分析导致心脏压塞的原因。结果 4例中，经皮冠状动脉腔内成形术(PTCA)及支架置人术1例，二尖瓣球囊扩张术2例，射频消融术1例。原因是导引钢丝损伤冠状动脉分支；房间隔穿刺位置过高损伤右心房；电极导管损伤冠状静脉窦。全部病例均因及早发现心脏压塞症状并经床旁超声心动图和X线透视所证实，及时采取抢救措施，包括心包穿刺和引流，输血，输液及用升压药等，全部病例均抢救成功。结论 心脏压塞是介入性治疗中少见并发症，抢救中最重要的是及时发现，立即行心包穿刺引流等急救措施。     

心脏介入性治疗中并发急性心脏压塞的诊断与治疗体会

目的 总结心脏介入性治疗中发生急性心脏压塞诊断和处理的经验与教训。方法 回顾性分析1986年1月至2003年6月1442例心脏病介入手术导致急性心脏压塞的资料。结果 4例患者在介入治疗术中或术后即刻出现胸闷、烦躁、大汗淋漓、血压下降、心率加快或减慢，X线示心脏搏动减弱或超声心动图示心包积液，诊断为急性心脏压塞，发生率0．3％，其中1例发生在植入起搏器术后即刻，1例在二尖瓣球囊扩张行房间隔穿刺时，2例发生于射频导管消融过程中。3例经心包穿刺引流成功，1例因射频导管消融导致左心房穿孔，心包穿刺失败，未能及时开胸切开心包，患者死亡。结论 心脏病介入性治疗操作术中并发急性心脏压塞可危及生命，及时诊断与处理非常重要，心包穿刺引流是首选的方法，必要时应及时开胸切开心包减压。     

心脏介入治疗并发急性心脏压塞11例临床分析

目的探讨心脏介入治疗并发急性心脏压塞的临床治疗方法。方法回顾性分析心脏介入治疗病人发生急性心脏压塞的特点、原因、治疗方法及预后。结果11例发生急性心脏压塞。其中4例发生在冠状动脉介入治疗术中,3例发生在射频消融术中,1例发生在先天性心脏病介入治疗术中．3例发生在二尖瓣球囊扩张术中。8例行心包穿刺引流后抢救成功,3例经心包穿刺治疗后未能有效控制出血,予外科开胸修补术后抢救成功,无死亡例数。结论心脏介入手术所致心脏压塞发生迅速,其症状具有特征性,正确识别和处理对急性心脏压塞的预后至关重要。     

心脏介入性治疗合并急性心脏压塞分析

目的 分析2746例各类心脏介入性治疗病例并发急性心脏压塞(acute cardiac tampon—ade，ACT的原因和诊断、处理的经验及教训。方法回顾性分析1995～2003年1061例射频消融，1384例冠状动脉介入治疗(percutaneous coronary intervention，PCI)，425例二尖瓣球囊扩张成形术(per-cutaneous balloon mitralvalvoplasty PBMV)，76例先天性心脏病介入性治疗的病人合并急性心脏压塞的原因和诊断处理的过程。结果 在2746例介入性治疗的患者中，共有9例发生ACT，发生率为0．33％。其中8例行急诊心包穿刺引流，1例开胸并行修补术。9例病人无1例死亡。1061例射频消融病例中，2例发生ACT，占0．89％。1384例PCI病人中2例出现ACT，发生率为0．14％，5例冠状动脉脉破裂，经球囊和带膜支架封堵等处理，没发生ACT。425例经皮二尖瓣球囊成形术患者中共有5例ACT，占1．18％。其中1例开胸行修补术。76例先天性心脏病无ACT并发。结论心脏介入性冶疗中ACT发生率较低，早期发现，及时心包穿刺引流，可以避免外科开胸手术治疗。     

经皮冠状动脉介入治疗并发急性心脏压塞的临床分析

目的:分析8例经皮冠状动脉介入治疗(PCI)并发的急性心脏压塞原因、临床表现和治疗结果。方法:2005年1月至2008年12月对5 241例冠心病患者进行了PCI术,8例患者并发急性心脏压塞。采用心包穿刺引流术处理,无效时采用外科手术。结果:急性心脏压塞的发生率为0.15%。8例患者早期均表现为胸闷、血压下降。7例患者行紧急心包穿刺引流,其中2例因引流后仍继续出血而行外科修补手术。1例患者未行心包穿刺引流死亡。结论:急性心脏压塞是PCI术的严重并发症,及时发现和有效救治是十分重要的。     

冠状动脉介入治疗并发冠状动脉穿孔及心脏压塞的处理对策

目的　探讨冠状动脉介入治疗 (PCI)中并发冠状动脉穿孔及心脏压塞的处理对策。方法　对我院 1989年 9月至 2 0 0 3年 9月期间发生的冠状动脉穿孔病例进行回顾性分析。结果　共完成经皮腔内冠状动脉成形术 (PTCA)及支架 72 32例。发生冠状动脉穿孔 18例 ,发生率为 0 2 5 % ,多数发生于慢性完全闭塞性病变 (83 3% ) ,其中引导钢丝所致穿孔者 9例 ,球囊扩张后穿孔 7例 ,置入支架后穿孔 2例。 14例 (77 8% )穿孔为少量对比剂排至心包腔内或心肌内 ,其中 7例用球囊长时间低压力贴附封堵破口 ,穿孔征象消失 ;6例用鱼精蛋白静脉注射中和肝素 ,1例未做特殊处理 ,穿孔消失。4 (2 2 2 % )例发生急性心脏压塞 ,超声心动图显示有心包积液 ,紧急心包穿刺引流后病情平稳。 2例外科急诊修补血管破口 ,同时行冠状动脉旁路移植术 (CABG)。无一例死亡。结论　PCI并发冠状动脉穿孔少见 ,及时发现和正确处理是避免严重并发症的关键。     

经静脉拔除心内起搏导线并发急性心脏压塞的特点与处理

目的分析经静脉拔除起搏电极导线过程中并发心脏压塞病例的特点与处理方法,为经静脉拔除电极过程中预警、识别与处理此类并发症提供借鉴意义。方法回顾2012年1月1日至2017年12月31日所有在北京大学人民医院经静脉拔除心内电极导线患者,根据病历记录资料总结电极拔除过程中发生心脏压塞的患者的临床表现、处理,并随访此类患者的转归。结果研究期间,共完成经静脉电极导线拔除手术922例,共拔除各类电极导线1 832根,发生心脏压塞12例,发生率为1.3%。此类患者的表现有胸闷、憋气、血压下降,透视下心影搏动减弱或消失。12例患者8例经过心包穿刺置管引流后治愈,4例需要外科开胸探查,其中3例患者于导管室紧急开胸。本组病例术中死亡1人,其余患者均痊愈出院。结论心脏压塞的特点为发生快,过程凶险,大多数患者经过心包穿刺置管引流后治愈。对于心包穿刺失败或无效的患者应即刻开胸心包腔减压是重要的外科抢救手段。     

经皮冠状动脉介入性治疗并发急性心脏压塞15例的诊断与处理

目的 急性心脏压塞是经皮冠状动脉介入性洽疗少见但严重的并发症之一。本文旨在总结分析此并发症的诊断、处理方法与临床效果。方法 回顾分析西京医院自1992年2月至2003年5月间行经皮冠状动脉介入性治疗的2326例冠心病患者，其中确诊为心脏压塞的患者15例占同期冠状动脉介入性治疗病例的0．64％。冠状动脉介入术中或术后患者突然出现烦躁、难以纠正的低血压、心率减慢等提示心脏压塞的症状与体征，X线示心脏搏动减弱伴心影扩大，超声心动图发现心包内液性暗区、冠状动脉造影发现局部造影剂外渗漏人心包腔。除一般抢救与治疗措施外，尽快采用常规心包穿刺抽液或中心静脉导管置入法引流心包积血。采用灌注球囊或带膜支架治疗制止冠状动脉出血，必要时行外科手术治疗。结果 15例心脏压塞患者中，8例在导管室行介入性治疗术中诊断，7例在术后延迟出现(30min～8h，平均4．5h)。8例患者仅行心包穿刺引流而解除心脏压塞；4例患者行灌注球囊／带膜支架治疗及心包穿刺引流后解除心脏压塞；3例病情严重者经外科处理。6例患者采用常规心包穿刺抽液方法，其中4例成功解除心脏压塞，2例经外科处理成功；9例患者采用中心静脉导管置入法，其中8例成功解除心脏压塞，1例经外科处理。结论 急诊床旁超声心动图和X线检查对于诊断冠状动脉介入治疗并发的急性心脏压塞有重要意义。心包穿刺引流是解除心脏压塞的首选治疗方法，中心静脉导管置入引流法是一种快速、安全、准确的方法。灌注球囊、带膜支架治疗及外科手术是处理心脏压塞的重要措施。     

心脏介入性手术并发心脏压塞的临床分析

目的:分析心脏介入手术并发心脏压塞的原因表现及治疗,为临床早期诊治提供依据。方法:3228例心脏介入性手术中共发生8例心脏压塞的病例,分析其可能的原因、临床表现以及其治疗结果。结果:其中3例与经皮冠状动脉内成形术有关,3例与经皮二尖瓣球囊成形术有关,2例与导管标测和射频消融术有关。心脏压塞的主要原因包括冠状动脉穿孔、心房穿孔、冠状静脉窦破裂以及左心室穿孔。6例经立即心包穿刺抽液150～500ml病情稳定,2例因为出血量大进行了外科手术,其中1例因为心脏穿孔无法缝合裂口死亡。结论:心脏压塞是心脏介入性手术的严重并发症,积极预防、早期发现、及时诊断和果断处理十分重要。     

心脏介入术并发急性心包填塞的临床分析

【】 目的 总结心脏介入术中并发急性心包填塞的防治体会。方法 回顾性分析6例心脏介入术中发生急性心包填塞患者的发病特点、发生原因及处理措施。结果 二尖瓣球囊扩张术(PBMV)中1例为房间隔穿刺位置过高致右心房穿孔而发生急性心包填塞,经紧急心外科手术救治成功,1例为送入穿刺鞘致心房穿孔所致,超声引导下心包穿刺置管引流48h后痊愈;冠状动脉介入治疗术(PCI)中1例为反复推送导丝穿破高度狭窄钙化的左前降支所致, 经紧急心外科手术救治成功,1例为急性前壁心肌梗死PCI时发生,经对症治疗及置管引流48小时后痊愈;射频消融术(RFCA)中1例为放置左上肺静脉电极导管时不慎将左心耳穿破所致,行猪尾导管引流、输血、升压等措施后心包填塞症状缓解;心脏永久性起搏器植入术中1例为电极损伤冠状静脉所致,行超声下猪尾导管心包穿刺引流及输血等治疗后,病情稳定。结论：急性心包填塞是心脏介入术的严重并发症,积极预防、及时发现、果断处理是防治的关键措施。     

Modified emergency department thoracotomy for postablation cardiac tamponade

Cardiac dysrhythmias are a common problem in the United States. Radiofrequency ablation is being used more frequently as a treatment for these diagnoses. Although rare, serious complications such as cardiac tamponade have been reported as a result of ablation procedures. Traditionally, emergency department (ED) thoracotomy has been reserved for cases of traumatic arrest only. We report a case of a successful modified ED thoracotomy in a patient with postablation cardiac tamponade and subsequent obstructive shock who failed intravenous fluid resuscitation, pressor administration, and multiple attempts at pericardiocentesis. In this case, a modified approach was used to incise the pericardium. Although this was associated with large blood loss, we believed that using the traditional method of completely removing the pericardium would have resulted in uncontrolled hemorrhage. Instead, our method led to successful resuscitation of the patient until definitive care was available. A smaller pericardial incision than is traditionally used during ED thoracotomy deserves further consideration and research to determine whether and when it may be most useful as a temporizing treatment of cardiac tamponade when other methods have failed.     

Delayed and recurrent cardiac tamponade following distal coronary perforation of hydrphilic guidewires during coronary intervention

Coronary artery perforation is a rare complication of percutaneous coronary intervention, but can result in cardiac tamponade and is thus potentially life-threatening. It is well recognized that the use of hydrophilic wires during interventional procedures increases the risk of coronary perforation. We report two cases in which a particular looping configuration was suspected of causing vessel laceration with subsequent development of pericardial effusion and tamponade. In one case, tamponade occurred several days after the index procedure, mimicking acute myocardial infarction. In the second case, tamponade was successfully treated with immediate pericardial drainage, but tamponade recurred several days later.     

Management Strategies in Pericardial Emergencies

BACKGROUND: The most frequent pericardial emergency is cardiac tamponade, but complications of an acute coronary syndrome and aortic dissection may also involve the pericardium. Acute pericarditis can also represent a medical emergency due to chest pain of upsetting intensity. Decompensations in chronic advanced constriction and in the clinical course of purulent pericarditis necessitate critical care as well. DIAGNOSIS AND MANAGEMENT: The diagnosis of cardiac tamponade is based on clinical presentation and physical findings, confirmed by echocardiography and cardiac catheterization. Tamponade is an absolute indication for urgent drainage, either by pericardiocentesis or surgical pericardiotomy. The approach for pericardiocentesis can be subxiphoid or intercostal using echocardiographic or fluoroscopic guidance. Urgent drainage, combined with intravenous antibiotics, is also mandatory in suspected purulent pericarditis. If confirmed, it should be combined with intrapericardial rinsing (best by a surgical drainage). Pericardiocentesis is contraindicated in cardiac tamponade complicating aortic dissection. This condition should immediately lead to cardiac surgery. Although pericardiectomy is the only treatment for permanent constriction, this procedure is contraindicated when extensive myocardial fibrosis and/or atrophy are demonstrated. CASE STUDY: Iatrogenic tamponade may occur during percutaneous mitral valvuloplasty, implantation of pacemakers, electrophysiology and radiofrequency ablation procedures, right ventricular endomyocardial biopsy, percutaneous coronary interventions, and rarely during Swan-Ganz catheterization. The authors report on a 79-year-old who suffered coronary perforation and cardiac tamponade during elective stent implantation. Tamponade was successfully treated with pericardiocentesis and implantation of a membrane-covered graft stent. Subsequent recurrent pericarditis/postpericardial injury syndrome with moderate pericardial effusion was initially treated with aspirin and then with aspirin and colchicine. At 6 months, the patient is in stable remission even after withdrawal of colchicine. CONCLUSION: Natural history of pericardial diseases can be complicated with pericardial emergencies requiring prompt diagnosis, intensive care with hemodynamic monitoring, and early aggressive management. Medical supportive measures, drainage of pericardial effusion, surgical pericardiotomy, and pericardiectomy should be applied when needed with no delay. This procedural approach also applies to iatrogenic interventions leading to tamponade.     

Prolonged persistence of a large pericardial effusion and hemodynamic evidence of cardiac tamponade during treatment of myxedema

We describe clinical, echocardiographic, and catheterization findings that were present initially and during therapy in a myxedematous patient with a large pericardial effusion and tamponade. Treatment with thyroxine resulted in a marked improvement of most of the clinical features of hypothyroidism and some improvement in cardiac function. However, the pericardial effusion as well as clinical and laboratory evidence of tamponade persisted for 2 months after full replacement doses of T4 had been achieved. The tamponade was finally relieved by fenestration of the parietal pericardium. These findings are consistent with evidence of an abnormality of pericardial drainage that persists for months after other thyroid hormone dependent functions are normalized by thyroxine replacement. Therefore prompt surgical drainage rather than dependence on medical therapy alone is indicated in myxedematous patients who have cardiac tamponade.     

Pulmonary edema following pericardiotomy for cardiac tamponade

A 57-year-old man with a history of a previous myocardial infarction presented with acute cardiac tamponade due to malignant pericardial effusion. Immediately following emergency surgical drainage of the pericardium by subxiphoid window, acute pulmonary edema developed. The sudden increase in venous return following the release of cardiac compression may result in this rare complication. Gradual removal of pericardial fluid under hemodynamic monitoring is advisable, particularly in patients with preexisting heart disease.     

Profile of cardiac tamponade in the medical emergency ward of a North Indian hospital.

OBJECTIVE: To determine the profile of patients presenting to the medical emergency ward with cardiac tamponade. DESIGN: Retrospective observational study. SETTING: Tertiary care hospital in North India. PATIENTS: Thirty patients (19 men and 11 women) presenting to the medical emergency ward with cardiac tamponade from March 1, 1995 to March 31, 1997. MAIN RESULTS: The mean age was 36.5+/-7.6 years for the men and 34+/-12.4 years for the women. Breathlessness, fever, cough, chest pain and easy fatigability were present in 97%, 90%, 70%, 57% and 37% of patients, respectively. Etiologically, tuberculosis accounted for 60%, malignant disease for 33% and hypothyroidism for 7% of cases of cardiac tamponade. Echocardiographically guided pericardiocentesis was carried out in all patients without any complications. Six patients underwent catheter pericardial drainage and, of these, four required pericardiostomy. CONCLUSIONS: Tuberculosis ranked as the most common cause of cardiac tamponade in Northern India, followed by malignancy. Therapeutically, echocardiographically guided pericardiocentesis for cardiac tamponade is a safe and effective procedure. For those with recurrent pericardial effusions, catheter pericardial drainage is a safe option until the underlying cause can be treated or surgery planned.     

Percutaneous balloon pericardiostomy for treatment of cardiac tamponade

Percutaneous balloon pericardiostomy was performed in eightseverely ill patients with malignancy (seven patients) and chronicrenal failure (one patient). To investigate the feasibilityof balloon pericardiostomy as a bedside procedure, echocardiographywas used in addition to fluoroscopy in monitoring the procedure.The pericardium was entered from the standard subxiphoid site.An 18 to 25 mm, 3 or 4 cm long, balloon catheter, introducedover a stiff guidewire was inflated across the parietal pericardium.Creation of a pericardial opening was obtained in each of theeight patients. Bleeding from the needle entry site was theonly complication observed in one patient. The balloon cathetercould be localized by echocardiography only in 218 cases. Twopatients died, 3 and 14 days after the procedure, from the primarydisease; six patients were still alive at follow-up rangingfrom 32 to 342 days. No recurrence of cardiac tamponade wasobserved in any patient. Percutaneous balloon pericardiostomy is efficacious and safein relieving pericardial tamponade and preventing its recurrencein severely ill patients. Fluoroscopy is needed to monitor theprocedure. The value of echocardiography is limited for follow-upcontrols of pericardial effusion.