Partial pericardiectomy for pericardial tamponade in patients with chronic uremia under dialysis]

Two dialyzed uraemic patients were subjected to partial pericardiectomy because of haemorrhagic pericarditis and pericardial tamponade. Seventeen and nine months, respectively, after the operation the patients have still been under intermittent home haemodialysis.     

Non-perforating pericardial rupture causing cardiac tamponade

A 51-year-old auto truck driver was transferred to our hospital after crashing. He had a severe pain on the left anterior chest wall with high central venous pressure of 30 cm H(2)O. Surveillance of the chest revealed cardiac tamponade and the right seventh rib fracture with left pleural effusion. Pericardiotomy through median sternotomy led to extrusive bloody pericardial effusion. Non-perforating pericardial laceration at the site of the adjoining muscular structure of the diaphragm was repaired with direct suture closure. His postoperative course was uneventful.     

Primary pericardial malignant fibrous histiocytoma causing cardiac tamponade

We describe herein an extremely rare case of a large primary pericardial malignant fibrous histiocytoma causing a cardiac tamponade that occurred in a 72-year-old woman. The clinical, radiographic, and pathologic features are reported here together with a brief review of the literature.     

Haemopericardium and cardiac tamponade complicating pulmonary lymphangioleiomyomatosis.

A case of pulmonary lymphangioleiomyomatosis complicated by haemopericardium and cardiac tamponade is reported. This was successfully managed by creating a subdiaphragmatic extraperitoneal window.     

Video-assisted thoracoscopic pericardiectomy for severe pericardial effusions.

Video-assisted thoracic surgery (VATS) has proven to be extremely useful in the diagnosis and treatment of multiple thoracic problems. We used the VATS technique to successfully treat refractory pericardial effusions associated with pericarditis by performing pericardiectomy.     

Acute pericardial tamponade complicating spinal surgery in a child with Duchenne muscular dystrophy

Summary A hitherto unrecognised problem of pericardial tamponade complicating spinal surgery in a child with Duchenne muscular dystrophy is reported in this paper.     

Anesthesia for pericardial window in a pregnant patient with cardiac tamponade and mediastinal mass

PURPOSE: To present a case report of anesthesia for pericardial window surgery for acute cardiac tamponade in a patient with an anterior mediastinal mass in late pregnancy. CLINICAL FEATURES: A 34-yr-old gravida 2, para 1 patient presented at 29 weeks gestation with dyspnea, orthopnea, chest pain, and cough. Investigations showed an anterior mediastinal mass due to Hodgkin's disease. A course of vinblastine at 31 weeks gestation resulted in symptomatic improvement but at 34 weeks gestation she developed an acute cardiac tamponade for which pericardial window drainage was required. Additional help and equipment were assembled in case of cardiopulmonary deterioration. Intra-arterial pressure and continuous fetal monitoring were established and iv access was secured in both arms and the left foot. After awake fibreoptic intubation, spontaneous ventilation was maintained. Anesthesia consisted of local anesthetic infiltration of the anterior chest wall, supplemented with fentanyl, midazolam, and ketamine. The patient remained stable, was extubated fully awake, and then monitored in an intensive care area. CONCLUSION: This patient presented with acute cardiac tamponade and an anterior mediastinal mass in late pregnancy, an unusual combination of challenges that requires a careful approach to anesthetic management.     

Chylopericardial tamponade complicating oesophago-gastrectomy

Although unusual, chyle leak following oesophagectomy is a recognised complication affecting 2-4% of patients. We describe the hitherto unreported sequelae of a chyle leak causing cardiovascular compromise secondary to pericardial tamponade 13 days after Ivor-Lewis oesophago-gastrectomy.     

Myocardial effects of pericardial tamponade

Through a previously implanted catheter, normothermic normal saline solution was infused into the pericardial sacs of dogs. Sufficient pericardial tamponade was induced to lower the arterial pressure from an average control of 160/112 mm. Hg to an average of 97/69. Tamponade was maintained for 6 hours during constant monitoring of arterial, central venous, and pericardial pressures. During the 72 hours following tamponade, serial determinations of serum creatine phosphokinase, serum glutamic oxaloacetic transaminase, and lactic dehydrogenase were made. At 72 hours the animals were sacrificed and their hearts studied for gross and microscopical myocardial pathology. All experimental animals showed striking enzyme elevations, and 6 of 10 had visible myocardial necrosis. Correlation between elevations of serum CPK and central venous and pericardial pressures with the degree of myocardial necrosis was significant at the p < 0.005, < 0.009, and < 0.013 levels, respectively. Prolonged pericardial tamponade may result in significant myocardial necrosis, which suggests coronary artery insufficiency and myocardial hypoxia as a cause.     

Emergency department initiation of percutaneous cardiopulmonary support for traumatic cardiac tamponade with coagulated pericardial effusion

Cardiac rupture following blunt trauma is associated with a high mortality rate. We present a rescued case of blunt traumatic cardiac tamponade successfully initiated with percutaneous cardiopulmonary support (PCPS) at the emergency department (ED) without pericardiocentesis.A 27-year-old woman was transferred to our hospital after a motor vehicle accident. She presented with profound shock, and the cardiac portion of the focussed assessment of sonography for trauma (FAST) showed almost coagulated pericardial effusion. We considered that the haemodynamic collapse was caused by cardiac tamponade, and we initiated PCPS in the ED. Subsequently, her systemic perfusion was preserved by PCPS, and she was transferred to the operating room safely. A laceration of the right atrium was successfully repaired. In cardiac tamponade, blood accumulation in the pericardium may be localised and the formation of blood clots may cause difficulty with aspiration. The initiation of PCPS afforded time to surgeons prior to definitive surgical repair and enabled the patient's transfer to the operating room securely.This report demonstrated the case of a rare, but successful outcome of resuscitation of a patient with blunt traumatic cardiac rupture with cardiac tamponade. PCPS is considered as an important treatment option in ED for traumatic cardiac tamponade, particularly if the effusion has clotted.     

Low cardiac output syndrome in children

Clinicians caring for critically ill children will commonly encounter low cardiac output states, especially after cardiac surgery. Anticipation and prevention can go some way to reducing morbidity and mortality. This article outlines the causes and assessment of this syndrome. Management strategies are discussed aimed at improving cardiac output by optimisation of left- and right-ventricle preload and afterload. Pharmacological strategies utilising well-established as well as new agents are outlined. Non-pharmacological strategies are presented, as well as methods of reducing the adverse effects of low cardiac output on the child.