Abnormal wall movements of the right ventricle and both atria in patients with pericardial effusion as indicators of cardiac tamponade

A retrospective study on 126 patients with pericardial effusionshowed cardiac tamponade to be present in 39 patients and absentin 87. We evaluated the distribution of the pericardial effusionas well as the effect of hydrodynamic compression on the differentheart chambers. Small to large volumes of pericardial fluidwere found in both groups of patients. Abnormal wall movementswere only present if pericardial effusion was adjacent. Hydrodynamiccompression signs consisted of abnormal wall movements of bothatria at enddiastole continuing into systole, and of the rightventricle in early- and mid-diastole. Most of the patients withcardiac tamponade showed an abnormal motion pattern of bothright atrium and ventricle (13 patients) or of the right atrialwall alone (12 patients). Abnormal motion of the right ventriclealone was seen in 6 patients, of both atria and right ventriclein 4 and of the left atrium alone in 1 patient. False-negativediagnoses of cardiac tamponade occurred in 3 of the 39 patientsand false-positives in 2 of the 87 (sensitivity 92%, specificity98%). Measurements of the duration of the inversion of bothatria increased the specificity of these abnormal wall movementsto 100%. Echocardiography can help to identify those patientswho are clinically at risk and need pericardial drainage.     

Delayed post-cardiac-surgery tamponade producing localized right atrial compression

A patient with dyspnea and lethargy 19 days after aortic valve replacement was admitted to the hospital with physical signs suggesting cardiac tamponade. Initial echocardiogram was unhelpful, but Swan-Ganz catheterizatlon showed a gradient in diastole between the right atrium and ventricle. Anglography and repeat echocardlography then showed a mass compressing the right atrium, which was confirmed at surgery.     

CARDIAC TAMPONADE FOLLOWING INFARCTION: MANAGEMENT WITH PERICARDIOCENTESIS AND SURGERY

Abstract: Four patients with cardiac tamponade following myocardial infarction are presented. Diagnostic clinical features and the role of echocardiography are discussed. Pericardiocentesis resulted in rapid improvement in clinical state but frequently tamponade recurred. Surgery was undertaken in three patients and two have survived long term.
If promptly recognised, tamponade following myocardial infarction may be treated.     

Primary Cardiac Angiosarcoma with Spontaneous Ruptures of the Right Atrium and Right Coronary Artery

Primary tumors of the heart are rarely seen. Cardiac angiosarcomas are malignant tumors that almost always have a poor prognosis. Atrium rupture and coronary artery fistula are very rare complications of primary cardiac angiosarcoma. We describe a 57‐year‐old man suffering from primary cardiac angiosarcoma with spontaneous ruptures of the right atrium and right coronary artery (RCA). Theoretically, either of these ruptures invariably results in pericardial effusion and tamponade that is rare but potentially life threatening. In this instance, however, the patient might have developed fibrous adhesions resulted from previous bloody pericardial effusion. A massive pericardial effusion was localized, which consequently prevented cardiac tamponade and hemodynamic collapse. Echocardiography revealed the tumor progression leading to detectable infiltration of solid mass into the right atrial (RA) wall, which is close to RCA. And color Doppler displayed the flow into the pericardial cavity through a disrupted RA wall and perforated RCA. Echocardiography remains the primary method of choice for evaluation of cardiac masses.     

Isolated right atrial tear following blunt chest trauma: report of three cases

Blunt chest trauma causing isolated right atrial tear and cardiac tamponade in three patients is reported. All three patients presented with hypotension, elevated central venous pressure and altered consciousness. Echocardiographic examination demonstrated pericardial effusion in all three cases. All three patients underwent operation with a median sternotomy approach without using cardiopulmonary bypass. At operation, two patients had one tear in the right atrium, the other had two tears in the right atrium. All three patients recovered uneventfully. Early use of echocardiography to detect the presence of hemopericardium and cardiac tamponade in patients with suspected atrial rupture following blunt chest trauma is advocated.     

Successful use of emergency transthoracic pacing in bradyasystolic cardiac arrest

We present the document successful resuscitation of six patients using emergency transthoracic pacing. Two patients were resuscitated from asystole, one had a slow supraventricular bradycardia following head trauma and spinal shock, and three patients had cardiovascular collapse secondary to complete A-V dissociation. One patient developed a non-fatal pericardial tamponade, but there were no cases of pneumothorax. All patients failed to respond to standard medical therapy. We believe that the initially successful resuscitation of these patients was related directly to the pacing procedure. Three patients had underlying pathology that did not allow longterm survival. Three patients were discharged from the hospital without neurologic sequelae. Although emergency transthoracic pacing has a relatively low success rate in bradyasystolic cardiac arrest and may be associated with serious complications, the procedure may be life-saving in selected cases.     

Compression of the superior vena cava and right atrium in cardiac tamponade

In an attempt to identify specific angiographic patterns which might be useful in distinguishing cardiac tamponade from constrictive pericarditis and other causes of right atrial hypertension, we studied the angiographic and hemodynamic characteristics of 10 patients with cardiac tamponade and compared these with similar characteristics in a comparable group of patients with either constrictive pericarditis, effusive-constrictive pericarditis, or pericardial effusion with left ventricular failure. Two predictive angiographic patterns of cardiac tamponade were noted: (1) a tapering or local lateral indentation of the intrapericardial portion of the superior vena cava, and (2) an exaggerated phasic variation in the diameter of the superior vena cava at its junction with the right atrium. Using the ratio of the minimum-to-maximum diameter of the intrapericardial superior vena cava (caval compression ratio), a stepwise logistic regression indicated that when this ratio was < 0.62, cardiac tamponade was present with a sensitivity of 80%, a specificity of 90%, and a p value < 0.001. The change in diameter of the superior vena cava between systole and diastole (phasic narrowing ratio) also was a discriminator of cardiac tamponade (p < 0.04). Two-dimensional echocardiographic studies in an additional group of 10 patients with cardiac tamponade demonstrated marked concavity of the right atrial free wall, which corresponded temporally to the angiographic abnormality, but was even more marked than that noted on the cineangiograms. These results indicate that specific changes can be appreciated on superior vena cavography and can be useful in distinguishing cardiac tamponade from other pericardial or myocardial processes associated with right atrial hypertension.     

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。     

Transcardiac pericardiocentesis: an emergency life-saving technique for cardiac tamponade

Life-threatening cardiac tamponade is one of the most serious complications of catheter-based cardiac procedures. Although most cases can be effectively treated by percutaneous pericardiocentesis, urgent surgical drainage is required in unsuccessful cases. Rarely, in collapsed patients, the delay for surgery, however minimal, may be fatal. We describe a technique whereby life-saving pericardial drainage was rapidly achieved via a novel transcardiac approach, using the transseptal puncture kit, after failure of conventional pericardiocentesis in a patient with procedure-related acute tamponade who rapidly deteriorated and developed cardiorespiratory arrest within a few minutes. Although surgical repair for the perforation had to be performed subsequently, the patient survived without sequelae. This transcardiac approach may be an important and potentially life-saving adjunctive technique after failure of conventional pericardiocentesis in rapidly deteriorating or extremely unstable patients.     

不同抗凝策略对心房颤动导管消融心脏压塞并发症处理的影响

目的：观察围术期不同抗凝策略对心房颤动（房颤）导管消融心脏压塞并发症处理的影响。方法连续入选2007年1月至2013年12月4487例导管消融术中发生心脏压塞并发症的患者27例,发生率0.6%。按围术期抗凝策略分组：第1组患者术前停用华法林3～5 d,以低分子肝素皮下注射桥接过渡;第2组患者围术期不中断华法林抗凝,国际标准化比值（INR）控制在1.8～2.5。对比两组患者心脏压塞并发症的临床处理及转归。结果共27例急性心脏压塞的患者入选,其中第1组18例,第2组9例。除术前INR（0.9＆#177;0.1比2.3＆#177;0.5,P＜0.001）之外,两组基线资料包括年龄、左心房前后径、血小板计数、术中肝素用量、术中活化凝血时间（ACT）等均差异无统计学意义。所有患者均在剑突下穿刺心包成功并置入6 F猪尾管引流,两组心包积液引流量分别为（365＆#177;222）ml和（506＆#177;300）ml,P=0.137;分别有10例（55.6%）和7例（77.8%）应用了自体血回输技术,P=0.406;分别有2例（11.1%）和1例（11.1%）心包引流无效进行急诊外科开胸,P＞0.999;两组患者住院时间分别为（9.6＆#177;3.3）d和（12.1＆#177;4.5）d, P=0.167。未发生其他严重并发症。结论房颤导管消融围术期不中断华法林抗凝对急性心脏压塞并发症的处理及预后无明显不良影响。     

Successful Re-administration of Atezolizumab for a Non-small-cell Lung Cancer Patient after Cardiac Tamponade Development as a Manifestation of Pseudo-progression Induced by Combination Treatment with Atezolizumab and Cytotoxic Chemotherapy

Pseudo-progression is a phenomenon induced by treatment with immune checkpoint inhibitors and is characterized by an increase in tumor size or the appearance of new lesions, followed by tumor regression. However, life-threatening conditions, such as cardiac tamponade, can develop in such patients. We herein report on a 69-year-old man with lung adenocarcinoma who developed cardiac tamponade as a manifestation of pseudo-progression induced by treatment with atezolizumab combined with cytotoxic chemotherapy. After managing the cardiac tamponade, atezolizumab was successfully re-administered along with cytotoxic chemotherapy without disease progression.     

Post-cardiac surgery tamponade mimicking acute hepatitis. Report of two cases.

Two patients developed cardiac tamponade from delayed hemorrhage into the pericardial sac following open heart surgery. The initial clinical manifestations of tamponade included nausea and dramatic elevations of serum aminotransferases, simulating acute hepatitis. To our knowledge, this presentation of cardiac tamponade has not been previously reported.     

心脏介入性治疗中合并即刻与迟发心脏压塞

目的 总结心脏介入性治疗术中发生的心脏压塞的临床特点和诊治经验。方法 回顾分析心脏起搏器植入术、快速心律失常射频导管消融术和冠心病介入性治疗中心脏压塞的临床特点和处理的方式及结果。结果 8例患者发生心脏压塞，其中男性5例，女性3例，年龄48～73岁。介入性治疗术中即刻出现填塞症状5例，迟发症状3例；救治成功7例，死亡1例。其中起搏器植入术2例，射频导管消融术3例，并发于冠心病介入性治疗术3例。结论 心脏介入性治疗合并即刻和迟发两类心脏压塞，多与操作不当有关。应提高认识，加强防范意识，改进操作技巧。     

Tamponade caused by localized compression of the superior vena cava and right atrium after aortic valve replacement under extracorporeal circulation

The authors report a case of localised compression of the right atrium due to a loculated intrapericardial haematoma after open heart surgery. The patient suddenly developed signs of superior vena caval obstruction during the third postoperative week. The diagnosis was made by 2D echocardiography and superior vena cavography. The authors review the literature and discuss the main clinical features of localised cardiac tamponade, underlying the value of 2D echocardiography in the postoperative management of cardiac surgical patients.     

Pericardial clot after open heart surgery: its specific localization and haemodynamics

Transoesophageal echocardiography disclosed a localized pericardialblood clot compressing the right atrium (RA) and/or right ventricle(RV) in 15 patients suffering from low cardiac output failuresoon after open-heart surgery. The left ventricular end-diastolicdiameter was small (38.4 ± 10.1 mm) and its fractionalshortening normal (34.9 ± 10.2%). These findings suggestedcardiac tamponade as a result of pericardial clot. However,the ‘y’ trough of the RA pressure tracing was prominent,which is not characteristic of typical cardiac tamponade, butrather of constrictive pericarditis. This implies thereforethat the pathophysiology of cardiac tamponade by pericardialclot differs from that of tamponade by fluid. Emergency open-chestremoval of the pericardial clot was performed in seven patients,with good results. Pericardial clot produces low cardiac outputsoon after open-heart surgery, but its location is specificand its haemodynamics are not characteristic of cardiac tamponade.     

Partial pericardial tamponade immediately after cardiac surgery

Partial pericardial tamponade is a critical situation frequently misdiagnosed. We describe five patients with this entity during an urgent surgical reintervention performed few hours after the initial one. We found clots compressing cardiac cavities in all, usually in the right atrium. In one of them we found also a clot compressing the left atrium. None of the patients studied had the classical clinical features of cardiac tamponade (Kussmaul's sign: pulsus paradoxus) and we found no difference in blood pressure, quantity of bleeding or pulmonary capillary pressure, considering the reinterventional moment in comparison to the values taken immediately after the initial surgery and the ones registered during the surgical reintervention. There was significative increase in the central venous pressure value, decreased urine output and drop in the cardiac index. Based on this observation, we believe it is possible to have a presumptive diagnosis of partial pericardial tamponade by bidimensional echocardiographic studies just before the surgical reintervention.     

Atrial tamponade causing acute ischemic hepatic injury after cardiac surgery

A patient developed late cardiac tamponade after aortic valve replacement and coronary artery bypass grafting. Nausea and dramatic elevations of serum aminotransferases were the initial clinical manifestations of cardiac tamponade. Severe acute ischemic hepatic injury secondary to isolated compression of both atrial cavities by two loculated thrombi was diagnosed.     

Pericardial tamponade due to erosion of a Figulla Flex II device after closure of an atrial septal defect

We present a case of an 8‐year‐old boy suffering from sudden‐onset severe chest pain and cardiogenic shock due to cardiac tamponade caused by erosion of a Figulla Flex II device. His symptoms developed 4 days after transcatheter closure of an atrial septal defect. After emergent pericardiocentesis, surgery was performed to remove the device, close the atrial septal defect, and repair the laceration in the anterior‐superior wall of the right atrium and the perforation on the aortic wall adjacent to the right atrial free wall perforation site. All surgical procedures were successful, and the patient was discharged without sequelae. Although there have been few reports on the erosion of this flexible device, a lethal complication can occur when the right‐sided disc of the oversized device impinges perpendicularly on the aortic wall.     

心脏直视手术后迟发性心包填塞诊治体会

心脏直视手术后迟发性心包填塞是临床上极为少见的术后并发症。本文报告9例，其中二尖瓣置换术6例，先天性心脏病矫治术3例。发生心包填塞的时间为手术后9～28天，平均17．6天。本组死亡2例，均由于未能识别而延误诊治。作者分析了本病发生因素，认为术后心衰控制不利和术后抗凝治疗过度为本病的主要诱因，并对迟发性心包填塞的早期临床表现、及时诊断和处理等问题进行了讨论。     

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。