Document Detail

Cardiac causes of shock early after open heart surgery: etiologic classification by radionuclide ventriculography.
MedLine Citation:
PMID:  3995709     Owner:  NLM     Status:  MEDLINE    
Early after open heart surgery, cardiac shock due to tamponade is easily misdiagnosed as ventricular dysfunction. The distinction is critical to successful therapy. We assessed the utility of 99mTc-red blood cell, gated equilibrium radionuclide ventriculography in 50 patients with early postoperative cardiac shock after historical, clinical, and invasive hemodynamic evaluation failed to identify either tamponade or ventricular dysfunction as the specific cause of their shock. The cause was established by radionuclide ventriculography in 45 of 50 patients and led to a change in therapy in 21 patients. A single cause was found in 35 patients: 13 had severe global dysfunction of the left ventricle (three patients), right ventricle (seven patients), or both ventricles (three patients); three had severe segmental left ventricular dysfunction; and 19 had an exaggerated region of photon deficiency (nine patients) or an abnormal and accumulating blood pool (10 patients) surrounding small hyperdynamic ventricles. Sixteen of these 19 patients with scintigraphic evidence of tamponade underwent aspiration with a pericardial needle or reoperation early after radionuclide ventriculography, resulting in confirmation of scintigraphic findings and improved hemodynamics. Ten additional patients had combined ventricular dysfunction and a pericardial abnormality, and five of these underwent reoperation resulting in improved hemodynamics. Radionuclide ventriculography provided no explanation for the cause of cardiac shock in five patients. Thus, the various causes of cardiac shock early after open heart surgery can be distinguished by 99mTc-red blood cell, gated equilibrium radionuclide ventriculography, eliminating diagnostic uncertainty that can occur with traditional evaluation.
T M Bateman; L S Czer; R M Kass; M J Raymond; A Chaux; J M Matloff; D S Berman; R J Gray
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Publication Detail:
Type:  Journal Article; Research Support, Non-U.S. Gov't; Research Support, U.S. Gov't, P.H.S.    
Journal Detail:
Title:  Circulation     Volume:  71     ISSN:  0009-7322     ISO Abbreviation:  Circulation     Publication Date:  1985 Jun 
Date Detail:
Created Date:  1985-07-16     Completed Date:  1985-07-16     Revised Date:  2007-11-15    
Medline Journal Info:
Nlm Unique ID:  0147763     Medline TA:  Circulation     Country:  UNITED STATES    
Other Details:
Languages:  eng     Pagination:  1153-61     Citation Subset:  AIM; IM    
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MeSH Terms
Cardiac Tamponade / classification,  etiology,  radionuclide imaging
Cardiovascular Diseases / surgery*
Postoperative Complications / classification,  etiology*,  radionuclide imaging
Shock, Cardiogenic / classification,  etiology*,  radionuclide imaging
Grant Support

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