| Prolonged right ventricular failure after relief of cardiac tamponade. | |
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MedLine Citation:
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PMID: 15128635 Owner: NLM Status: MEDLINE |
Abstract/OtherAbstract:
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PURPOSE: To report a case of severe and fatal cardiac complication following pericardiotomy to relieve a malignant tamponade. Right ventricular (RV) failure was responsible for major hypoxemia and for a persistent shunt through a patent foramen ovale. In the absence of pulmonary embolism and coronary occlusion, possible pathophysiologic mechanisms are discussed. CLINICAL FEATURES: This 53-yr-old patient presented with oropharyngeal carcinoma previously treated by chemotherapy. One month later, he showed clinical and echocardiographic signs of cardiac tamponade. He had a circumferential pericardial effusion with complete end-diastolic collapse of the right cavities. After an emergent pericardiotomy, he rapidly presented severe hypoxemia. Transesophageal echocardiography showed an akinetic and dilated right ventricle, paradoxical septal wall motion and a normal left ventricular function. A contrast study revealed a right-to-left shunt. No residual pericardial effusion was detectable. Pulmonary angiography excluded a pulmonary embolism and the coronary angiogram was normal. Troponin Ic was elevated postoperatively and peaked on day two (3.78 micro g x L(-1)). The patient died of refractory shock with persistent intracardiac shunt and RV akinesia on day nine. CONCLUSION: Although pulmonary embolism or thrombus of a coronary vessel are the most common causes of prolonged RV failure after pericardiotomy, other mechanisms may be invoked. The possibility is raised that a rapid increase in RV tension may induce the development of muscular injury and impair coronary blood flow, despite a normal coronary angiogram. These could result in a stunned myocardium and opening of a patent foramen ovale. We hypothesize that gradual decompression of a chronic pericardial effusion might be beneficial in patients at risk. |
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Authors:
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Arnaud Geffroy; Hélène Beloeil; Erik Bouvier; Arnaud Chaumeil; Pierre Albaladejo; Jean Marty |
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Publication Detail:
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Type: Case Reports; Journal Article |
Journal Detail:
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Title: Canadian journal of anaesthesia = Journal canadien d'anesthésie Volume: 51 ISSN: 0832-610X ISO Abbreviation: Can J Anaesth Publication Date: 2004 May |
Date Detail:
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Created Date: 2004-05-06 Completed Date: 2004-09-07 Revised Date: 2007-11-15 |
Medline Journal Info:
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Nlm Unique ID: 8701709 Medline TA: Can J Anaesth Country: Canada |
Other Details:
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Languages: eng Pagination: 482-5 Citation Subset: IM |
Affiliation:
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Department of Anesthesiology and Critical Care, Hôpital Beaujon, Assistance Publique-Hôpitaux de Paris, Université Xavier Bichat Paris 7, Clichy Cedex, France. arnaud.geffroy@bjn.ap-hop-paris.fr |
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| MeSH Terms | |
Descriptor/Qualifier:
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Anoxia
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etiology Cardiac Tamponade / complications*, physiopathology Echocardiography, Transesophageal Electrocardiography Fatal Outcome Heart Septal Defects, Atrial / etiology, physiopathology Humans Male Middle Aged Oropharyngeal Neoplasms / surgery Pericardiectomy Respiration, Artificial Shock, Septic / chemically induced Ventricular Dysfunction, Right / etiology*, physiopathology |
From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine
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