Document Detail

Prolonged right ventricular failure after relief of cardiac tamponade.
MedLine Citation:
PMID:  15128635     Owner:  NLM     Status:  MEDLINE    
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.
Arnaud Geffroy; Hélène Beloeil; Erik Bouvier; Arnaud Chaumeil; Pierre Albaladejo; Jean Marty
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Publication Detail:
Type:  Case Reports; Journal Article    
Journal Detail:
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:
Created Date:  2004-05-06     Completed Date:  2004-09-07     Revised Date:  2007-11-15    
Medline Journal Info:
Nlm Unique ID:  8701709     Medline TA:  Can J Anaesth     Country:  Canada    
Other Details:
Languages:  eng     Pagination:  482-5     Citation Subset:  IM    
Department of Anesthesiology and Critical Care, Hôpital Beaujon, Assistance Publique-Hôpitaux de Paris, Université Xavier Bichat Paris 7, Clichy Cedex, France.
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MeSH Terms
Anoxia / etiology
Cardiac Tamponade / complications*,  physiopathology
Echocardiography, Transesophageal
Fatal Outcome
Heart Septal Defects, Atrial / etiology,  physiopathology
Middle Aged
Oropharyngeal Neoplasms / surgery
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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