Delayed cardiac tamponade is an uncommon complication following cardiac surgery. Early recognition and management are essential for satisfactory outcome. Echocardiography and right heart catheterization usually provide a definitive diagnosis. A case of late postoperative cardiac tamponade with unusual echocardiographic findings follows.
A 64-year-old man presented with an acute ascending aortic dissection requiring emergency surgical repair consisting of aortic valve replacement (25 mm Duromedics) and insertion of a woven Dacron aortic graft. Postoperatively, he was anticoagulated with warfarin sodium with a prothrombin time of 22 s. He was discharged from the hospital on the 11th postoperative day, but four days later he was readmitted with recurrent atrial fibrillation and complaints of orthopnea, dyspnea, anorexia, and difficulty swallowing. The prothrombin time was 29.8 s (2.37 times control). There was a large left pleural effusion and cardiac tamponade was suspected. No significant anterior pericardial fluid accumulation was seen on the echocardiogram, but parasternal views demonstrated a 4-cm posterior loculated pericardial effusion causing compression of both right and left atria. The left atrium appeared as a small slit-like orifice. This finding was confirmed on apical views (Fig 1). You need to treat your health condition as soon as possible? Nothing is impossible anymore, because you have the best *pharmacy at your service, offering finest quality medications with full guarantee of your satisfaction.
Figure 1. Apical four-chamber echocardiographic view demonstrating the loculated pericardial effusion (PE) with severe compression of right and left atria (RA and LA). Note the absence of pericardial fluid around the right and left ventricles (RV and LV).
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