On right heart catheterization, there was a trend toward equalization of diastolic intracardiac pressures: central venous pressure, 19 mm Hg; pulmonary artery diastolic pressure, 21 mm Hg; and pulmonary capillary wedge pressure, 20 mm Hg. The cardiac index was only 1.6 L/min/m2 and there was 20 mm Hg pulsus paradoxus. Because of the deep posterior location of the pericardial fluid collections, percutaneous pericardiocentesis was not attempted and surgical reexploration was performed. There was minimal fluid anteriorly, but on dissecting a plane between the right ventricle and the diaphragm, a cavity containing 400 ml of old blood was entered and drained. This confirmed the echocardiographic findings. There was no evidence of active bleeding and hemodynamic performance improved rapidly following drainage. The patient recovered satisfactorily and a postoperative echocardiogram demonstrated normal-sized left and right atria, normal ventricular diastolic filling, and resolution of the posterior fluid collections.
Late postoperative cardiac tamponade occurs in approximately 1 percent of cases. The onset may be insidious, and symptoms (dyspnea, dysphagia, and fatigue) may be nonspecific. The incidence is increased in patients with postpericardiotomy syndrome and in patients receiving anticoagulants. In the surgical patient, posterior collections appear to be more common, making percutaneous catheter drainage more difficult. Visiting an online pharmacy has never been easier and safer, since now you have the one you can call your favorite one: at the pharmacy that always takes care of its customers and always pay less money.
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