scholarly journals Resuscitative transesophageal echocardiography in the diagnosis of post-CABG loculated pericardial clot causing cardiac tamponade

2021 ◽  
Vol 13 (1) ◽  
Author(s):  
Osman Adi ◽  
Azma Haryaty Ahmad ◽  
Chan Pei Fong ◽  
Asri Ranga ◽  
Nova Panebianco
Keyword(s):  
Pericardial Effusion ◽  
Cardiac Tamponade ◽  
Transesophageal Echocardiography ◽  
Artery Bypass ◽  
Bypass Graft ◽  
Delayed Diagnosis ◽  
Case Series ◽  
Hemodynamic Instability ◽  
Diagnostic Challenge ◽  
Life Threatening

Abstract Background Pericardial effusion is a known complication of post-open cardiac surgery which can progress to life-threatening cardiac tamponade. Classical signs of tamponade such as hypotension and pulsus paradoxus are often absent. Diagnosing acute cardiac tamponade with transthoracic echocardiography (TTE) can be challenging in post-cardiac surgical patients due to distorted anatomy and limited scanning windows by the presence of surgical dressings or scar. Additionally, this patient population is more likely to have a loculated pericardial effusion, or an effusion that is isoechoic in appearance secondary to clotted blood. These findings can be challenging to visualize with traditional TTE. Missed diagnosis of cardiac tamponade due to loculated pericardial clot can result in delayed diagnosis and clinical management. Case presentation We report a case series that illustrates the diagnostic challenge and value of resuscitative transesophageal echocardiography (TEE) in the emergency department (ED) for the diagnosis of cardiac tamponade due to posterior loculated pericardial clot in post-surgical coronary artery bypass graft (CABG) patients. Conclusions Cardiac tamponade due to loculated posterior pericardial clot post-CABG requires prompt diagnosis and appropriate management to avoid the potential for hemodynamic instability. Transesophageal echocardiography allows a rapid diagnosis, early appropriate referral and an opportunity to institute appropriate therapeutic measures.

scholarly journals More than Meets the Eye: An Interesting Case of Cardiac Tamponade

2019 ◽  
Vol 2 (2) ◽  
Author(s):  
Camille A Clarke
Keyword(s):  
Ventricular Tachycardia ◽  
Coronary Artery ◽  
Pericardial Effusion ◽  
Cardiac Tamponade ◽  
Artery Bypass ◽  
Bypass Graft ◽  
Interesting Case ◽  
Pericardial Fluid ◽  
Learning Objective ◽  
Artery Disease

This interesting case highlights the presentation of a 68-year-old Latino male with coronary artery disease and coronary artery bypass graft surgery eight years who presented with non-specific respiratory symptoms. At the time of his initial evaluation he was noted to have persistent bigeminy and a 5 beat run of ventricular tachycardia. During his hospital stay he was again noted to have marked arrhythmias, with a 40 beat run of ventricular tachycardia. Urgent echocardiogram was obtained and revealed significant pericardial effusion compressing his right ventricle. On cardiac catheterization patient was found to have a patent graft but trasudative pericardial fluid causing tamponade and arrhythmia both which completely resolved after drainage. Learning Objective 1: Recognize ventricular arrhythmias as an atypical presentation of pericardial effusion and cardiac tamponade. Learning Objective 2: Appreciate the utility of echocardiogram in elucidating etiologies of non-sustained ventricular tachycardia.

Role of Intraoperative Transesophageal Echocardiography in Patients Having Coronary Artery Bypass Graft Surgery

2004 ◽  
Vol 78 (5) ◽  
pp. 1586-1590 ◽  
Author(s):  
Fatema E. Qaddoura ◽  
Martin D. Abel ◽  
Karen L. Mecklenburg ◽  
Krishnaswamy Chandrasekaran ◽  
Hartzell V. Schaff ◽  
...  
Keyword(s):  
Coronary Artery ◽  
Coronary Artery Bypass Graft ◽  
Transesophageal Echocardiography ◽  
Coronary Artery Bypass ◽  
Artery Bypass ◽  
Bypass Graft ◽  
Artery Bypass Graft ◽  
Intraoperative Transesophageal Echocardiography

scholarly journals Should we use diastolic function parameters to determine preload responsiveness in cardiac surgery? A pilot study

2021 ◽  
Vol 1 (1) ◽  
Author(s):  
Athanase Courbe ◽  
Clotilde Perrault-Hébert ◽  
Iolanda Ion ◽  
Georges Desjardins ◽  
Annik Fortier ◽  
...  
Keyword(s):  
Pilot Study ◽  
Cardiac Index ◽  
Transesophageal Echocardiography ◽  
Diastolic Function ◽  
Fluid Responsiveness ◽  
Artery Bypass ◽  
Bypass Graft ◽  
Left Ventricular ◽  
Link Type ◽  
Preload Responsiveness

Abstract Background Left ventricular (LV) diastolic function (DF) may play an important role in predicting fluid responsiveness. However, few studies assessed the role of diastolic function in predicting fluid responsiveness. The aim of this pilot study was to assess whether parameters of right and left diastolic function assessed with transesophageal echocardiography, including the mitral E/e′ ratio, is associated with fluid responsiveness among patients undergoing elective bypass graft surgery. We also sought to compare other methods of fluid responsiveness assessment, including echocardiographic and hemodynamic parameters, pulse pressure variation, and stroke volume variation (SVV) (arterial pulse contour analysis, Flotrac/Vigileo system). Results We prospectively studied seventy patients undergoing coronary artery bypass grafting (CABG) monitored with a radial arterial catheter, transesophageal echocardiography (TEE), and a pulmonary artery catheter (for cardiac output measurements), before and after the administration of 500 mL of crystalloid over 10 min after the anesthetic induction. Thirteen patients were excluded (total of 57 patients). Fluid responsiveness was defined as an increase in cardiac index of ≥ 15%. There were 21 responders (36.8%) and 36 non-responders (63.2%). No difference in baseline pulsed wave Doppler echocardiographic measurements of any components of the mitral, tricuspid, and pulmonary and hepatic venous flows were found between responders and non-responders. There was no difference in MV tissue Doppler measurements between responders and non-responders, including E/e′ ratio (8.7 ± 4.1 vs. 8.5 ± 2.8 in responders vs. non-responders, P = 0.85). SVV was the only independent variable to predict an increase in cardiac index by multivariate analysis (P = 0.0208, OR = 1.196, 95% CI (1.028-1.393)). Conclusions In this pilot study, we found that no parameters of right and left ventricular diastolic function were associated with fluid responsiveness in patients undergoing CABG. SVV was the most useful parameter to predict fluid responsiveness. Trial registration ClinicalTrials.gov, NCT 02714244. Registered 21 March 2016—retrospectively registered.

scholarly journals Benign Pericardial Hemangioma—A Rare Cause of Cardiac Tamponade

2021 ◽  
Vol 31 (03) ◽  
pp. 754-757
Author(s):  
Dhanya Jacob ◽  
Thara Pratap ◽  
Anand Kumar ◽  
Rashmi R. ◽  
Vishnu A. K.
Keyword(s):  
Computed Tomography ◽  
Chest Pain ◽  
Pericardial Effusion ◽  
Cardiac Tamponade ◽  
Pain Severity ◽  
Atypical Chest Pain ◽  
Secondary Tumors ◽  
Life Threatening ◽  
Primary Neoplasms ◽  
Threatening Situation

AbstractPericardial tumors are very rare. It can be primary or secondary, of which secondary tumors are more common. Pericardial hemangiomas are extremely rare primary neoplasms and there are only very few cases published in the literature. These patients can be asymptomatic. When symptomatic, they present with dyspnea, palpitation, or atypical chest pain. Severity of symptoms depends on the size and location of the tumor. Pericardial effusion with features of cardiac tamponade can lead to a life-threatening situation. Here, we report a case of pericardial hemangioma in a patient who presented with breathlessness and tamponade which was diagnosed preoperatively with computed tomography.

scholarly journals Fate of a coronary artery intramural haematoma complicating aortic root surgery: a case report

2020 ◽  
Vol 4 (5) ◽  
pp. 1-5
Author(s):  
Giulio Folino ◽  
Raffaele Scaffa ◽  
Andrea Salica ◽  
Ruggero De Paulis
Keyword(s):  
Coronary Artery ◽  
Aortic Root ◽  
Artery Bypass ◽  
Healing Process ◽  
Bypass Graft ◽  
Intramural Haematoma ◽  
Coronary Syndrome ◽  
Bentall Procedure ◽  
Aortic Root Surgery ◽  
Life Threatening

Abstract Background Coronary intramural haematoma (CIH) is an uncommon but potentially life-threatening complication during aortic root surgery (such as Bentall procedure). Depending on its extension it can lead to cardiogenic shock. Documented reports of this complication are lacking in literature. Case summary In the report we present a case of CIH and its management and we show a stepwise imaging of the healing process that gives an insight of the fate of CIHs. Discussion This case raises awareness of CIH as differential diagnosis for myocardial ischaemia during aortic root surgery. It underlines the effectiveness of immediate surgical revascularization, highlights the potential temporary role of coronary artery bypass graft that can stabilize the acute coronary syndrome and may give time to the CIH to reabsorb and native coronary circulation to re-establish.

Preoperative and postoperative predictors of early and delayed extubation after coronary artery bypass surgery

1998 ◽  
Vol 7 (1) ◽  
pp. 37-44 ◽  
Author(s):  
LV Doering ◽  
F Imperial-Perez ◽  
S Monsein ◽  
F Esmailian
Keyword(s):  
Coronary Artery ◽  
Coronary Artery Bypass Graft ◽  
Coronary Artery Bypass ◽  
Artery Bypass ◽  
Bypass Graft ◽  
Hemodynamic Instability ◽  
Artery Bypass Graft ◽  
Combined Model ◽  
Delayed Extubation ◽  
Myocardial Oxygen Supply

OBJECTIVE: To identify preoperative, intraoperative, and postoperative predictors of early (6 hours or less after surgery) and delayed (more than 6 hours) extubation after coronary artery bypass graft surgery. METHODS: The sample for this prospective nonrandomized study consisted of 116 consecutive patients in a 12-bed cardiothoracic ICU who had coronary artery bypass graft surgery in a 6-month period and were followed up prospectively until transfer to an observation unit. RESULTS: Age and the presence of early hemodynamic instability (within the first 3 hours after ICU admission) were independent predictors of intubation times of more than 6 hours when each was considered in separate multivariate models of preoperative, intraoperative, and postoperative variables. In a combined model, when considered with age and ejection fraction, the presence of early hemodynamic instability increased the odds by 4.7 times that extubation would occur more than 6 hours after surgery. For every 1 year increase in age, the odds of extubation occurring more than 6 hours after surgery increased by 6.5%. CONCLUSIONS: Older age and the presence of early hemodynamic instability are associated with postoperative intubation periods of more than 6 hours after coronary artery bypass graft surgery. Clinicians should evaluate extubation goals in older patients carefully. Clinical management of hemodynamic instability should be aimed at prompt optimization of myocardial oxygen supply to limit ischemia and its sequelae.

Symptoms of massive cardiac tamponade during support of biventricular assist device

2018 ◽  
Vol 41 (5) ◽  
pp. 245-246
Author(s):  
Mosab Al Shakaki ◽  
Angelo M Dell’Aquila ◽  
Andreas Rukosujew
Keyword(s):  
Computed Tomography ◽  
Pericardial Effusion ◽  
Cardiac Tamponade ◽  
Ventricular Assist Device ◽  
Clinical Symptoms ◽  
Hemodynamic Instability ◽  
Computed Tomography Scan ◽  
Assist Device ◽  
Ventricular Assist ◽  
Tomography Scan

Typical symptoms of cardiac tamponade are jugular venous distension, pulsus paradoxus, hypotension, and rest dyspnea. However, these clinical symptoms can be masked in patients with ventricular assist device and even more in patients supported with a biventricular-HeartWare ventricular assist device. Hereby, we report the case of a 30-year-old man supported with a biventricular-HeartWare ventricular assist device, who underwent a computed tomography scan due to suspect of ventricular assist device thrombosis. In the first scan, no pericardial effusion could be detected; however, a flow-limiting formation suggestive of a thrombus was localized in the outflow graft of the right ventricular assist device immediately before the anastomosis with pulmonary artery. Lysis therapy was initiated. On the same day, two episodes of sustained ventricular tachycardia and ventricular fibrillation without hemodynamic instability had to be promptly treated with antiarrhythmic drugs and electrical defibrillations. On the same day, a second computed tomography scan showed a massive pericardial effusion that required an emergency resternotomy.

Sign in / Sign up

Export Citation Format

Share Document