1/10. diagnosis of cardiac tamponade by echocardiography: changes in mitral valve motion and ventricular dimensions, with special reference to paradoxical pulse.The echocardiographic findings in three patients who presented with pericardial effusion and cardiac tamponade are described. Cyclic respiratory changes affected the diastolic movement of the anterior mitral leaflet, viz., during inspiration its anterior excursion decreased in amplitude and the E-F slope diminished. This inspiratory alteration in mitral valve motion was accompanied by an increase in right ventricular dimensions and a reciprocal decrease in left ventricular dimensions. Pericardial paracentesis confirmed the presence of effusion and relieved cardiac tamponade in all the patients. Repeat echocardiography, performed in two of the patients immediately after the pericardial tap, showed that the E-F slope had become steeper and that phasic respiratory variations in the diastolic motion of the anterior mitral leaflet were no longer present. The compatibility of our observations with the theories which endeavor to explain the mechanism of the paradoxical pulse in pericardial effusion with cardiac tamponade is discussed. We suggest that the abnormalities in anterior mitral leaflet motion defined by echocardiography constitute a useful addition to the study of patients with suspected cardiac tamponade resulting from pericardial effusion.- - - - - - - - - - ranking = 1keywords = motion (Clic here for more details about this article) |
2/10. Prolonged right ventricular failure after relief of cardiac tamponade.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.- - - - - - - - - - ranking = 0.14285714285714keywords = motion (Clic here for more details about this article) |
3/10. Superior vena cava perforation and cardiac tamponade after filter placement in the superior vena cava--a case report.The purpose of this paper is to report the complication of perforation of the superior vena cava (SVC) leading to cardiac tamponade after the insertion of a Trapease IVC filter in the SVC position. A 29-year-old man was hit by motor vehicle and sustained numerous injuries including a left skull fracture, intracerebral hemorrhage, and left open tibial shaft fracture. During his hospitalization, he developed an extensive symptomatic right upper extremity deep venous thrombosis involving the brachial, axillary, subclavian, internal jugular, and brachiocephalic veins. Owing to an intracerebral bleed, anticoagulation was contraindicated. Therefore, a Trapease filter (Cordis Inc.) was placed in the SVC via the left subclavian vein. Four hours later, the patient became hypotensive with associated tachycardia and tachypnea. Computed tomography of his chest revealed a hematoma around the SVC, a moderate amount of fluid within the pericardium, and a moderate-sized right pleural effusion. The patient was taken to the operating room and a pericardial window was performed. Approximately 500 cc of blood was evacuated from the pericardium and immediate improvement in vital signs was noted. The patient was discharged from the hospital 2 weeks later and at 6-month follow-up had made full recovery. This is the first case of SVC perforation leading to cardiac tamponade after the insertion of a Trapease filter. Owing to the rigid structure of the filter and associated motion of the SVC and pericardium, the Trapease filter may be contraindicated in the SVC.- - - - - - - - - - ranking = 0.14285714285714keywords = motion (Clic here for more details about this article) |
4/10. pericardial effusion and electrical alternans: echocardiographic assessment.Clinical diagnosis of pericardial effusion is often difficult, and assessment of the effects of effusion on cardiac hemodynamics is often imprecise. Electrical alternans is a reasonably specific ECG indicator of the presence of a large effusion and imminent or actual cardiac tamponade. If echocardiography verifies the presennce of pericardial fluid and shows abnormal cardiac motion, a diagnosis of cardiac tamponade can be made without further, more invasive, studies.- - - - - - - - - - ranking = 0.14285714285714keywords = motion (Clic here for more details about this article) |
5/10. Mechanism of electrical alternans in patients with pericardial effusion.Electrical alternans concomitant with pericardial effusion has been considered a pathognomonic sign suggestive of a large effusion with cardiac tamponade, particularly if there is P wave alternans as well as QRS alternans. However, the mechanism of this phenomonon remains controversial. A patient with pericardial effusion secondary to adenocarcinoma of the lung with metastases, pericardial effusion, electrical alternans, and cardiac tamponade was studied by echocardiography, right and left heart catheterization, and pericardiocentesis. Hemodynamic data were consistent with cadiac tamponade. The echocardiogram demonstrated a large anterior and posterior pericardial effusion. Noncongruous motion of the septum and posterior wall was pericardial effusion. Noncongruous motion of the septum and posterior wall was recorded at a rate equal to the heart rate. In addition, congruous motion of the septum and posterior wall was recorded at a rate that was half the heart rate and corresponded to the electrical alternans. The congruous movement disappeared after pericardiocentesis, as did the electrical alternans. The electrical alternans is synchronous with and due to the pendulous movement of the heart within the pericardial sac, as demonstrated by echocardiogram and cineangiograms.- - - - - - - - - - ranking = 0.42857142857143keywords = motion (Clic here for more details about this article) |
6/10. Right atrial tamponade complicating cardiac operation: clinical, hemodynamic, and scintigraphic correlates.Persistent bleeding into the pericardial space in the early hours after cardiac operation not uncommonly results in cardiac tamponade. Single chamber tamponade also might be expected, since in this setting the pericardium frequently contains firm blood clots localized to the area of active bleeding. However, this complication has received very little attention in the surgical literature. We are therefore providing documentation that isolated right atrial tamponade can occur as a complication of cardiac operation and that there exists a potential for misdiagnosis and hence incorrect treatment of this condition. Right atrial tamponade may be recognized by a combination of low cardiac output, low blood pressure, prominent neck veins, right atrial pressure in excess of pulmonary capillary wedge pressure and right ventricular end-diastolic pressure, and a poor response to plasma volume expansion. Findings on chest roentgenogram and gated wall motion scintigraphy may be highly suggestive. This review should serve to increase awareness of this complication and to provide some helpful diagnostic clues.- - - - - - - - - - ranking = 0.14285714285714keywords = motion (Clic here for more details about this article) |
7/10. Left ventricular outflow obstruction induced by tamponade in hypertrophic cardiomyopathy.Echocardiographic abnormalities of valvular movement described in patients with pericardial effusions have included systolic anterior motion (SAM) of the mitral valve. Published illustrations have shown, however, "pseudo-SAM" rather than true SAM. We report a patient with asymmetric septal hypertrophy whose echocardiogram during tamponade showed true SAM, which was no longer apparent and could not be provoked following resolution of tamponade. Two prior cardiac catheterizations revealed no intraventricular pressure gradients in either normal or postextrasystolic beats. Tamponade was the only stimulus that provoked signs of obstruction in this patient with asymmetric septal hypertrophy.- - - - - - - - - - ranking = 0.14285714285714keywords = motion (Clic here for more details about this article) |
8/10. Abnormal septal motion in cardiac tamponande with pulse paradoxus. Echocardiographic and hemodynamic observations.In a patient with cardiac tamponade and pulses paradoxus the echocardiogram showed markedly abnormal septal motion, consisting of posterior displacement during inspiration. This displacement resulted from an increase in right ventricular size and a decrease in left ventricular volume, not attributable to a change in position of the heart. The correlation of this finding with hemodynamic events showed that the inspiratory drop in arterial pressure followed septal displacement. These observations support the hypothesis that pulsus paradoxus may be caused by competition of the ventricles for filling within a relatively rigid pericardial space. Displacement of the interventricular septum could be the mechanism by which this completition takes place.- - - - - - - - - - ranking = 0.71428571428571keywords = motion (Clic here for more details about this article) |
9/10. Atypical late cardiac tamponade after mitral valve replacement: case presentation with hemodynamic and echocardiographic observations.A patient developed oliguria, peripheral edema, and dyspnea 5 days after mitral valve replacement. Chest roentgenogram and echocardiogram suggested pericardial effusion. Although pulsus paradoxus was absent, cardiac tamponade was suspected and subsequently confirmed during pericardiocentesis. Before pericardiocentesis right and left ventricular diastolic pressures were equal, as well as intrapericardial and right atrial pressures. The left ventricular cavity was reduced in size on the echocardiogram. Interventricular septal motion was normal. pericardiocentesis normalized the hemodynamics and allowed the left ventricle to reexpand. Certain atypical features are tentatively explained as the combined effect of constrictive and effusive components caused by intrapericardial hemorrhage.- - - - - - - - - - ranking = 0.14285714285714keywords = motion (Clic here for more details about this article) |
10/10. Fatal cardiac tamponade associated with posterior spinal instrumentation. A case report.STUDY DESIGN: Case report of a fatal complication of pedicle screw instrumentation and review of the literature. OBJECTIVE: To describe the clinical and postmortem findings in a 35-year-old man who sustained a T11 burst fracture that was managed by transpedicular posterior instrumentation and who died 12 days after surgery of cardiac tamponade caused by a prick injury of the right coronary artery. SUMMARY OF BACKGROUND DATA: Posterior pedicle screw instrumentation is considered a safe and effective method for stabilizing a spinal motion segment. Nevertheless, there are several rare but significant complications that may occur. This is the first report of a heart tamponade after transpedicular screw insertion. methods: A 35-year-old man was treated for a T11 burst fracture with posterior transpedicular stabilization. The surgery was uncomplicated. RESULTS: Twelve days after the intervention, the patient died of cardiogenic shock. Postmortem examination showed a heart tamponade of 350 mL blood originating in a prick injury of the right coronary artery. Histologic findings showed evidence that the injury was caused during surgery by a Kirschner wire. CONCLUSION: There are numerous possible intraoperative complications in posterior pedicle screw fixation, such as nerve root and spinal cord injuries. This case of a fatal heart tamponade after transpedicular screw insertion is rare. It shows that the surgeon must be aware of potential risks associated with such a procedure and have a comprehensive three-dimensional understanding of the anatomic structures involved.- - - - - - - - - - ranking = 0.14285714285714keywords = motion (Clic here for more details about this article) |
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