Late cardiac tamponade after open heart surgery: incidence, role of anticoagulants in its pathogenesis and its relationship to the postpericardiotomy syndrome.

Abstract

Cardiac tamponade that occurs late after cardiac surgery (7 days) is relatively uncommon but potentially fatal. Its incidence, clinical course and relationship to the postpericardiotomy syndrome were analyzed in 1290 consecutive adult patients who survived surgery. Criteria for diagnosis of cardiac tamponade were elevated jugular venous pressure; hypotension or decreased cardiac index; characteristic hemodynamics at cardiac catheterization; and echocardiographic evidence of pericardial effusion. Ten of the 1290 patients (0.8%) developed cardiac tamponade. Surgery was for congenital heart disease in 5 patients, valvular heart disease in 2 patients, and coronary artery disease in 3 patients. The onset of hemodynamic compromise ranged from 15-180 days postoperatively (mean 49 days). All patients had echocardiographic evidence of pericardial fluid, 8 had a pericardial friction rub at the time of cardiac tamponade, 9 had pericardial pain, and all were considered to have a postpericardiotomy syndrome. One patient was receiving coumadin and 2 patients were receiving aspirin before the diagnosis of cardiac tamponade. Nine patients underwent pericardiocentesis (0.5-1 l of fluid). There were no deaths in the group. The syndrome resolved in 9 patients with conservative medical therapy and 1 patient required pericardial stripping for recurrent cardiac tamponade. Cardiac tamponade occurred in 0.8% of patients who survived cardiac surgery; cardiac tamponade occurred in patients without prior anticoagulation, in marked contrast to previously reported cases; pericardiocentesis and conservative medical therapy were successful in treating the majority of patients; clear symptoms and signs of pericardial involvement were present before cardiac tamponade occurred.