Lymphatic cardiac tamponade after open-heart surgery with liver dysfunction

Area of Science:

• Cardiology
• Thoracic Surgery
• Hepatology

Background:

• Infective endocarditis can lead to mitral regurgitation, necessitating surgical intervention.
• Alcoholic liver dysfunction presents complex challenges in managing cardiac conditions.
• Postoperative lymphatic leakage is a rare but serious complication following cardiac surgery.

Observation:

• A 46-year-old female with alcoholic liver dysfunction developed recurrent cardiac tamponade after mitral valvuloplasty for infective endocarditis.
• The tamponade was attributed to lymphatic leakage from injured vessels in the pericardial space.
• Initial management did not resolve the recurrent effusions.

Findings:

• Redo median sternotomy with laparotomy successfully identified and repaired injured lymphatic vessels.
• The lymphatic leakage was definitively treated, resolving the recurrent cardiac tamponade.
• The patient experienced an uneventful recovery and was discharged 20 days post-reoperation.

Implications:

• This case highlights lymphatic leakage as a rare cause of recurrent cardiac tamponade, particularly in patients with liver dysfunction.
• Successful surgical management underscores the importance of identifying and addressing lymphatic injury in complex cardiac cases.
• Understanding this complication can guide diagnostic and therapeutic strategies in similar high-risk patient populations.