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[Cardiac perforation and tamponade during TIPS placement].
K Asehnoune1, D Azoulay, P Andreani
1Département d'Anesthésie-Réanimation et Unité Propre de Recherche de l'Enseignement Supérieur, Equipe d'Accueil (UPRES-EA 3540), Hôpital de Bicêtre, 94275 Le Kremlin-Bicêtre, France. asehnounekarim@hotmail.com
Annales Francaises D'Anesthesie Et De Reanimation
|July 25, 2006
Summary
A patient experienced severe hemodynamic compromise after a transjugular intrahepatic portosystemic shunt (TIPS) procedure. This was caused by cardiac tamponade due to right heart perforation, which was successfully treated.
Area of Science:
- Interventional Cardiology
- Cardiovascular Surgery
- Gastroenterology
Background:
- Transjugular intrahepatic portosystemic shunt (TIPS) procedures are used for intractable ascites.
- Acute hemodynamic compromise is a rare but serious complication post-TIPS.
Observation:
- A patient developed acute severe hemodynamic compromise immediately following a TIPS procedure.
- Clinical and echographic evaluation revealed pericardial effusion and cardiac tamponade.
Findings:
- The cardiac tamponade was likely caused by right heart perforation during guidewire and catheter manipulation.
- Pericardial fluid drainage temporarily restored hemodynamic status.
- Surgical closure of the right ventricle perforation was successful, and the patient survived.
Implications:
- Cardiac tamponade should be considered in the differential diagnosis of hemodynamic instability after TIPS.
- This case highlights the importance of prompt recognition and management of cardiac injury during TIPS procedures.
- Adherence to meticulous technique during TIPS placement can mitigate the risk of cardiac perforation.