Pseudo-pericardial tamponade after cardiac surgery

Area of Science:

• Cardiology
• Cardiac Surgery
• Echocardiography

Background:

• Cardiac tamponade is a frequent complication following cardiac surgery, often presenting as hypotension and low cardiac output.
• Transesophageal echocardiography (TEE) is a key diagnostic tool for evaluating post-operative complications.
• Mitral valve replacement and coronary artery bypass grafting are complex procedures with potential for iatrogenic injuries.

Observation:

• A patient presented with suspected cardiac tamponade post-mitral valve replacement and coronary artery bypass grafting, as suggested by TEE findings.
• Intraoperative surgical exploration did not confirm the presence of cardiac tamponade.
• An unusual finding was an abnormal right atrial filling pattern visualized on TEE.

Findings:

• The abnormal right atrial filling was attributed to a prominent Eustachian valve.
• The Eustachian valve was found to be trapped within the sutures used to repair an iatrogenic inferior vena cava laceration.
• This mechanical obstruction, rather than pericardial effusion, mimicked the echocardiographic signs of cardiac tamponade.

Implications:

• This case underscores the importance of considering rare anatomical variations and iatrogenic complications during cardiac surgery.
• Accurate diagnosis requires correlation of imaging findings with surgical findings, especially when atypical presentations occur.
• Awareness of this specific complication involving the Eustachian valve and inferior vena cava repair is crucial for preventing misdiagnosis and ensuring patient safety.