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Late pericardial tamponade after aortic and mitral valve replacement
H Huwer1, I Volkmer, J Dyckmans
1Department of Thoracic and Cardiovascular Surgery, University of the Saarland, Homburg, FRG.
The Thoracic and Cardiovascular Surgeon
|February 1, 1988
Summary
A post-cardiac surgery patient experienced tamponade mimicking myocardial infarction. A large blood clot compressing the right ventricle caused these symptoms, resolving after surgical removal.
Area of Science:
- Cardiology
- Cardiac Surgery
Background:
- Postoperative complications after double valve replacement can be complex.
- Pericardial tamponade is a serious complication requiring prompt diagnosis and management.
Observation:
- A patient presented with signs mimicking posterior wall myocardial infarction 11 days post-double valve replacement.
- Nitrate administration worsened the patient's condition, while ST elevation during supraventricular tachycardia episodes showed transient improvement.
Findings:
- Coronary angiography and valve function were normal pre- and post-operatively.
- Right ventricular and atrial pressures indicated tamponade, with imaging suggesting ventral compression.
- A large retroventricular hematoma was discovered during re-thoracotomy, causing right ventricular outflow tract compression.
Implications:
- Surgical evacuation of the hematoma led to immediate hemodynamic and ECG improvement.
- This case highlights that atypical presentations of pericardial tamponade can mimic myocardial infarction.
- Vagally mediated symptoms, including bradycardia and ST elevation, can result from cardiac compression.