Hemorrhagic pericardial effusion superimposed on total anomalous pulmonary venous connection: First-reported case

Among congenital heart diseases (CHD), total anomalous pulmonary venous connection (TAPVC), constitutes approximately 0.5-2 % of all detected cardiac anomalies in newborns. Hemorrhagic pericardial effusions are frequently caused by malignancy and iatrogenic cause; however, they can be idiopathic.

We introduce an exceptional case of a previously healthy young adult male who sought medical attention at our institution due to chest discomfort. Investigation revealed a large hemorrhagic pericardial effusion, which recurred three times despite treatment with pericardiocentesis. Further investigation revealed a TAPVC, which subsequently resolved following surgical repair.

TAPVC carries a mortality rate of up to 80 % if unrepaired by one year of age. The supracardiac type of TAPVC and presence of atrial septal defect (ASD) are factors that contribute to survival. The simultaneous occurrence of hemorrhagic pericardial effusions in the setting of unrepaired TAPVC in adults is uncommon. The resolution of the hemorrhagic pericardial effusion suggests a possible association between the two disease entities.

Our case draws attention due to the scarcity of available medical literature reporting such a unique occurrence. Providers should remain vigilant regarding a possible superimposed hemorrhagic pericardial effusion, which could develop in the setting of unrepaired TAPVC in adults.