Evaluation and Management of Cardiac Tamponade During Transcatheter Aortic Valve Replacement

Cardiac tamponade is rare but life-threatening complication of transcatheter aortic valve replacement (TAVR). Rapid identification of the source of bleeding is critical for timely and effective management.

A 72-year-old woman with severe aortic stenosis developed cardiac tamponade during TAVR. Initial echocardiography and aortic and left ventricular angiography failed to identify the etiology. Simultaneous pericardial fluid and arterial blood gas analysis suggested left-sided cardiac injury, prompting re-evaluation of angiograms, which revealed a subtle left ventricular perforation. The patient was initially managed with pericardiocentesis but finally required an open surgery.

Current guidelines do not mention the role of pericardial fluid gas analysis in the management of cardiac tamponade. This case illustrates its importance in differentiating right- from left-sided perforation, as most right-sided perforations can be managed conservatively, whereas more than 50% left-sided perforations require urgent surgery.

Pericardial fluid gas analysis can guide appropriate management of cardiac tamponade during TAVR.