Delayed cardiac tamponade following open heart surgery. Analysis of 12 patients

The present report reviews our experience with 12 cases of delayed cardiac tamponade following open heart surgery, which occurred at various times after the seventh postoperative day (average 19 days). In each case the diagnosis was made on clinical grounds, supported by the radiographic findings in all, and confirmed by echocardiography in 4. Pericardial effusion was serous in 5 patients, sero-sanguineous in 3, sanguineous in 3, and purulent in one; it was most frequently caused by a postpericardiotomy syndrome (7 cases). A single pericardiocentesis was curative in 6 instances, while repeat procedures were required in 2 because of recurrence. A repeat median sternotomy was performed in 5 patients associated with pericardiocentesis, and a pericardiectomy in 2. Three patients died within one month from the initial operation; no recurrences have been noted so far in the long-term survivors. According to the results of the present investigation, early clinical recognition is considered the clue to a successful outcome. Sole pericardiocentesis is followed by immediate improvement of the patient's state, and is often curative, but recurrences may require other maneuvers for further fluid evacuation. Awareness of this possible complication may contribute to a decrease in the still high mortality rate associated with this condition.