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[Diastolic restriction caused by an encysted hemopericardium a year after coronary bypass]
Insights
A patient developed congestive cardiac failure post-bypass surgery due to encysted hemopericardium. Pericardial drainage resolved the condition, highlighting its importance over pericardectomy for post-cardiac surgery effusions.
Area of Science:
- Cardiology
- Cardiac Surgery
- Diagnostic Imaging
Background:
- Congestive cardiac failure can occur post-aorto-coronary bypass surgery.
- Pericardial effusion is a potential complication following cardiac procedures.
Observation:
- A 54-year-old patient presented with congestive cardiac failure one year after bypass surgery.
- Investigations revealed a pericardial effusion causing cardiac compression (adiastole).
- Echocardiography was crucial in diagnosing the encysted hemopericardium.
Findings:
- Pericardial drainage yielded approximately 300 cc of fluid, confirming encysted hemopericardium.
- Cardiac catheterization demonstrated progressive normalization of intracardiac pressures post-drainage.
- A stress test ruled out constrictive pericarditis.
Implications:
- Diastolic restriction with residual effusion post-cardiac surgery warrants consideration of pericardial drainage.
- Pericardial drainage should be prioritized over pericardectomy in such cases.
- Early diagnosis and intervention via drainage can improve patient outcomes.
Abstract:
The case of a 54 year old patient presenting with congestive cardiac failure one year after single aorto-coronary bypass surgery is reported. Paraclinical investigations showed a pericardial effusion compressing the inferior wall of the heart. Echocardiography was essential for diagnosis. This localised compression was responsible for the haemodynamic changes of adiastole. Pericardial drainage confirmed the diagnosis of an encysted hemopericardium containing about 300 ccs of liquid. Right and left cardiac catheter studies before and after surgery, and 8 months postoperatively, showed progressive normalisation of the intracardiac pressures. A volume expansion stress test excluded possible associated pericardial constriction. Therefore, the finding of diastolic restriction with a residual effusion after cardiac surgery should orientate management towards pericardial drainage before considering pericardectomy.