ISOLATED RIGHT ATRIAL TAMPONADE AFTER OPEN-HEART-SURGERY - ROLE OF ECHOCARDIOGRAPHY IN DIAGNOSIS AND MANAGEMENT

Ten patients with isolated right atrial tamponade complicating open he art surgery were identified over a 3.5-year period at three institutio ns. Clinical manifestations varied but were typically those of decreas ed perfusion with elevated central venous pressure. Hemodynamically th ese patients had systemic hypotension and tachycardia with elevated ce ntral venous pressure but without elevation of pulmonary artery or pul monary artery wedge pressures. The correct diagnosis in each case was established by echocardiography; 7 via the transthoracic and 3 via the transesophageal approach. The typical echocardiographic feature was a n extrinsic extracardiac mass compressing the atrium. Doppler findings included high flow velocities through the right atria, and color flow demonstrated narrow color jets through compressed, slit-like right at ria, Surgical exploration confirmed these findings in each case. We co nclude that the combination of clinical awareness and appropriate hemo dynamic evaluation can alert the physician to the possibility of isola ted right atrial hematoma causing decreased perfusion and/or shock fol lowing open heart surgery. Echocardiography using either the transthor acic or transesophageal approach can establish the diagnosis and lead to timely surgical intervention.