LATE POSTERIOR CARDIAC-TAMPONADE AFTER OPEN-HEART-SURGERY

Objective. Late cardiac tamponade after open heart surgery is a relati vely uncommon, but potentially serious complication. We retrospectivel y analyzed 14 patients who had posterior cardiac tamponade 13 to 210 d ays after open heart surgery. Patients. Between May 1988 and July 1995 , 3150 adult patients undewent open heart surgery at the Gulhane Milit ary Medical Academy. In 35 of 3150 patients (1.11%) late pericardial e ffusions developed, and in 14 (0.44% of 3150 consecutive open heart su rgery performed on adult patients in our center) of these patients had posterior tamponade. There were moderate symptoms including fatigue, malaise, and dyspnea on exertion in all patients. The diagnosis was ma de by echocardiography in 13 patients, and by tomographic scanning in 1 patient. Analysis of these 14 patients revealed that all of them had hemodynamic criteria consistent with tamponade physiology on right he art catheterization with Swan-Ganz catheters. Results. Echocardiograph y guid pericardiocentesis through the left anterior axillary line was effective in decompressing of posterior cardiac tamponade in 10 of 14 patients. Three patients required operative surgical drainage after un successful pericardiocentesis through subxiphoid area. Two patients wh o underwent surgical drainage died, and in one patient surgical perica rdiotomy had complete evacuation of posterior pericardial fluid with m ajor complication. Conclusions. 2-D echocardiography guid pericardioce ntesis through left anterior axillary line was found to be a useful, s afe, and simple technique. It can be used as an alternative treatment to surgical pericardiotomy for posterior cardiac tamponade after open heart surgery.