CARDIAC-TAMPONADE COMPLICATING PROXIMAL AORTIC DISSECTION - IS PERICARDIOCENTESIS HARMFUL

Background Cardiac tamponade frequently complicates acute proximal aor tic dissection and is one of the most common causes of death from aort ic dissection. Well-defined strategies for the management of acute aor tic dissection now exist; however, little is known about how best to m anage the hemopericardium that may complicate it. Methods and Results Using a computer-based review, we retrospectively identified 10 patien ts presenting to our hospital over a 13-year period who were diagnosed with both aortic dissection and cardiac tamponade. All 10 had proxima l dissections. Three of the 10 presented as the sudden onset of fatal electromechanical dissociation, 6 presented with hypotension, and 1 wa s normotensive on presentation. Of the 7 hypotensive or normotensive p atients diagnosed with cardiac tamponade, 4 underwent successful peric ardiocentesis while awaiting surgery. At time intervals of 5 to 40 min utes after their pericardiocenteses, 3 of the 4 patients experienced s udden onset of electromechanical dissociation and death; the fourth pa tient survived and underwent surgical repair. Of the 3 hypotensive or normotensive patients who had either no pericardiocentesis or an unsuc cessful pericardiocentesis, all 3 underwent successful surgical repair and survived. Conclusions In this study, patients with an aortic diss ection complicated by cardiac tamponade have an early mortality of 60% . While 3 of the 10 died from electromechanical dissociation immediate ly upon presentation, the 3 other deaths all occurred shortly after su ccessful pericardiocentesis, a procedure undertaken to stabilize them. While the number of patients in this series is small, the observation s do raise the possibility that in patients with cardiac tamponade com plicating aortic dissection pericardiocentesis could be harmful rather than beneficial. Possible mechanisms for why the performance of peric ardiocentesis might destabilize such patients are proposed.