Cardiac perforation and tamponade during transjugular intrahepatic portosystemic shunt placement

A patient developed acute severe hemodynamic compromise during a transjugul ar intrahepatic portosystemic shunt (TIPS) procedure For intractable ascite s. Rapid clinical and radiographic evaluation of the patient disclosed peri cardial blood and cardiac tamponade as the cause, probably due to right hea rt perforation from guidewire and catheter manipulation. The tamponade was successfully treated percutaneously, and the patient survived. Cardiac tamp onade should be considered in the differential diagnosis of patients who de velop hypotension during TIPS placement.