Detection of iatrogenic cardiac tamponade by transesophageal echocardiography during vena cava filter procedure

Purpose: To present a patient who developed cardiac tamponade during insert ion of an inferior vena cava (NC) filter. Intraoperative transesophageal ec hocardiography (TEE) was used as a means to diagnose the cardiac tamponade and to facilitate guiding of pericardiocentesis. Clinical features: A 45-yr-old man with protein S deficiency complicated by repeated attacks of deep vein thrombosis and pulmonary thromboembolism was scheduled for insertion of an IVC filter. He had history of chronic renal insufficiency, heart failure, and cerebral infarction with mild left hemipa resis. Current medication included diltiazem (30 mg, 1 tab tid), prednisolo ne (5 mg, 2 tabs qd), and warfarin (2.5 mg daily). Preoperative transthoracic echocardiography demonstrated bilateral pleural effusions, moderate mitral regurgitation and tricuspid regurgitation, left atrial appendage thrombus and severe generalized hypokinesia of left ventri cle. Nuclear medicine examination by Tc-99 showed election fractions of lef t ventricle and right ventricle as 20% and 22%, respectively. Under the imp ression of protein S deficiency with multiple attacks of thromboembolism an d failure of anticoagulant therapy he was arranged for the procedure of ven a caval filter insertion. Unfortunately, iatrogenic cardiac tamponade occur red during the course of the procedure with rapid hemodynamic deterioration . Because of the expedient of routine monitoring of cardiac condition with TEE, a prompt diagnosis was made. We successfully improved the patient's he modynamic status after transthoracic echo-guided pericardiocentesis. Conclusion: Intraoperative TEE is recommended to be used routinely in patie nts undergoing vena cava filter procedures. The availability of echocardiog raphic monitoring in the operation room allows the confirmation of the diag nosis and facilitation pericardiocentesis.