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Ann Thorac Surg 1978;26:155-164
© 1978 The Society of Thoracic Surgeons

Articles

Delayed Postoperative Cardiac Tamponade: Diagnosis and Management

Robert L. Hardesty, M.D.*, Mark Thompson, M.D., David B. Lerberg, M.D., Ralph D. Siewers, M.D., James D. O'Toole, M.D., Rosemarie Salerni, M.D., Henry T. Bahnson, M.D.

Departments of Surgery and Cardiology, University of Pittsburgh School of Medicine, Pittsburgh, PA

Accepted for publication November 22, 1977.

* Address reprint requests to Dr. Hardesty, Department of Surgery, University of Pittsburgh School of Medicine, Pittsburgh, PA 15261

Symptoms and signs of decreased cardiac output associated with an elevated venous pressure should alert one to the possibility of delayed cardiac tamponade. Enlargement of the cardiothoracic ratio shown by serial roentgenograms and demonstration of significant pericardial effusion by echocardiogram or radionuclide angiocardiography support the diagnosis. Erratic response of the prothrombin time to administration of warfarin and abnormal results of liver function test are additional clues to its diagnosis. Right heart catheterization documents the presence of tamponade and excludes other diagnostic considerations. Operative decompression of the pericardial space can be accomplished by pericardicentesis, subxiphoid pericardiotomy, median sternotomy, or thoracotomy. Hemodynamic observations following the relief of tamponade assure that an adequate therapeutic procedure has been performed.




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