Delayed cardiac tamponade following open-heart surgery

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Two types of cardiac tamponade can occur following open-heart surgery. (1) The early type is seen during the first 48 hours after an open-heart procedure. (2) The delayed or latent type, which is the subject of this report, usually occurs after the 5th postoperative day and may occur as late as 30 days postoperatively.

In our experience, early cardiac tamponade has been less serious than the delayed type. Early tamponade is often promptly diagnosed for the simple reason that it occurs during the period in which the patient is closely monitored in the cardiac intensive care unit. Furthermore, we have considerably reduced the occurrence of early tamponade because mediastinal exploration is done as soon as there is any sign of excessive bleeding in the immediate postoperative period.

Delayed or latent cardiac tamponade may occur after the patient has been transferred to a regular nursing floor or after discharge from the hospital. Recognition of delayed cardiac tamponade is extremely difficult because the signs and symptoms are often confused with other causes of a “low output state.” We report our experience in the management of this challenging problem.

Clinical material

From January 1971 through December 1973, approximately 6,000 open-heart procedures were performed at the Cleveland Clinic Hospital. All operations were done through a median sternotomy incision. Routine cannulation included both cavae for venous drainage, aorta for arterial return, and the left atrium for decompression and left heart pressure measurement at the time of operation. Heparin was antagonized with protamine sulfate in a. . .


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