Undrained bloody pericardial effusion in the early postoperative period after coronary bypass surgery: a prospective blood pool study.
To assess the clinical importance of hemopericardium after cardiac surgery, serial blood pool scintigrams were performed in 13 random patients throughout the initial hours after coronary artery bypass graft surgery. Scintigraphic measurements of pericardial fluid accumulation and left ventricular ejection fraction were made. Hemodynamics, cardiac, output, and chest tube drainage were monitored; and symptoms of postpericardiotomy syndrome were recorded for a mean of 7.4 months after surgery. Seven of the 13 patients had no scintigraphic evidence of bloody pericardial effusion. Six patients had scintigraphic evidence of bloody pericardial effusion; three of these effusions were small, localized posteriorly, and evident throughout the study. In two other patients large collections of fluid (over 100 ml) developed. In one of these patients increased mediastinal drainage required reoperation. The other patient remained stable although mediastinal drainage decreased. The sixth patient showed a moderate effusion (95 ml) that decreased without evident effusion or drainage when the last image was taken. Two patients (one with evidence of a postoperative bloody effusion), had symptoms of postpericardiotomy syndrome in the follow-up period. This study reports the generally benign occurrence of bloody postoperative mediastinal effusions, the frequent accumulation of substantial amounts of undrained sanguineous fluid, and the lack of connection between the presence and or amount of pericardial blood and the postpericardiotomy syndrome. The importance of these scintigraphic findings can be interpreted only with knowledge of associated mediastinal drainage.
D000368:Aged; D001026:Coronary Artery Bypass / Q000009:adverse effects*; D004322:Drainage; D005260:Female; D006439:Hemodynamics; D006801:Humans; D008297:Male; D008875:Middle Aged; D010490:Pericardial Effusion / Q000000981:diagnostic imaging / Q000209:etiology* / Q000503:physiopathology; D011446:Prospective Studies; D011877:Radionuclide Imaging