title: Catheter pericardiocentesis for delayed tamponade after cardiac valve operation.
abstract: BACKGROUND
  Late tamponade is a rare cause of morbidity and mortality after cardiac valve operation. We describe our recent experience with this entity.
  
  
  METHODS
  This is a single institution, procedure-matched, retrospective review of patients undergoing pericardiocentesis more than 7 days after cardiac operation, during a 7-year period.
  
  
  RESULTS
  Pericardiocentesis for delayed tamponade was performed in 43 of 9,612 patients. Although isolated valve operation accounted for 17% of all patients overall, 76% of patients undergoing pericardiocentesis (33 of 43) had undergone isolated valve operation. The average age in this group was 58 years, compared to an average of 68 years in all patients. Patients presented with tamponade an average of 18 days after operation. Positive predictors included elevated prothrombin time on presentation. Of the patient cohort 75% presented with dyspnea, 61% with inability to diurese, and 61% with hypotension. Echocardiography detected effusions in all patients, but specific echocardiographic signs of tamponade were present in only 30%. Of the patients, 97% were successfully treated by pericardiocentesis. All were safely restarted on warfarin. One patient required pericardial window.
  
  
  CONCLUSIONS
  Delayed cardiac tamponade is more common after isolated valve operation, as opposed to coronary artery bypass grafting and valve/coronary artery bypass grafting. It tends to occur in the third postoperative week in younger patients who are aggressively anticoagulated. Pericardiocentesis with catheter placement is highly effective, and patients can be reanticoagulated safely. This series underestimates the incidence of late tamponade, as some patients may present to outside facilities. The diagnosis is aided by a high degree of suspicion.
authors.affiliation: Division of Cardiac Surgery, Massachusetts General Hospital, Harvard Medical School, Boston 02114, USA.
authors.forename: Abeel A
authors.initials: AA
authors.lastname: Mangi
authors.forename: Igor F
authors.initials: IF
authors.lastname: Palacios
authors.forename: David F
authors.initials: DF
authors.lastname: Torchiana
mesh_terms: D000328:Adult; D000368:Aged; D001780:Blood Coagulation Tests; D002305:Cardiac Tamponade / Q000175:diagnosis / Q000601:surgery*; D002315:Cardiopulmonary Bypass; D003131:Combined Modality Therapy; D004452:Echocardiography; D005260:Female; D019918:Heart Valve Prosthesis Implantation; D006801:Humans; D008297:Male; D008875:Middle Aged; D010491:Pericardial Window Techniques; D020519:Pericardiocentesis; D011183:Postoperative Complications / Q000175:diagnosis / Q000601:surgery*; D012189:Retrospective Studies; D012307:Risk Factors; D014859:Warfarin / Q000009:adverse effects
chemical_list: D014859:Warfarin