Near infrared spectroscopy changes with pericardial tamponade.
OBJECTIVE
Report on the use of near infrared spectroscopy (NIRS) for the recognition of pericardial tamponade after neonatal congenital heart surgery.


METHODS
Case report.


METHODS
Pediatric cardiac intensive care unit.


METHODS
Seven-day-old term infant with double inlet left ventricle, hypoplastic aortic arch, and ascending aorta, postoperative day (POD) 3 from the Norwood procedure.


METHODS
After an initial stable early postoperative course, the patient's cerebral saturation decreased from the 50s on POD 2, to the 40s in the early morning hours of POD 3. By 9 am on POD 3, the cerebral saturation decreased further to the mid 30s. No change in pulsoximetry, arterial blood gas acid base balance, or blood pressure occurred. An echocardiogram was performed due to the progressive decline in cerebral saturation values. A 10-mm circumferential pericardial effusion was diagnosed. The effusion was drained without incident. Cerebral saturation returned to the 50s, the patient had no further complications and was discharged to home on POD 15.


CONCLUSIONS
Pericardial tamponade is a well-known complication of open heart surgery in children, and early recognition of this can be difficult. This case report demonstrated cerebral saturation to be decreased as impending pericardial tamponade developed. Along with the commonly used markers of tamponade, near infrared spectroscopy measurement of cerebral saturation may also be of benefit in recognizing this life-threatening condition.
Maher
Kevin O
KO
Children's Healthcare of Atlanta, Emory University School of Medicine, Atlanta, GA, USA. maherk@kidsheart.com
Phelps
Heather M
HM
Kirshbom
Paul M
PM
D000015:Abnormalities, Multiple / Q000175:diagnosis / Q000601:surgery; D001784:Blood Gas Analysis; D006348:Cardiac Surgical Procedures / Q000009:adverse effects* / Q000379:methods; D002305:Cardiac Tamponade / Q000175:diagnosis* / Q000209:etiology / Q000628:therapy; D002560:Cerebrovascular Circulation / Q000502:physiology; D004322:Drainage; D005500:Follow-Up Studies; D006330:Heart Defects, Congenital / Q000175:diagnosis / Q000601:surgery*; D006801:Humans; D007231:Infant, Newborn; D008297:Male; D008991:Monitoring, Physiologic / Q000379:methods; D010092:Oximetry; D011182:Postoperative Care / Q000379:methods; D011183:Postoperative Complications / Q000175:diagnosis / Q000628:therapy; D018570:Risk Assessment; D019265:Spectroscopy, Near-Infrared / Q000379:methods*; D016896:Treatment Outcome