An Unusual Cause of Cardiac Tamponade during Cardiac Catheterization Study

Abstract

Introduction. Catheter-based diagnostic and therapeutic procedures are rapidly advancing. However, catheter related complications sometimes become life threatening. Cardiac tamponade is a rare but serious complication of this procedure. We have summarized one cardiac tamponade pejoration due to secondary coronary vessels laceration by the implanted pericardial drainage. Case report. A 4-year-old baby having Tetralogy of Fallot was posted for diagnostic catheterization study. Patient was induced with sevoflurane and spontaneous respiration was maintained. After catheter insertion to RV, dye was injected through the catheter which rapidly spread into the pericardial cavity indicating right ventricle perforation. Immediately, blood was aspirated under transthoracic echocardiographic guidance and hemodynamics started improving. For the provision of quick access to aspirate further collection, an intrapericardial sheath was inserted after multiple attempts. Patient's condition started deteriorating again. TTE revealed again some collection and it was increasing gradually. On exploration, it was found that there was continuous bleeding from a lacerated epicardial vessel which contributed to the pericardial collection leading to further tamponade effect. This second iatrogenic injury complicated the management of the first iatrogenic cardiac perforation and, thereby, created a life-threatening situation which needed immediate surgical exploration. Discussion. Usual cause of tamponade after right ventricular perforation is bleeding from the RV, but in our case the second tamponade was not due to bleeding from the RV, but was rather from new laceration injury of epicardial vessels which was remained undiagnosed till exploration.

Anesthesiologist in cardiac catheterization laboratories; the roles and goals!! a postgraduate educational review

“… Air embolism[ 19 ] Arrhythmias: various types of bradyarrhythmia and tachyarrhythmia are noted Thrombus formation on device or applicator and embolization Embolization of the device Stuck guide wire or devices (failure to deflate after inflation) Pericardial hemorrhage and tamponade: This is caused by wire damage to a cardiac structure[ 20 ] Hypotension, hypertension, bradycardia, and tachycardia: All should be treated accordingly. Sudden cardiac arrest[ 21 ] Tet spell or cyanotic spell[ 22 ] Anaphylactic reactions to contrast dye.…”

Cardiac tamponade with pneumothorax- An unusual life threatening complication following permanent pacemaker implantation.

“…Postcardiac injury syndrome and stroke following PPI is also known [2]. Pneumothorax as a complication of vascular access during cardiac interventions have been reported [3].The management of accidental and iatrogenic foreign body injuries to heart should be managed on priority as foreign bodies may manifest with infection, arrhythmia, or neurotic complications like cardiac tamponade [4].Life threatening complications of like cardiac tamponade is a surgical emergency and urgent surgery is the only mode of therapy in these individuals [5].In a largescale, real-world experience of PPI in developed countries, the results indicate an increase in the incidence of in-hospital tamponade [6].Cardiac tamponade can occur secondary to perforation of the right ventricle during pacemaker electrode insertion and manipulation [7].Cardiac perforation usually occur more common through right ventricular apex as it is relatively thinner than the other implantable sites like septum or right ventricular outflow tract [8]. Low body mass index, age more than eighty years and prolonged use of steroids are the risk factors of cardiac chamber perforation [8].…”