Successful Treatment of Cardiac Tamponade due to Rupture of the Heart Performing an Open-chest Pericardiotomy

Abstract

A 78-year-old woman with mild dementia was found unconscious by her family. She was transported by an ambulance to our emergency room (ER). Initially, she was comatose and in a state of shock. The echocardiographic findings suggested cardiac tamponade by hematoma. Computed tomography also showed tamponade without aortic dissection. After imaging, she went into cardiac arrest, was returned to the ER, and tracheal intubation and left thoracotomy for pericardiotomy were performed. A return of spontaneous circulation was obtained by following this procedure. Bleeding from a rupture of the left cardiac free wall was confirmed, and the rupture was closed with TachoSil®. After closing the thoracotomy, electrocardiography revealed ST elevation in the precordial leads. Subsequently, placement of an indwelling intraaortic balloon pump and coronary angiography (CAG) were performed. CAG showed an occlusion of the anterior interventricular branch and circumflex branch of the left coronary artery. She underwent conservative therapy in a coronary care unit. Finally, after obtaining hemodynamic stability and baseline mental status, she was transferred to another medical facility. We herein report a rare case involving the successful treatment of cardiac tamponade due to rupture of the heart performing an open-chest pericardiotomy and additionally discuss the key points for obtaining a favorable outcome.

Effect of the Presence of Cardiac Tamponade on Jugular Vein Diameter in Cases of Cardiac Arrest Due to Thoracic Aortic Disease

“…This was necessary as ultrasound frequently proved ineffective in detecting tamponade caused by coagulation, if there is a lack of careful observation or if physicians are inexperienced [ 1 , 3 ]. If the presence of cardiac tamponade can be clarified, even in cases of cardiac arrest, decompression can be performed in expectation of ROSC, and the number of patients able to return to society can be improved [ 2 ]. Therefore, resuscitation methods including relief of cardiac tamponade may be required if physicians detect dilation of the internal or external jugular vein in patients with endogenous cardiac arrest.…”

“…In cases of cardiac arrest, we routinely investigate the cause by ultrasonography, and unless the patient is known to have terminal cancer or the family does not wish for it, blood tests and computed tomography (CT) are performed [1][2][3][4][5]. The causes of cardiac arrest include thoracic aortic diseases, some of which can lead to cardiac arrest via cardiac tamponade.…”

A High-Echoic Layer Surrounding the Heart Suggesting Cardiac Tamponade by Clotting

“…Unfortunately, the present patient failed to obtain a favorable outcome; however, the urgent resolution of cardiac tamponade by clotting and subsequent treatments might result in a favorable outcome in other patients. 2,3 Fig. 3 Urgent thoracotomy with pericardiotomy revealed a clot weighing approximately 1 kg.…”