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European Journal of Cardio-Thoracic Surgery, Vol 10, 1136-1138, Copyright © 1996 by European Association for Cardio-thoracic Surgery

ARTICLES

Localized intraoperative cardiac tamponade

EH Asham and J Pepper
Academic Unit of Cardiothoracic Surgery, The Royal Brompton National Heart and Lung Institute, London, England.

A 65-year-old lady had undergone mitral and aortic valve replacement following an open mitral valvotomy and aortic valve exploration 5 years earlier. At reoperation, following sternotomy, extensive adhesions were encountered and it was decided to perform minimal dissection of the heart. Both the aortic and mitral valves were replaced using 23 mm and 29 mm St. Jude bileaflet valves, respectively. At the end of the procedure it was difficult to wean the patient off bypass as her mean arterial pressure dropped and the heart became dilated. It was found that a tamponade had developed, as a result of bleeding from the vent site in the pulmonary artery, and dissected a plane between the heart and the adherent pericardium. Her condition improved dramatically as the tamponade was released and she came off cardiopulmonary bypass with no inotropic support.