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Eur Heart J Acute Cardiovasc Care. 2015 Apr;4(2):124-8. doi: 10.1177/2048872614549737. Epub 2014 Sep 2.

Controlled pericardiocentesis in patients with cardiac tamponade complicating aortic dissection: experience of a centre without cardiothoracic surgery.

Author information

1
Department of Cardiology, Hospital Garcia de Orta, Almada, Portugal inesmariarosariocruz@gmail.com.
2
Department of Cardiology, Hospital Garcia de Orta, Almada, Portugal.

Abstract

BACKGROUND:

Cardiac tamponade has been reported in 18.7% of patients with acute type A aortic dissection and its presence is associated with worse outcomes. Emergency aortic repair together with intra-operative pericardial drainage is the recommended treatment approach. However, controversy surrounds how to manage patients with haemopericardium and cardiac tamponade who cannot survive until surgery.

PURPOSE:

To describe a case series of patients with critical cardiac tamponade complicating aortic dissection admitted to a hospital without cardiothoracic surgery, and in whom preoperative controlled pericardial drainage was performed.

METHODS AND RESULTS:

Single centre retrospective study: during a nine-year period, 21 patients with Stanford type A aortic dissection were admitted at our centre; six of them (28.6%) presented clinical and echocardiographic signs of cardiac tamponade (four males; mean age 58±17 years). In this subgroup, controlled pericardiocentesis was safely performed with no major immediate complications and it was effective in five patients, improving haemodynamic instability and allowing transfer to the operating room.

CONCLUSIONS:

Preoperative controlled pericardiocentesis can be lifesaving when managing patients with critical cardiac tamponade (pulseless electrical activity or refractory hypotension) complicating acute type A aortic dissection, namely when cardiac surgery is not immediately available.

KEYWORDS:

Aortic dissection; cardiac tamponade; pericardiocentesis

PMID:
25182464
DOI:
10.1177/2048872614549737
[Indexed for MEDLINE]

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