Late cardiac tamponade after open heart surgery: incidence, role of anticoagulants in its pathogenesis and its relationship to the postpericardiotomy syndrome.

Cardiac tamponade that occurs late after cardiac surgery (7 days) is relatively uncommon but potentially fatal. We analyzed its incidence, clinical course and relationship to the postpericardiotomy syndrome in 1290 consecutive adult patients who survived surgery. Criteria for diagnosis of cardiac tamponade were (1) elevated jugular venous pressure, (2) hypotension or decreased cardiac index, (3) characteristic hemodynamics at cardiac catheterization, and (4) echocardiographic evidence of pericardial effusion.Ten of the 1290 patients (0.8%) developed cardiac tamponade. Surgery was for congenital heart disease in five patients, valvular heart disease in two patients, and coronary artery disease in three patients. The onset of hemodynamic compromise ranged from 15–180 days postoperatively (mean 49 days). All patients had echocardiographic evidence of pericardial fluid, eight had a pericardial friction rub at the time of cardiac tamponade, nine had pericardial pain, and all were considered to have a postpericardiotomy syndrome. One patient was receiving coumadin and two patients were receiving aspirin before the diagnosis of cardiac tamponade. Nine patients underwent pericardiocentesis (0.5–1 1 of fluid). There were no deaths in the group. The syndrome resolved in nine patients with conservative medical therapy and one patient required pericardial stripping for recurrent cardiac tamponade.In this study, cardiac tamponade occurred in 0.8% of patients who survived cardiac surgery; cardiac tamponade occurred in patients without prior anticoagulation, in marked contrast to previously reported cases; pericardiocentesis and conservative medical therapy were successful in treating the majority of patients; clear symptoms and signs of pericardial involvement were present before cardiac tamponade occurred.