Resistant Pericardial Tamponade

An 87-year-old woman with critical aortic stenosis and preserved left ventricular (LV) systolic function (ejection fraction 50%) was admitted with pulmonary edema. She stabilized with medical therapy, and a decision was made to perform balloon aortic valvuloplasty as a bridge to potential transcatheter aortic valve implantation.Initially, a temporary pacemaker was inserted from the right femoral vein to the right ventricle to allow rapid pacing during aortic valvuloplasty. The heavily calcified aortic valve was crossed with an Amplatz left 1 6F catheter and a straight Amplatz 0.035-inch Super Stiff wire (Boston Scientific Corp, Natick, MA), but difficulties were experienced gaining a stable wire position at the LV apex. The patient complained of chest pain, with rapid hemodynamic deterioration, and a clinical diagnosis of pericardial tamponade was confirmed with transthoracic echocardiography (Figure 1A; online-only Data Supplement Movie I). On color Doppler imaging, a jet from the lateral wall of the LV into the pericardial space could be identified (Figure 1B; …