Cardiac Tamponade From Compression of the Pulmonary Arterial Outflow Graft of a Biventricular Assist Device

A 19-year-old patient with a Thoratec Paracorporeal Biventricular Assist Device implanted 15 weeks previously complained of discomfort in his back and chest area, lightheadedness, and diaphoresis, and was noted to have a blood pressure of 62/26 mm Hg. Device alarms sounded for both the left and right ventricular assist devices indicating that the paracorporeal pumps were not filling normally.An ECG showed sinus tachycardia with low voltage (Figure 1). A portable chest radiograph showed enlargement of the cardiac silhouette, loss of the left hemidiaphragmatic contour, and mild left midlung atelectasis (Figure 2). Transthoracic and transesophageal echocardiography showed a large pericardial hematoma with compression of the right ventricle and diastolic compression of the pulmonary arterial outflow graft (Figure 3 and Movies I and II in the online-only Data Supplement). The aortic outflow graft and the right atrium did not appear to be compressed. Computed tomographic scanning confirmed the extent of the pericardial hematoma and demonstrated a mass effect on the right ventricle (Figure 4).Figure 1. ECG showing sinus tachycardia with low …