Circulation, Vol 90, 2375-2378, Copyright © 1994 by American Heart Association
EM Isselbacher, JE Cigarroa and KA Eagle
BACKGROUND--Cardiac tamponade frequently complicates acute proximal aortic
dissection and is one of the most common causes of death from aortic
dissection. Well-defined strategies for the management of acute aortic
dissection now exist; however, little is known about how best to manage the
hemopericardium that may complicate it. METHODS AND RESULTS-- Using a
computer-based review, we retrospectively identified 10 patients presenting
to our hospital over a 13-year period who were diagnosed with both aortic
dissection and cardiac tamponade. All 10 had proximal dissections. Three of
the 10 presented as the sudden onset of fatal electromechanical
dissociation, 6 presented with hypotension, and 1 was normotensive on
presentation. Of the 7 hypotensive or normotensive patients diagnosed with
cardiac tamponade, 4 underwent successful pericardiocentesis while awaiting
surgery. At time intervals of 5 to 40 minutes after their
pericardiocenteses, 3 of the 4 patients experienced sudden onset of
electromechanical dissociation and death; the fourth patient survived and
underwent surgical repair. Of the 3 hypotensive or normotensive patients
who had either no pericardiocentesis or an unsuccessful pericardiocentesis,
all 3 underwent successful surgical repair and survived. CONCLUSIONS--In
this study, patients with an aortic dissection complicated by cardiac
tamponade have an early mortality of 60%. While 3 of the 10 died from
electromechanical dissociation immediately upon presentation, the 3 other
deaths all occurred shortly after successful pericardiocentesis, a
procedure undertaken to stabilize them. While the number of patients in
this series is small, the observations do raise the possibility that in
patients with cardiac tamponade complicating aortic dissection
pericardiocentesis could be harmful rather than beneficial. Possible
mechanisms for why the performance of pericardiocentesis might destabilize
such patients are proposed.
ARTICLES
Cardiac tamponade complicating proximal aortic dissection. Is pericardiocentesis harmful?
Cardiac Unit, Massachusetts General Hospital, Boston 02114.
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