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Dry tamponade is a rare complication of percutaneous coronary intervention. It encompasses a heterogenous pathophysiology and is used to describe hemodynamic compromise secondary to a coronary artery perforation, without free-flowing fluid in the pericardium. Tamponade physiology can result from compressive epicardial, intramyocardial, subepicardial hematomas, or dissecting intramyocardial hematomas. The diagnosis of dry tamponade requires hemodynamic derangement in the context of a compressive hematoma as demonstrated by imaging. Although echocardiography can often help identify dry tamponade, additional studies including right heart catheterization, computed tomography, or cardiac magnetic resonance imaging can inform the exact mechanism and help guide management. This article describes a case of dry tamponade, reviews the existing literature on the topic, and offers expert recommendations on diagnosis and management., (© 2024 Wiley Periodicals LLC.)

A 55-year-old male with acute pericarditis presented with low-pressure cardiac tamponade (LPCT) unresponsive to volume infusion. Subsequent pericardiocentesis resulted in hemodynamic improvement and unmasking of pericardial constriction. This case provides illustrative hemodynamic tracings of LPCT. Additionally, the presence of concurrent pericardial constriction that may indicate a plausible underlying mechanism for the blunted responsiveness to fluid expansion in LPCT. The underlying physiologic processes and the associated hemodynamic tracings are discussed., (© 2024 The Authors. Catheterization and Cardiovascular Interventions published by Wiley Periodicals LLC.)

Compressive pericardial physiology (i.e., cardiac tamponade) reduces ventricular chamber volume/filling and cardiac output, which exacerbates coexisting hemodynamic derangements. In this hemodynamic rounds, we demonstrate the interaction of two hemodynamic conditions in one patient with acute pericardial tamponade in the setting of aortic stenosis (AS). Simultaneous pressures across the aortic valve before and after relief of cardiac tamponade demonstrate an acute and uncommon improvement in the hemodynamics of AS., (© 2020 Wiley Periodicals, Inc.)

Objective: To investigate predictors, treatment, and long-term outcomes associated with coronary perforation (CP) in patients who underwent retrograde percutaneous coronary intervention (PCI) through epicardial collaterals for chronic total occlusion (CTO)., Background: Data regarding CP during retrograde PCI through epicardial collaterals for CTO are scarce., Methods: We included 155 patients who underwent retrograde CTO PCI through epicardial collaterals at Guangdong Cardiovascular Institute from August 2011 to December 2017. The median follow-up was 2.5 years. Major adverse cardiac events (MACEs) were analyzed using the Kaplan-Meier method, and independent predictors of long-term MACE were determined using a multivariable Cox model., Results: CP occurred in 24 (15.5%) patients, with the frequency of Ellis classes 1 or 2 and 3 being 41.7% and 58.3%, respectively. Seven (4.5%) patients had tamponade, which was effectively managed using coil embolization and pericardiocentesis. Renal dysfunction (odds ratio [OR]: 5.27; 95% confidence interval [CI]: 1.47-18.88; P = 0.011), right coronary artery (RCA) CTO (OR: 4.34; 95% CI: 1.29-14.63; P = 0.018), and Epi-CTO score ≥ 2 (OR: 3.27; 95% CI: 1.12-9.58; P = 0.030) were independent predictors of CP. At the 7-year follow-up, 17 patients had MACE. Multivariable analysis revealed that CP was not associated with worse long-term clinical outcomes (hazard ratio: 1.55; 95% CI: 0.45-5.32, P = 0.484)., Conclusions: Retrograde CTO PCI through epicardial collaterals is at increased risk of CP, which is associated with renal dysfunction, RCA CTO, and Epi-CTO score ≥ 2. Prompt and proper management of CP is important. CP is not significantly associated with adverse clinical outcomes., (© 2019 Wiley Periodicals, Inc.)

Objectives: In this study, we examined the predictive value of the left ventricular end-diastolic pressure (LVEDP) in patients undergoing balloon aortic valvuloplasty (BAV)., Background: The LVEDP is a useful indicator of hemodynamic status in patients with severe aortic stenosis. In BAV, decompensated heart failure is associated with worse outcomes., Methods: We identified all consecutive patients with severe symptomatic aortic stenosis who underwent retrograde BAV at the Massachusetts General Hospital from 2004 to 2008. Patients were stratified and compared according to their baseline LVEDP into ≤15 mm Hg, 16-20 mm Hg, 21-25 mm Hg, and ≥26 mm Hg. Procedural and in-hospital outcomes and adverse events were compared. Multivariate logistic regression was used for the adjusted analysis., Results: A total of 111 patients with a mean age of 83±11 years underwent BAV. Of these, the LVEDP was ≤15 mm Hg in 29 (26%), 16-20 mm Hg in 41 (37%), 21-25 mm Hg in 16 (14%), and ≥26 mm Hg in 25 (23%) patients. Baseline characteristics were similar among the four groups. Noticeably, patients with high LVEDP levels had significantly higher rates of the combined endpoint of in-hospital death, myocardial infarction (MI), cardiopulmonary arrest, and tamponade was P = 0.02. Periprocedural MI was more common among those with higher LVEDP (16% vs. 2.3%; P = 0.04). Multivariate analysis revealed LVEDP (OR 1.08, for each mm Hg increase in pressure, 95 % CI 1.02-1.14), small LV chamber size, and New York Heart Association class as independent predictors of adverse outcomes., Conclusions: The LVEDP is an important independent predictor of poor in-hospital outcome during BAV. In these patients, the immediate hemodynamic status may be more important than the baseline left ventricular systolic function. Hemodynamic optimization before or during BAV should be considered and may be beneficial., (Copyright © 2013 Wiley Periodicals, Inc., a Wiley company.)

Cardiac tamponade represents a medical emergency necessitating emergent pericardiocentesis. Use of two-dimensional echocardiography (ECHO) has improved the safety of pericardiocentesis, but procedural challenges may occur when performed in an emergent manner outside of the catheterization laboratory without availability of fluoroscopy and readily available pressure transducers. The most problematic situation is the initial finding of bloody fluid on aspiration where intrapericardial versus intravascular location of the needle must be determined. We report two cases of cardiac tamponade managed with the use of a novel, disposable lightweight digital pressure transducer to directly measure intrapericardial pressures during an ECHO guided pericardiocentesis. In both cases the fluid initially encountered was grossly bloody and rapid definition of whether this was pericardial fluid versus an inappropriately located needle in the vascular space was critical. This type of novel, disposable self contained manometer has the potential to further minimize complications associated with pericardiocentesis. It offers a cost effective alternative and answers questions about the shifting point of service for pericardiocentesis from the invasive cath lab to less costly locations (Drummond, et al., J Am Soc Echocardiogr 1998;11:433-435)., (Copyright © 2012 Wiley Periodicals, Inc.)

Cardiac tamponade can be a lethal complication in the cardiac catheterization laboratory. Patients with obstructive hypertrophic cardiomyopathy are particularly vulnerable to the hemodynamic effects of tamponade because of their heightened sensitivity to ventricular load in the generation of forward stroke volume. Cardiac tamponade should be distinguished from the normal effects of respiration on dynamic outflow tract obstruction in these patients. This recognition not only ensures an accurate hemodynamic diagnosis, but it also will expedite timely therapy for patients in need., (Copyright © 2010 Wiley-Liss, Inc.)

Cardiac tamponade is a common cardiac emergency requiring prompt diagnosis and intervention. A thorough understanding of the spectrum of clinical and hemodynamic changes in patients with pericardial effusion is vital for interventional cardiologists. This review discusses pathophysiology of cardiac tamponade with emphasis on hemodynamic aberrations. Specific clinical situations that lead to atypical hemodynamic presentations of cardiac tamponade are emphasized with a review of various diagnostic and therapeutic procedures., (2005 Wiley-Liss, Inc.)

Clinical examination and transthoracic echocardiography play a vital role in the management of patients with pericardial effusion and cardiac tamponade physiology. We report patients in advanced phase 3 cardiac tamponade with variant clinical and hemodynamic presentations. These atypical cardiac tamponade cases include: A patient with severe aortic valve regurgitation who lacked pulsus paradoxus; a patient with systemic sclerosis without hypotension; and a patient with pulmonary hypertension lacking right heart collapse on echocardiography. Recognition of these atypical clinical and hemodynamic manifestations of cardiac tamponade will avoid undue delay in the treatment.

Coronary perforation and resultant cardiac tamponade are well-known but rare complications of percutaneous coronary interventions. We present a case that demonstrates coronary sinus compression caused by increasing pericardial pressure as a new sign of impending cardiac tamponade. This previously unreported angiographic sign preceded hemodynamic, symptomatic, and echocardiographic evidence of tamponade.

Although cardiac involvement has been commonly described in HIV-infected patients, cardiac tamponade is an unusual feature of AIDS-related non-Hodgkin's lymphoma. We describe an AIDS patient with undiagnosed non-Hodgkin's lymphoma presenting with hemodynamics of pericardial tamponade.

A so-far undescribed complication of Wallstent deployment occurred in a 68-yr-old patient with symptomatic coronary artery disease. The patient had coronary angioplasty to the right coronary artery, complicated by a dissection which necessitated stent implantation. After insertion of one Wallstent, further significant distal disease was observed. An attempt to insert a second Wallstent failed due to inability to retract the constraining membrane and deploy the stent. The stent was withdrawn and another Wallstent was inserted through and distally to the first deployed stent. This time it was not only impossible to retract the membrane but also to withdraw the unimplanted stent. Further attempts to withdraw the stent ended in breakage of the stent delivery system, coronary artery rupture, and cardiac tamponade. The patient was successfully resuscitated and an emergency bypass operation was performed. The mechanism of failure of the Wallstent delivery system is discussed, and recommendations for operators are made.

Failure of right atrial pressure to normalize after pericardial pressure is relieved suggests persistent effusive-constrictive physiology, myocardial failure, or cardiomyopathy which may have indistinguishable hemodynamic pressure waveforms. Clinical characteristics, ancillary testing, and endomyocardial biopsy may be required to obtain a definite diagnosis in such cases. The hemodynamic waveforms obtained during pericardiocentesis provide insight into the pathophysiologic processes, producing symptoms of dyspnea in this interesting patient group.

Constrictive physiology characteristically alters atrial and ventricular waveforms. Normal pressure and flow responses to inspiration are blocked or reversed. The impairment of early diastolic filling is the common feature of restrictive myocardial, as well as diseased pericardial, processes. Low pressure tamponade can limit cardiac output, but may be difficult to detect by clinical signs alone. Examination of the pressure waveforms may provide clues to the diagnosis of constrictive physiology in these patients.

A patient developed oliguria, peripheral edema, and dyspnea 5 days after mitral valve replacement. Chest roentgenogram and echocardiogram suggested pericardial effusion. Although pulsus paradoxus was absent, cardiac tamponade was suspected and subsequently confirmed during pericardiocentesis. Before pericardiocentesis right and left ventricular diastolic pressures were equal, as well as intrapericardial and right atrial pressures. The left ventricular cavity was reduced in size on the echocardiogram. Interventricular septal motion was normal. Pericardiocentesis normalized the hemodynamics and allowed the left ventricle to reexpand. Certain atypical features are tentatively explained as the combined effect of constrictive and effusive components caused by intrapericardial hemorrhage.

Cardiac tamponade was induced in dogs by the infusion of saline into the pericardial cavity. The mean arterial pressure dropped to approximately one-third and the cardiac output to one-fourth of the control level. This was accompanied by the release of vasoactive humoral mediators. Among the vasoconstrictor mediators measured in the plasma, the greatest rise during early tamponade occurred in vasopressin concentrations. Considerable elevations of epinephrine and nonrepinephrine concentrations and plasma renin activity were also demonstrated, these mediators reaching their maximum levels in late tamponade. This study for the first time demonstrates significant rises in plasma thromboxane B2 and histamine levels in cardiac tamponade. The histamine level elevation was greater in the portal venous blood than in the arterial blood. It is suggested that histamine may play a counterregulatory role in cardiac tamponade by attenuating excessive vasoconstriction caused by the activation of various vasoconstrictor systems.

Acute cardiac tamponade was created in a large animal model in an effort to investigate the hemodynamic and oxygen transport variables during the inflation of the pneumatic antishock garment (PASG) to two different pressures (60 and 80 mm Hg). Inflation of PASG to either pressure under these conditions had no significant effects on filing pressures to the right or left heart, cardiac index, arterial blood gases, oxygen delivery, indexed pulmonary, and systemic vascular resistances. We conclude in this animal model of acute cardiac tamponade that no beneficial or harmful effects were demonstrated during the application and inflation of the pneumatic antishock garment to 60 or 80 mm Hg.