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Chirurgia 2008 October;21(5):263-6

language: English

Delayed refractory cardiac tamponade complicating postpericardiotomy syndrome

Maeda R. 1, Isowa N. 1, Setozaki S. 2, Saito Y. 2, Soeda T. 2

1 Divisions of Thoracic Surgery Matsue Red Cross Hospital Shimane, Japan
2 Department of Cardiovascular Surgery Matsue Red Cross Hospital Shimane, Japan


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We report a case of delayed refractory cardiac tamponade complicating postpericardiotomy syndrome (PPS) in a 60-year-old man that was successfully treated by video-assisted thoracoscopic pericardial fenestration. The patient underwent aortic valve replacement (AVR) for aortic stenosis (AS). Postoperatively, the patient was found to have a moderate pericardial effusion diagnosed as PPS and was treated with nonsteroidal anti-inflammatory drugs. Four months after the operation, he presented to the emergency room complaining of shortness of breath. Cardiac tamponade was diagnosed, emergent pericardiocentesis was performed, and his shortness of breath quickly resolved. Although a nonsteroidal anti-inflammatory drug and steroid were administered, cardiac tamponade soon recurred. Therefore, video-assisted thoracoscopic pericardial fenestration was performed to establish a definitive diagnosis and for treatment. Histology of the pericardial tissue revealed chronic non-specific pericarditis. The patient was uneventfully discharged on the IV day after surgery and there were no signs of recurrence 7 months later.

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