Cardiac tamponade

Introduction: Cardiac tamponade is the accumulati-on of large amounts of fluid in the pericardial cavity, resulting in an increase in intrapericardial pressure, which leads to a decrease in venous return as well as the gradual decrease of ventricular diastolic filling with reduction of cardiac output. The prevalence of cardiac tamponade is 25-30% of the total amount of pericardial effusions. One of the serious ethiologies is perforation rupture of the coronary artery during coronary an-gioplasty. Cardiac tamponade is a major medical emer-gency, with a high risk of death being. We present a case of a perforation with the angioplasty guide wire of a coronary artery (Ellis type II perforation).
Case presentation: A 59-year-old hypertensive and diabetic patient is presented to the emergency depart-ment with anginal chest pain. Paraclinic shows electrical changes (where T wave negative in the anterior terri-tory) and the increase of myocardial necrosis enzymes, diagnoses for myocardial infarction. It is immediately transferred to the coronary intensive care unit, then the cardiac catheterization laboratory. Coronography presents a critical lesion in the left anterior descending artery (LAD) at the origin of the first diagonal branch (Medina 1.1.1 lesion). The other two coronary arteries are free. We perform coronary angioplasty with a phar-macologically active stent 3.0×18 mm, with LAD flow, but closes the diagonal branch (D1) and severe angina. Difficultly cross an angioplasty guide wire in D1 and dilatation with semicomponent balloon the 1.5×10 mm with a good end result. He is transferred to the coro-nary intensive care unit, stable hemodynamic and wi-thout anginal pain. At two hours, the patient accuses severe retrosternal pain with clinical signs of low car-diac output. Emergency echocardiography shows accu-mulation of a large amount of pericardial fluid with a haemorrhagic appearance.
The patient is readmitted to the cardiac catheteriza-tion laboratory for pericardiocentesis with extracting 300ml of hemorrhagic fluid. On this occasion repeat the angiography showing an Ellis type II coronary per-foration in the distal segment of D1 probably caused by the tip of the angioplasty guide wire. Due to active blee-ding it is decided to implant a graft stent over the origin of the diagonal ram, with the closure of the bleeding so-urce. He is re-transferred to UTIC, asymptomatic, and without further accumulation of pericardial fluid. The patient was discharged 10 days later.
Discussion: Because, the literature describes the pre-dominantly Ellis type III Coronary Perforations as a tamponade ethiology, we have presented the case, of a patient with a minor initial coronary perforation, type Ellis I-II, (not seen at the end of the first procedure) evolved in two strokes, complicating with cardiac tam-ponade. Therefore, patients after coronary angioplasty should be followed for several hours in the coronary in-tensive care unit and the complete cardiac catheteriza-tion laboratory for emergency situations is mandatory Conclusion: Coronary artery perforation is a compli-cation which possibly fatal, which should be preven-ted by correct and careful manipulation of angioplasty materials. Knowing the possible complications of co-ronary procedures is mandatory and their resolution must be prompt

ISSN – online: 2734 – 6382
ISSN-L 1220-658X
ISSN – print: 1220-658X
The Romanian Journal of Cardiology is indexed by:
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CODE: 379
CME Credits: 10 (Romanian College of Physicians)