[Skip to Content]
Sign In
Individual Sign In
Create an Account
Institutional Sign In
OpenAthens Shibboleth
[Skip to Content Landing]
December 1969

Latent Mediastinal Tamponade After Open-Heart Surgery

Author Affiliations

San Francisco
From the departments of cardiovascular surgery, Presbyterian Hospital, and the Heart Research Institute, Institute of Medical Sciences, Pacific Medical Center, San Francisco.

Arch Surg. 1969;99(6):808-814. doi:10.1001/archsurg.1969.01340180132025

Postoperative cardiac tamponade due to mediastinal blood clot or fluid under tension may remain latent for some days after open heart surgery. The initial clinical state frequently masquerades as a state of refractory congestive cardiac failure or a mild low cardiac output syndrome producing mental disorientation. When severe tamponade eventuates there is an extreme surgical emergency, but as one to two weeks may have elapsed since surgery the significance is often missed.

The classical picture of tamponade due to pericardial fluid as described by Stewart et al1 may occur, but usually there is mediastinal tamponade similar to the acute traumatic mediastinal hematomata described by Endress2 and Al-Naaman,3 or an encysted collection of clot about the heart producing local compression of one or more cardiac chambers.4

This paper describes seven cases of latent tamponade at Pacific Medical Center which have been instructive in avoiding errors in diagnosis

Stewart, H.J.; Crane, N.F.; and Dietrick, J.E.:  Studies of Circulation in Pericardial Effusion ,  Amer Heart J 16:189-197 ( (Aug) ) 1938.Crossref
Endress, Z.F.:  Traumatic Mediastinal Hematoma: Report of Two Cases ,  Amer J Roentgen 70:576-580 ( (Oct) ) 1953.
Al-Naaman, Y.D.:  Acute Compression of the Mediastinum by a Hematoma ,  Amer J Surg 98:735-738 ( (Nov) ) 1959.Crossref
Yacoub, M.H.; Cleland, W.P.; and Deal, C.W.:  Left Atrial Tamponade ,  Thorax 21:305-309 ( (July) ) 1966.Crossref
Wright, I.S.; Marple, CD.; and Beck, D.F.:  Myocardial Infarction: Its Clinical Manifestations and Treatment With Anticoagulants: A Study of 1,031 Cases , New York: Grune & Stratton, Inc., 1954, p 656.
Waldron, B.R., et al:  Myocardial Rupture and Hemopericardium Associated With Anticoagulant Therapy ,  New Eng J Med 251:892-894 ( (Nov) ) 1954.Crossref
Leedham, C.L., and Orbison, J.A.:  Cardiac Tamponade Associated With the Administration of Dicumarol ,  Circulation 1:1065-1072 ( (May) ) 1950.Crossref
Williams, C.L., Jr.; Beckwith, J.R.; and Wood, J.E., Jr.:  Hemorrhagic Pericardial Fluid in Acute Benign Nonspecific Pericarditis ,  Ann Intern Med 52:914-923 ( (April) ) 1960.
Fell, S.C., et al:  Anticoagulant Induced Hemopericardium With Tamponade ,  New Eng J Med 272:670-674 ( (April) ) 1965.Crossref
Nerlich, W.E.:  Determinants of Impairment of Cardiac Filling During Progressive Pericardial Effusion ,  Circulation 3:377-383 ( (March) ) 1951.Crossref
Warren, J.V., et al:  Pericardial Tamponade From Stab Wound of the Heart: A Study Using the Method of Right Heart Catheterization ,  Amer Heart J 31:418-425 ( (April) ) 1946.Crossref
Beck, C.S.:  Further Observations on Stab Wounds of the Heart ,  Ann Surg 115:698-702 ( (April) ) 1942.Crossref
Cooper, F.W., Jr.; Stead, E.A., Jr.; and Warren, J.V.:  The Beneficial Effect of Intravenous Infusions on Acute Pericardial Tamponade ,  Ann Surg 120:822 ( (Dec) ) 1944.Crossref
Cooley, D.A., et al:  Treatment of Penetrating Wounds of the Heart: Experimental and Clinical Observations ,  Surgery 37:882-889 ( (June) ) 1955.
Laszlo, M.H.:  Constrictive Pericarditis as a Sequel to Hemopericardium: Report of a Case Following Anticoagulant Therapy ,  Ann Intern Med 46:403-413 ( (Feb) ) 1957.Crossref
Smith, G.W., and Müller, W.H., Jr.:  Evolution and Current Concepts of Surgical Treatment of Constrictive Pericarditis ,  Progr Cardiovasc Dis 4:346-372 ( (Jan) ) 1962.Crossref
Littman, D., and Spodick, D.H.:  Total Electrical Alternation in Pericardial Disease ,  Circulation 17:912-917 ( (May) ) 1958.Crossref
Lawrence, L.T., and Cornin, J.F.:  Electrical Alternans and Pericardial Tamponade ,  Arch Intern Med 112:415-418 ( (Sept) ) 1963.Crossref