Regional cardiac tamponade.

A 39 yr old hypertensive man† presented to the Cardiology Emergency, Sree Chitra Tirunal Institute for Medical Sciences and Technology, Thiruvananthapuram, India, in September 2017 with extensive Stanford type A aortic dissection extending beyond the renal arteries and severe aortic regurgitation. He underwent emergent supracoronary ascending aortic replacement with 28 mm albograft with arch debranching (ascending bicarotid bypass). On the 9th postoperative day, he presented with breathlessness. All peripheral pulses were palpable and the aortic click was normal. Transthoracic echocardiography showed moderate localized pericardial effusion anterior to the right ventricle with diastolic free wall collapse (Figure & Video A). The left ventricle was normal. Urgent pericardiocentesis yielded 700 ml of serous fluid and normalized the wall motion abnormalities (Video B). There was mild AR and the neo-aortic root was normal. Subsequently, he underwent thoracic endovascular aortic repair for descending thoracic aortic aneurysm with residual dissection. The patient remained well at four-month follow up.

Figure

Two-dimensional transthoracic echocardiographic stills from the parasternal short-axis projection in end diastole. (A) The localized pericardial effusion and diastolic right ventricular free wall collapse (white arrow). (B) Minimal effusion after drainage of pericardial fluid normalization of the right ventricular free wall motion (white arrow). LV, left ventricle; PE, pericardial effusion; RV, right ventricle.