Jonathan Vincent Lee, Mirela Emmanuela, Jonathan Bryan Lee, Vito Anggarino Damay

Cardiac Tamponade in Post-CABG Surgery Patient: A Case Report of Post-Pericardiotomy Syndrome

Introduction

Cardiac tamponade in post-cabg surgery patient: a case report of post-pericardiotomy syndrome. Case report: Cardiac tamponade in a post-CABG patient due to Post-Pericardiotomy Syndrome. Learn about early recognition and vigilance for late-onset cardiac surgery complications.

Abstract

Background: Cardiac tamponade is the situation where fluid accumulates in the pericardial cavity and compresses the heart, which leads to reduced cardiac output and shock. Their prevalence in post-open heart surgery, especially Coronary Artery Bypass Graft (CABG) surgery is 24% and commonly related to Post-Pericardiotomy Syndrome (PPS). Case Summary: A 57-year-old female with a history of CABG surgery presented to emergency with chief complaints of shortness of breath in the last 3 days, especially when lying down. The patient underwent CABG surgery from CAD2VD + LM in the last month. Physical examination found a muffled first & second heart sound and distended jugular vein. The electrocardiograph of the patient showed sinus rhythm with low voltage. Echocardiography was done on the patient, and the result showed severe pericardial effusion with a D shape and collapse of the right ventricle. We performed a pericardiocentesis with an initial drainage of 737 cc of serosanguineous fluid. Post-procedural echocardiography showed reduced pericardial effusion, good LV contractility, and RV not collapsed. Pericardial fluid analysis concluded it was a transudative type. Patient were stable on admission and discharged uncomplicated. This patient developed cardiac tamponade with a history of CABG surgery. Conclusion: Cardiac tamponade occurs frequently in post-CABG surgery patients, both in early and late onset. It is important to recognize the early signs of cardiac tamponade, as the condition does not always present during the early phase. This case also highlighted the importance of recognizing and preventing PPS as a delayed cause of tamponade, even when there is no apparent sign of systemic inflammation. -- Highlight: 1. A 57-year-old post-CABG patient presented with cardiac tamponade one month after surgery, ultimately diagnosed as post-pericardiotomy syndrome (PPS) based on clinical and imaging findings. 2. Prompt echocardiography-guided pericardiocentesis and recognition of PPS as a delayed inflammatory cause of tamponade highlight the importance of vigilance for late-onset complications after cardiac surgery.

Review

This case report effectively highlights the crucial issue of cardiac tamponade occurring in a post-Coronary Artery Bypass Graft (CABG) surgery patient, specifically attributing its development to Post-Pericardiotomy Syndrome (PPS). The paper presents the case of a 57-year-old female who developed classic signs of cardiac tamponade one month post-CABG, necessitating urgent diagnostic evaluation and intervention. The patient's presentation with shortness of breath, muffled heart sounds, jugular venous distension, and subsequent echocardiographic findings of severe pericardial effusion with right ventricular collapse, underscores the importance of a high index of suspicion in this patient population. Successful pericardiocentesis led to rapid resolution of symptoms, providing a clear demonstration of effective management. A significant strength of this report lies in its emphasis on the delayed presentation of cardiac tamponade and its association with PPS, even in the absence of overt systemic inflammatory signs. While PPS is a recognized complication, its manifestation as late-onset tamponade, without a clear inflammatory trigger, serves as an important clinical reminder. The report reinforces the indispensable role of prompt echocardiography for diagnosis and guides practitioners toward timely, life-saving pericardiocentesis. The detailed clinical course, from presentation to discharge, offers a valuable educational snapshot for clinicians managing post-cardiac surgery patients, underscoring the need for vigilance beyond the immediate postoperative period. The finding of transudative pericardial fluid, despite the diagnosis of PPS, presents an interesting facet for discussion in the broader context of PPS pathophysiology in the full manuscript. In conclusion, this case report serves as a pertinent reminder for cardiac surgeons, cardiologists, and emergency physicians regarding the potential for late-onset cardiac tamponade following CABG, particularly due to PPS. It underscores that this life-threatening condition may not always present early and can manifest insidiously, necessitating ongoing patient education regarding symptoms and persistent clinical suspicion. The report powerfully advocates for early recognition through clinical assessment and diagnostic imaging, followed by swift intervention, to ensure optimal patient outcomes. This publication contributes meaningfully to the existing literature by reinforcing critical aspects of post-cardiac surgery care and complications.

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