Chuttani K, Pandian N G, Mohanty P K, Rosenfield K, Schwartz S L, Udelson J E, Simonetti J, Kusay B S, Caldeira M E
Department of Medicine, Tufts University School of Medicine, Boston, MA.
Circulation. 1991 Jun;83(6):1999-2006. doi: 10.1161/01.cir.83.6.1999.
Cardiac tamponade after cardiac surgical procedures is often associated with hemodynamically significant localized pericardial effusions. The localized collection of pericardial effusion in the postoperative period and the atypical presentation of cardiac tamponade limit the use of conventional clinical and echocardiographic signs usually seen with a circumferential pericardial effusion. Observation of left ventricular diastolic collapse in the echocardiogram of a patient with postoperative regional cardiac tamponade prompted us to explore the frequency of this sign in regional cardiac tamponade.
We retrospectively analyzed the echocardiograms of 18 patients with postoperative cardiac tamponade for the following echocardiographic findings: right atrial collapse, right ventricular diastolic collapse, left atrial collapse, and left ventricular diastolic collapse. Three of the 18 patients had circumferential pericardial effusion, and 15 had loculated pericardial effusion; in 10, the effusion was predominantly posterior, and in the other five, it extended laterally or inferiorly. The conventional echocardiographic signs of cardiac tamponade such as right atrial collapse, right ventricular diastolic collapse, and left atrial collapse were present in only 3, 1, and 3 of these 15 patients, respectively, but all exhibited left ventricular diastolic collapse. Increasing pressure within the compartment of a loculated pericardial effusion reaching the limit of pericardial distensibility and consequent transient reversal of transmural left ventricular pressure during diastole are most likely the basis for diastolic collapse of the thick-walled ventricle in a setting of regional cardiac tamponade.
We conclude that left ventricular diastolic collapse is a frequent sign of regional cardiac tamponade and could be a useful marker of tamponade in postoperative patients.
心脏外科手术后的心包填塞常与具有血流动力学意义的局限性心包积液相关。术后心包积液的局部积聚以及心包填塞的非典型表现限制了通常在环形心包积液中所见的传统临床和超声心动图体征的应用。一名术后局部心脏压塞患者的超声心动图中观察到左心室舒张期塌陷，促使我们探究该体征在局部心脏压塞中的出现频率。
我们回顾性分析了18例术后心包填塞患者的超声心动图，以观察以下超声心动图表现：右心房塌陷、右心室舒张期塌陷、左心房塌陷和左心室舒张期塌陷。18例患者中3例有环形心包积液，15例有局限性心包积液；其中10例积液主要位于后方，另外5例积液向外侧或下方延伸。这15例患者中，传统的心包填塞超声心动图体征，如右心房塌陷、右心室舒张期塌陷和左心房塌陷，分别仅在3例、1例和3例中出现，但所有患者均表现出左心室舒张期塌陷。局限性心包积液腔内压力升高达到心包扩张极限，进而导致舒张期左心室跨壁压力短暂逆转，这很可能是局部心脏压塞情况下厚壁心室舒张期塌陷的基础。
我们得出结论，左心室舒张期塌陷是局部心脏压塞的常见体征，可能是术后患者心包填塞的有用标志物。
