Floerchinger Bernhard, Camboni Daniele, Schopka Simon, Kolat Philipp, Hilker Michael, Schmid Christof
Department Cardiothoracic Surgery, University Medical Center Regensburg 93053, Regensburg, Germany.
J Cardiothorac Surg. 2013 Jun 24;8:158. doi: 10.1186/1749-8090-8-158.
Cardiac tamponade is a severe complication after open heart surgery. Diagnostic imaging is challenging in postoperative patients, especially if tamponade develops with subacute symptoms. Hypothesizing that delayed tamponade after open heart surgery is not sufficiently detected by transthoracic echocardiography, in this study CT scans were used as standard reference and were compared with transthoracic echocardiography imaging in patients with suspected cardiac tamponade.
Twenty-five patients after open heart surgery were enrolled in this analysis. In case of suspected cardiac tamponade patients underwent both echocardiography and CT imaging. Using CT as standard of reference sensitivity, specificity, positive and negative predictive values of ultrasound imaging in detecting pericardial effusion/hematoma were analyzed. Clinical appearance of tamponade, need for re-intervention as well as patient outcome were monitored.
In 12 cases (44%) tamponade necessitated surgical re-intervention. Most common symptoms were deterioration of hemodynamic status and dyspnea. Sensitivity, specificity, positive and negative predictive values of echocardiography were 75%, 64%, 75%, and 64% for detecting pericardial effusion, and 33%, 83%, 50, and 71% for pericardial hematoma, respectively. In-hospital mortality of the re-intervention group was 50%.
Diagnostic accuracy of transthoracic echocardiography is limited in patients after open heart surgery. Suplemental CT imaging provides rapid diagnostic reliability in patients with delayed cardiac tamponade.
心脏压塞是心脏直视手术后的一种严重并发症。诊断成像对于术后患者具有挑战性，尤其是当压塞出现亚急性症状时。假设经胸超声心动图不能充分检测出心脏直视手术后的延迟性压塞，在本研究中，CT扫描被用作标准参考，并与疑似心脏压塞患者的经胸超声心动图成像进行比较。
25例心脏直视手术后的患者纳入本分析。在疑似心脏压塞的情况下，患者接受了超声心动图和CT成像检查。以CT作为参考标准，分析超声成像在检测心包积液/血肿方面的敏感性、特异性、阳性和阴性预测值。监测压塞的临床表现、再次干预的必要性以及患者的预后。
12例（44%）患者因压塞需要进行手术再次干预。最常见的症状是血流动力学状态恶化和呼吸困难。超声心动图检测心包积液的敏感性、特异性、阳性和阴性预测值分别为75%、64%、75%和64%，检测心包血肿的分别为33%、83%、50%和71%。再次干预组的院内死亡率为50%。
经胸超声心动图在心脏直视手术后患者中的诊断准确性有限。补充CT成像为延迟性心脏压塞患者提供了快速的诊断可靠性。
