Huang Henry D, Garcia Mariana, Alam Mahboob, Misra Arunima, Lakkis Nasser, Tabbaa Rashed
Baylor College of Medicine, Section of Cardiology, Houston, TX, USA.
Instituto Tecnologico de Estudios Superiores de Monterrey, Monterrey, Mexico.
J Cardiol Cases. 2013 Dec 16;9(2):48-49. doi: 10.1016/j.jccase.2013.09.008. eCollection 2014 Feb.
A 57-year-old male underwent mechanical mitral valve replacement for severe mitral regurgitation of a prolapsed myxomatous mitral valve. The patient's post-operative recovery period was uneventful until the eighth day when he decompensated into pulseless electrical activity arrest. A bedside transthoracic echocardiogram revealed a large, smooth-edged mass nearly obliterating the right atrial cavity. Color Doppler demonstrated flow within the right atrium around the mass. After computed tomography scan showed that an intrapericardial hematoma was extrinsically compressing the right atrium, the patient underwent emergent mediastinal exploration with evacuation of 700 ml of coagulated blood. The patient made a full recovery. <: Loculated intrapericardial hematoma is an infrequently encountered but serious complication of cardiac surgery that may lead to life-threatening cardiac tamponade. When clinically suspected, computed tomographic imaging or transesophageal echocardiography may be useful to confirm diagnosis. Hemodynamically significant intrapericardial hematoma should be treated by urgent surgical evacuation.>.
一名57岁男性因黏液瘤样二尖瓣脱垂导致严重二尖瓣反流而接受了二尖瓣机械瓣膜置换术。患者术后恢复期一直平稳，直到第八天出现失代偿，发展为无脉电活动骤停。床旁经胸超声心动图显示一个大的、边缘光滑的肿块，几乎完全占据了右心房腔。彩色多普勒显示肿块周围右心房内有血流。计算机断层扫描显示心包内血肿对右心房造成外部压迫后，患者接受了紧急纵隔探查，排出了700毫升凝血。患者完全康复。<：局限性心包内血肿是心脏手术中一种罕见但严重的并发症，可能导致危及生命的心脏压塞。临床怀疑时，计算机断层成像或经食管超声心动图可能有助于确诊。具有血流动力学意义的心包内血肿应通过紧急手术引流进行治疗。>
