Cardiology Division, Saint Esprit Kaslik University USEK, Hospital Notre Dame des Secours, PO Box # 3, Saint Charbel Street, 12345, Byblos, Lebanon.
J Med Case Rep. 2023 Jun 25;17(1):264. doi: 10.1186/s13256-023-03988-w.
Bleeding in the postoperative period after cardiac surgery is relatively frequent, especially in patients with early anticoagulant therapy, as in the case of mechanical valve replacement. Diffuse hemopericardium is relatively easy to diagnose; however, loculated pericardial hematomas leading to hemodynamic collapse are relatively rare and their diagnosis is more challenging.
This report is of a 75-year-old Asian woman who presented dyspnea, confusion and hemodynamic collapse related to loculated pericardial hematoma compressing the right atrium 3 days after mechanical aortic valve replacement. Urgent transthoracic echocardiogram performed as point-of-care approach showed right atrial compression, the aortic valve prosthesis had normal function. Surgical removal of the hematoma resulted in complete recovery.
Loculated pericardial hematoma might lead to hemodynamic collapse. Close monitoring of hemodynamic parameters is essential, also point-of-care echocardiography is essential for early recognition and prompt management in patients with critical hemodynamic condition.
心脏手术后的术后出血较为常见，尤其是在早期接受抗凝治疗的患者中，如机械瓣置换术后。弥漫性血心包相对容易诊断；然而，导致血流动力学崩溃的局限性心包积血则较为少见，其诊断也更具挑战性。
本报告介绍了一位 75 岁亚洲女性，在机械主动脉瓣置换术后 3 天出现呼吸困难、意识模糊和与局限性心包积血压迫右心房相关的血流动力学崩溃。即时床旁经胸超声心动图显示右心房受压，主动脉瓣假体功能正常。手术清除血肿后完全恢复。
局限性心包积血可能导致血流动力学崩溃。密切监测血流动力学参数至关重要，在血流动力学不稳定的患者中，即时床旁超声心动图对于早期识别和及时处理也至关重要。
