Localized tamponade of the right atrium and right ventricle: induction of intracardiac right-to-left shunting after the use of a Gott shunt.

After repair of a traumatic tear of the descending aorta, using a Gott shunt between the left ventricle and the distal descending aorta, a patient was readmitted with profound postural cyanosis and dyspnea. Catheterization showed right-to-left shunting at the atrial level caused by extrinsic deformation of the right atrium and right ventricle. Sternotomy showed selective pericardial tamponade on the right side of the heart caused by a localized collection of organizing thrombus and old blood. The previously unsuspected large patent foramen ovale was closed. This complication represents a form of iatrogenic cyanosis tardice and is thought to be attributable to the method of shunting used during the first operation. Moreover, this complication should be easily preventable if the pooled blood and clot in the most dependent portion of the pericardial cavity is adequately evacuated.