Late pericardial tamponade after aortic and mitral valve replacement.

A report is presented on a patient who developed a pericardial tamponade on the 11th postoperative day after double valve replacement. Instead of classical signs of tamponade, however, the signs of posterior wall infarction were most prominent. The administration of nitrate resulted in deterioration of the circulatory situation, but the ST elevation in supraventricular tachycardia occurring from time to time regressed. As before the operation, coronary angiography showed normal conditions, and valve function was normal. The contrast-medium imaging of the right ventricle suggested a compression from ventral, and the right ventricular and right atrial pressures corresponded to a tamponade situation: in rethoracotomy, a blood coagulum roughly the size of a fist was found ventral to the right ventricle. After clearing the hematoma, there was an immediate improvement of the circulatory situation, and the ECG alterations regressed. Enzyme alterations in terms of myocardial infarction did not occur. We explained the symptoms as follows: The coagulum compressed the outflow tract of the right ventricle and thus caused on the one hand the hemodynamic situation of tamponade and on the other hand an extreme vagotonia with consecutive bradycardia and ST elevation.