A case of cardiac tamponade complicating acute type A aortic dissection for which a small amount of pericardial drainage was effective

• Published in: Nihon Kyukyu Igakukai Zasshi 2014/10/15, Vol.25(10), pp.792-796
• Main Authors: Fujii, Kouich, Miyatake, Satoru, Ishiyama, Masaya, Ooki, Motomichi, Tomioka, Hideto, Kase, Kenichi, Kobayashi, Kenji
• Format: Article
• Language: eng ; jpn
• Subjects: false lumen; pericardial space; pericardiocentesis; pressure gradient; resuscitation
• ISSN: 0915-924X; 1883-3772
• DOI: 10.3893/jjaam.25.792

A 70-year-old man was transported to our emergency department by ambulance after complaining of sudden chest and back pain. On arrival, his level of consciousness was 300 by the Japan Coma Scale, pulse rate 49 beats/min, and blood pressure 96/80 mmHg. We suspected cardiac tamponade due to acute type A aortic dissection (AADA), because emergency echocardiography revealed pericardial effusion. After endotracheal intubation, cardiopulmonary arrest occurred. Two minutes after cardiopulmonary resuscitation, spontaneous circulation was restored. Pericardiocentesis was performed, because he became hemodynamically unstable. After the aspiration of about 10 mL of blood, his blood pressure rapidly increased and circulatory dynamics then stabilized. Based on the results of CT, a diagnosis of AADA was established. The patient underwent emergency surgery (partial replacement of the ascending aortic arch). On hospital day 22, he left the ICU. However he experienced aspiration pneumonia and died on hospital day 177. Pericardiocentesis for cardiac tamponade complicating AADA should be considered when circulation cannot be maintained while waiting for surgery. At the time of pericardiocentesis, it is important to prevent an excessive increase in blood pressure with a minimum amount of drainage.