Cardiac Tamponade in Post Coronary Artery Bypass Graft Surgery Patient, Is it Post-Pericardiotomy Syndrome : A Case Report

Background: Cardiac tamponade is defined as a medical emergency that could lead to shock. Cardiac tamponade prevalence in post open heart surgery is common especially Coronary Artery Bypass Graft (CABG) surgery (24%) and related to Post-Pericardiotomy Syndrome (PPS). 

Case Summary: A 57-year-old Asian female with a history of CABG surgery presented to emergency with chief complaints of shortness of breath in the last 3 days especially when lying down. Patient underwent CABG surgery from CAD2VD + LM in the last month. Physical examination found a muffled first & second heart sound and distended jugular vein. Electrocardiograph of the patient showed sinus rhythm with low voltage. Echocardiography was done in the patient and the result showed severe pericardial effusion with D shape and collapse of the right ventricle. Pericardiocentesis is performed and results in 737cc serosanguineous fluid. Post-procedural echocardiography showed reduced pericardial effusion, good LV contractility, and RV not collapsed. Pericardial fluid analysis concluded as a transudative type. 

Conclusion: This patient developed pericardial effusion with cardiac tamponade with history of CABG surgery as the only significant history. Early identification of PPS is important and preventive strategies need to be done to prevent unwanted complication.