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VALIDITY OF TEE IN THE DIAGNOSIS OF POST-OPERATIVE CARDIAC TAMPONADE

^a Departments of Surgery and
^b Anesthesia, Dalhousie University, Halifax, Nova Scotia

INTRODUCTION:

Cardiac tamponade is a life-threatening complication following cardiac surgery that requires accurate diagnosis to prevent adverse outcomes. The clinical diagnosis of tamponade in the ICU is based on indirect evidence and can be challenging. Transesophageal echocardiography (TEE) has more recently been employed in the diagnosis of tamponade and although particular echocardiographic signs may indicate tamponade, few studies compare TEE findings with intraoperative findings. We evaluated the accuracy of TEE in making the diagnosis of tamponade in the ICU by comparing TEE findings with surgical findings.

METHODS:

Retrospectively we identified all patients having a TEE in the ICU for suspected tamponade in a consecutive series of cardiac surgery cases from June 1997 to July 2003. A TEE diagnosis of tamponade was made when blood or clot was found around the heart, with chamber collapse or compression judged to impair filling. Among patients who underwent re-exploration, a surgical diagnosis of tamponade was made when mediastinal blood and or clot was found with hemodynamic improvement upon its removal.

RESULTS:

Eighty-eight patients had a TEE in the ICU for suspected tamponade following cardiac surgery. Tamponade was identified by TEE in 30 (34%) patients. Of those, 25 (83%) returned to the OR where tamponade was confirmed in 18 (72%) patients. Tamponade was ruled out by TEE in 58 (66%) patients who had TEE in the ICU; of these, 13 (22%) returned to the OR and tamponade was found in 2 (15%) patients. In-hospital mortality for all patients who had TEE for suspected tamponade was 28% (25/88).

CONCLUSION:

Among the 38 patients for whom surgical confirmation of TEE findings was available, TEE was accurate in 76% (29/38) of cases. Thus, TEE is a valuable adjunct in the diagnosis of tamponade. However, of the patients with negative TEE who were re-explored, there was an appreciable rate of tamponade. TEE alone cannot reliably rule out this diagnosis.

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