Highlights an atypical presentation of late cardiac tamponade after mitral valve replacement that lacked pulsus paradoxus but responded successfully to pericardiocentesis.
Absence of pulsus paradoxus should not preclude pericardiocentesis in suspected post-MVR tamponade; extends recognition of atypical cases but remains hypothesis-generating.
A patient developed oliguria, peripheral edema, and dyspnea 5 days after mitral valve replacement. Chest roentgenogram and echocardiogram suggested pericardial effusion. Although pulsus paradoxus was absent, cardiac tamponade was suspected and subsequently confirmed during pericardiocentesis. Before pericardiocentesis right and left ventricular diastolic pressures were equal, as well as intrapericardial and right atrial pressures. The left ventricular cavity was reduced in size on the echocardiogram. Interventricular septal motion was normal. Pericardiocentesis normalized the hemodynamics and allowed the left ventricle to reexpand. Certain atypical features are tentatively explained as the combined effect of constrictive and effusive components caused by intrapericardial hemorrhage.
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Orzan et al. (1977) studied this question.
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