An evaluation of diagnostic sensitivity of transthoracic echocardiography in diagnosis of post-cardiac surgery tamponade

Amac: Bu calismada transtorasik ekokardiyografinin (TTE) kalp cerrahisi sonrasi gelisen kardiyak tamponad tanisindaki tanisal ozgullugu ve duyarliligi degerlendirildi. Ca­lis­ma­ pla­ni:­ Ocak 2010 ve Eylul 2012 arasinda acik kalp cerrahisi yapilan 2300 hastadan kanama veya kardiyak tamponad nedeniyle revizyon cerrahisi gereken 118’i (39 erkek, 79 kadin; ort. yas 55.4±15.2 yil; dagilim 19-80 yil) retrospektif olarak degerlendirildi. Yetmis uc hastanin TTE verileri mevcuttu. Transtorasik ekokardiyografinin ve hipotansiyon, oliguri ve metabolik asidoz gibi klinik parametrelerin tanisal ozgullugu ve duyarliligi cerrahi dogrulama esas alinarak hesaplandi. Ozgulluk ve duyarlilik oranlari Cochrane Q testi ve McNemar test kullanilarak karsilastirildi. Bul gu lar: Ilk ameliyat sonrasi gecen surenin ortalama ve medyan degerleri sirasiyla 12.0±11.7 ve dokuz gun (0-62 gun) idi. Genel mortalite 28 hastada (%38.4) goruldu. Cerrahi olarak kanitlanmis tamponad hastalarinda, TTE %64.5 duyarliliga sahip iken %92.0’sinde hipotansiyon, %80.6’sinda oliguri ve %45.1’inde metabolik asidoz mevcuttu (p<0.001). Cerrahi olarak tamponad olmadigi dogrulanmis hastalarda, TTE %90.9 ozgulluge sahip iken, %54.5’inde hipotansiyon, %81.8’inde oliguri ve %45.4’unde metabolik asidoz mevcuttu (p=0.07). Ozgulluk oranlari gecen zamanla sabitken duyarlilik oranlari yedi gunden sonra artma egilimindeydi. So­nuc:­Transtorasik ekokardiyografi ameliyat sonrasi hemodinamik bozulmanin degerlendirilmesinde onemli bir role sahiptir. Ancak, testin kardiyak tamponad tanisindaki yuksek yanlis negatiflik orani, yuksek klinik suphe varliginda zaman kaybinin onlenmesi icin akilda tutulmalidir. Anah tar soz cuk ler: Ekokardiyografi; duyarlilik; ozgulluk; tamponad. Background:­This study aims to evaluate the diagnostic specificity and sensitivity of transthoracic echocardiography (TTE) for the diagnosis of cardiac tamponade after cardiac surgery. Methods: Of 2,300 patients who underwent open heart surgery between January 2010 and September 2012, 118 (39 males, 79 females; mean age: 55.4±15.2 years; range 19 to 80 years) who required a revision surgery for bleeding and/or cardiac tamponade were retrospectively analyzed. Data of TTE were available in 73 patients. Diagnostic specificity and sensitivity of the TTE and clinical parameters including hypotension, oliguria, and metabolic acidosis were estimated with respect to surgical confirmation. Sensitivity and specifity rates were compared using the Cochrane Q test and McNemar test. Results:­ The mean and median time from the first operation were 12.0±11.7 and nine days, respectively (0 to 62 days). Overall mortality occurred in 28 patients (38.4%). Among patients with surgically confirmed tamponade, TTE showed 64.5% sensitivity, whereas hypotension was present in 92.0%, oliguria in 80.6% and metabolic acidosis in 45.1% (p<0.001). Among patients with unconfirmed tamponade, TTE showed 90.9% specificity, whereas hypotension was present in 54.5% patients, oliguria in 81.8% and metabolic acidosis in 45.4% (p=0.07). Specificity rates showed constancy with time, while sensitivity rates tended to increase after seven days. Conclusion:­Transthoracic echocardiography plays an important role in the evaluation of postoperative hemodynamic impairment. However, its high false negativity rate for diagnosis of cardiac tamponade should be kept in mind to prevent further delay in patients with high clinical suspicion.