A Cardiac Tamponade that Does Not Require Pericardiocentesis; a Letter to Editor

Cardiac tamponade is a leading cause of death in patients with aortic dissection. When aortic dissection is accompanied by cardiac tamponade, emergency surgery to repair the aorta is required. The treatment approach for this group of patients differs from other cases with pericardial effusions, and percutaneous pericardiocentesis is contraindicated. Attempting pericardiocentesis in this type of tamponade leads to increased leakage from the aorta into the pericardium, worsening the patient's condition. Here I present a 29-year-old woman with chest pain who called emergency medical service to her home. Cardiac arrest occurred during her transfer to the emergency department. During the cardiac resuscitation, this pericardiocentesis was performed, but drainage was unsuccessful due to the presence of a gelatinous fluid, despite the needle being visible within the pericardial space. Suspecting aortic dissection as the cause of cardiac tamponade, an on call cardiothoracic surgeon was immediately consulted. The surgeon ordered the patient to be transferred to the operating room, while cardiac resuscitation was continued. Following the surgery, the surgeon reported that the patient has a cardiac tamponade caused by an aortic dissection, and that the gelatinous effusion resulted was a result of clotted blood around the heart. However, the patient did not survive after surgery.