Recurrent Cardiac Tamponade Following an Open Mitral Valve Replacement

Cardiac tamponade is a life-threatening complication characterized by the accumulation of fluid or blood within the pericardial sac surrounding the heart, leading to increased intra-pericardial pressure and impaired ventricular filling. This is a known complication of cardiothoracic procedures, including coronary artery bypass grafting (CABG) and mitral valve repairs, and can rapidly progress to decreased cardiac output, hypotension, and eventual cardiac collapse. We report the case of a 62-year-old male with an unremarkable past medical history who was admitted to the hospital due to recurrent fevers and bacterial infections, which were found to be due to mitral valve vegetation, and subsequently underwent open mitral valve replacement. His postoperative course was complicated by recurrent cardiac tamponade requiring multiple operative interventions, ultimately resulting in an extended ICU stay, but he was eventually discharged to inpatient rehab two weeks after the fact. The recurrent hemopericardium in this case was most consistent with surgical and coagulopathic bleeding, with a possible secondary contribution from an upregulated inflammatory response related to the patient's infective endocarditis. After any cardiac surgery, a high index of suspicion for cardiac tamponade should be maintained in patients who become hemodynamically unstable. Presentation is often nonspecific, and diagnosis requires a high index of suspicion combined with prompt imaging, with the aid of interdisciplinary collaboration in order to successfully treat patients expeditiously.