A Case of Intrapericardial Hematoma Four Years after Open-Heart Surgery

Tamponade occurring several years after open-heart surgery is rare ; the decision to surgically intervention for tamponade is a difficult one. We present our experience with a case of tamponade that occurred 4 years after open heart surgery. The patient was a 70-year-old man who underwent aortic valve replacement (CarbomedicsTM 27 mm), pulmonary vein isolation, right atrium maze operation, and ligation of the left atrial appendage. Four years after the surgery, he was admitted to our hospital because of dyspnea on exertion and leg edema. Echocardiography and computed tomographic (CT) scan revealed a hematoma in the intrapericardial cavity, which was pressing on the posterior wall of the left ventricle, for which surgery was indicated. After the hematoma was removed, there was bleeding from the left atrial appendage. Hemostasis was performed with one mattress suture. A postoperative CT scan demonstrated that the left ventricle deformity had disappeared and the cardiac hemodynamics were normalized. During the follow-up period, no recurrent hematoma was observed. This evidence suggests that tamponade occurred because of re-bleeding from the left atrial appendage where the bleeding was stopped by the pressure of the hematoma.