A 58 year-old male patient submitted to mechanical valve prosthesis implant was hemodynamically stable at the postoperative unit and over time developed progressive cardiovascular collapse, requiring high doses of vasopressor amines. The image illustrates selective external compression of the right cardiac chamber, mainly of the right atrium, which caused an unsuspected cardiac tamponade.
Figure 1.
A) All reasoning to explain the cardiovascular collapse was concentrated on cardiogenic shock, as the serial radiographs were not suggestive of cardiac tamponade. B) The diagnosis was established by transthoracic echocardiography, which often does not disclose the diagnosis and makes the transesophageal echocardiogram a mandatory procedure. There is an image suggestive of an intrapericardial collection (arrow) causing right atrial compression.