Seidler N, Asher SR, Chen T, Gordon P, Sodha N, Maslow A. Low-pressure tamponade due to hemothorax after transcatheter edge-to-edge repair of the mitral valve. World J Cardiol 2025; 17(5): 106567 [DOI: 10.4330/wjc.v17.i5.106567]
Corresponding Author of This Article
Shyamal R Asher, MD, Assistant Professor, Department of Anesthesiology, Brown University Health, 593 Eddy Street Davol 129, Providence, RI 02903, United States. ashershy@gmail.com
Research Domain of This Article
Anesthesiology
Article-Type of This Article
Case Report
Open-Access Policy of This Article
This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
World J Cardiol. May 26, 2025; 17(5): 106567 Published online May 26, 2025. doi: 10.4330/wjc.v17.i5.106567
Low-pressure tamponade due to hemothorax after transcatheter edge-to-edge repair of the mitral valve
Nicholas Seidler, Shyamal R Asher, Tzonghuei Chen, Paul Gordon, Neel Sodha, Andrew Maslow
Nicholas Seidler, Shyamal R Asher, Tzonghuei Chen, Andrew Maslow, Department of Anesthesiology, Brown University Health, Providence, RI 02903, United States
Paul Gordon, Department of Cardiology, Brown University Health, Providence, RI 02903, United States
Neel Sodha, Department of Cardiac Surgery, Brown University Health, Providence, RI 02903, United States
Co-corresponding authors: Shyamal R Asher and Andrew Maslow.
Author contributions: Seidler N wrote the initial draft of the manuscript and researched the topic and references; Maslow A was a primary care giver, and researched and prepared the manuscript; Asher SR and Chen T wrote and edited the manuscript; Gordon P and Sodha N were primary care givers and helped write and edit the manuscript. There are two corresponding authors as they provided equal contribution to the manuscript preparation and submission. Dr. Maslow was the primary anesthesiologist for the case. He can respond to any correspondence related to specifics of the case, the management decisions, and outcomes. In addition to manuscript editing, Dr. Asher assisted with compiling all the required documents for submission. Dr Asher can respond to any correspondence related to the submission process.
Informed consent statement: Written consent for submission and publication of this case report was obtained from the patient.
Conflict-of-interest statement: No conflicts of interest to report.
CARE Checklist (2016) statement: The authors have read the CARE Checklist (2016), and the manuscript was prepared and revised according to the CARE Checklist (2016).
Open Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: https://creativecommons.org/Licenses/by-nc/4.0/
Corresponding author: Shyamal R Asher, MD, Assistant Professor, Department of Anesthesiology, Brown University Health, 593 Eddy Street Davol 129, Providence, RI 02903, United States. ashershy@gmail.com
Received: March 6, 2025 Revised: April 2, 2025 Accepted: April 24, 2025 Published online: May 26, 2025 Processing time: 79 Days and 6.2 Hours
Abstract
BACKGROUND
The use of percutaneous transcatheter edge-to-edge repair (TEER) for mitral regurgitation (MR) has increased, including an increased application to older, frailer, and higher risk patients.
CASE SUMMARY
A 74 year-old woman with severe MR, a left ventricular ejection fraction of 45%, and a small circumferential pericardial effusion underwent TEER of the mitral valve. After the placement of two MitraClips, the MR was assessed as mild to moderate. Within 10-20 minutes after the completion of the case, the patient was dyspneic and hypotensive despite volume resuscitation. Point-of-care ultrasound (POCUS) showed no changes in cardiac contractility, valve function, or the pericardial space. The right heart chambers appeared small with right atrial (RA) diastolic collapse. There was no evidence of venous congestion. Further exam showed a large right pleural fluid collection. Given the clinical scenario of dyspnea, hypotension, and diastolic RA collapse, low-pressure tamponade was suspected. A thoracentesis expelled 1200 mL of blood with immediate hemodynamic improvement. The patient made an uneventful recovery.
CONCLUSION
The application of POCUS is crucial for detecting, diagnosing, and properly managing cardiac dysfunction and procedural complications associated with TEER. While tamponade is classically associated with a pericardial effusion and vena caval plethora, their absence does not dismiss the suspicion or diagnosis of tamponade. This case highlights the value of POCUS in assessing low-pressure tamponade caused by a large, pressurized pleural effusion. Clinical suspicion, supported by POCUS findings, was confirmed by a thoracentesis that resulted in immediate hemodynamic improvement.
Core Tip: In the case presented, the acute accumulation of blood in the right pleural space resulted in low-pressure tamponade, which was further confirmed by a thoracentesis that resulted in immediate improvement in hemodynamics. The case highlights varied presentation of tamponade and the value of periprocedural ultrasound to assess cardiopulmonary dysfunctions.
