Low-pressure tamponade due to hemothorax after transcatheter edge-to-edge repair of the mitral valve

Figure 1 Point-of-care ultrasound exam. A: Post-procedure cardiac apical four-chamber view showing large fluid collection posterior and lateral (PlEff) to the right atrium (RA) causing RA collapse (white arrow showing inward position of the RA wall) during ventricular systole (i.e., atrial diastole); B: Post-procedure cardiac subcostal view showing four chambers and RA collapse during atrial diastole (white arrows showing inward position of the RA wall) and a small right ventricle (RV); C: Transesophageal echocardiographic view, obtained during the procedure, showing pericardial effusion along the RA and right ventricular chambers (RV) measuring approximately 1.1 to 1.2 cm; D: Post-procedure subcostal view showing inferior cava diameter of 0.8 cm; E: Ultrasound of the right chest demonstrating collapsed lung and a large right chest fluid.

Figure 2 Chest X-ray. A: Pre-procedure chest radiograph obtained the day before the scheduled mitral clip procedure. The lung fields appear hyperinflated with flattened diaphragms. There is extensive hardware (rods) seen along the spine; B: Post-procedure chest radiograph showing new haziness (white arrow) consistent with fluid. At this time, the patient was hypotensive and severely acidotic most due to a respiratory acidosis presumably related to extensive right lung collapse; C: Post-chest-tube-placement chest radiograph showing clearance of right pleural fluid. The lung fields appear smaller perhaps consistent with pulmonary atelectasis. As the prior films also see, there is extensive hardware along the spine.