Interactive Case – September 2019

CARDIAC TAMPONADE DURING TAVI (TRANS-CATHETER AORTIC VALVE IMPLANTATION) PROCEDURES

Presented by Alberto Hernandes, Barcelona, Spain and Moataz M. Emara, Mansoura, Egypt

Case Presentation

A lady 89 y-old, with multiple comorbidities and EuroSCORE of 0,46, underwent TAVI under general anaesthesia. During the procedure and prior to valve deployment, blood pressure decreased progressively, heart rate was fixed under pacemaker and several doses of metaraminol was given but no response, at this point CVP started to rise.

Q1 – What is your differential diagnosis?

  1. Coronary ostial occlusion
    or
  2. Cardiac tamponade

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Q2 – Looking at the trans-gastric short axis TEE shown below, how would you manage the patient first?

  1. Pericardiocentesis
  2. Urgent surgical exploration
  3. Pericardial window

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Q3 – TEE showed pericardial tamponade. During immediate pericardiocentesis, the patient’s parameters were changed as per the patient’s monitor below. 
What would be the cause of blood pressure shooting? 

  1. Aortic dissection
  2. Drug-induced
  3. Un-calibrated waveform
  4. Stroke

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And stay tuned for the final answer!

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