CARDIAC TAMPONADE DURING TAVI (TRANS-CATHETER AORTIC VALVE IMPLANTATION) PROCEDURES
Presented by Alberto Hernandes, Barcelona, Spain and Moataz M. Emara, Mansoura, Egypt
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?
- Coronary ostial occlusion
- Cardiac tamponade
Q2 – Looking at the trans-gastric short axis TEE shown below, how would you manage the patient first?
- Urgent surgical exploration
- Pericardial window
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?
- Aortic dissection
- Un-calibrated waveform