Emergency Autotransfusion for Managing Iatrogenic Hemorrhagic Pericardial Effusion

Abstract

Iatrogenic hemorrhagic pericardial effusion (IHPE) is one of the major complications encountered in daily percutaneous intracardiac interventions. A 79-year-old man was scheduled for percutaneous left atrial appendage closure (PLAAC) at our department. He had non-valvular atrial fibrillation, with a contraindication to oral anticoagulants because of a history of recurrent significant intestinal bleeding with angiodysplasia. During the deployment of the PLAAC device (Watchman device), patient became hemodynamically unstable with a typical decrease in the systolic arterial pressure of more than 10 mm Hg during inspiration (pulsus paradoxus) because pericardial tamponade occurred due to perforation of the left atrial appendage. We report our successful experience with management of IHPE by immediate pericardiocentesis, insertion of percutaneous catheter drainage (PCD), and retransfusing drained pericardial blood through a central venous line. IHPE is not uncommon complication in daily percutaneous intracardiac interventions. Pulsus paradoxus is the most important clinical sign of cardiac tamponade. Our approach by immediately retransfusing drained pericardial blood through a central venous line allowed rapid physiologically appropriate recovery. Future consensus of opinion of experts focusing on autotransfusion in such cases is needed.




J Med Cases. 2017;8(4):114-116
doi: https://doi.org/10.14740/jmc2789w