Late-Onset Type I Left Ventricular Rupture following Double-Valve Replacement: An Unexpected Cause of Cardiac Tamponade

Aditya Doni  Pradana; Real Kusumanjaya  Marsam; Hendry Purnasidha  Bagaswoto; Habibie  Arifianto; Putrika Prastuti Ratna Gharini

doi:10.18502/jthc.v20i2.19711

Aditya Doni Pradana Department of Cardiology and Vascular Medicine, Faculty of Medicine, Public Health and Nursing, Universitas Gadjah Mada – Dr. Sardjito General Hospital, Yogyakarta, Indonesia
Real Kusumanjaya Marsam Department of Cardiology and Vascular Medicine, Faculty of Medicine, Public Health and Nursing, Universitas Gadjah Mada – Dr. Sardjito General Hospital, Yogyakarta, Indonesia
Hendry Purnasidha Bagaswoto Department of Cardiology and Vascular Medicine, Faculty of Medicine, Public Health and Nursing, Universitas Gadjah Mada – Dr. Sardjito General Hospital, Yogyakarta, Indonesia
Habibie Arifianto Department of Cardiology and Vascular Medicine, Faculty of Medicine, Universitas Sebelas Maret – Dr. Moewardi General Hospital, Surakarta, Indonesia.
Putrika Prastuti Ratna Gharini Department of Cardiology and Vascular Medicine, Faculty of Medicine, Public Health and Nursing, Universitas Gadjah Mada – Dr. Sardjito General Hospital, Yogyakarta, Indonesia.

DOI: https://doi.org/10.18502/jthc.v20i2.19711

Keywords: Cardiac Tamponade; Type I LV Rupture; Echocardiography; Cardiac CT; Pericardial Window; Heart Valve Surgery

Abstract

Background: Cardiac tamponade is a life-threatening emergency caused by substantial pericardial accumulation of fluid, blood, or pus. This buildup compresses the cardiac chambers, resulting in hemodynamic compromise, shock, and possible death. Postoperative cardiac tamponade incidence ranges from 0.1% to 6%. We describe a case of late-onset type I left ventricular (LV) rupture after double-valve replacement (DVR), presenting as cardiac tamponade.

Case Presentation: A 58-year-old woman was referred to our hospital with a 1-month history of progressive breathlessness and orthopnea. She had undergone DVR surgery, specifically an aortic and mitral valve replacement, 3 months prior to admission. Echocardiography performed at the referring hospital revealed a large, loculated pericardial mass, suspected to be a hemopericardium, that was compressing the LV structure and causing cardiac tamponade. Further imaging with cardiac computed tomography (CT) demonstrated contrast extravasation at the atrioventricular groove adjacent to the prosthetic mitral valve, which confirmed a type I LV rupture.

The patient was diagnosed with a late-onset type I LV wall rupture following DVR. Urgent pericardiocentesis was performed, followed by an open thoracotomy, the creation of a pericardial window, and the surgical repair of the rupture site.

Conclusions: Multimodal cardiac imaging, such as echocardiography and cardiac computed tomography, is essential for comprehensive assessment and characterization of the underlying etiology of postoperative cardiac tamponade.