Images in Cardiovascular Medicine Tension Pneumopericardium After Cardiac Surgery A Rare but Lethal Problem

A 13-month-old girl who had no medical history unevent-fully underwent patch closure of an atrial septal defect under mild hypothermic cardiopulmonary bypass. An imme-diately postoperative chest radiograph did not show any unusual findings (the Figure, A), and the process of weaning her from the ventilator was started. Just before extubation (6 hours after transfer to the intensive care unit), a sudden desaturation occurred, and a massive bloody secretion drained through the endotracheal tube. Echocardiography showed that the interventricular septal motion was slightly paradoxical, but ventricular contractility was normal. Chest radiograph revealed an unexpected massive pneumopericar-dium with bilateral pulmonary edema and pneumomediasti-num with subcutaneous emphysema (the Figure, B). After a large amount of air was drained by mobilization of a pericardial tube, vital signs and arterial blood gas stabilized