Recurrent late cardiac tamponade following cardiac surgery:a deceiving and potentially lethal complication

Background - Cardiac tamponade, characterized by inflow obstruction of the heart chambers by extracardiac compression, is a potentially lethal complication following cardiac surgery.Case report - We present a case of recurrent cardiac tamponade following valve surgery. At first presentation, diagnosis was delayed because of atypical symptoms and the absence of accumulated pericardial fluid on the transthoracic echocardiogram. After succesful treatment, tamponade reoccurred with typical clinical and echocardiographic features.Conclusion - This case teaches us to appreciate the varied presentation of tamponade after cardiac surgery, and shows the need for a high index of suspicion and the early use of echocardiography to confirm the diagnosis. Depending on pericardial morphology and the postoperative time window, treatment consists of drainage, either by surgical therapy or percutaneous pericardiocenthesis. Postoperative follow-up is warranted in patients with risk factors for tamponade, such as a history of previous tamponade, valve surgery, clotting abnormalities and the use of anticoagulants.