Left ventricular cardiac tamponade

Left ventricular (LV) cardiac tamponade

Usual manifestation of cardiac tamponade on echocardiography is diastolic collapse of right atrium and right ventricle. This is because right sided chambers can be compressed with much lower intrapericardial pressures than the thicker left ventricle. Isolated LV cardiac tamponade can occur postoperatively due to loculated collections posterior to the left ventricle. Echocardiogram will show left ventricular diastolic compression without associated right ventricular or right atrial collapse.

Another situation in which isolated left ventricular diastolic collapse occurring with circumferential pericardial effusion also with cor pulmonale has been reported by Raghava R Gollapudi, Mark Yeager and Allen D Johnson [1]. In this case, right ventricular collapse was possibly prevented by the severe pulmonary hypertension and right ventricular hypertrophy. The disorder was noted in a case of connective tissue disorder with cor pulmonale. Left ventricular diastolic collapse can significantly affect left ventricular filling and cardiac output. The classic finding of cardiac tamponade – pulsus paradoxus, may be masked in left ventricular tamponade.

An interesting case of left ventricular diastolic collapse and regional tamponade following cardiac surgery due to a large left pleural effusion, without any pericardial effusion has also been described by Rajinder S Bilku, Dilraj K Bilku, Michael D Rosin and Martin Been [2]. In this case, tamponade occurred more than two weeks after the surgery, which was an elective aortic valve replacement.

Another case series presented one case with left ventricular tamponade with post cardiac surgery loculated pericardial effusion and another with severe pulmonary hypertension and circumferential pericardial effusion [3]. The post mitral valve replacement loculated posterior pericardial effusion was drained from the axilla by echocardiographic and fluoroscopic guidance. As the pericardial effusion was circumferential in the second case, it was drained by the subxiphoid route. Paradoxical pulse was absent in both cases. Jugular venous pressure was not elevated in the case with loculated posterior effusion. The patient with severe pulmonary hypertension had prominent cv wave in the jugular venous pulse due to severe tricuspid regurgitation.

In regional left heart tamponade due to loculated effusion, right ventricle is free to expand in inspiration without interfering with left ventricular filling. This can explain the lack of pulsus paradoxus, which was shown by Schwartz SL et al in an experimental study [4].

References

1. Raghava R Gollapudi, Mark Yeager, Allen D Johnson. Cardiol Rev. Jul-Aug 2005;13(4):214-7.
2. Rajinder S Bilku, Dilraj K Bilku, Michael D Rosin, Martin Been. J Am Soc Echocardiogr. 2008 Aug;21(8):978.e9-11.
3. Kumar B, Kodliwadmath A, Singh A, Upadhyay A, Darbari A, Duggal B. Left ventricular tamponade- pathophysiology determines the therapeutic approach: a case series. Eur Heart J Case Rep. 2020 Dec 11;5(2):ytaa502.
4. Schwartz SL, Pandian NG, Cao QL, Hsu TL, Aronovitz M, Diehl J. Left ventricular diastolic collapse in regional left heart cardiac tamponade. An experimental echocardiographic and hemodynamic study. J Am Coll Cardiol. 1993 Sep;22(3):907-13.