Pericardial effusion and cardiac tamponade following percuta
Case Report:
A male preterm 980 g by birth weight was born to 25-year-old primigravida with 28 weeks of gestation. The baby was delivered with a cesarean section for the indication of fetal distress. In view of respiratory distress, the baby received single dose of natural bovine surfactant within half an hour of birth and was ventilated with nasal continuous positive airway pressure. A PICL (Vygon, Germany) was inserted electively on the 5 th day of life through the right saphenous vein. The chest X-ray confirmed the position of the catheter tip at the junction of inferior vena cava and right atrium just above the diaphragm. On the 7 th day of life, the baby suddenly deteriorated in the form of desaturations, tachycardia, and hypotension. On examination, the neonate appeared cyanosed, with saturations of 85% and delayed capillary refill time. On auscultation, the heart sounds were feeble and blood pressure showed a systolic reading of 30 mm mercury. The baby was therefore immediately intubated and was put on mechanical ventilation with pressure control mode and 100% oxygen. Systemic hypotension was corrected with inotropes. In view of this sudden deterioration, a chest roentgenogram was called for, which showed marked cardiomegaly and a cardiothoracic ratio of 0.68 [Figure 1]. In view of the above findings, a two-dimensional echocardiogram was performed, which showed a massive PCE [Figure 2]. There was a diastolic collapse of the free wall of the right atrium, indicating cardiac tamponade. Pericardiocentesis was immediately performed, and 9 ml of yellowish fluid was aspirated through a subxiphoid percutaneous approach. Subsequently, the skin color of the neonate improved rapidly, his vital signs gradually returned to normal, and his oxygen requirement decreased from 90% to 30%. Echocardiography done later showed increased contractility with resolution of the PCE [Figure 3]. The PICL line was immediately withdrawn....;year=2017;volume=21;issue=1;spage=57;epage=59;aulast=Desai