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Title: Detection of occult pericardial hemorrhage early after open-heart surgery using technetium-99m red blood cell radionuclide ventriculography

Abstract

Pericardial or mediastinal hemorrhage requiring reoperation occurs in 2% to 5% of patients, usually early (0 to 48 hours), after open-heart surgery. This hemorrhage may be occult, and resulting cardiac tamponade may easily be misinterpreted as ventricular dysfunction, common early postoperatively. In such cases, appropriate and timely intervention may not occur. Of 50 patients evaluated by technetium-99m red blood cell gated equilibrium radionuclide ventriculography (RNV) because of early postoperative cardiogenic shock of uncertain etiology, 17 had unique scintigraphic images suggestive of intrathoracic hemorrhage. Of these 17, 5 had a generalized halo of abnormal radioactivity surrounding small hyperdynamic right and left ventricles, 11 had localized regions of intense blood pool activity outside the cardiac chambers (two with compression of single chambers), and one demonstrated marked radionuclide activity in the right hemithorax (2000 ml of blood at reoperation). Twelve patients had exploratory reoperation for control of hemorrhage as a direct result of the scintigraphic findings, three were successfully treated with fresh frozen plasma and platelet infusions along with medical interventions to optimize cardiac performance, and two patients died in cardiogenic shock (presumed tamponade) without reoperation. In the 12 reoperated patients, all were confirmed to have active pericardial bleeding. Scintigraphic localization of abnormalmore » blood pools within the pericardium corresponded to the sites at which active bleeding was witnessed at reoperation. The abnormal bleeding was etiologically related to the tamponade state, with marked improvement in hemodynamics after reoperation. Nine additional patients were reoperated for presumed tamponade after RNV revealed an exaggerated halo of photon deficiency surrounding the cardiac chambers.« less

Authors:
; ; ; ; ; ; ; ;
Publication Date:
Research Org.:
Cedars-Sinai Medical Center, Los Angeles, CA
OSTI Identifier:
5764015
Resource Type:
Journal Article
Journal Name:
Am. Heart J.; (United States)
Additional Journal Information:
Journal Volume: 108:5
Country of Publication:
United States
Language:
English
Subject:
59 BASIC BIOLOGICAL SCIENCES; 62 RADIOLOGY AND NUCLEAR MEDICINE; HEART; SCINTISCANNING; SURGERY; SIDE EFFECTS; ERYTHROCYTES; HEMORRHAGE; ISOMERIC NUCLEI; LABELLED COMPOUNDS; PATIENTS; TECHNETIUM 99; TRACER TECHNIQUES; BETA DECAY RADIOISOTOPES; BETA-MINUS DECAY RADIOISOTOPES; BIOLOGICAL MATERIALS; BLOOD; BLOOD CELLS; BODY; BODY FLUIDS; CARDIOVASCULAR SYSTEM; COUNTING TECHNIQUES; DIAGNOSTIC TECHNIQUES; HOURS LIVING RADIOISOTOPES; INTERMEDIATE MASS NUCLEI; ISOMERIC TRANSITION ISOTOPES; ISOTOPE APPLICATIONS; ISOTOPES; MATERIALS; MEDICINE; NUCLEI; ODD-EVEN NUCLEI; ORGANS; PATHOLOGICAL CHANGES; RADIOISOTOPE SCANNING; RADIOISOTOPES; SYMPTOMS; TECHNETIUM ISOTOPES; YEARS LIVING RADIOISOTOPES; 550901* - Pathology- Tracer Techniques; 550601 - Medicine- Unsealed Radionuclides in Diagnostics

Citation Formats

Bateman, T.M., Czer, L.S., Gray, R.J., Kass, R.M., Raymond, M.J., Garcia, E.V., Chaux, A., Matloff, J.M., and Berman, D.S. Detection of occult pericardial hemorrhage early after open-heart surgery using technetium-99m red blood cell radionuclide ventriculography. United States: N. p., 1984. Web. doi:10.1016/0002-8703(84)90742-7.
Bateman, T.M., Czer, L.S., Gray, R.J., Kass, R.M., Raymond, M.J., Garcia, E.V., Chaux, A., Matloff, J.M., & Berman, D.S. Detection of occult pericardial hemorrhage early after open-heart surgery using technetium-99m red blood cell radionuclide ventriculography. United States. doi:10.1016/0002-8703(84)90742-7.
Bateman, T.M., Czer, L.S., Gray, R.J., Kass, R.M., Raymond, M.J., Garcia, E.V., Chaux, A., Matloff, J.M., and Berman, D.S. Thu . "Detection of occult pericardial hemorrhage early after open-heart surgery using technetium-99m red blood cell radionuclide ventriculography". United States. doi:10.1016/0002-8703(84)90742-7.
@article{osti_5764015,
title = {Detection of occult pericardial hemorrhage early after open-heart surgery using technetium-99m red blood cell radionuclide ventriculography},
author = {Bateman, T.M. and Czer, L.S. and Gray, R.J. and Kass, R.M. and Raymond, M.J. and Garcia, E.V. and Chaux, A. and Matloff, J.M. and Berman, D.S.},
abstractNote = {Pericardial or mediastinal hemorrhage requiring reoperation occurs in 2% to 5% of patients, usually early (0 to 48 hours), after open-heart surgery. This hemorrhage may be occult, and resulting cardiac tamponade may easily be misinterpreted as ventricular dysfunction, common early postoperatively. In such cases, appropriate and timely intervention may not occur. Of 50 patients evaluated by technetium-99m red blood cell gated equilibrium radionuclide ventriculography (RNV) because of early postoperative cardiogenic shock of uncertain etiology, 17 had unique scintigraphic images suggestive of intrathoracic hemorrhage. Of these 17, 5 had a generalized halo of abnormal radioactivity surrounding small hyperdynamic right and left ventricles, 11 had localized regions of intense blood pool activity outside the cardiac chambers (two with compression of single chambers), and one demonstrated marked radionuclide activity in the right hemithorax (2000 ml of blood at reoperation). Twelve patients had exploratory reoperation for control of hemorrhage as a direct result of the scintigraphic findings, three were successfully treated with fresh frozen plasma and platelet infusions along with medical interventions to optimize cardiac performance, and two patients died in cardiogenic shock (presumed tamponade) without reoperation. In the 12 reoperated patients, all were confirmed to have active pericardial bleeding. Scintigraphic localization of abnormal blood pools within the pericardium corresponded to the sites at which active bleeding was witnessed at reoperation. The abnormal bleeding was etiologically related to the tamponade state, with marked improvement in hemodynamics after reoperation. Nine additional patients were reoperated for presumed tamponade after RNV revealed an exaggerated halo of photon deficiency surrounding the cardiac chambers.},
doi = {10.1016/0002-8703(84)90742-7},
journal = {Am. Heart J.; (United States)},
number = ,
volume = 108:5,
place = {United States},
year = {1984},
month = {11}
}