Localised cardiac tamponade following cardiac surgery

We report two cases of severe cardiac tamponade following cardiac surgery. In each case a haemorrhagic collection resulted in a localised tamponade. The clinical presentation in both cases was atypical and, although the possibility of tamponade was considered, the absence of classical signs delayed diagnosis until echocardiography was performed. These cases illustrate the varied presentation of tamponade after cardiac surgery which may be localised, highlighting the need for a high level of clinical suspicion and early use of echocardiography to make a prompt diagnosis. The transoesophageal echocardiogram may have particular relevance in the detection of localised collections causing a tamponade effect. The cases indicate that post-operative cardiac tamponade occurs over a wide time-scale following surgery and that anticoagulation may be a contributing factor.