Editorial: Invisible hematoma causing shock after open-heart surgery: Localized cardiac tamponade

Shock is a physiological state characterized by an inadequate issue perfusion and cellular oxygenation associated with persisent hypotension, resulting in adverse effects on multiple organ ystems. Possible causes of shock following cardiac surgery include ump failure, pulmonary embolism, hypovolemia, sepsis, and tamonade. As the prolongation of shock status can lead to irreversible rgan damage or death, a prompt diagnosis of underlying cause nd initiation of treatment are critical. Echocardiography is generlly the first option for comprehensive assessment. However, in are cases, unexpected cardiac tamponade can occur as a cause f shock following cardiac surgery, and this may not be detected sing transthoracic echocardiography in the early period after urgery. Huang et al. [1] reported a case who had cardiac arrest n day 8 after mechanical mitral valve replacement. They found large intra-pericardial mass compressing the right atrium (RA), rare condition, referred to as “localized” or “isolated cardiac amponade.” There have been several reports of a localized hematoma or emorrhage causing systemic hypotension after cardiac surgery 2–11]. These patients exhibited progressive and persistent ypotension, tachycardia, and elevated central venous or RA ressures; these features are consistent with cardiac tamponade. owever, pulmonary capillary wedge pressure and pulmonary rtery pressure were normal, and pulsus paradoxus was absent. he period from surgery to the onset of shock varied considerbly – from 12 h to 31 months. The cause of hypotension was ot revealed using transthoracic echocardiography, but transsophageal echocardiography could provide an excellent image uality due to the alternative acoustic window. In reality, immeditely after cardiac surgery, the area observable using transthoracic chocardiography is limited. In addition to surgical wounds and ressings, mechanical ventilators and intra-aortic balloon pump estrict possible changes in patient position for alternate views, and his often results in poor image quality. Moreover, when a patient s in agony, examination and diagnosis must be performed quickly