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Cardiac perforation and tamponade: a potentially fatal complication during transjugular intrahepatic portosystemic shunt placement.

Article Excerpt
Abstract: Transjugular intrahepatic portosystemic shunt (TIPS) is a low-resistance channel between the hepatic vein and the intrahepatic portion of the portal vein. This is an important addition to the therapeutic armamentarium against portal hypertension. Complications are either technical or due to the creation of a shunt. Procedure-related mortality is about to 2%. Cardiac perforation, one of the rarest complications during TIPS, can occur while traversing the catheter from the jugular vein past the right atrium to enter the hepatic vein. We are reporting the case of a 50-year-old woman who became acutely hypotensive with cardiovascular compromise during the TIPS procedure. A stat echocardiogram confirmed cardiac tamponade and emergency pericardiocentesis resulted in improvement of hemodynamic status with complete recovery.

Key Words: transjugular intrahepatic portosystemic shunt (TIPS), portal hypertension, cardiac tamponade

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In 1969, Rosch et al introduced the idea of creating an intrahepatic shunt leading to decompression of the splanchnic venous system in patients with portal hypertension. (1) Initial work with placement of a transjugular intrahepatic portosystemic shunt (TIPS) device in humans was first reported in 1982 by Colapinto. The use of an expandable metal stent...