Paradoxical hypertension complicating postoperative cardiac tamponade: a diagnostic challenge after minimally invasive asd closure

This report details a 54-year-old female who presented with severe hypertension (170/100 mmHg) and acute dyspnea approximately six weeks after minimally invasive cardiac surgery (MICS) for atrial septal defect (ASD) closure. The initial presentation, characterized by significant hypertension and elevated NT-proBNP, mimicked hypertensive heart failure, prompting diuretic administration. However, a bedside echocardiogram confirmed a significant pericardial effusion, leading to emergent pericardiocentesis. Subsequent investigations revealed a large, organized hemopericardium causing cardiac tamponade, despite the atypical hypertensive state. This case highlights the diagnostic challenge posed by cardiac tamponade when it presents with paradoxical hypertension, a phenomenon reported in a notable subset of tamponade cases. It underscores the potential pitfalls of initial management if the underlying tamponade is masked and emphasizes the need for a high index of suspicion for pericardial complications even after MICS. Surgical re-exploration for clot evacuation led to a favorable outcome.