{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,9]],"date-time":"2026-10-09T14:21:53Z","timestamp":1791555713762,"version":"4.3.4"},"reference-count":22,"publisher":"Frontiers Media SA","license":[{"start":{"date-parts":[[2025,8,8]],"date-time":"2025-08-08T00:00:00Z","timestamp":1754611200000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":["frontiersin.org"],"crossmark-restriction":true},"short-container-title":["Front. Cardiovasc. Med."],"abstract":"<jats:sec><jats:title>Background<\/jats:title><jats:p>Type A aortic dissection (TAAD) complicated by cardiac tamponade represents a life-threatening cardiovascular emergency. Acute pericardial effusion can severely compromise cardiac function. Although emergent surgical repair remains the gold standard, preoperative hemodynamic instability substantially increases surgical risk. Controlled pericardial drainage (CPD) has been proposed as a bridging intervention to rapidly relieve tamponade symptoms while mitigating the complications associated with excessive drainage. However, its clinical utility remains controversial because of concerns that the elevation in post-drainage blood pressure may accelerate dissection progression or trigger rupture. This case report highlights the successful use of CPD to stabilize a patient with TAAD and cardiac tamponade, facilitating a safe transition to definitive surgery. It also discusses the clinical utility of this strategy.<\/jats:p><\/jats:sec><jats:sec><jats:title>Case presentation<\/jats:title><jats:p>A 48-year-old man presented to the emergency department with an acute onset of altered mental status lasting 50\u2005min. Bedside ultrasound and aortic computed tomography angiography confirmed a TAAD diagnosis complicated by pericardial tamponade. After the examination, the patient experienced sudden hypotension, which was promptly managed with emergency CPD, resulting in rapid stabilization of blood pressure. Subsequently, the patient underwent \u201cSun's procedure\u201d and artificial vascular replacement, during which 500\u2005mL of pericardial blood was extracted. The patient recovered well and was discharged 24\u2005days after the surgery.<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusion<\/jats:title><jats:p>With rigorous hemodynamic monitoring and a multidisciplinary framework, CPD effectively functions as a preoperative stabilization approach in patients with TAAD complicated by pericardial tamponade, securing valuable time for subsequent surgical interventions.<\/jats:p><\/jats:sec>","DOI":"10.3389\/fcvm.2025.1595842","type":"journal-article","created":{"date-parts":[[2025,8,8]],"date-time":"2025-08-08T05:27:55Z","timestamp":1754630875000},"update-policy":"https:\/\/doi.org\/10.3389\/crossmark-policy","source":"Crossref","is-referenced-by-count":1,"title":["Case Report: Application of controlled pericardial drainage in type A aortic dissection complicated by cardiac tamponade"],"prefix":"10.3389","volume":"12","author":[{"given":"Yixin","family":"He","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ying","family":"Yang","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1965","published-online":{"date-parts":[[2025,8,8]]},"reference":[{"key":"B1","doi-asserted-by":"publisher","first-page":"211","DOI":"10.1161\/CIRCRESAHA.124.325458","article-title":"ACKR1hiECs promote aortic dissection through adjusting macrophage behavior","volume":"136","author":"Wang","year":"2025","journal-title":"Circ Res"},{"key":"B2","doi-asserted-by":"publisher","first-page":"745","DOI":"10.7150\/ijms.104622","article-title":"Unveiling the role of risk factors and predictive models in acute type-a aortic dissection surgery: OI downregulation and its association with immune disorders","volume":"22","author":"Ding","year":"2025","journal-title":"Int J Med Sci"},{"key":"B3","doi-asserted-by":"publisher","first-page":"196","DOI":"10.1186\/s12872-021-02014-5","article-title":"Mid-term outcomes of modified valve-sparing aortic root replacement versus the Bentall procedure for middle-aged Chinese patients with acute DeBakey I aortic dissection: a single-center retrospective study","volume":"21","author":"Wu","year":"2021","journal-title":"BMC Cardiovasc Disord"},{"key":"B4","doi-asserted-by":"publisher","first-page":"ezac261","DOI":"10.1093\/ejcts\/ezac261","article-title":"Treatment of the aortic root in acute aortic dissection type A: insights from the German Registry for Acute Aortic Dissection Type A (GERAADA) registry","author":"Kallenbach","year":"2022","journal-title":"Eur J Cardiothorac Surg"},{"key":"B5","doi-asserted-by":"publisher","first-page":"e20791","DOI":"10.1016\/j.heliyon.2023.e20791","article-title":"Association of troponin I and macrophages in cardiac tamponade with Stanford type A aortic dissection","volume":"9","author":"Kimura","year":"2023","journal-title":"Heliyon"},{"key":"B6","doi-asserted-by":"publisher","first-page":"e615","DOI":"10.5001\/omj.2024.15","article-title":"Aortic dissection complicated by coronary malperfusion and tamponade: a case report","volume":"39","author":"Abdul-Nabi","year":"2024","journal-title":"Oman Med J"},{"key":"B7","doi-asserted-by":"publisher","first-page":"1210","DOI":"10.1016\/j.hlc.2020.01.008","article-title":"Surgery for type A aortic dissection: 14-year contemporary cohort study","volume":"29","author":"Wang","year":"2020","journal-title":"Heart Lung Circ"},{"key":"B8","doi-asserted-by":"publisher","first-page":"1357","DOI":"10.1016\/j.athoracsur.2020.01.078","article-title":"Long-term outcomes after controlled pericardial drainage for acute type A aortic dissection","volume":"110","author":"Nakai","year":"2020","journal-title":"Ann Thorac Surg"},{"key":"B9","doi-asserted-by":"publisher","first-page":"1126","DOI":"10.1016\/j.rec.2015.10.008","article-title":"2015 ESC guidelines for the diagnosis and management of pericardial diseases","volume":"68","author":"Adler","year":"2015","journal-title":"Rev Esp Cardiol (Engl Ed)"},{"key":"B10","doi-asserted-by":"publisher","first-page":"331","DOI":"10.1038\/s41569-020-00472-6","article-title":"Epidemiology and management of aortic disease: aortic aneurysms and acute aortic syndromes","volume":"18","author":"Bossone","year":"2021","journal-title":"Nat Rev Cardiol"},{"key":"B11","doi-asserted-by":"publisher","first-page":"735","DOI":"10.1016\/j.jtcvs.2021.04.053","article-title":"2021 The American Association for Thoracic Surgery expert consensus document: surgical treatment of acute type A aortic dissection","volume":"162","author":"Malaisrie","year":"2021","journal-title":"J Thorac Cardiovasc Surg"},{"key":"B12","doi-asserted-by":"publisher","first-page":"1029","DOI":"10.1016\/j.amjcard.2008.12.013","article-title":"Characteristics and in-hospital outcomes of patients with cardiac tamponade complicating type A acute aortic dissection","volume":"103","author":"Gilon","year":"2009","journal-title":"Am J Cardiol"},{"key":"B13","doi-asserted-by":"publisher","first-page":"1536","DOI":"10.1080\/08941939.2022.2078022","article-title":"Perioperative complications and postoperative mortality in patients of acute Stanford type A aortic dissection with cardiac tamponade","volume":"35","author":"Ji","year":"2022","journal-title":"J Invest Surg"},{"key":"B14","doi-asserted-by":"publisher","first-page":"141","DOI":"10.1186\/s13019-025-03370-5","article-title":"Incidence of secondary pericardial effusions associated with different etiologies: a comprehensive review of literature","volume":"20","author":"Ebrahimi","year":"2025","journal-title":"J Cardiothorac Surg"},{"key":"B15","doi-asserted-by":"publisher","first-page":"1013979","DOI":"10.3389\/fcvm.2022.1013979","article-title":"The safety of pericardiocentesis in patients under antithrombotic therapy: a single-center experience","volume":"9","author":"Zhu","year":"2022","journal-title":"Front Cardiovasc Med"},{"key":"B16","doi-asserted-by":"publisher","first-page":"1062","DOI":"10.1002\/ccd.31042","article-title":"Hemodynamics of low-pressure cardiac tamponade: an illustrative case report","volume":"103","author":"Thach","year":"2024","journal-title":"Catheter Cardiovasc Interv"},{"key":"B17","doi-asserted-by":"publisher","first-page":"101936","DOI":"10.1016\/j.jaccas.2023.101936","article-title":"Cardiac tamponade with a transaortic percutaneous left ventricular assist device: when alarms caused no alarm","volume":"19","author":"Sande Mathias","year":"2023","journal-title":"JACC Case Rep"},{"key":"B18","doi-asserted-by":"publisher","first-page":"S97","DOI":"10.1161\/CIRCULATIONAHA.111.082685","article-title":"Impact of controlled pericardial drainage on critical cardiac tamponade with acute type A aortic dissection","volume":"126","author":"Hayashi","year":"2012","journal-title":"Circulation"},{"key":"B19","doi-asserted-by":"publisher","first-page":"E43","DOI":"10.1002\/ccd.22537","article-title":"Guidelines for the diagnosis and management of patients with thoracic aortic disease: executive summary. A report of the American College of Cardiology Foundation\/American Heart Association Task Force on Practice Guidelines, American Association for Thoracic Surgery, American College of Radiology, American Stroke Association, Society of Cardiovascular Anesthesiologists, Society for Cardiovascular Angiography and Interventions, Society of Interventional Radiology, Society of Thoracic Surgeons, and Society for Vascular Medicine","volume":"76","author":"Hiratzka","year":"2010","journal-title":"Catheter Cardiovasc Interv"},{"key":"B20","doi-asserted-by":"publisher","first-page":"2873","DOI":"10.1093\/eurheartj\/ehu281","article-title":"2014 ESC guidelines on the diagnosis and treatment of aortic diseases: document covering acute and chronic aortic diseases of the thoracic and abdominal aorta of the adult. The Task Force for the Diagnosis and Treatment of Aortic Diseases of the European Society of Cardiology (ESC)","volume":"35","author":"Erbel","year":"2014","journal-title":"Eur Heart J"},{"key":"B21","doi-asserted-by":"publisher","first-page":"e0229648","DOI":"10.1371\/journal.pone.0229648","article-title":"Surgical rescues for critical hemopericardium complicated by acute type A aortic dissection: emergent subxiphoid pericardiotomy or cardiopulmonary bypass first?","volume":"15","author":"Lin","year":"2020","journal-title":"PLoS One"},{"key":"B22","doi-asserted-by":"publisher","first-page":"274","DOI":"10.1002\/ccr3.3513","article-title":"Acute aortic dissection combined with cardiac tamponade in an elderly patient saved by pericardial drainage: a case report","volume":"9","author":"Une","year":"2020","journal-title":"Clin Case Rep"}],"container-title":["Frontiers in Cardiovascular Medicine"],"original-title":[],"link":[{"URL":"https:\/\/www.frontiersin.org\/articles\/10.3389\/fcvm.2025.1595842\/full","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,8,8]],"date-time":"2025-08-08T05:27:57Z","timestamp":1754630877000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.frontiersin.org\/articles\/10.3389\/fcvm.2025.1595842\/full"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2025,8,8]]},"references-count":22,"alternative-id":["10.3389\/fcvm.2025.1595842"],"URL":"https:\/\/doi.org\/10.3389\/fcvm.2025.1595842","relation":{},"ISSN":["2297-055X"],"issn-type":[{"value":"2297-055X","type":"electronic"}],"subject":[],"published":{"date-parts":[[2025,8,8]]},"article-number":"1595842"}}