A Comprehensive Systemic Literature Review of Pericardial Decompression Syndrome: Often Unrecognized and Potentially Fatal Syndrome

Abstract

Background: Pericardial Decompression Syndrome (PDS) is defined as paradoxical hemodynamic deterioration and/or pulmonary edema, commonly associated with ventricular dysfunction. This phenomenon was first described by Vandyke in 1983. PDS is a rare but formidable complication of pericardiocentesis which if not managed appropriately is fatal. PDS as an entity has dispersed literature; this review is to understand its epidemiology, presentation, and management. Methodology: Medline: Science Direct and Google Scholar databases were utilized to do a systemic literature search. PRISMA protocol was employed. Abstracts, case reports, case series and clinical studies were identified since 1983 to 2019. A total of 6508 articles were reviewed out of which 210 were short listed, after removal of duplicates 49 manuscripts were included in this review. For Statistical analysis, patient data was tabulated in SPSS version 20. Cases were divided into two categories surgical and percutaneous groups. T test was done for continuous variable and chi square test was done for categorical data was used for analysis. Results: A total of 42 full length case reports, 2 poster abstracts, 3 case series of 2 patients , 1 case series of 4 patient s and 1 case series of 5 patients were included in the study. A total of 59 cases were included in this manuscript. Our data had 45.8% (n=27) males and 54.2% (n=32) females. The mean age of patients was 48.04 ± 17 years. Pericardiocentesis was performed in 52.5% (n=31) cases, Pericardiostomy was performed in 45.8% (n=27). The most common identifiable cause pericardial effusion was found to be malignancy in 35.6% (n=21). 23 cases reported pre-procedural ejection fraction which ranged from 20%-75% with a mean of 55.8 ± 14.6%, while 26 cases reported post procedural ejection fraction which ranged from 10%-65% with a mean of 30% ± 15.1%. Data was further divided into two categories namely, pericardiocentesis and pericardiostomy. The outcome as death was significant in the pericardiostomy arm with a p-value of < 0.00. Use of inotropic agents for the treatment of PDS was more common in needle pericardiocentesis with a p-value of 0.04. Lastly, the computed recovery time did not yield any significance with a p-value of 0.275. Conclusion: Pericardial decompression syndrome is a rare condition with high mortality. Operators performing pericardial drainage should be aware of this complication following drainage of cardiac tamponade, since early recognition and expeditious supportive care are the only therapeutic modalities available for adequate management of this complication.

Pericardial Decompression Syndrome: A Case Series and Literature Review

“…Scarce literature exists outlining the risk and predictive factors of developing PDS. A recent review of PDS identified five characteristics associated with the development of PDS following drainage: malignancy-related effusions, history of radiotherapy, female sex, volume of pericardial fluid drained, and the rate of pericardial drainage 3 . In this review, 59 cases of PDS were identified between 1983 and 2019 3 .…”

“…A recent review of PDS identified five characteristics associated with the development of PDS following drainage: malignancy-related effusions, history of radiotherapy, female sex, volume of pericardial fluid drained, and the rate of pericardial drainage 3 . In this review, 59 cases of PDS were identified between 1983 and 2019 3 . Amongst these, malignancy was the most common cause of pericardial effusion, occurring in 38.7% of cases, followed by idiopathic effusions 3 .…”

“…Emergent needle decompression or surgical pericardiostomy are the mainstay of treatment to improve cardiac hemodynamics. However, in approximately 5% of percutaneously managed cardiac tamponade 2 , patients may experience paradoxical hemodynamic instability also known as pericardial decompression syndrome (PDS) 3 . PDS is defined as paradoxical hemodynamic instability following pericardial drainage leading to ventricular dysfunction 3 .…”

“…However, in approximately 5% of cases of percutaneously managed cardiac tamponade, 2 patients may experience paradoxical hemodynamic instability, also known as pericardial decompression syndrome (PDS). 3 PDS is defined as paradoxical hemodynamic instability following pericardial drainage leading to ventricular dysfunction. 3 However, the exact etiology of PDS remains unclear.…”

“… 3 PDS is defined as paradoxical hemodynamic instability following pericardial drainage leading to ventricular dysfunction. 3 However, the exact etiology of PDS remains unclear. In this report, we describe the cases of 3 patients with PDS, and provide a review of the current literature on this topic (see Table 1 for patient characteristics).…”