Acute Right Ventricular Failure After Surgical Drainage of Pericardial Tamponade: A Case Report of Pericardial Decompression Syndrome and Review of the Literature

Chung, Jaeyoon; Ocken, Levi; Wolo, Elizabeth; Herman, Corey R.; Goldhammer, Jordan E.

doi:10.1053/j.jvca.2018.04.009

Cited by 14 publications

(14 citation statements)

References 12 publications

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“…Interestingly, 29% of patients died and the mortality risk was found to be higher in patients who underwent surgical pericardiotomy [3]. In those who survived with LV impairment, TTE follow-up showed a return of normal LV function [4]. Similarly, reports of RV dysfunction in those who survived also showed a return of normalized RV function.…”

Section: Discussionmentioning

confidence: 99%

“…A bedside transthoracic echocardiogram (TTE) showed a new early diastolic RV collapse with a large pericardial effusion ( Figure 1, Video 1). The inferior vena cava was dilated at 29 mm ( Figure 2), was non-compressible, and had a blunted respirophasic motion (Video 2, Figures 3,4). She underwent an emergent pericardial window with the removal of 1.2 liters of serous fluid and adequate clinical improvement.…”

Section: Case Presentationmentioning

confidence: 99%

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Damned If You Drain, Damned If You Don't: A Case of Pericardial Decompression Syndrome

Rao

Alcantar

Espinoza

et al. 2020

Cureus

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Pericardial decompression syndrome (PDS) is an unusual clinical scenario with a reported incidence of 5% in all surgical or percutaneously managed pericardial tamponade patients. It is defined as a paradoxical hemodynamic instability leading to left ventricular (LV), right ventricular (RV), or biventricular dysfunction. An 84-year-old female with a history of a chronic pericardial effusion presented with symptoms of tamponade. She had had multiple prior admissions with an extensive and unyielding workup for the etiology of her pericardial effusion. During the present admission, a transthoracic echocardiogram (TTE) confirmed an augmenting pericardial effusion causing cardiac tamponade. She underwent a pericardial window with the removal of 1.2 liters of serous fluid. Postoperatively, she went into cardiogenic shock from right heart failure. Unfortunately, there also was re-accumulation of the pericardial effusion and worsening hemodynamic instability. Due to her poor prognosis, she was transitioned to comfort care. Although the etiology of PDS is unknown, it has been theorized to be caused by an imbalance of sympathetic-parasympathetic states after a rapid decompression. Currently, there are no clear guidelines or recommendations regarding the quantity of fluid that can be removed safely. More awareness leading to a more cautious and staged pericardial drainage might be the required solution.

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Section: Discussionmentioning

confidence: 99%

Section: Case Presentationmentioning

confidence: 99%

Damned If You Drain, Damned If You Don't: A Case of Pericardial Decompression Syndrome

Rao

Alcantar

Espinoza

et al. 2020

Cureus

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“…При дробном удалении экссудата пациенты легче переносили вмешательство, при эвакуации 200-400 мл уже отмечалось повышение артериального давления и снижение ЦВД. Постепенная декомпрессия сердца предотвращала развитие опасной правожелудочковой недостаточности и систолической дисфункции левого желудочка, что согласуется с литературными данными [23,24]. Если при эвакуации большого объема экссудата сохранялись признаки сдавления сердца, подозревали выраженный спаечный процесс, в том числе с локальным осумкованным скоплением жидкости.…”

Section: кг органов грудной клетки у пациентки со злокачественным новunclassified

Life-threatening conditions in pericarditis of different etiologies: diagnosis and treatment

et al. 2019

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Purpose of the study: to analyze the etiology, diagnostic criteria and results of treatment of life-threatening conditions in pericarditis of different etiologies (based on our clinic materials).Materials and methods. The study included cases of hospitalization of patients with a diagnosis of «Pericarditis» and ICD-10 codes for pericardial diseases for the period from 2009 to 2018. In the course of the work, the history and clinical picture of the disease, laboratory and radiation research methods were analyzed. All patients started treatment of the underlying disease and performed symptomatic therapy, including those aimed at restoring hemodynamics and normalizing water and electrolyte disorders, stopping inflammation and auto-aggression of the immune system. When signs of compression/cardiac tamponade were detected, pericardiocentesis was performed, according to indications, drainage/fenestration of the cardiac sac, pericardiotomy were performed. In the postoperative period was carried out antibacterial and symptomatic therapy.Results. Life-threatening diseases of the pericardium accounted for 32,03% of all patients treated in the hospital for pericarditis. The most frequently detected signs of a hemodynamically significant compression and cardiac tamponade, less often purulent and constrictive P. Isolated 25 patients underwent closed drainage with pericardiocentesis, in 1 case the drainage was supplemented with f ibrinolytic therapy. Sanitation of the cavity and fenestration of the pericardium were carried out in 11 patients, pericardiotomy with notched drainage in 2 patients, thoracotomy with pericardiectomy – 4. In the postoperative period, the symptoms of inflammation were reduced, the level of cardiac enzymes decreased, the electrolyte balance stabilized. Most patients noted a distinct regression of the symptoms of pericarditis and cardiac compression. Recurrent P was noted in 5 cases, deaths occurred in 4 cases (8,16%).Conclusion. Early verification of the diagnosis and timely decompression of the heart with fractional evacuation of the exudate or pericardectomy with respect to the sequence of release of the heart chambers from adhesions and adhesions against the background of complex therapy allows to achieve positive dynamics, and fenestration of the cardiac bag with the formation of a sufficiently sized opening during recurrent fluid accumulation or intrapericardial fibrin. development of severe complications of pericarditis even in patients with multiple concomitant diseases evanii and oncopathology.

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“…A common indication to perform these procedures is pericardial effusion that causes hemodynamic instability (cardiac tamponade) or evolves towards that condition. In the current scientific literature there are about 35 cases of this syndrome published from 1983 to 2013 [1,2], although the term pericardial decompression syndrome was not coined until 2010 [3]. According to the current literature, the incidence could be around 4% after subxiphoid pericardiotomy and 11% after surgical window, although the degree of ventricular dysfunction in each case is very variable.…”

Section: Case Presentationmentioning

confidence: 99%

“…According to the current literature, the incidence could be around 4% after subxiphoid pericardiotomy and 11% after surgical window, although the degree of ventricular dysfunction in each case is very variable. Mortality varies between 29 and 80% [1,2], although these data could be sensibly different due to little scientific evidence available.…”

Section: Case Presentationmentioning

confidence: 99%

Ventricular Failure After Pericardial Decompression- Successful Outcome By Early ECMO Implant

Veiras¹,

Bolón²,

Aneiros³

et al. 2019

Surg Res

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We report a case of a 68-year-old woman referred to our hospital after being diagnosed of acute coronary syndrome with ST elevation but no evidence of coronary stenosis amenable of percutaneous or surgical approach. She was transferred to our institution due to pericardial effusion with incipient haemodynamic compromise and under suspicion of contained cardiac rupture. Pericardial collection was shown in a rutine transthoracic echocardiogram study meanwhile the patient was recovering from coronary event in a different hospital with no Cardiac Surgery facilities. After sternotomy and removal of pericardial fluid, biventricular failure developed with no answer to inotrope support. Venous-arterial extracorporeal membrane oxygenation (VA-ECMO) through femoral vasculature was initiated in few minutes. The outcome of this patient was succesful and biventricular function was completely recovered.

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Acute Right Ventricular Failure After Surgical Drainage of Pericardial Tamponade: A Case Report of Pericardial Decompression Syndrome and Review of the Literature

Cited by 14 publications

References 12 publications

Damned If You Drain, Damned If You Don't: A Case of Pericardial Decompression Syndrome

Damned If You Drain, Damned If You Don't: A Case of Pericardial Decompression Syndrome

Life-threatening conditions in pericarditis of different etiologies: diagnosis and treatment

Ventricular Failure After Pericardial Decompression- Successful Outcome By Early ECMO Implant

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