Pericardial effusions in the cancer population: Prognostic factors after pericardial window and the impact of paradoxical hemodynamic instability

Wagner, Patrick; McAleer, Eileen; Stillwell, Elizabeth E.; Bott, Matthew; Rusch, Valerie W.; Schaffer, Wendy; Huang, James

doi:10.1016/j.jtcvs.2010.09.015

Cited by 53 publications

(69 citation statements)

References 18 publications

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“…Numico et al, looking at their own observations, suggested that patients with greater volume of effusion may have a better response after intrapericardial therapy (34). On the other hand, evidence of tamponade on ECG, larger effusion volume, and positive cytological findings may predict a higher risk of paradoxical hemodynamic instability after pericardial window in patients with cancer (35). Our study revealed that the degree of hemodynamic instability was insignificant for the final efficacy of rescue intrapericardial cisplatin chemotherapy.…”

Section: Treatment Of Recurrent Pericardial Effusionmentioning

confidence: 51%

Determinants of Survival After Emergency Intrapericardial Cisplatin Treatment in Cancer Patients with Recurrent Hemodynamic Instability After Pericardiocentesis

Darocha¹,

Wilk²,

Walaszkowska-Czyż³

et al. 2018

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. Conclusion: Efficacy of rescue intrapericardial chemotherapy with cisplatin is independent of parameters of hemodynamic instability and levels of inflammatory markers in recurrent pericardial effusion.Pericardial diseases constitute an infrequent, although very serious clinical problem among oncological patients. They practically always cause deterioration of the patient's quality of life. The increasing amount of pericardial effusion and the resulting cardiac tamponade is a life-threatening condition which requires urgent diagnostics and treatment.The European Society of Cardiology (ESC) Position Paper related to cardio-oncology summarizes the knowledge on acute and chronic pericarditis as the complication resulting from anticancer treatment: some cytotoxic drugs and radiotherapy (1). Experts indicate that pericardial complications in oncology are usually associated with mediastinal tumors occupying the pericardium. The document does not discuss the issue of pericardial effusion as a potential manifestation of malignant tumor progression. The present state of knowledge concerning malignant pericarditis is based on several retrospective studies and descriptions of small groups of patients. This article presents our own prospective experience related to the treatment of patients suffering from recurrent pericardial effusion and hemodynamic instability in the course of malignant disease.The primary purpose of the observation was the assessment of determinants of overall survival of oncological patients subject to emergency pericardiocentesis and intrapericardial chemotherapy with the use of cisplatin due to recurrent symptomatic pericardial effusion and cardiac tamponade.The detailed aims included the identification of factors which could have direct impact on the overall survival of patients, these included among others: complications of pericardiocentesis and cisplatin administered intrapericardially; signs of inflammatory process: pericardial effusion culture test results, fever, white blood cell count; hemodynamic conditions: baseline level of N-terminal pro-B type natriuretic peptide (NTproBNP), volume and duration of pericardial drainage; interval for recurrence pericardial effusion; possibility of further anticancer treatment. 373

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Section: Treatment Of Recurrent Pericardial Effusionmentioning

confidence: 51%

Determinants of Survival After Emergency Intrapericardial Cisplatin Treatment in Cancer Patients with Recurrent Hemodynamic Instability After Pericardiocentesis

Darocha¹,

Wilk²,

Walaszkowska-Czyż³

et al. 2018

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“…It resembles hyperadrenergic stress cardiomyopathy of the left ventricle (takotsubo). It is observed more frequently in patients with malignant, large‐volume effusions and following pericardiocentesis for cardiac tamponade . It has been hypothesized that the sudden increase in preload of the thin‐walled RV following pericardial fluid drainage culminates in decreased myocardial contractility due to overstretch of myocardial sarcomeres .…”

Section: Discussionmentioning

confidence: 99%

“…It is observed more frequently in patients with malignant, large-volume effusions and following pericardiocentesis for cardiac tamponade. 2 It has been hypothesized that the sudden increase in preload of the thin-walled RV following pericardial fluid drainage culminates in decreased myocardial contractility due to overstretch of myocardial sarcomeres. 1 Others suggested that it is the decreased coronary flow resulting from large pericardial effusion that does not reverse postpericardiocentesis is the cause of the RV failure.…”

Section: Discussionmentioning

confidence: 99%

Paradoxical Hemodynamic Instability After Pericardial Window

et al. 2016

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Paradoxical hemodynamic instability (PHI), also called postoperative low cardiac output syndrome (LCOS), is a rare but fatal complication after drainage of a pericardial effusion (PEf). This condition usually develops within hours postprocedure and appears unrelated to the method of drainage. The exact mechanism of this condition is not well understood. We present a case of an 84-year-old patient with no previous cardiac or cancer history who presented with acute shortness of breath (SOB). Computed tomography (CT) ruled out pulmonary embolism and echocardiography confirmed early tamponade. Following emergent subxiphoid pericardiectomy, the patient developed hemodynamic instability and shock and subsequent multiorgan failure. Repeat echocardiography revealed left ventricular (LV) hypercontractility and new right ventricular (RV) dilatation with akinesis. The patient's condition continued to deteriorate in spite of maximal doses of pressors. The patient died after the family's request to discontinue further extraordinary measures.

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“…2 PDS after pericardiocentesis has been described more often in the literature than SCM. [2][3][4][5] However, SCM post pericardiocentesis has been underestimated because there is no objective examination to differentiate PDS from SCM. Ayoub et al 4 suggested that some reports of PDS may actually be SCM post pericardiocentesis.…”

Section: Introductionmentioning

confidence: 99%

Transient midventricular ballooning syndrome with thrombus post pericardiocentesis in a patient with malignant breast cancer

Moon

Lee

et al. 2016

J of Clinical Ultrasound

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One day after pericardiocentesis for pericardial effusion in a patient with malignant breast cancer, the clinical and echocardiographic examination for recurrent dyspnea suggested stress cardiomyopathy with mid left ventricular ballooning and thrombus rather than pericardial decompression syndrome. Physicians should therefore pay attention to the possibility of ventricular dysfunction with thrombus post pericardiocentesis and to differences between stress cardiomyopathy and pericardial decompression syndrome. © 2016 Wiley Periodicals, Inc. J Clin Ultrasound 45:53-57, 2017.

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Pericardial effusions in the cancer population: Prognostic factors after pericardial window and the impact of paradoxical hemodynamic instability

Cited by 53 publications

References 18 publications

Determinants of Survival After Emergency Intrapericardial Cisplatin Treatment in Cancer Patients with Recurrent Hemodynamic Instability After Pericardiocentesis

Determinants of Survival After Emergency Intrapericardial Cisplatin Treatment in Cancer Patients with Recurrent Hemodynamic Instability After Pericardiocentesis

Paradoxical Hemodynamic Instability After Pericardial Window

Transient midventricular ballooning syndrome with thrombus post pericardiocentesis in a patient with malignant breast cancer

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