Author + information
- Rajesh Pradhan,
- Toshimasa Okabe,
- Kazuki Yoshida,
- Dimitrios Angouras,
- Matthew Decaro and
- Gregary Marhefka
Pericardial decompression syndrome (PDS) is a rare and potentially fatal complication of apparently successful pericardiocentesis, characterized by paradoxical hemodynamic deterioration, ventricular dysfunction and pulmonary edema. We sought to elucidate epidemiology and clinical factors associated with mortality in PDS.
A systematic review of PDS reported in PubMed was performed. We collected baseline clinical variables, echocardiographic and hemodynamic variables, methods of drainage (needle versus surgical drainage), amount of fluid, and clinical outcomes. A case of PDS from our institution was added. T-test and Fisher's exact test were used for analysis of continuous and categorical variables, respectively.
Total 34 cases (male 12: female 22) were identified. Needle pericardiocentesis, surgical drainage, or both were performed in 18, 15 and 1 patients, respectively. The procedure was done for cardiac tamponade in 32 cases. The mean age was 48 ± 17. Large effusion was seen in 29 (85%) cases. Twenty patients (59%) had an underlying malignancy. Etiologies of effusion were malignant, infectious, traumatic, post-radiation, post-cardiotomy and unknown in 12 (35%), 3 (9%), 1 (4%), 1(4%), 1(4%) and 15 (44%) cases, respectively. Thirty cases reported the amount of effusion drained, and the mean amount was 902 ± 404 mL. The minimum drained effusion was 450 mL. The onset of PDS after the procedure varied widely, ranging from “immediate” to 48 hours. Cardiogenic pulmonary edema without shock, left ventricular (LV) failure only, right ventricular failure only, biventricular failure, and non cardiogenic pulmonary edema were seen in 9 (26%), 14 (41%), 3 (9%), 7 (20%) and 1 (4%) cases, respectively. Ten patients (33%) died of PDS. Mortality was seen only after surgical drainage and the association was statistically significant (p < 0.001). Severe LV dysfunction normalized in all PDS survivors.
PDS is a rare complication of pericardiocentesis with a high mortality rate. The minimum amount of drained effusion in our series was 450 mL. Surgical drainage was a predictor of mortality in PDS.
Poster Sessions, Expo North
Sunday, March 10, 2013, 3:45 p.m.-4:30 p.m.
Session Title: Pericardial Diseases
Abstract Category: 23. Pericardial/Myocardial Disease
Presentation Number: 1250-141
- 2013 American College of Cardiology Foundation