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Sobieski C, Herner M, Goyal N, Khor LL, Chang L, Bieging E, McGarry TJ. Pericardial Decompression Syndrome After Drainage of Chronic Pericardial Effusions. JACC Case Rep 2022; 4:1515-1521. [PMID: 36444176 PMCID: PMC9700074 DOI: 10.1016/j.jaccas.2022.08.023] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2022] [Revised: 07/20/2022] [Accepted: 08/10/2022] [Indexed: 06/16/2023]
Abstract
Pericardial decompression syndrome (PDS) is a potentially fatal disorder of left ventricular function that sometimes occurs after drainage of a pericardial effusion for cardiac tamponade. Patients at risk for PDS are difficult to identify. Here, we report 2 cases where PDS developed after drainage of effusions that had been present for years, suggesting that patients with chronic effusions are at higher risk for PDS. (Level of Difficulty: Advanced.).
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Affiliation(s)
- Catherine Sobieski
- Department of Internal Medicine, University of Utah School of Medicine, Salt Lake City, Utah, USA
| | - Maranda Herner
- Department of Internal Medicine, University of Utah School of Medicine, Salt Lake City, Utah, USA
- Division of Cardiovascular Medicine, Department of Internal Medicine, University of Utah School of Medicine, Salt Lake City, Utah, USA
| | - Noopur Goyal
- Department of Internal Medicine, University of Utah School of Medicine, Salt Lake City, Utah, USA
- Division of Cardiovascular Medicine, Department of Internal Medicine, University of Utah School of Medicine, Salt Lake City, Utah, USA
| | - Lillian L. Khor
- Department of Internal Medicine, University of Utah School of Medicine, Salt Lake City, Utah, USA
- Division of Cardiovascular Medicine, Department of Internal Medicine, University of Utah School of Medicine, Salt Lake City, Utah, USA
- Division of Cardiology, Department of Internal Medicine, George E. Wahlen VA Medical Center, Salt Lake City, Utah, USA
| | - Lowell Chang
- Department of Internal Medicine, University of Utah School of Medicine, Salt Lake City, Utah, USA
- Division of Cardiovascular Medicine, Department of Internal Medicine, University of Utah School of Medicine, Salt Lake City, Utah, USA
- Division of Cardiology, Department of Internal Medicine, George E. Wahlen VA Medical Center, Salt Lake City, Utah, USA
| | - Erik Bieging
- Department of Internal Medicine, University of Utah School of Medicine, Salt Lake City, Utah, USA
- Division of Cardiovascular Medicine, Department of Internal Medicine, University of Utah School of Medicine, Salt Lake City, Utah, USA
- Division of Cardiology, Department of Internal Medicine, George E. Wahlen VA Medical Center, Salt Lake City, Utah, USA
| | - Thomas J. McGarry
- Department of Internal Medicine, University of Utah School of Medicine, Salt Lake City, Utah, USA
- Division of Cardiovascular Medicine, Department of Internal Medicine, University of Utah School of Medicine, Salt Lake City, Utah, USA
- Division of Cardiology, Department of Internal Medicine, George E. Wahlen VA Medical Center, Salt Lake City, Utah, USA
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Amro A, Mansoor K, Amro M, Sobeih A, Suliman M, Okoro K, El-Hamdani R, Vilchez D, El-Hamdani M, Shweihat Y
R. A Comprehensive Systemic Literature Review of Pericardial Decompression Syndrome: Often Unrecognized and Potentially Fatal Syndrome. Curr Cardiol Rev 2021; 17:101-110. [PMID: 32515313 PMCID: PMC8142365 DOI: 10.2174/1573403x16666200607184501] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/05/2020] [Revised: 04/28/2020] [Accepted: 05/05/2020] [Indexed: 11/22/2022] Open
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 discrete 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 from 1983 to 2019. A total of 6508 articles were reviewed, out of which, 210 were short-listed, and 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 conducted for continuous variable and chi-square test was conducted for categorical data 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 patients 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, and pericardiostomy was performed in 45.8% (n=27). The most common identifiable cause of pericardial effusion was found to be malignancy in 35.6% (n=21). Twenty-three 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. The 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.
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Affiliation(s)
- Ahmed Amro
- Address correspondence to this author at the Internal Medicine Department, Joan C. Edwards School of Medicine, Marshall University, Huntington, WV 25755, USA; Tel: 3046544199; E-mail:
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Zhang J, Zhang Q, Chen X, Zhang N. Management of neoplastic pericardial disease. Herz 2019; 45:46-51. [PMID: 31297544 DOI: 10.1007/s00059-019-4833-4] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2019] [Revised: 06/07/2019] [Accepted: 06/14/2019] [Indexed: 12/14/2022]
Abstract
At present, there is no accurate and effective method for treating neoplastic pericardial effusion. This study analyzed the current literature on the treatment of neoplastic pericardial effusion to provide advice and guidance for clinical treatment. Surgical treatments include pericardial puncture, extension of catheter drainage, pericardial window, and surgical pericardiotomy. Each surgical procedure has a corresponding indication, and the best treatment is selected according to the patient's specific conditions. Systemic chemotherapy is effective in lymphoma and small cell lung cancer that are sensitive to chemotherapeutic drugs. Although pericardial injection of drugs is effective for pericardial tamponade and recurrent pericardial effusion, these methods can only temporarily relieve symptoms and cannot prolong the life of patients. In recent years, immunotherapy, especially adoptive immunotherapy, has achieved good results in the treatment of neoplastic pericardial effusion, thus providing a novel treatment option for neoplastic pericardial effusion.
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Affiliation(s)
- J Zhang
- Department of Cardiology, the Fourth Affiliated Hospital of Hebei Medical University, 050011, Shijiazhuang, Hebei Province, China
| | - Q Zhang
- Department of Clinical Medicine, Basic Medical College of Seven Years (2014), Hebei Medical University, 050017, Shijiazhuang, Hebei Province, China
| | - X Chen
- Department of Clinical Medicine, Basic Medical College of Seven Years (2014), Hebei Medical University, 050017, Shijiazhuang, Hebei Province, China
| | - N Zhang
- Department of Cardiology, the Fourth Affiliated Hospital of Hebei Medical University, 050011, Shijiazhuang, Hebei Province, China.
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Chung J, Ocken L, Wolo E, Herman CR, Goldhammer JE. Acute Right Ventricular Failure After Surgical Drainage of Pericardial Tamponade: A Case Report of Pericardial Decompression Syndrome and Review of the Literature. J Cardiothorac Vasc Anesth 2018; 33:768-771. [PMID: 29731332 DOI: 10.1053/j.jvca.2018.04.009] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/09/2018] [Indexed: 12/21/2022]
Affiliation(s)
- Jaeyoon Chung
- Department of Anesthesiology, Sidney Kimmel Medical College at Thomas Jefferson University, Philadelphia, PA
| | - Levi Ocken
- Department of Anesthesiology, Sidney Kimmel Medical College at Thomas Jefferson University, Philadelphia, PA
| | - Elizabeth Wolo
- Department of Anesthesiology, Sidney Kimmel Medical College at Thomas Jefferson University, Philadelphia, PA
| | - Corey R Herman
- Department of Anesthesiology, Sidney Kimmel Medical College at Thomas Jefferson University, Philadelphia, PA
| | - Jordan E Goldhammer
- Department of Anesthesiology, Sidney Kimmel Medical College at Thomas Jefferson University, Philadelphia, PA.
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Abstract
Disease of the pericardium represents a relatively rare indication for cardiac surgery, and there exist no widely accepted guidelines for surgical management. As such, the surgical approach to the pericardium has relied largely on institutional experience with a slow evolution based on published studies. In particular, management of pericardial constriction has varied widely from surgeon to surgeon and institution to institution, in large part due to a perception of inherent high risk to the procedure. This review covers the current practice of surgery for disease of the pericardium, with particular focus on the evolution of indications for pericardiectomy, new applications in inflammatory or relapsing pericarditis, and the progressive refinement in surgical technique and operative planning which have led to significantly improved outcomes in experienced centers.
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