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Systematic Review Article

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

Author(s): Ahmed Amro*, Kanaan Mansoor, Mohammad Amro, Amal Sobeih, Mohamed Suliman, Kelechukwu Okoro, Rawan El-Hamdani, Daniel Vilchez, Mehiar El-Hamdani and Yousef R. Shweihat

Volume 17, Issue 1, 2021

Published on: 07 June, 2020

Page: [101 - 110] Pages: 10

DOI: 10.2174/1573403X16666200607184501

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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.

Keywords: Pericardial decompression syndrome, pulmonary edema, ventricular dysfunction, pericardiocentesis, pericardial drainage, cardiac tamponade.

Graphical Abstract

[1]
Wagner PL, McAleer E, Stillwell E, et al. Pericardial effusions in the cancer population: Prognostic factors after pericardial window and the impact of paradoxical hemodynamic instability. J Thorac Cardiovasc Surg 2008; 55(11): 3954-63.
[2]
Vandyke WH Jr, Cure J, Chakko CS, Gheorghiade M. Pulmonary edema after pericardiocentesis for cardiac tamponade. N Engl J Med 1983; 309(10): 595-6.
[http://dx.doi.org/10.1056/NEJM198309083091006] [PMID: 6877287]
[3]
Han AJ, Slomka T, Mehrotra A, Murillo LC, Alsafwah SF, Khouzam RN. Paradoxical hemodynamic instability after pericardial window. Echocardiography 2016; 33(8): 1251-2.
[http://dx.doi.org/10.1111/echo.13229] [PMID: 27046800]
[4]
Abdelsalam M, Moritz TA, Snyder JA, Cheriyath P, Spizzieri CL. Paradoxical hemodynamic instability complicating pericardial window surgery for cardiac tamponade in a cancer patient. Tex Heart Inst J 2012; 39(5): 711-3.
[PMID: 23109775]
[5]
Dosios T, Theakos N, Angouras D, Asimacopoulos P. Risk factors affecting the survival of patients with pericardial effusion submitted to subxiphoid pericardiostomy. Chest 2003; 124(1): 242-6.
[http://dx.doi.org/10.1378/chest.124.1.242] [PMID: 12853529]
[6]
Angouras DC, Dosios T. Pericardial decompression syndrome: A term for a well-defined but rather underreported complication of pericardial drainage. Ann Thorac Surg 2010; 89(5): 1702-3.
[http://dx.doi.org/10.1016/j.athoracsur.2009.11.073] [PMID: 20417826]
[7]
Sabzi F, Faraji R. Predictors of post pericardiotomy low cardiac output syndrome in patients with pericardial effusion. J Cardiovasc Thorac Res 2015; 7(1): 18-23.
[http://dx.doi.org/10.15171/jcvtr.2014.04] [PMID: 25859311]
[8]
Pradhan R, Okabe T, Yoshida K, Angouras DC, DeCaro MV, Marhefka GD. Patient characteristics and predictors of mortality associated with pericardial decompression syndrome: a comprehensive analysis of published cases. Eur Heart J Acute Cardiovasc Care 2015; 4: 113-20.
[9]
PRISMA http://www.prisma-statement.org/PRISMAStatement/Default.aspx
[10]
Dosios T, Angouras D. Low cardiac output syndrome complicating subxiphoid pericardiostomy for pericardial effusion. J Thorac Cardiovasc Surg 1997; 113(1): 220.
[http://dx.doi.org/10.1016/S0022-5223(97)70423-9] [PMID: 9011698]
[11]
Bernal JM, Pradhan J, Li T, Tchokonte R, Afonso L. Acute pulmonary edema following pericardiocentesis for cardiac tamponade. Can J Cardiol 2007; 23(14): 1155-6.
[http://dx.doi.org/10.1016/S0828-282X(07)70887-5] [PMID: 18060102]
[12]
Flores VM, Pascual Figal DA, Martínez CC, Valdés-Chávarri M. Transient left ventricular dysfunction following pericardiocentesis. An unusual complication to bear in Mind, Rev. Española Cardiol. Engl Educ 2009; 62(9): 1071-2.
[13]
Fozing T, Zouri N, Adam O, Oezbek C. Management of a patient with pericardial decompression syndrome and HOCM. BMJ Case Rep 2016; 2016: 2015-7.
[http://dx.doi.org/10.1136/bcr-2015-211550] [PMID: 27251601]
[14]
Takeuchi T, Fujimoto N, Dohi K, et al. Acute pulmonary edema with new giant V wave immediately after pericardiocentesis. Int J Cardiol 2016; 212: 253-4.
[http://dx.doi.org/10.1016/j.ijcard.2016.03.158] [PMID: 27054499]
[15]
Wolfe MW, Edelman ER. Transient systolic dysfunction after relief of cardiac tamponade. Ann Intern Med 1993; 119(1): 42-4.
[http://dx.doi.org/10.7326/0003-4819-119-1-199307010-00007] [PMID: 8498762]
[16]
Uemura S, Kagoshima T, Hashimoto T, et al. Acute left ventricular failure with pulmonary edema following pericardiocentesis for cardiac tamponade--a case report. Jpn Circ J 1995; 59(1): 55-9.
[http://dx.doi.org/10.1253/jcj.59.55] [PMID: 7752446]
[17]
Sunday R, Robinson LA, Bosek V. Low cardiac output complicating pericardiectomy for pericardial tamponade. Ann Thorac Surg 1999; 67(1): 228-31.
[http://dx.doi.org/10.1016/S0003-4975(98)01143-6] [PMID: 10086556]
[18]
Koerner MM, Alam M, El-Banayosy A, et al. A case of biventricular failure after pericardial window for large pericardial effusion. Heart Surg Forum 2015; 18(1): 036.
[http://dx.doi.org/10.1532/hsf.1227]
[19]
Liao BT, Lo SS. Paradoxical hemodynamic collapse after subxiphoid pericardial window. A A Case Rep 2015; 4(6): 65-7.
[http://dx.doi.org/10.1213/XAA.0000000000000120] [PMID: 25774750]
[20]
Basmaji SG, Peretz-Larochelle M, Bernier ML. Pericardial decompression syndrome: A rare and potentially dramatic complication of pericardiocentesis. Int J Cardiol 2015; 178: 297-8.
[http://dx.doi.org/10.1016/j.ijcard.2014.11.077] [PMID: 25465843]
[21]
Albeyoglu S, Aldag M, Ciloglu U, Kutlu H, Dagsali S. Biventricular transient systolic dysfunction after mitral valve replacement: Pericardial decompression syndrome. Int J Surg Case Rep 2016; 28: 145-8.
[http://dx.doi.org/10.1016/j.ijscr.2016.09.045] [PMID: 27710875]
[22]
Güler GB, Güler E, Günhan Demir G, Güneş HM. Pericardial decompression syndrome: an uncommon but dangerous complication after successful pericardiocentesis. Kosuyolu Hear J 2017; 20(3): 253-5.
[http://dx.doi.org/10.5578/khj.10324]
[23]
Lango R, Kowalik MM, Siondalski P, Rogowski J, Dabrowska-Kugacka A. High-volume hemofiltration as adjuvant therapy for refractory shock after pericardiocentesis. Heart Surg Forum 2011; 14(5): E313-6.
[http://dx.doi.org/10.1532/HSF98.20111028] [PMID: 21997655]
[24]
Klimis H, Altman M, Tan T, Natividad J, Abraham R, Thomas L. A case of persistent right ventricular failure after rapid decompression of a large chronic pericardial effusion. CASE (Phila) 2018; 2(4): 142-6.
[http://dx.doi.org/10.1016/j.case.2018.02.001] [PMID: 30128413]
[25]
Thrush DN. Biventricular failure after pericardial window. J Cardiothorac Vasc Anesth 1998; 12(6): 676-8.
[http://dx.doi.org/10.1016/S1053-0770(98)90242-7] [PMID: 9854667]
[26]
Anguera I, Paré C, Perez-Villa F. Severe right ventricular dysfunction following pericardiocentesis for cardiac tamponade. Int J Cardiol 1997; 59(2): 212-4.
[http://dx.doi.org/10.1016/S0167-5273(97)02918-5] [PMID: 9158180]
[27]
Liou M, Adawi RL, Rosen M, Jenny D. Biventricular failure post tamponade drainage in a patient with systemic lupus erythematosus and pulmonary hypertension. Chest 2005; 128(1): 472-4.
[http://dx.doi.org/10.1016/S0012-3692(15)37999-X] [PMID: 16002982]
[28]
Ligero C, Leta R, Bayes-Genis A. Transient biventricular dysfunction following pericardiocentesis. Eur J Heart Fail 2006; 8(1): 102-4.
[http://dx.doi.org/10.1016/j.ejheart.2005.05.012] [PMID: 16111917]
[29]
Al Banna R, Husain A. Reversible severe biventricular dysfunction postpericardiocentesis for tuberculous pericardial tamponade. BMJ Case 2011; pp. 2-5.
[30]
Lim ASAL, Paz-Pacheco E, Reyes M, Punzalan F. Pericardial decompression syndrome in a patient with hypothyroidism presenting as massive pericardial effusion: A case report and review of related literature. BMJ Case Rep 2011; 2011: 1-7.
[http://dx.doi.org/10.1136/bcr.04.2011.4117] [PMID: 22679149]
[31]
Dosios T, Stefanidis A, Chatziantoniou C, Sgouropoulou S. Thorough clinical investigation of low cardiac output syndrome after subxiphoid pericardiostomy. Angiology 2007; 58(4): 483-6.
[http://dx.doi.org/10.1177/0003319706291147] [PMID: 17875962]
[32]
Ayoub C, Chang M, Kritharides L. A case report of ventricular dysfunction post pericardiocentesis: stress cardiomyopathy or pericardial decompression syndrome? Cardiovasc Ultrasound 2015; 13(1): 32.
[http://dx.doi.org/10.1186/s12947-015-0026-3] [PMID: 26179174]
[33]
Geffroy A, Beloeil H, Bouvier E, Chaumeil A, Albaladejo P, Marty J. Prolonged right ventricular failure after relief of cardiac tamponade. Can J Anaesth 2004; 51(5): 482-5.
[http://dx.doi.org/10.1007/BF03018312] [PMID: 15128635]
[34]
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 2019; 33(3): 768-71.
[PMID: 29731332]
[35]
Glasser F, Fein AM, Feinsilver SH, Cotton E, Niederman MS. Non-cardiogenic pulmonary edema after pericardial drainage for cardiac tamponade. Chest 1988; 94(4): 869-70.
[http://dx.doi.org/10.1378/chest.94.4.869] [PMID: 3168582]
[36]
Karamichalis JM, Gursky A, Valaulikar G, Pate JW, Weiman DS. Acute pulmonary edema after pericardial drainage for cardiac tamponade. Ann Thorac Surg 2009; 88(2): 675-7.
[http://dx.doi.org/10.1016/j.athoracsur.2009.02.001] [PMID: 19632445]
[37]
Said Ahmed TJ. BarreraCalix, L. Woods, and D. Woredekal, Pericardial decompression syndrome in a patient with low volume pericardial fluid removal. Chest 2017; 152(4): A279.
[http://dx.doi.org/10.1016/j.chest.2017.08.305]
[38]
Shenoy MM, Dhar S, Gittin R, Sinha AK, Sabado M. Pulmonary edema following pericardiotomy for cardiac tamponade. Chest 1984; 86(4): 647-8.
[http://dx.doi.org/10.1378/chest.86.4.647] [PMID: 6478913]
[39]
Downey RJ, Bessler M, Weissman C. Acute pulmonary edema following pericardiocentesis for chronic cardiac tamponade secondary to trauma. Crit Care Med 1991; 19(10): 1323-5.
[http://dx.doi.org/10.1097/00003246-199110000-00016] [PMID: 1914491]
[40]
A. C and C. M. Ventricular impairment after pericardiocentesis: Stress Cardiomyopathy (SCM) or pericardial decompression syndrome (PDS)? Heart Lung Circ 2015; 24(3): S223.
[41]
Moon D, Lee SN, Lee BW, Lee K, Lee EK, Son SW. Transient midventricular ballooning syndrome with thrombus post pericardiocentesis in a patient with malignant breast cancer. J Clin Ultrasound 2017; 45(1): 53-7.
[http://dx.doi.org/10.1002/jcu.22369] [PMID: 27219864]
[42]
Palatianos GM, Thurer RJ, Pompeo MQ, Kaiser GA. Clinical experience with subxiphoid drainage of pericardial effusions. Ann Thorac Surg 1989; 48(3): 381-5.
[http://dx.doi.org/10.1016/S0003-4975(10)62862-7] [PMID: 2774723]
[43]
Allen KB, Faber FP, Warren WH, Shaar CJ. Pericardial effusion: Subxiphoid pericardiostomy vs. percutaneous catheter drainage. Ann Thorac Surg 1999; 67(2): 437-40.
[PMID: 10197666] [http://dx.doi.org/10.1016/s0003-4975(98)01192-8]
[44]
Wagner PL, McAleer E, Stillwell E, et al. Pericardial effusions in the cancer population: Prognostic factors after pericardial window and the impact of paradoxical hemodynamic instability. J Thorac Cardiovasc Surg 2011; 141(1): 34-8.
[http://dx.doi.org/10.1016/j.jtcvs.2010.09.015] [PMID: 21092993]
[45]
Horr SE, Mentias A, Houghtaling PL, et al. Comparison of outcomes of pericardiocentesis versus surgical pericardial window in patients requiring drainage of pericardial effusions. Am J Cardiol 2017; 120(5): 883-90.
[http://dx.doi.org/10.1016/j.amjcard.2017.06.003] [PMID: 28739031]
[46]
Braverman AC, Sundaresan S. Cardiac tamponade and severe ventricular dysfunction. Ann Intern Med 1994; 120(5): 442.
[http://dx.doi.org/10.7326/0003-4819-120-5-199403010-00030]
[47]
Sunderji I, Kuhl M, Mathew T. Post pericardiocentesis low cardiac output syndrome in a patient with malignant thymoma. BMJ Case Rep 2009; 2009: bcr12.2008.: 1364.
[48]
Sharaf M, Rajaram M, Mulji A. Intracardiac shunt with hypoxemia caused by right ventricular dysfunction following pericardiocentesis. Can J Cardiol 2008; 24(9): e60-2.
[http://dx.doi.org/10.1016/S0828-282X(08)70673-1] [PMID: 18787727]
[49]
Versaci F, Donati R, Mezzanotte R, Chiariello L, Ammirati F. An unusual complication following pericardiocentesis: reversible left ventricular dysfunction. J Cardiovasc Med (Hagerstown) 2015; 16(Suppl. 2): S133-5.
[http://dx.doi.org/10.2459/JCM.0b013e32833cdbf1] [PMID: 20625309]
[50]
Imazio M. Pericardial decompression syndrome: A rare but potentially fatal complication of pericardial drainage to be recognized and prevented. Eur Heart J Acute Cardiovasc Care 2015; 4(2): 121-3.
[http://dx.doi.org/10.1177/2048872614557771] [PMID: 25406423]
[51]
Methachittiphan N. A case of recurrent hypotension after life-saving pericardiocentesis for cardiac tamponade. J Am Coll Cardiol 2016; 67(13): 1052.
[http://dx.doi.org/10.1016/S0735-1097(16)31053-1]
[52]
Sevimli S, Arslan S, Gündoğdu F, Senocak H. Development of left ventricular apical akinesis and thrombus during pericardiocentesis for pericardial tamponade. Turk Kardiyol Dern Ars 2008; 36(5): 338-41.
[PMID: 18984988]
[53]
Weijers RWJH, Post JC. Transient left ventricular systolic dysfunction mimicking myocardial infarction after pericardiocentesis. Neth Heart J 2013; 21(7-8): 364-6.
[54]
Konstam MA, Levine HJ. Pulmonary edema after pericardiocentesis. N Engl J Med 1984; 310(6): 391.
[http://dx.doi.org/10.1056/NEJM198402093100615] [PMID: 6690972]
[55]
Ischaki E, Vasileiadis I, Koroneos A, et al. Acute heart failure following decompression of tuberculosis induced pericardial tamponade. Respir Med CME 2008; 1(2): 87-9.
[http://dx.doi.org/10.1016/j.rmedc.2007.10.010]
[56]
Chamoun A, Cenz R, Mager A, et al. Acute left ventricular failure after large volume pericardiocentesis. Clin Cardiol 2003; 26(12): 588-90.
[http://dx.doi.org/10.1002/clc.4960261209] [PMID: 14677814]
[57]
Kuroda M, Amano M, Enomoto S, et al. Severe right ventricular and tricuspid valve dysfunction after pericardiocentesis. J Med Ultrason (2001) 2016; 43(4): 533-6.
[http://dx.doi.org/10.1007/s10396-016-0738-5] [PMID: 27577563]
[58]
Manyari DE, Kostuk WJ, Purves P. Effect of pericardiocentesis on right and left ventricular function and volumes in pericardial effusion. Am J Cardiol 1983; 52(1): 159-62.
[http://dx.doi.org/10.1016/0002-9149(83)90088-7] [PMID: 6858905]
[59]
Hamaya Y, Dohi S, Ueda N, Akamatsu S. Severe circulatory collapse immediately after pericardiocentesis in a patient with chronic cardiac tamponade. Anesth Analg 1993; 77(6): 1278-81.
[http://dx.doi.org/10.1213/00000539-199312000-00031] [PMID: 8250323]
[60]
Skalidis EI, Kochiadakis GE, Chrysostomakis SI, Igoumenidis NE, Manios EG, Vardas PE. Effect of pericardial pressure on human coronary circulation. Chest 2000; 117(3): 910-2.
[http://dx.doi.org/10.1378/chest.117.3.910] [PMID: 10713029]
[61]
Neelakandan B, Jayanthi N, Kanthimathi R. Subxiphoid drainage for pericardial tamponade. Nurs Outlook 1995; 43(2): 94-5.
[PMID: 7753651]
[62]
Mahajan A, Mahajan N, Suri A, Mahajan K. Pericardiocentesis decompression syndrome: An uncommon complication of a common procedure IHJ Cardiovasc Case Reports 2019; 3(1): 18-20.
[http://dx.doi.org/10.1016/j.ihjccr.2019.04.001]
[63]
Al Banna R, Husain A. Reversible severe biventricular dysfunction postpericardiocentesis for tuberculous pericardial tamponade. BMJ Case Rep 2011; 2011: bcr0220113837.
[http://dx.doi.org/10.1136/bcr.02.2011.3837] [PMID: 22689547]
[64]
Philippakis G, Marinakis A, Manoloudakis N. Pericardial window procedures: Implications on left ventricular function. Int J Surg Case Rep 2013; 4(4): 403-5.
[http://dx.doi.org/10.1016/j.ijscr.2013.02.002] [PMID: 23474977]
[65]
Moudgil R, Babar AK, Iliescu C. Systolic dysfunction after pericardiocentesis : A case report of pericardial decompression syndrome. J Clin Case Reports Rev 2018; 1(3): 13-4.
[66]
Sng CYE, Koh CH, Lomarda AM, Tan SY. Transient acute left ventricular dysfunction post-pericardiocentesis for cardiac tamponade. J Cardiol Cases 2015; 12(4): 133-7.
[http://dx.doi.org/10.1016/j.jccase.2015.06.005] [PMID: 30546577]
[67]
Moores DWO, Allen KB, Faber LP, et al. Subxiphoid pericardial drainage for pericardial tamponade. J Thorac Cardiovasc Surg 1995; 109(3): 546-51.
[http://dx.doi.org/10.1016/S0022-5223(95)70287-3] [PMID: 78773]

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