Acute Pulmonary Edema After Pericardial Drainage for Cardiac Tamponade

doi:10.1016/j.athoracsur.2009.02.001

The Annals of Thoracic Surgery

Volume 88, Issue 2, August 2009, Pages 675-677

https://doi.org/10.1016/j.athoracsur.2009.02.001 Get rights and content

Pericardial effusions with tamponade may present a clinical challenge in management for the cardiothoracic surgeon. We report a case of acute pulmonary edema secondary to the rapid release of a chronic traumatic pericardial effusion that resulted in the death of the patient.

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Acute pulmonary edema after pericardiocentesis for cardiac tamponade is an unusual complication [1, 2, 3, 4, 5]. It was first described in 1983 by Vandyke and colleagues [6], who hypothesized that left ventricular dysfunction after pericardiocentesis for chronic tamponade may be related to acute hemodynamic changes from interventricular volume mismatch in the setting of elevated systemic vascular resistance and tachycardia. The initial left ventricular response is characterized by optimization

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Cited by (20)

Pericardial Decompression Syndrome After Drainage of Chronic Pericardial Effusions
2022, JACC: Case Reports
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.)
Pericardial tamponade: A comprehensive emergency medicine and echocardiography review
2022, American Journal of Emergency Medicine
Citation Excerpt :
As aspiration continues, the pericardial fluid should be drained slowly. Though more often associated with surgical drainage, a rapid evacuation of > 1 L of fluid can lead to pericardial decompression syndrome [8,184,208-212]. With a mortality of 29% in 35 cases found between 1983-2013 [208], this condition manifests immediately or up to within 48 hours as cardiogenic pulmonary edema and left-, right-, or biventricular heart failure.
Pericardial tamponade requires timely diagnosis and management. It carries a high mortality rate.
This review incorporates available evidence to clarify misconceptions regarding the clinical presentation, while providing an in-depth expert guide on bedside echocardiography. It also details the decision-making strategy for emergency management including pericardiocentesis, along with pre- and peri-procedural pearls and pitfalls.
Pericardial effusions causing tamponade arise from diverse etiologies across acute and sub-acute time courses. The most frequently reported symptom is dyspnea. The classically taught Beck’s triad (which includes hypotension) does not appear commonly. Echocardiographic findings include: a pericardial effusion (larger size associated with tamponade), diastolic right ventricular collapse (specific), systolic right atrial collapse (sensitive), a plethoric non-collapsible inferior vena cava (sensitive), and sonographic pulsus paradoxus. Emergent pericardiocentesis is warranted by hemodynamic instability, impending deterioration, or cardiac arrest. Emergent surgical indications include type A aortic dissection causing hemopericardium, ventricular free wall rupture after acute myocardial infarction, severe chest trauma, and iatrogenic hemopericardium when bleeding cannot be controlled percutaneously. Pre-procedure management includes blood products for patients with traumatic hemopericardium; gentle intravenous fluids to hypotensive, hypovolemic patients with consideration for vasoactive medications; treatment of anticoagulation, coagulopathies, and anemia. Positive-pressure ventilation and intravenous sedation can lower cardiac output and should be avoided if possible. Optimal location for echocardiography-guided pericardiocentesis is the largest, shallowest fluid pocket with no intervening vital structures. Patient positioning to prevent hypoxia and liberal amounts of local anesthesia can facilitate patients remaining still. Safe needle guidance and confirmation of catheter placement is achieved using low-depth sonographic views, injection of agitated saline, and evaluation of initial aspirate for hemorrhage. Pericardial fluid should be drained slowly to avoid pericardial decompression syndrome.
An understanding of the pathophysiology, clinical presentation, echocardiographic findings, and time-sensitive management of pericardial tamponade is essential for emergency physicians.
Acute Right Ventricular Failure After Surgical Drainage of Pericardial Tamponade: A Case Report of Pericardial Decompression Syndrome and Review of the Literature
2019, Journal of Cardiothoracic and Vascular Anesthesia
Citation Excerpt :
This clinical syndrome was first described by Vandyke et al in 1983 referring to a case of acute pulmonary edema following pericardiocentesis for cardiac tamponade.2 The term “pericardial decompression syndrome” was not used until 2010 in a publication by Angouras responding to a case report of a young woman with fatal pulmonary edema and hemodynamic collapse after a subxiphoid decompression of a pericardial effusion.3,6 Prior to this, there had been multiple reports with varying descriptions of cardiovascular decompensation, but not having enough in common to support the existence of such a syndrome; terms such as paradoxical hemodynamic instability and postoperative low cardiac output syndrome also have been used to describe similar phenomena.7–9
Pericardial decompression syndrome: A rare entity
2016, Revista Colombiana de Cardiologia
El síndrome de descompresión pericárdica es una complicación poco frecuente, que puede presentarse posterior al drenaje del pericardio y llevar a un desenlace fatal.
Se describe el caso de un paciente de 60 años de edad, con antecedente de cáncer de recto, manejado con quimioterapia y radioterapia e intervenido quirúrgicamente, se descartó embolia pulmonar por gammagrafía de ventilación perfusión y se documentó derrame pericárdico de aproximadamente 700 cc y quien posterior a este drenaje presentó disfunción ventricular sistólica requiriendo de soporte inotrópico y manejo en cuidados intensivos.
Es necesario tener en mente esta entidad y especial cuidado al realizar este procedimiento reconociendo las manifestaciones clínicas de esta entidad, además, de las estrategias de manejo.
Pericardial decompression syndrome is a rare complication that can develop following pericardial drainage and can lead to a fatal outcome.
The case of a 60 year-old patient with a history of rectal cancer treated with chemotherapy and radiation therapy who had undergone surgery. Pulmonary embolism was ruled out with a ventilation/perfusion scan and pericardial effusion of approximately 700 cc was documented; following its drainage the patient showed ventricular systolic dysfunction, thus requiring inotropic support and management in the ICU.
This entity must be considered and enough care taken when performing this procedure. Clinical manifestations and management strategies must be identified.
Management of cardiac tamponade after cardiac surgery
2012, Journal of Cardiothoracic and Vascular Anesthesia
Citation Excerpt :
Pericardiocentesis may be associated with a variety of complications, including laceration of the right ventricle or a coronary artery, arrhythmias, pneumothorax, and acute respiratory distress syndrome. Postpericardiocentesis acute left ventricular failure, pulmonary edema, and cardiogenic shock have been reported.77-81 In conclusion, anesthesiologists who manage surgical pericardial drainage of a cardiac tamponade face an unstable hemodynamic situation resulting from abnormal ventricular filling and the consequent reduction in systolic volume.
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2010, Annals of Thoracic Surgery

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Case reportAcute Pulmonary Edema After Pericardial Drainage for Cardiac Tamponade

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Chest

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Can J Cardiol

Case report
Acute Pulmonary Edema After Pericardial Drainage for Cardiac Tamponade