Cardiac tamponade and large pericardial effusions in systemic sclerosis

Dunne, James V.; Chou, Julie P.; Viswanathan, Mohan; Wilcox, Pearce; Huang, Simon

doi:10.1007/s10067-010-1667-0

Cited by 30 publications

(38 citation statements)

References 29 publications

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“…First, the standard of care for treatment of patients with pericardial tamponade and impending hemodynamic collapse has been pericardial drainage (1,3,4,6) either percutaneously by pericardiocentesis or by surgical decompression. Previously reported data by Hemnes et al (6) suggested that the one year mortality of PH patients with hemodynamically significant pericardial effusion in the absence of intervention may be 50%, and that the perioperative mortality associated with operative intervention in their patient population was also 50% (one of two patients died).…”

Section: Discussionmentioning

confidence: 99%

“…PAH due to connective tissue disease such as scleroderma with pericardial effusion may confer additional risk (2, 3, 4) Data from the REVEAL registry suggest the prevalence of pericardial effusion among WHO diagnostic class 1 PAH patients may be as high as 25% (2) Pericardiocentesis or surgical pericardial window have been used for refractory, recurrent, or hemodynamically unstable pericardial effusions due to a wide range of etiologies (1) . A case series of six PAH patients with pericardial tamponade revealed 50% mortality over one year period if effusion was not drained and of two patients who received intervention for effusion with pericardial window (PW) placement (5) , one patient expired.…”

Section: Introductionmentioning

confidence: 99%

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Pulmonary hypertension complicated by pericardial effusion: a single center experience

Honeycutt

Safdar

2012

Ther Adv Respir Dis

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Pericardial effusion is an independent predictor of mortality in patients with pulmonary arterial hypertension (PAH). However, the management and outcomes of patients with pulmonary hypertension and pericardial effusion are not well described. A retrospective observational study was conducted at Baylor College of Medicine and The Methodist Hospital by screening all patients admitted between June 1, 2005 and June 1, 2010 with the ICD-9 codes for pulmonary hypertension and pericardial effusion. 138 patients with pericardial effusion were identified, and 103 patients were excluded if they had valvular heart disease, recent surgery or end stage renal disease. Thirty-five patients with PH diagnosed by a historical right heart catheterization or echocardiography and with documented pericardial effusion were included in this analysis. Demographic, hemodynamic, laboratory and survival data was collected. The mean age was 49.5±36 years (mean ± SD), 31 of 35 patients were females (93%) and pulmonary artery systolic pressure was 77±19 mm Hg. Mean follow-up period was 20.5±12.9 months. Fifteen patients had PAH associated with connective tissue disease (50%). Majority of the patients (87%) with pericardial effusion were managed conservatively. Four patients (13%) who were hemodynamically unstable underwent pericardial window placement. One of them was started on epoprostenol and two patients had the doses of PAH-specific medications uptitrated. Three of four pericardial window patients survived to the conclusion of the follow-up period. The overall survival in our cohort was 60% with three patients lost to follow-up. Connective tissue disease-associated PAH and female gender were predominant in our cohort of patients with pericardial effusion. Seventy-five percent of patients who were treated with pericardial window for hemodynamically unstable pericardial effusion survived till the end of the study period. Pericardial window may be a therapeutic option in unstable PH patients with pericardial effusion. Further studies are needed to determine the optimal treatment strategy for such patients.

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Pulmonary hypertension complicated by pericardial effusion: a single center experience

Honeycutt

Safdar

2012

Ther Adv Respir Dis

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“…In general, draining pericardial effusions should be avoided. Although anecdotal case reports suggest that opening of the pericardium may improve cardiac function (85), two small series reported 50% mortality in patients who had their effusion drained (86,87).…”

Section: Percutaneous Interventionsmentioning

confidence: 99%

Intensive Care Unit Management of Patients with Severe Pulmonary Hypertension and Right Heart Failure

Hoeper

Granton

2011

Am J Respir Crit Care Med

272

249

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Despite advances in medical therapies, pulmonary arterial hypertension (PAH) continues to cause significant morbidity and mortality. Although the right ventricle (RV) can adapt to an increase in afterload, progression of the pulmonary vasculopathy that characterizes PAH causes many patients to develop progressive right ventricular failure. Furthermore, acute right ventricular decompensation may develop from disorders that lead to either an acute increase in cardiac demand, such as sepsis, or to an increase in ventricular afterload, including interruptions in medical therapy, arrhythmia, or pulmonary embolism. The poor reserve of the right ventricle, RV ischemia, and adverse right ventricular influence on left ventricular filling may lead to a global reduction in oxygen delivery and multiorgan failure. There is a paucity of data to guide clinicians caring for acute right heart failure in PAH. Treatment recommendations are frequently based on animal models of acute right heart failure or case series in humans with other causes of pulmonary hypertension. Successful treatment often requires that invasive hemodynamics be used to monitor the effect of strategies that are based primarily on biological plausibility. Herein we have developed an approach based on the current understanding of RV failure in PAH and have attempted to develop a treatment paradigm based on physiological principles and available evidence.

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“…Although pericardial disease has been majorly described in association with renal failure in as many as 2/3rd of patients, some patients may develop fibrofibrinous pericarditis for which no other apparent cause is evident. Pericardial effusion presenting with tamponade could be attributable to the presence of severe pulmonary arterial hypertension with or without underlying lung disease 4. In this case the mortality may be as high as 55%.…”

Section: Discussionmentioning

confidence: 96%

Recurrent cardiac tamponade in a young woman

et al. 2013

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A young woman presented with recurrent pericardial effusion, she had previously been treated with antitubercular medications. She had clinical features of systemic sclerosis (SSc) which was subsequently confirmed on further workup. She was also found to be profoundly hypothyroid. Cardiac tamponade is uncommon in both SSc as well as hypothyroidism, unlike in our patient who was found to have both of these disorders. In her case, the pericardial involvement probably ante-dated the other features of SSc.

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Cardiac tamponade and large pericardial effusions in systemic sclerosis

Cited by 30 publications

References 29 publications

Pulmonary hypertension complicated by pericardial effusion: a single center experience

Pulmonary hypertension complicated by pericardial effusion: a single center experience

Intensive Care Unit Management of Patients with Severe Pulmonary Hypertension and Right Heart Failure

Recurrent cardiac tamponade in a young woman

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