Management of a patient with pericardial decompression syndrome and HOCM

Abstract

A 44-year-old man, with a history of arterial hypertension, was referred with increasing shortness of breath due to a large pericardial effusion and imminent tamponade. Emergency ultrasound-guided pericardiocentesis resulted in the rapid withdrawal of 2760 cc of serous fluid. 3 hours later, the patient developed acute pulmonary oedema, which was successfully treated. Hypertrophic obstructive cardiomyopathy was later diagnosed and malignancy was excluded as a cause of the effusion. Clinicians performing pericardiocentesis need to be aware of pericardial decompression syndrome (PDS), a rare but serious complication. Although the underlying mechanisms causing PDS are not fully understood, patients with high left ventricular (LV) filling pressures are at particular risk. In other words: diastolic dysfunction of the LV is a risk factor for the occurrence of PDS.

Pericardial Decompression Syndrome: A Comprehensive Review of a Controversial Entity

“…Two (2.8%) cases reported new-onset right to left shunt occurring after right ventricular failure. 5 7 8 9 10 11 12 14 15 16 21 22 23 24 25 26 27 28 29 30 31 32 33 34 35 36 37 38 39 40 41 42 43 44 45 46 47 48 49 50 51 52 53 54 55 56 57 58 59 60 61 62 63 64 65 66 67 68 69 70 71 72 73 74…”

Pericardial Decompression Syndrome and an Evanescent Tricuspid Regurgitation: A Real Conundrum

“…The pathophysiology is not fully understood at present. Several hypotheses have been put forward [ 10 ], and they are as follows:…”

Emergency Veno-Arterial Extracorporeal Membrane Oxygenation for Pericardial Decompression Syndrome

“…Few cases were reported with PDS presented with uni- or biventricular dysfunction [ 9 – 14 ]. Also, few cases were reported with acute pulmonary edema even with normal ventricular function [ 15 – 17 ]. Our patient had already a right ventricular (RV) dysfunction that was aggravated after pericardiocentesis even with slow cautious drainage.…”