Pericardial decompression syndrome: A comprehensive review

Abstract

Pericardial decompression syndrome (PDS) is an infrequent, life-threatening complication following pericardial drainage for cardiac tamponade physiology. PDS usually develops after initial clinical improvement following pericardiocentesis and is significantly underreported and may be overlooked in the clinical practice. Although the precise mechanisms resulting in PDS are not well understood, this seems to be highly associated with patients who have some underlying ventricular dysfunction. Physicians performing pericardial drainage should be mindful of the risk factors associated with the procedure including the rare potential for the development of PDS.

Cardiac tamponade in COVID‐19 patients: Management and outcomes

“…The pathophysiology of COVID‐19 cardiac tamponade is possibly a result of the marked systemic inflammatory response to the virus, leading to myocarditis and pericarditis. Pericardial drainage can be followed by severe pericardial decompression syndrome, leading to paradoxical hemodynamic instability and/or pulmonary edema following an otherwise noncomplicated pericardial drainage 11 . Myocardial ischemia, can also be explained by the hyper‐coagulability (resulting from endothelial damage and the inflammatory response) in these patients 12,13 .…”

Massive left ventricular thrombosis in pericardial decompression syndrome

“…These include a hemodynamic mechanism whereby sudden increase in venous return following rapid removal of pericardial fluid would result in chamber dilation, increase in wall stress, and culminate in myocardial stunning. 2,3 The ischemic theory hypothesizes that the prolonged compression of the epicardial coronary arteries would results in loss of autoregulatory mechanism and impairment of coronary vasodilation following decompression and thus, result in myocardial ischemia and stunning. [2][3][4] Lastly, rapid removal of pericardial fluid may result in increased cardiac sympathetic tone, catecholamine release, and stress-induced cardiomyopathy.…”

“…2,3 The ischemic theory hypothesizes that the prolonged compression of the epicardial coronary arteries would results in loss of autoregulatory mechanism and impairment of coronary vasodilation following decompression and thus, result in myocardial ischemia and stunning. [2][3][4] Lastly, rapid removal of pericardial fluid may result in increased cardiac sympathetic tone, catecholamine release, and stress-induced cardiomyopathy. [2][3][4][5] Regardless of the underlying mechanism(s), PDS may result in irreversible cardiac dysfunction and even death that perhaps can be avoided by less aggressive removal of chronic pericardial fluid in the setting of tamponade.…”

“…1,2 The time course of development of PDS varies and may range from minutes to days after the procedure. 3 It is believed that PDS occurs more commonly following rapid removal of pericardial effusion as is often the case with surgical rather than percutaneous drainage. 4 Intracardiac thrombosis has not been recognized as a complication of PDS in recent reviews 3,4 and only one previous case has been reported with a relatively small left ventricular (LV) apical thrombus.…”

“…3 It is believed that PDS occurs more commonly following rapid removal of pericardial effusion as is often the case with surgical rather than percutaneous drainage. 4 Intracardiac thrombosis has not been recognized as a complication of PDS in recent reviews 3,4 and only one previous case has been reported with a relatively small left ventricular (LV) apical thrombus. 5 We report a unique case of PDS associated with massive LV apical thrombosis in the setting of occult malignancy.…”