Abstract
Pericardial decompression syndrome is an ambiguous clinical entity which has generated
controversy regarding its existence. Following pericardial decompression, patients
experienced clinical deterioration ranging in complications from pulmonary edema to
death that could not be attributed to any other distinct clinical pathology. Multiple
theories have suggested the pathophysiology behind pericardial decompression syndrome
is related to preload-afterload mismatch following pericardial decompression, coronary
microvascular ischemia, and stress from high adrenergic state. Our review aims to
describe this syndrome by analyzing demographics, etiology of pericardial effusion,
method of drainage, volume of pericardial fluid removed, time to decompensation, and
clinical outcomes. A systematic review of MEDLINE/PubMed and Google Scholar literature
databases were queried for case reports, case series, review articles, and abstracts
published in English journals between 1983 and December 2022. Each author's interpretation
of echocardiographic and/or pulmonary arterial catheterization data provided in the
case reports was used to characterize ventricular dysfunction. Based on our inclusion
criteria, 72 cases of pericardial decompression syndrome were included in our review.
Our results showed that phenotypic heterogeneity was present based on echocardiographic
findings of right/left or biventricular failure with similar proportions in each type
of ventricular dysfunction. Time to decompensation was similar between immediate,
subacute, and acute cases with presentation varying between hypoxic respiratory failure
and shock. This review article highlights theories behind the pathophysiology, clinical
outcomes, and therapeutic options in this high mortality condition.
Keywords
cardiovascular disease - pericardiocentesis - cardiac tamponade - pericardiostomy
- pericardial decompression syndrome - shock - ischemia
