Biventricular transient systolic dysfunction after mitral valve replacement: Pericardial decompression syndrome

Area of Science:

• Cardiology
• Cardiac Surgery
• Critical Care Medicine

Background:

• Pericardial decompression syndrome (PDS) is a rare complication following pericardial fluid drainage, characterized by hemodynamic instability and cardiac dysfunction.
• It occurs in less than 5% of patients managed for pericardial tamponade.
• This manuscript details a case of PDS after pericardial window creation.

Purpose of the Study:

• To describe a case of acute biventricular heart failure and pulmonary edema post-pericardial window surgery.
• To discuss the clinical presentation and management of PDS in the context of existing literature.

Main Methods:

• A case report of a 43-year-old female patient who developed PDS after mitral valve replacement and subsequent pericardial window surgery.
• Transthoracic echocardiography (TTE) was used to assess cardiac function and pericardial effusion.
• Management involved inotropic support and diuretics.

Main Results:

• The patient developed acute biventricular systolic dysfunction and pulmonary edema shortly after rapid removal of over 1000ml of pericardial fluid.
• Left ventricular ejection fraction (LVEF) dropped from 50% to 15-20% but recovered to 50% within two weeks with medical management.
• Gradual weaning from inotropes was possible, with improved cardiac function.

Conclusions:

• Rapid decompression of large pericardial effusions, especially in postcardiotomy patients, carries a risk of PDS.
• Gradual fluid removal and close hemodynamic monitoring are crucial to prevent or manage PDS.
• Early recognition and supportive care can lead to favorable outcomes.