Paradoxical Hemodynamics in Pericardial Decompression Syndrome: Cardiogenic Shock and Recovery With Mechanical...

Pericardial decompression syndrome is a rare but potentially fatal complication of pericardiocentesis or surgical drainage, causing paradoxical hemodynamic collapse despite technically successful fluid evacuation.

A 59-year-old woman with malignant pericardial effusion underwent pericardial window surgery. Four hours later, she developed refractory shock and severe left ventricular dysfunction with a Takotsubo pattern, despite nonobstructive coronary arteries. A percutaneous left ventricular assist device provided hemodynamic support. Her left ventricular function gradually recovered.

Pericardial decompression syndrome may involve hemodynamic, ischemia, and autonomic pathophysiology. Mechanical circulatory support can bridge recovery in pericardial decompression syndrome complicated by stress cardiomyopathy.

Pericardial fluid drainage can paradoxically lead to cardiogenic shock given multifactorial hemodynamic and neurohormonal responses; clinicians should maintain high vigilance for hemodynamic deterioration even after technically successful drainage. Mechanical circulatory support with a percutaneous left ventricular assist device can provide effective stabilization and myocardial recovery and can be lifesaving in nonischemic cardiogenic shock.