Department of Internal Medicine, Joan C. Edwards School of Medicine, Marshall University, Huntington, WV 25755, United States.
School of Medicine, Misr University of Science and Technology, Cairo, Egypt.
Curr Cardiol Rev. 2021;17(1):101-110. doi: 10.2174/1573403X16666200607184501.
Pericardial Decompression Syndrome (PDS) is defined as paradoxical hemodynamic deterioration and/or pulmonary edema, commonly associated with ventricular dysfunction. This phenomenon was first described by Vandyke in 1983. PDS is a rare but formidable complication of pericardiocentesis, which, if not managed appropriately, is fatal. PDS, as an entity, has discrete literature; this review is to understand its epidemiology, presentation, and management.
Medline, Science Direct and Google Scholar databases were utilized to do a systemic literature search. PRISMA protocol was employed. Abstracts, case reports, case series and clinical studies were identified from 1983 to 2019. A total of 6508 articles were reviewed, out of which, 210 were short-listed, and after removal of duplicates, 49 manuscripts were included in this review. For statistical analysis, patient data was tabulated in SPSS version 20. Cases were divided into two categories surgical and percutaneous groups. t-test was conducted for continuous variable and chi-square test was conducted for categorical data used for analysis.
A total of 42 full-length case reports, 2 poster abstracts, 3 case series of 2 patients, 1 case series of 4 patients and 1 case series of 5 patients were included in the study. A total of 59 cases were included in this manuscript. Our data had 45.8% (n=27) males and 54.2% (n=32) females. The mean age of patients was 48.04 ± 17 years. Pericardiocentesis was performed in 52.5% (n=31) cases, and pericardiostomy was performed in 45.8% (n=27). The most common identifiable cause of pericardial effusion was found to be malignancy in 35.6% (n=21). Twenty-three 23 cases reported pre-procedural ejection fraction, which ranged from 20%-75% with a mean of 55.8 ± 14.6%, while 26 cases reported post-procedural ejection fraction which ranged from 10%-65% with a mean of 30% ± 15.1%. Data was further divided into two categories, namely, pericardiocentesis and pericardiostomy. The outcome as death was significant in the pericardiostomy arm with a p-value of < 0.00. The use of inotropic agents for the treatment of PDS was more common in needle pericardiocentesis with a p-value of 0.04. Lastly, the computed recovery time did not yield any significance with a p-value of 0.275.
Pericardial decompression syndrome is a rare condition with high mortality. Operators performing pericardial drainage should be aware of this complication following drainage of cardiac tamponade, since early recognition and expeditious supportive care are the only therapeutic modalities available for adequate management of this complication.
心包减压综合征（PDS）定义为矛盾性血流动力学恶化和/或肺水肿，通常与心室功能障碍有关。这一现象最初由 Vandyke 于 1983 年描述。PDS 是心包穿刺术的一种罕见但严重的并发症，如果处理不当，可导致死亡。PDS 作为一种实体，有其特定的文献；本综述旨在了解其流行病学、表现和治疗。
利用 Medline、Science Direct 和 Google Scholar 数据库进行系统文献检索。采用 PRISMA 方案。从 1983 年到 2019 年，确定了摘要、病例报告、病例系列和临床研究。共查阅了 6508 篇文章，其中有 210 篇被列入短名单，在去除重复项后，共有 49 篇文章被纳入本综述。为了进行统计分析，将患者数据制成表格输入 SPSS 版本 20。病例分为手术组和经皮组。对连续变量进行 t 检验，对分类数据进行卡方检验进行分析。
共有 42 篇全文病例报告、2 篇海报摘要、3 篇 2 例病例系列、1 篇 4 例病例系列和 1 篇 5 例病例系列纳入研究。本研究共纳入 59 例。我们的数据中有 45.8%（n=27）的男性和 54.2%（n=32）的女性。患者的平均年龄为 48.04±17 岁。心包穿刺术在 52.5%（n=31）的病例中进行，心包切开术在 45.8%（n=27）的病例中进行。最常见的可识别心包积液病因是恶性肿瘤，占 35.6%（n=21）。23 例报告了术前射血分数，范围从 20%到 75%，平均为 55.8±14.6%，而 26 例报告了术后射血分数，范围从 10%到 65%，平均为 30%±15.1%。数据进一步分为心包穿刺术和心包切开术两组。心包切开术组的死亡率有显著差异，p 值<0.00。在治疗 PDS 时，使用正性肌力药物的情况在针吸心包穿刺术组更为常见，p 值为 0.04。最后，计算的恢复时间没有产生任何意义，p 值为 0.275。
心包减压综合征是一种罕见的疾病，死亡率很高。进行心包引流的术者应意识到这种并发症在心包填塞引流后会发生，因为早期识别和迅速的支持性治疗是治疗这种并发症的唯一有效方法。
