Cabada-Garcia Maria Jose, Rodriguez-Rivera Jahir, Jerjes-Sanchez Carlos, Castillo-Perez Mauricio, Gutierrez-Gallegos Paola, Martinez-Rodriguez Ana Lucia, Paredes-Gutierrez Enrique, Quevedo-Salazar Renata Claudia, De Leon-Gutierrez Humberto, Lopez-Cortes Oscar David, Panneflek Jathniel, Monjaras-Alvarado Raul, Moron-Mosso Jesus Antonio, Gonzalez-Medina Jaime Guillermo
Tecnológico de Monterrey, Escuela de Medicina y Ciencias de la Salud, Monterrey, Nuevo León, México.
Fellow of the General Directorate of Quality and Health Education, Ministry of Health, Mexico City, México.
Front Cardiovasc Med. 2025 Aug 18;12:1610419. doi: 10.3389/fcvm.2025.1610419. eCollection 2025.
Controversy persists regarding the use of pericardial effusion drainage in patients with pulmonary arterial hypertension (PAH), as several studies report high rates of post-procedure morbidity and mortality.
We conducted a systematic review to evaluate the safety of pericardiocentesis (PC) in patients with PAH and a large or hemodynamically significant pericardial effusion. We focused on studies involving patients with PAH who presented with a large or hemodynamically significant pericardial effusion and underwent PH. Our primary objective was to evaluate the incidence of major periprocedural complications, and our secondary objectives were to identify the clinical presentation and echocardiographic findings.
We identified 35 patients across 16 studies. Connective tissue disease was the most common etiology of PAH. Drainage strategies during PC differed across studies. The overall mortality rate was 20%, and we identified pericardial decompression syndrome in 14% of patients. Dyspnea and peripheral edema dominated the clinical presentation. Echocardiographic findings of cardiac tamponade, particularly left-sided chamber collapse, appeared more frequently.
PC in patients with PAH carries a heightened risk of pericardial decompression syndrome and mortality. However, careful patient selection, echocardiographic guidance, gradual decompression, and continuous hemodynamic monitoring during the procedure may help improve outcomes.
PROSPERO 585310.
关于肺动脉高压（PAH）患者心包积液引流的应用仍存在争议，因为多项研究报告了术后高发病率和死亡率。
我们进行了一项系统评价，以评估心包穿刺术（PC）在患有大量或具有血流动力学意义的心包积液的PAH患者中的安全性。我们重点关注涉及患有大量或具有血流动力学意义的心包积液并接受PC的PAH患者的研究。我们的主要目标是评估围手术期主要并发症的发生率，次要目标是确定临床表现和超声心动图检查结果。
我们在16项研究中确定了35例患者。结缔组织病是PAH最常见的病因。不同研究中PC期间的引流策略有所不同。总死亡率为20%，我们在14%的患者中发现了心包减压综合征。呼吸困难和外周水肿是主要的临床表现。心脏压塞的超声心动图表现，特别是左侧心室塌陷，出现得更为频繁。
PAH患者的PC存在心包减压综合征和死亡的高风险。然而，在手术过程中仔细选择患者、超声心动图引导、逐渐减压和持续血流动力学监测可能有助于改善预后。
PROSPERO 585310。
