PDS describes the cardiogenic shock and pulmonary edema following drainage of pericardial effusions. It can present immediately following percutaneous or surgical drainage but can be delayed by up to 24 to 48 hours. The etiology of PDS is unclear but has been attributed to many causes including myocardial stunning from impaired epicardial perfusion, acute RV failure from volume overload with decompression, acute septal shift from RV filling causing LV dysfunction, stress cardiomyopathy from post-drainage neurohormonal alterations, acute severe post-drainage hypertension, and abrupt catecholamine withdrawal after the restoration of normal cardiac filling dynamics. In a retrospective review of 35 cases, almost all of the patients presented with cardiac tamponade (94%) with normal pre-drainage ventricular function and large pericardial effusions, although PDS occurring after drainage of effusions as small 250 mL has been described. The majority of patients presented with LV or biventricular failure (60%), followed by isolated cardiogenic pulmonary edema (29%) and RV failure (9%). There is a paucity of information regarding preventive measures apart from slow, rather than rapid, pericardial decompression, and treatment is supportive. The timeline for myocardial recovery is variable.

References

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• Geffroy A, Beloeil H, Bouvier E, et al. Prolonged right ventricular failure after relief of cardiac tamponade. Can J Anaesth. 2004;51:482-485.
• Pradhan R, Okabe T, Yoshida K, et al. Patient characteristics and predictors of mortality associated with pericardial decompression syndrome: a comprehensive analysis of published cases. Eur Heart J Acute Cardiovasc Care. 2015;4:113-120.
• Sobieski C, Herner M, Goyal N, Khor LL, Chang L, Bieging E, McGarry TJ. Pericardial decompression syndrome after drainage of chronic pericardial effusions. JACC Case Rep. 2022;4:1515-1521.