Acute Right Ventricular Failure Immediately Following Subxiphoid Pericardial Window Requiring Temporary Cardiopulmonary Bypass Support: A Case Report of Pericardial Decompression Syndrome

Division

Far West

Hospital

MountainView Hospital

Document Type

Case Report

Publication Date

6-24-2022

Keywords

cardiac tamponade, paradoxical hemodynamic collapse, pericardial decompression syndrome, pericardial window, right ventricular failure

Disciplines

Anesthesiology | Cardiovascular Diseases

Abstract

Cardiac tamponade is a life-threatening condition requiring emergent intervention, such as a pericardial window, to drain the pericardial effusion, subsequently improving cardiac output. A rare complication of this procedure is pericardial decompression syndrome which results in a paradoxical cardiovascular collapse. A 65-year-old male with bacterial endocarditis status posts mitral and aortic valve replacement presented for an emergent subxiphoid pericardial window to relieve cardiac tamponade. After draining 850mL of pericardial fluid, the patient suffered a cardiac arrest secondary to acute right ventricular failure seen on an intraoperative transesophageal echocardiogram (TEE). Despite manual compressions and high-dose vasopressors, hemodynamics did not improve, and the patient was emergently placed on cardiopulmonary bypass (CPB) support. Within two hours, CPB support was successfully weaned. Temporary CPB can improve acute right ventricular failure following pericardial decompression without needing longer-term extracorporeal support.

Publisher or Conference

Cureus

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