A note on pericardiocentesis, severe pulmonary hypertension, right heart failure and left heart failure

Pericardial tamponade itself is a life threatening disease process and rarely it's risk outweighs the benefit. But patients with severe pulmonary hypertension may carry higher risk and chance of dying by procedure itself. Actually, effusion in pericardial chamber sometime is lifesaving in patients with severe pulmonary hypertension as they may be preventing dilatation of the right ventricle (RF failure). Drainage of that fluid may cause acute RV dilatation/failure and collapse of hemodynamics, rarely salvageable.

Unlikely but pericardiocentesis may cause left heart failure with cardiogenic pulmonary edema. This is probably due to sudden increase in venous return atop on underlying left ventricular(LV) dysfunction. But acute left ventricular failure is usually managed and salvaged in contrast to acute right ventricular failure. It is a very rare complication of pericardiocentesis and should not prevent the procedure.


References:

1.  Acute right ventricular dilation and echocardiographic volume overload following pericardiocentesis for relief of cardiac tamponade. Am Heart J 1984; 107:1266.

2.Wolfe MW, Edelman ER. Transient systolic dysfunction after relief of cardiac tamponade. Ann Intern Med 1993; 119:42.