Low cardiac output complicating pericardiectomy for pericardial tamponade

Neoplastic involvement of the pericardium resulting in an effusion and subsequent tamponade is an emergency requiring prompt decompression, generally safely accomplished by subxiphoid pericardiectomy. However, the current case report describes a patient with florid pericardial tamponade who underwent surgical decompression with transient hemodynamic improvement, who then rapidly developed progressive, heart failure and death. This paradoxical response to pericardial decompression, similar to that seen occasionally with pericardiectomy in constrictive pericarditis, may be more frequent than currently appreciated. Its cause may relate to the sudden removal of the chronic external ventricular support from the effusion resulting in ventricular dilatation and failure.